Leadership Learning Experience (LLE)
Quality improvement projects are the backbone of patient safety, quality care, and a conducive working environment. The nursing profession depends highly on evidence-based practices for practice changes. Quality improvement (QIs) projects highly depend on healthcare data and vigorous research and consultation to ensure they present the best evidence-based practice to improve the healthcare environment.
Periodic organizational evaluation is essential to resolve problems before escalating and increasing mortalities and morbidities. Nurses work together with other healthcare providers to develop and implement these QIs for better healthcare and conducive work environments.
This essay analyzes a healthcare problem affecting a specific population, examines supporting data and literature, and proposes an evidence-based solution for the healthcare problem.
1. Problem Identification
Patient fall is the chosen topic for this change proposal. Falls are a leading course of unintentional injury and mortality in healthcare settings. They are unanticipated events and can affect an individual with good health. Their consequences vary on a severity continuum from no injury (near misses and trips?), bruises and scratches, to severe sentinel events such as limb fractures, internal organ injury, and death (WHO, 2021).
Death often results from falls from higher heights, internal organ injury, and blunt object injury. These events can be prevented, and thus, they should not pose such a threat to healthcare settings. These falls majorly affect the elderly and chronically ill patients in healthcare settings
1A. Problem/Issue Explanation
Patient fall in nursing practice is an area of significance. Until recently, nurses were fully responsible for patient falls, although they are responsible for patient monitoring. Patient monitoring is a nursing role, and most falls are attributed to poor monitoring. However, the interrelation of factors affecting patient falls includes other professionals involved in prescribing, assessing, and treating patients (Kiel et al., 2018).
Falls lead to high patient morbidity and mortality. Falls are associated with high lawsuits costs and disciplinary measures such as revoked licenses, job loss, and fines. Falls lead to low staff morale and other psychological effects such as depression from the event’s trauma.
Patient families suffer trauma and grief when they lose their loved ones. The institution suffers from a soiled reputation leading to low patient turnup and a disciplinary hearing at the local and federal levels. Thus, patient falls significantly affect all stakeholders in the healthcare environment, which is why I chose the topic.
2. Problem/Issue Investigation
Older adults and chronically ill patients are more exposed to patient falls than the general population. In addition, inpatients sustain more falls than outpatients. Outpatient falls, especially emergency department patients are statistically significant hence their involvement in the project proposal.
According to the CDC, over $50 billion in healthcare costs are spent on fall-related expenses, and over $750 million is spent on fatal injuries in the US (CDC, 2020). Insurance agencies such as Medicare and Medicaid do not cover patient falls, and thus patients and institutions carry the burden of patient falls.
Falls are also hardly reported due to stern institutional measures; hence some missed falls go untreated, causing significant health problems to affected individuals. Thus, patient falls are a significant health issue requiring stern measures to end patient suffering and high healthcare costs.
2A. Evidence of the Problem/Issue
According to IHI, CDC, and AHRQ, about 300 million patients fall globally, one out five lead to an injury (fatal), and about 0.07% die from fall injuries (WHO, 2021). According to the CDC, falls have been rising steadily, and statistics show a 31% rise in the number of falls in the last ten years (CDC, 2020).
Globally, over 36 million older adults fall each year, and more than 30 000 die from fall injuries (CDC, 2020). Falls also occur at home, and they account for over 3 million emergency department older adults’ visits. Thus, patient falls are a significant and global health issue of concern.
3. Analyzing the Problem/Issue
Patient falls are the leading cause of unintentional injury in healthcare and the second leading cause of death, second to road traffic accidents (WHO, 2021). Unfortunately, falls are hardly reported, especially non-fatal falls, due to the low perceived benefits and consequences of reporting these falls.
From the hospital records, 43 falls were reported in the last year, and the older adults account for 27/43 falls. One patient died after sustaining head injuries, and the death had a significant effect on the family, care providers, and the institution. Given the current state of patient falls, there needs a proactive fall prevention program/ initiative to prevent future falls.
3A. Contributing Factors to the Problem/Issue
Various personal and environmental factors cause Falls. More than 90% of falls occur during outdoor activities and alighting from bed, requiring advanced monitoring skills, knowledge, and tools (Kiel et al., 2019).
As mentioned earlier, even healthy individuals can fall under unconducive environments hence the need to prevent these falls proactively. Personal factors include health conditions, mental status, and medications. Confusion leads to attempts to perform tasks without consideration for physical ability, leading to falls.
Musculoskeletal conditions expose individuals to falls and are the leading personal factor causing falls. Some medications, such as benzodiazepines, can lead to dizziness and drowsiness, leading to falls (Kim et al., 2019). Proper assessment and labeling of these patients on drugs with fall prevalence are thus integral.
Environmental factors include poor lighting, lack of bed and handrails, slippery floors, and faulty equipment (Kiel et al., 2019). Poor lighting and lack of handrails can lead to missed steps; hence, staircase falls are highly fatal. Slippery floors are majorly remedied by restricting movement when washing and using recommended hospital flooring systems. Management of these risk factors is an integral part of the fall prevention process.
4. Proposed Solution to the Problem/Issue
AHRQ and IHI recommend various interventions such as monitoring, patient risk assessment, and managing environmental factors. The proposed solution to the practice issue is wearable sensors and risk assessment tools in older patients. Patient monitoring is integral to minimizing falls.
Monitoring helps capture falls and promote fall reporting, helps understand the falls patterns, and thus helps prevent these falls (Greene et al., 2019). Risk assessment tools help determine personal and environmental factors exposing a patient to falls. They are digital tools that aid in holistic fall prevention through prior planning (Möller et al., 2021). High-risk patients are accorded better care and monitoring, thus enhancing their safety.
Wearable sensors are mostly worn on the waist and feet. These sensors use technologies to measure distances, acceleration, gait, and speed. Changes in acceleration and speed may signify falls, near-misses, or fall risks. Gait and balance sensors (especially with radar technology) help determine early the need for assistive devices (Möller et al., 2021). Risk assessment tools and wearable sensors thus improve fall reporting and prevention.
4A. Proposed Solution Justification
As mentioned earlier, patient and environmental factors lead to patient falls. Patient factors lead to more falls. As also discussed, most falls occur outdoors. Existing strategies to manage patient falls include bed and room sensors. Room sensors provide live footage, alert Bed sensors alert the care providers when patients alight or get into bed (Greene et al., 2019). Thus, they only detect falls during movement into and out of bed. Wearable sensors use rechargeable batteries with low power usage; thus, they are economical.
However, these two interventions have minimal effects on fall prevention. In addition, room sensors violate ethical codes, and patient privacy is not guaranteed. According to Wang et al. (2018), wearable sensors act like patient companions, and they can be utilized in settings outside the hospital settings. In another study, wearable sensors improved patient falls reporting and significantly reduced patient falls.
5. Resources for Proposal Implementation
There are various resources required for the implementation of this project. They include wearable sensors, informatics staff, a computer program embedded in the health information systems, and additional power sources. Funds from the donors will help acquire these resources. The recurrent expenses are staff payment, power, and other minute costs which the institution will provide. The availability of these resources will influence the success of the change proposal.
The estimated total costs of the program are about $400 000 initial costs and about $90000 annual recurrent costs. The costs are relatively high and require funding from the government and donors. Cost-benefit and return on investment in healthcare are evaluated based on the costs saved.
The program will significantly improve fall reporting to inform future planning to prevent falls. The program will also reduce lawsuits and their associated costs. Falls lead to high healthcare costs, which the patient and institutions pay. According to WHO (2021), treating patient falls costs between $2000-$7000.
Preventing falls will reduce these costs and ensure the availability of funds for other healthcare projects. Thus, all involved parties (patients, healthcare staff, and institutions) will benefit from the healthcare project. The project thus provides a good return on investment
6. Proposal Implementation Timeline
The implementation of the project will require at least three months for the preparation phase, six months of implementation and observation, and a grace period of three months before its evaluation. The project will thus take one year between proposal and evaluation.
The long period will allow the project to have a permanent impact, and therefore the evaluation will be reasonable. It will also allow modifications and improvements to promote its success. The decision on continuation or termination will be based on statistical significance by comparing patient falls data before and after project implementation.
7. Proposal Key Stakeholders
Every project requires stakeholders. The stakeholders for this project are donors, healthcare leaders, healthcare providers, and patients. Consulting stakeholders increases the quality of healthcare proposals and increases the chances of its success. It also ensures that the project is holistic and encompasses all patient needs without negatively affecting other aspects of care, such as healthcare resources.
Patients are the first keyholders. Patients provide the best information regarding their needs, and including this information ensures the success of interventions (Bobak et al., 2020). Healthcare leaders are the next stakeholder, and they provide administrative regulations and resources (Rosen et al., 2018). They ensure the project is beneficial to the institution ad provide their advanced knowledge to improve the projects.
The donors as stakeholders provide resources, ensure the proposal optimally uses resources, and advise on resource utilization (Bobak et al., 2019). Healthcare providers are vital stakeholders in providing ideas to improve the change proposal. They also provide moral and handy support during the proposal implementation.
7A. Engaging Stakeholders Input and Feedback
After engaging with the stakeholders, they provided vital information to the change proposal. Patients agreed to support the project but raised concerns on their privacy but were assured that these sensors do not collect any other information except movement information, crucial to the project.
The donors requested a written budget approved by the institution and suggested that they should pride a project manager during the project implementation. The healthcare leaders suggested removing the informatics role from the budget, claiming that the existing staff can accommodate the new role without straining them. The healthcare providers promised support and assistance during the change management.
7B. Working With Stakeholders to Achieve Success
The healthcare providers will assist in patient assessment and develop the patient risk assessment tool, which healthcare leaders will approve and improve for use in the project. The donors will provide leadership for the project and have successfully managed other healthcare projects. Thus, they are likely to succeed in this project.
Patients will provide information that will be used to inform the assessment tool and evaluate the project’s success. The healthcare leaders will regulate resources to ensure optimal use of existing resources because the donors will fund a proportion of the project (Mannion & Davies, 2018). These stakeholders should all play their roles to achieve the project’s success.
8A.Implementation of the Proposed Solution
Implementation of the program will be multifactorial. The first phase will include purchasing resources such as wearable sensors, the computer program, and their installation. The phase will require critical control to ensure resources are not misused and the activities are carried out as outlined in the project plan. The implementation process’s second phase will encompass the process evaluation through advanced monthly reporting and morning briefs.
The third phase will be the evaluation process. The computer software dedicated to this project to store data from the risk assessment tool and wearable sensors will provide data for project evaluation (Möller et al., 2021). The number of falls detected, near-misses, and falls prevented will be evaluated against similar evidence before the project’s implementation.
8B. Roles as a Detective, Scientist, and Manager of the Healing Environment
As a detective, I observed the healthcare environment, patients, and staff and determined the areas that require improvement. I also investigated the disabling and ineffective processes that needed change. I detected the extent of the damage and what other institutions were doing to remedy the problem and added the knowledge to the shared pool for proper planning.
As a scientist in the healing environment, I examined the collected and existing evidence of the problem for relevance and validity. I also collaborated with fellow healthcare providers to discuss the best ways to manage the problem.
I researched scientific evidence-based solutions from reputable databases and used learned knowledge and skills to remedy the situation. I assessed the effects of the proposed solution on the various stakeholders to ensure the decision relays maximum benefits with no health risks.
Managers of the healing environment coordinate care provision and ensure the availability of resources for a project. In this project investigation and proposal development, I coordinated with other healthcare providers by delegating and overseeing activities to ensure expertise and inclusivity (Rosen et al., 2018).
I also laid strategies to ensure the availability of support from all stakeholders and the adequacy of financial and human resources. I also gathered formidable data to validate the healthcare problem and its remedy. In addition, I used learned managerial skills to gain buy-in from stakeholders and ensure effective change management.
Patient falls are a global health issue with significant effects on healthcare institutions, professionals, and patients. Patient falls causes high healthcare costs, and the burden is higher among older adults. Wearable sensors and risk assessment tools are essential in preventing patient falls and improving fall reporting.
The project will reduce the burden of falls in the healthcare institution and contribute to a conducive working environment. Patients, healthcare leaders, donors, and healthcare professionals are integral stakeholders whose involvement will influence the change’s success. The project’s evaluation will be based on the primary objectives; improve fall reporting and prevent patient falls. The results will then determine the project’s continuity.
Bobak, C. A., Svoboda, M., Giffin, K. A., Wall, D. P., & Moore, J. (2020). Raising the stakeholders: Improving patient outcomes through interprofessional collaborations in AI for healthcare. In BIOCOMPUTING 2021: Proceedings of the Pacific Symposium (pp. 351-355). https://doi.org/10.1142/9789811232701_0035
Center for Disease Control and Prevention (CDC), (2020). Older Adult Fall Prevention. Cost of Older Adult Falls. https://www.cdc.gov/falls/data/fall-cost.html
Greene, B. R., McManus, K., Redmond, S. J., Caulfield, B., & Quinn, C. C. (2019). Digital assessment of falls risk, frailty, and mobility impairment using wearable sensors. NPJ Digital Medicine, 2(1), 1-7. https://doi.org/10.1038/s41746-019-0204-z
Kiel, D. P., Schmader, K., & Lin, F. (2018). Falls in older persons: Risk factors and patient evaluation. UpToDate. Waltham: UpToDate Inc. https://www.medilib.ir/uptodate/show/3012
Kim, J., Kim, S., Park, J., & Lee, E. (2019). Multilevel factors influencing falls of patients in hospital: the impact of nurse staffing. Journal of Nursing Management, 27(5), 1011-1019. https://doi.org/10.1016/j.cger.2019.01.007
Mannion, R., & Davies, H. (2018). Understanding organizational culture for healthcare quality improvement. BMJ, 363. https://doi.org/10.1136/bmj.k4907
Möller, U. O., Fänge A, M., & Hansson E, E. (2021). Modern technology against falls–A description of the MoTFall project. Health Informatics Journal, 27(2), 14604582211011514. https://doi.org/10.1177/14604582211011514
Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), 433. https://doi.org/10.1037/amp0000298
Wang, K., Redmond, S. J., & Lovell, N. H. (2018). Monitoring for elderly care: the role of wearable sensors in fall detection and fall prediction research. (1st Ed.). In Telemedicine and Electronic Medicine (pp. 619-651). CRC Press.
World Health Organization (WHO), (2021). Falls. https://www.who.int/news-room/fact-sheets/detail/falls