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PROJECT DESCRIPTION

PICOT:

For the nursing and ancillary support staff of a primary care clinic (P), how does the fall risk management protocol (I) compare to current practice (C) affect fall rate (O) over 12 weeks (T)?

Brief Summary:

Falls among older adults are a health concern that can have profound physical, psychological, and social implications. As the global population ages, addressing this issue becomes imperative to ensure the well-being and independence of older individuals (Arkkukangas et al., 2021). Fall rates have emerged as a concern within the primary care clinic. The present fall rate of our clinic is noted to be elevated at around 3 to 5 falls per month, the national rate is estimated at 700,000 to 1 million annual falls each year, contributing to a considerable proportion of adverse events and injuries. The healthcare expenses associated with falls impose a potentially financially burdensome amount on the clinic and patients, Medicare, for instance, expended approximately $28.9 billion in 2015 on medical expenses linked to nonfatal falls in the elderly. Falls can potentially undermine the reputation and diminish patient satisfaction with a healthcare facility (Elrod et al., 2023). In response to this matter, a proposed intervention involving the implementation of an evidence-based protocol for managing fall risks will be undertaken to effectively mitigate fall rates within the primary care context.

Primary Objective: To reduce to zero the incidence of falls within the primary care setting.

Secondary Objective:

1. Enhance staff compliance with falls assessment and reassessment.

2. Improve communication and reporting among healthcare professionals.

3. Actively engage the patient in the fall prevention protocol, fostering their awareness and commitment to reducing the risk of falls and thereby enhancing their safety and overall well-being.

Proposed Evidence-based Intervention(s):

1. Implementation of fall risk management protocol based on findings from Abd et al. (2022).

2. Development of interprofessional communication strategies informed by Brach et al. (2021).

3. Patient and family education on fall prevention strategies inspired by Choi et al. (2019).

PROJECT DESIGN AND METHODS

Project Design: Quality Improvement.

Model For Improvement

: Plan-Do-Study-Act (PDSA) Implementing a fall prevention project using the Plan-Do-Study-Act (PDSA) cycle involves identifying fall risks, setting objectives, implementing evidence-based strategies, and continually assessing outcomes through iterative cycles of planning, action, evaluation, and adjustment. This systematic approach aims to reduce fall incidents by applying effective interventions and refining strategies based on data-driven insights.

Target Population Undergoing the Practice Change: The primary care clinic’s nursing and ancillary support staff.

Inclusion Criteria: All registered nurses, licensed practical nurses, medical assistants, and nursing aides employed at the primary care clinic.

Exclusion Criteria: Patient less than 18 years old. Patients with terminal illnesses or conditions that significantly limit their life expectancy may not be suitable candidates for a fall prevention program with long-term benefits. Individuals currently experiencing acute medical conditions that require immediate attention or hospitalization might be excluded from the program until their medical condition stabilizes.

Estimated Project Length (weeks): 12 weeks (2-week pre-work, 8-week implementation, 2-week data collection and analysis)

OUTCOME MEASURES AND ANALYSIS

Primary Outcome Measures: Reduction in fall incidence at the primary care clinic.

Secondary Outcome Measures:

1. Compliance with falls assessment and reassessment.

2. Effectiveness of interprofessional communication strategies.

3. Patient and family satisfaction with fall prevention education.

Data Analysis and Results Reporting:

References

Abd, A. E., Schwab, C., Clementz, A., Fernandez, C., & Hindlet, P. (2022). Safety of elderly fallers: Identifying associated risk factors for 30-Day unplanned readmissions using a clinical data warehouse.
Journal of Patient Safety,
18(3), 230–236.

https://doi.org/10.1097/pts.0000000000000893

Arkkukangas, M., Bååthe, K. S., Ekholm, A., & Tonkonogi, M. (2021). A 10-week judo-based exercise program improves working-age adults’ physical functions, such as balance, strength, and falling techniques.
BMC Public Health,
21(1), 744.

https://doi.org/10.1186/s12889-021-10775-z

Brach, J. S., Juarez, G., Perera, S., Cameron, K., Vincenzo, J. L., & Tripken, J. (2021). Dissemination and Implementation of Evidence-Based Falls Prevention Programs: Reach and Effectiveness.
The Journals of Gerontology: Series A,
77(1), 164–171.

https://doi.org/10.1093/gerona/glab197

Choi, N. G., Choi, B. D., DiNitto, D. M., Marti, C. N., & Kunik, M. E. (2019). Fall-related emergency department visits and hospitalizations among community-dwelling older adults: Examination of health problems and injury characteristics.
BMC Geriatrics,
19(1).

https://doi.org/10.1186/s12877-019-1329-2

Elrod, C. S., Pappa, S. T., Heyn, P. C., & Wong, R. A. (2023). Using an academic-community partnership model to deliver evidence-based falls prevention programs in a metropolitan setting: A community case study.
Frontiers in Public Health,
11, 1073520.

https://doi.org/10.3389/fpubh.2023.1073520

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