SNPG956 Policy Critique Policy Document Assessment Rubric

Background:

With an advancing age the human body is said to lose the ability to maintain equilibrium. This is the primary reason why incidences of fall are extremely common among the elderly people. According to studies, it has been mentioned that, 30% of the elderly people are injured on account of fall. Further statistical evidences state that the incidence of fall related injury is on the rise in people aged 65 and above. Studies further reveal that on an average 20% of the elderly people visit hospital because of sustaining injuries due to fall (Bird et al., 2013). ‘Fall’ has been defined as a procedure that leads to imbalance and loss of body control resulting in complete collapse. It is a serious concern and must be addressed on immediate basis. The NSW policy on fall prevention in elderly people aims at designing strategies to deal with problem effectively (Gelbard et al., 2014). It should be critically noted here that Australia hosts a major segment of the old age population. In close association with the population census ratio as evaluated in the year 2014, it was stated that 15% of the total population was aged 65 years old and above. Further, the ratio is expected to rise up to 19% by 203 (Haines et al., 2013)1. A wide range of risk factors has been associated with incidences of fall with the advancing age. Some of the factors include depression, dementia, dizziness, vertigo, improper home environment, blurred vision and inappropriate footwear (Jeon et al., 2014). In accordance to the statistical evidences, it should be noted that between the time span of 2010-2011, 92,150 cases of elderly fall and injury were reported that required hospitalization. The annual medical expense involved for the treatment was calculated equivalent to $ 600 million (Kaminska et al., 2015). Hence, it can be said that there is an alarming need to formulate policies so as to address the issue of fall prevention among the elderly in an effective manner. Most of the cases of fall and injury have been reported within home care settings. However, it should be noted that a high prevalence of fall related injuries among the old age patients have also been observed within the hospital settings. Hence, it can be stated that injury related to accidental fall is preventable to a significant extent. Effective planning and coordinated working at the national level in collaboration with the health care professionals can help in the reduction of the rate of accidents to a great extent. This report aims to review the existing policies and suggest reforms so as to deliver effective care to the elderly segment of the Australian population susceptible to fall.

Overview:

The risk associated with the hike in incidences of fall injury in the old age patients can be controlled to a significant extent. In this regard it must be stated that research studies have suggested a wide range of therapeutic interventions that can be applied on the elderly patients so as to prevent injuries related to accidental falls. Administration of minimal muscle strengthening exercise activities have been reported to be effective for the old people (Lee et al., 2013). Other therapeutic interventions for the treatment and prevention of fall include, administration of occupational therapy in high risk population aged 70 and above, providence of hip-guards or hip-protectors, treatment of blurred vision or cataract, concise geriatric assessment and multidisciplinary assessment in high risk populations. In addition to this, awareness strategies to educate care givers and nursing professionals to engage in a patient-centred care process can also help in minimising the probability of fall. It should be noted that the older people have the right to live in an independent manner free from any possible accidental injury arising due to falls (Lovarini et al., 2013). The Australian Commission on Safety and Quality in health care emphasises on designing strategies so as to educate the health care professionals about the mandatory guidelines that must be followed so as to reduce risks associated with fall within a hospital setting. However it is important to review the existing policies and incorporate reforms so as to strengthen the system of care for the geriatric group. At the same time, it should also be noted that proper integration of the revised policy into the health care network and working in collaboration with the national level can help in enhancing the quality of the care framework. The proposed reform in the existing policy would deal with two important factors. The first being the ability to impart sufficient training to the professionals in order to enhance the level of care provided to the patients injured because of fall. The second factor would deal with empowering the patient to practice self management and take ownership of the medical condition in order to cooperate and speed up the process of recovery. In this context, it can be stated that the old age people have often been associated as moody and non-cooperative at a hospital setting. Healthcare professionals have primarily revealed these two characteristics as the major obstacles that hinder with the successful implementation of a care plan. Hence, the revised policy through awareness schemes and education would aim to educate the professionals in administering a holistic patient centred care plan. It is expected that it would lead to an accelerated and complete recovery. As old age has been often compared to a second childhood, it is important to for the care givers to be sensitive while dealing with the patients (Mitchell et al., 2013). Further, the patients should also be administered a complete care which would not only focus on improving the physical health but would also promote mental and emotional wellness. It can be expected that on successful implementation of the proposed strategy the incidence of injuries related to fall can be controlled to a great extent which would also reduce the combined medical expenditure related to fall prevention in future.

Awareness Strategies:

It has been seen that despite the application of the fall prevention strategy by the public health association of Australia, majority of the care facilities are unable to care for older adults as the rate of fall has increased. Therefore, for this purpose, there should be some changes or improvements in the existing policy or regulations is that with the existing policies or regulations the changes can be visible on the rates and stats of falling related to older people in care homes as well as healthcare facilities (Lord & Washington, 2018).

The first changes or improvement which will be included in the policy related to care strategies will be providing awareness in the care facilities and nursing professionals so that while caring for the patient or older adults in the care home they can utilize the evidence-based practice to prevent fall in the care homes or hospitals. Further, they should be provided with training and educational program so that their healthcare professionals can understand the strategies and activities which can prevent fall episodes in older people prone for falling (Hempel et al., 2013).

The third action which can be implemented or changes in the policy will be including the care quality improvement checklist which will be provided to the healthcare or care homes so that they can evaluate the loopholes and lacks present in their process (Lord & Washington, 2018). This will increase the sense of evaluation of their own care process and they will be responsible for their action while caring for older patients admitted in their care facility. Besides these the other care interventions which will be implemented to improve or change the existing policy about fall prevention in Australia will be providing a fall alert strategy to all the high-risk fallers in the healthcare facility (Hempel et al., 2013). All the patients who are highly prone to fall, they will be provided with a specific strap with color coding on their hand so that by watching them, the professionals can understand the type of care will need in the care process (Goodwin et al., 2014).  Further, the patients will also be provided with educational facility so that they can understand the need and self-efficacy so that they can prevent their fall episode on their own, if any care professionals are not around them. These are therefore, the care improvement strategy or plan which can be implemented in the care process so that while caring for care process so that while caring for patients with fall risks, the care professionals can understand the strategy using which they can prevent falls in them (Hempel et al., 2013).

Review of the new policy:

There are research processes that determine that these changes or improvement can be critically important for the process using which fall prevention can be strengthened and prevented in the care homes and healthcare facilities. In this context the research article of Maetzler et al. (2013) should be discussed in which the primary aim of the care facilities was to provide educational training to the care professionals so that while caring for the older adults, the professionals can use specific theories and strategies mentioned in the communication and educatable intervention to make the process helpful for the patients and prevent their fall. It was evident from the article results that maximum of the strategic and educational planning was provided to the healthcare or care professionals using educational or skilled training due to which they were able to use those skills and educational concepts in the care process so that while caring for older adults prone to fall, the proper care can be implemented in the process (Maetzler et al., 2013).

The second article chosen for this section is the article by Goodwin et al. (2014) in which, the primary aim of the researchers was to identify the process using which the care facility identifies the fall prone patients whom they provided specific training and education so that they can themselves care for their fall prevention strategies. In this process, the researchers carried out survey and interview to more than 10 healthcare facilities and finally it was proven that the care facilities primarily used color coordination strategy to mark the patients while are majority affected with fall risks and prone to affect their health due to their risks for fall. Further, it is the duty of the care facilities to determine that the colour coordination cannot be mixed a each of the patient is tagged differently as per their own risk related to falls and hence, the primary role of the care facilities was to identify the issues in patients an as per their severity tag them with a marker so that whenever the patients are at risk, the care professionals can solve their pain and fall related issue (Goodwin et al., 2014).

Implementation strategies of the new policy:

There is very less amount of evidences which determines that these changes or implementation in the fall prevention policies has been used in the care facility as practical practice so that while caring for older adults it can be implemented for their fall related risk prevention. In an article, by Silva, Eslick and Duque (2013) researchers mentioned several guidance or strategies using which these factors can be implemented in the care process. They mentioned that, to make the training and educational section successful, it is important that the care professionals understand the severity level of these processes and falls in the older adults in Australia so that while relating to the tragedy and risk, they can take active part in the educational facility (Silva, Eslick & Duque, 2013). Further, it will also allow them to understand the positives and negatives of the process and therefore, providing them with education should be done after explaining the complete process and risk for their complete support and efficiency in the process. Therefore, this researcher completely focused on the importance of active participations of healthcare facilities professionals and care home carers in the successful implementation of the proposed changes in the existing care policy for fall prevention (Silva, Eslick & Duque, 2013). Secondly, another research article was about the care facility and the importance of including the patient in the fall preventing intervention (Siris et al., 2014). This is important as they are an important prat of care process and if they are aware of their steps, they will be prone to les fall events and injuries. Hence, the researchers identified the need of care process ab patient involvement and found that the care intervention achieved success when the patients supported them for the care process hence, it was evident that the care process is more successful in the presence and support of patients and hence, involvement pf patient and related intervention was important (Siris et al., 2014).

Recommendations for evaluation:

There are several evaluation methods which can be used to determine the effectiveness of the modified care process and then it can be used to identify the most effective care process using which the care professionals can identify the process which can be used for fall prevention in patients with major fall risks in old age care homes of healthcare facilities (Hempel et al., 2013).

The first evaluation process will the FRS, which is one of the most effective validated tools which is used in the evaluation of the care process for older adults an this determines that the older adults are able to understand the main preventive and interventions which is important for the care process and improvement of the older adults prone to risk of fall (Lord & Washington, 2018). This is an important care evaluation and hence, it will be used to identify the effectiveness of the care process. The second intervention will be the mobility assessment, in which the patient mobility will be assessed and depending on the care process of the older adult and its effectiveness will be judged. It is an important care evaluation as it is directly associated with mobility, which is affected after falls in majority of the older adults (Maetzler et al., 2013). Therefore, is the patient is able to carry out mobility, then the intervention is bale to provide proper care to the patient and hence, intervention will be successful. these are the way using which care process will be evaluated (Goodwin et al., 2014).

References:

Bird, M. L., Pittaway, J. K., Cuisick, I., Rattray, M., & Ahuja, K. D. (2013). Age-related changes in physical fall risk factors: results from a 3 year follow-up of community dwelling older adults in Tasmania, Australia. International journal of environmental research and public health, 10(11), 5989-5997.

Gelbard, R., Inaba, K., Okoye, O. T., Morrell, M., Saadi, Z., Lam, L., ... & Demetriades, D. (2014). Falls in the elderly: a modern look at an old problem. The American Journal of Surgery, 208(2), 249-253.

Goodwin, V. A., Abbott, R. A., Whear, R., Bethel, A., Ukoumunne, O. C., Thompson-Coon, J., & Stein, K. (2014). Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis. BMC geriatrics, 14(1), 15.

Haines, T. P., Nitz, J., Grieve, J., Barker, A., Moore, K., Hill, K., ... & Robinson, A. (2013). Cost per fall: a potentially misleading indicator of burden of disease in health and residential care settings. Journal of evaluation in clinical practice, 19(1), 153-161.

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., ... & Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494.

Jeon, M. Y., Jeong, H., Petrofsky, J., Lee, H., & Yim, J. (2014). Effects of a randomized controlled recurrent fall prevention program on risk factors for falls in frail elderly living at home in rural communities. Medical science monitor: international medical journal of experimental and clinical research, 20, 2283.

Kami?ska, M. S., Brodowski, J., & Karakiewicz, B. (2015). Fall risk factors in community-dwelling elderly depending on their physical function, cognitive status and symptoms of depression. International journal of environmental research and public health, 12(4), 3406-3416.

Lee, H. C., Chang, K. C., Tsauo, J. Y., Hung, J. W., Huang, Y. C., & Lin, S. I. (2013). Effects of a multifactorial fall prevention program on fall incidence and physical function in community-dwelling older adults with risk of falls. Archives of physical medicine and rehabilitation, 94(4), 606-615.

Lord, D., & Washington, S. (2018). Introduction. In Safe Mobility: Challenges, Methodology and Solutions (pp. 1-10). Emerald Publishing Limited.

Lovarini, M., Clemson, L., & Dean, C. (2013). Sustainability of community-based fall prevention programs: a systematic review. Journal of safety research, 47, 9-17.

Maetzler, W., Domingos, J., Srulijes, K., Ferreira, J. J., & Bloem, B. R. (2013). Quantitative wearable sensors for objective assessment of Parkinson's disease. Movement Disorders, 28(12), 1628-1637.

Mitchell, R. J., Watson, W. L., Milat, A., Chung, A. Z., & Lord, S. (2013). Health and lifestyle risk factors for falls in a large population-based sample of older people in Australia. Journal of safety research, 45, 7-13.