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Barrier to Quality

Discuss About The Fall Prevention System Harm Minimization.

According to World Health Organization, falls is a serious problem faced by people in old age. Research shows that people who are above 65 years and a tendency of frequent fall leading to serious damages such as head injuries, dislocation as well as fractures (Gelbard  et al., 2014). Fall represents the most severe type of accidents among people who are above 65 years Bethesda Hospital. Reports indicate that 37 % of the populations are exposed to fall assessment programs. According to the National Safety and Quality Health Service Standards (NSQHS), risks of injuries as well as harm as a result of fall is advanced for elder people due to impaired vision, weakness in the muscle, poor balance, reduced bone density as well as those who are under some medication (Reed-Jones et al., 2013). Thus, there is a need for educational programs to be carried out so that the old age population becomes aware of ways to prevent frequent falls leading to injuries and deaths Carpenter, et al., 2014). Therefore, this proposal will look at the causes and ways of preventing fall at Bethesda Hospital.

NSQHS standards 10 calls for the health care facilities to establish and maintaining the system to help in fall prevention. Additionally, there is a need to have a multifactorial strategy in fall prevention standby (Silvester et al., 2013).  According to the research by the Australian Commission on Safety and Quality Healthcare, injuries and harm related to fall in hospitals are the most common problem among elder people (Luk, Chan & Chan, 2015). Moreover, the data from the Australian Commission on Safety and Quality Healthcare claims that people who are above 80 years usually fall at least once a year. The research also indicates that approximately 5% of the fall experienced by the elder people living in the communities always leads to hospitalization (Gill, Murphy, Gahbauer & Allore, 2013). About 10% to 25% of the fall witnessed in different nursing homes as well as hospital usually results in fractures. Therefore, this research aims to propose measures that can lead to reductions in the incidences fall among old patients whenever they enter into the compounds of the Bethesda Hospital. Additionally, the research will look at ways of minimizing injuries and harms caused by fall in cases they occur to the patients (Carpenter, et al., 2014). NSQHS standards ten perceived that care providers were unaware of vital skills such as exercise that plays a significant role in managing fall (Watson, Jones & Cretchley, 2014).

Project Proposal Aim

Observation and follow up will be undertaken in Bethesda Hospital to determine the reason why there has been an increase in the cases of older people falling and getting life-threatening injuries (Phelan, Mahoney, Voit & Stevens, 2017). The proposal wanted to determine the main barriers to fall prevention before proposing some improvement projects to minimize such kinds of fall (Kaskutas, Dale,  Lipscomb, & Evanoff, 2013).  Previous research reveals that the primary barrier to fall prevention in various health care facilities within Australia was lack of clinical skills by care providers in managing fall (Ambrose, Paul & Hausdorff, 2013). Moreover, the caregivers have not been aware that hearing problem among the old people was a significant risk factor that can lead to fall (Igual, Medrano & Plaza, 2013). Some healthcare workers when interviewed claimed that they advise the old people not to exercise to avoid falling again. Secondly, some HCPs carry out under assessment concerning incidences of falling because they don't view it as a priority or something that is more serious (Borsboom & Cramer, 2013). Instead, HCPs only offers essential consultation and fails to explore possible causes of fall among the old people (Loganathan, Ng, Tan, & Low, 2015). Therefore, this proposal will look at all potential barriers to fall prevention among the old people and come up with the possible solution to fall prevention. Fatalism which is claimed to be a significant cause of fall among ageing generation will also be examined. Additionally, aged individuals who believe that nothing can be done to stop their deteriorating thereby failing to see physiotherapy will also be evaluated. Denial by the ageing population, reluctant to adhere to assistance advice, stigmatization of fall and others causes of fall prevention among the older people within the healthcare facilities will also be examined (Peach et al., 2017). 

The primary aim of this proposal is to evaluate techniques that can be used to prevent fall and injuries to older people by 60% for a period of 12 months at Bethesda Hospital through proactively communication and documentation of risk status (Delahoz & Labrador 2014). Consequently, this will be fourthly supported by ensuring that patients, as well as HCPs, are engaged when undertaking fall prevention plan by making sure that fall management is done during discharge and hospitalization (King, Harrington, Linedale, & Tanner, 2018). The project will require a budget of approximately $10, 000

Falls among older are becoming a primary concern in various hospital setting and nursing home residents since they often lead to severe injuries or even deaths. This literature review will focus on the causes prevention measures that when implemented will help deal with this challenging situation in various hospitals setting in Australia.  There are essential benefits that are associated with instituting a comprehensive plan to minimize fall in different healthcare facilities. Carrying out analysis of numerous thriving programs; it was evident that an integrative program consisting of staff training, environmental modification patient evaluation among other plays a massive role in the overall fall prevalence reduction.  A fall is an unpleasant event which makes the patient rest involuntarily with the lower surface despite being preventable barrier within the hospital setting (Bruno, Gonçalves, Reis, Pedro, & Pedro, (2016). There have as been 700, 000-1000, 000 number of falls that occur yearly within the hospital setting. Additionally, Schick et al., (2018) argue that fall often leads to complications like vital internal bleeding, laceration fractures and many other fatalities (Ambrose, Paul & Hausdorff, (2013). Falls are grouped into three main categories; that is accidental, anticipated as well as unanticipated physiological falls (Staggs, Davidson, Dunton, & Crosser, 2015). Falls that are as a result of physiology includes; ailment, medication, and age which are reflected in the risk assessment score that are given to the patient. However, unanticipated falls are unforeseen since it is impossible to identify them since the standard risk fails to identify victims resulting from unanticipated victims (Ventola, 2014).

Literature Review

Research claims that physiological falls account for 78% all of the falls among the old people thereby contributing to the highest percentage while accidental falls count to 14% (Gilchrist, Guy & Cripton, 2013). Therefore from this statistics, it is obvious most of the cases that involve situations where risk falls can be easily foreseen as well as prevented (Van et al., 2015). Fall caused by physiological effects can occur either due to intrinsic and extrinsic factors. Intrinsic factors include conditions related to impairment levels or physical fitness like acute illness, vision, age, balance, musculoskeletal issues among others (Rowe, 2013). Nevertheless, extrinsic factors entail environmental conditions like poor lighting and clutter.  Managing extrinsic risk plays a vital role in reducing fall prevalence in different hospital settings (Phelan et al., 2015). Therefore, there is a serious need to reduce fall prevalence in various health facilities. Research indicates that there has been a significant reduction in fall ranging from 19%-77% among the old people within health centers where fall prevention programs have been carried out (Vieira, et al., 2013).

One major technique that should be looked when there is a need to reduce a vast number of falls is through the use of assistive mechanism among the patients (Rashidi &Mihailidis, 2013). Despite a great deal of success witnessed with specific prevention methods when guidelines are implemented through right procedures, intervention on fall prevalence often achieves great success. Various hospitals should instruct the use of the assistive mechanism for patients and ensure that the patients can easily request assistance through calls (Koh, Brach, Harris, & Parchman, 2013). Patients are supposed to be given footwear by the management of the hospital top reduced the risk of falling (Duggan, Mitchell & Moore, 2013). One of the primary interventions that can help in preventing the patients from falling is to ensure that the environment is well lit as well as ensuring that transport means like handhold is within the reach of the patients (Williams, Szekendi, & Thomas, (2014). Therefore, this will ensure that in case any patient feels the risk of falling then they can quickly reach at the devices hence preventing falling (Cattelani et al., 2015).

While the literature does not have captured all the necessary causes and prevention mechanism of falling among the old people in the hospital setting, it is noted that physiological falls account for significant cause of descents in the hospital while the significant prevention technique is through the use of an assistive mechanism. Additionally, there is a need to developed assistive guidelines that will ensure that there is collaboration between HCPs and patients in working together to reduce the number of fall being experienced within hospital settings (Carrothers et al., 2013). From the literature, it is witnessed that if cooperation between the patients and care workers is implemented, then it will help in giving the patient confidence to follow the guidelines without seeking the help of the nurses thereby minimizing fall prevalence. According to Pham, Girard, & Pronovost, (2013) when patients are involved in teaching regarding fall reduction techniques, it often makes it easy to implement the method leading to a safer system of healthcare

The field work will be conducted in December holiday Bethesda Hospital in Australia. The site is chosen because of high number of old patient who visit the hospital regularly. Data collection methods that will be used include observation, in-depth interviews, and questionnaires and focused group discussions. The data that will be collected will be analyzed by both qualitative and quantitative measures.

This research will use stratified random sampling method whereby patient will be dived into three groups or strata according to their occupational, age and gender because it assures that we will be able to represent not only the overall population,

The primary data will be collected through observation method, conducting in-depth interviews and focused group discussions. The existing secondary sources will be used to generate information on past trends of various activities

  1. Current

According to recent studies, interactions between healthcare providers (HCPs) and patients are not well developed and stand at approximately 63% at the moment. Out of all the fall prevention mechanisms done daily, a big percentage do follow the prevention guidelines recommended by the national statistic (Stevens, Phelan, 2013). Most of the health care providers at have failed to adhere with the guidelines collaboration between them and patients in ensuring that there is a reduction of falls among the ageing grouped within the healthcare setting (Berger et al., 2013). According to research, Bethesda Hospital experience approximately 30 falls of old people.

  1. Ideal Sate

Although the statistic shown by the studies indicates a much lower expectation as compared to the recommended Australian Commission on Safety and Quality Healthcare, the governing structure as well as systems that have been put in place has played a prominent role in reducing injuries and harm caused by fall among the ageing population =According National Safety and Quality Health Service Standards (NSQHS) show that if nothing is done by 2051for the ageing population then there will be an increases of cost related to injuries induce by fall from an estimation of  $498.2 million to $1,375 million by 2051. Therefore, to ensure that there is a long-term goal for fall reduction prevalence at Bethesda Hospital, the state should work to ensure that there is an establishment of patient-centered care that is safe and well equipped (Ungar et al., 2013).

From various studies, there is need to educate HCPs together with the patients at Bethesda Hospital on ways that can be used to identify risks related to the fall of old individuals (Pergolotti, Deal, Lavery, Reeve, & Muss, 2015). Additionally, both HCPs and patients should be engaged when developing fall programs. An observation concerning the number of falls happening in the hospital as well as interviews will be used to measure the effectiveness concerning the quality of improvement (Lavallee et al., 2016). The measurements will take place on two stages before and one month after carrying out the intervention.

Carrying out assessment and implementation of fall prevention at Bethesda Hospital requires systematic cycle knows as PDSA (plan, do, study and act) will be used. To reduce the fall prevalence in the hospital among the old people, PDSA will play a vital role in ensuring the prevention strategies and structures are adhered to by all individuals who are involved (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013)

  1. Plan:

Plan refers to a call to action and collaboration by various stakeholders to guide, implement as well as coordinate approaches aimed at preventing older people from falling. This type of quality improvement projects program aims at improving patient-nurses interaction at Bethesda Hospital to minimize the fall prevalence among the ageing population during the treatment period (Scott, et al., (015). Here, observation will be done under different stages, i.e., at the beginning of the program to observe the interaction between patients and HCPs and after one month of the program. Plan must also cover the objective of the proposal, i.e., to reduce the number of accidental fall among the old people in the Bethesda Hospital. Data obtained from the observation will be collected and analyzed. The evaluation from both the patients and HCPs will be used to determine the effectiveness of the program as well as strategies to enhance the PDSA cycle.

  1. Do:

It mainly concerns with the implementation of the appropriate programs such as creation of awareness among the staff and patients on the significant causes of fall. Education will be carried out through an organized workshop to both HCPs on how to handle old people who have higher fall prevalence within the Bethesda Hospital. Poster with well-written strategies and gridline concerning the handling of old patients with higher fall prevalence will be mounted on patient rooms indicating their role and that of the HCPs in preventing falls that may lead to injuries and harm.

  1. Study:

Here, evaluation of changes takes place. The study will deals with three elements, i.e., process, outcome, and balance. Process refers ways on how the programs are used to educate patients and caregivers concerning fall management and prevention techniques. Outcome is the appropriate and inappropriate results of falls prevention program. Appropriate outcome occurs when there is a reduction in the number of falls after implementing fall-prevention programs while inappropriate outcome occurs when there is an increase. Balancing refers including an average number of patients when undertaking the study in fall prevention. This study aims to reduce the cases of fall among the old people at Bethesda Hospital by approximately 60%. Additionally, it also aimed at enhancing patient-HCPs interaction during treatment. Cultural and linguistic challenges can be addressed through involvements of family members to ensure a higher success rate (Prince et al., 2015).

  1. Act:

Adoption, rejection or modification of the changes will be adopted at this stage. The proposal examines the changes that can be made to ensure that there are improvements. For example, if the poster containing information on fall prevention does not result in substantive reduction in the number of people falling at Bethesda Hospital, then book with information and picture on fall prevention can be given to the patients Regular training will be undertaken to ensure that HCPs, staff members, and patients are aware of new strategies as well as programs that are used to promote and enhance safe patient-centered care thereby minimizing injuries caused by fall and (El-Khoury, Cassou, Charles, & Dargent-Molina, 2013)


Reduction in fall prevalence within various healthcare facilities requires safe, efficient, timely and patient-centered system.  Earlier identification of the causes and prevention techniques is seen as a quality of improvement mechanism to fall among the ageing population. PSDA helps in developing a small cycle towards building in coexistence between the patients and HCPs. According to the research care providers plays an essential role when it comes to overall prevention patients falls. Therefore, to ensure that there is a success of any program implemented, nurses should be provided with adequate training to ensure that they can recognize patients who are at risk of falling thus ensuring safety culture in the hospital.


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