Falls are a common cause of morbidity and the leading cause of nonfatal injuries and trauma-related hospitalizations in the United States (Center for Disease Control and Prevention, 2012). Falls can occur in home and as well as in any health care facility. In hospitals, falls consistently make up the largest single category of reported incidents, with most falls occurring as a result of medication related issues, toileting, and hospital environment conditions. With falls accounting for the leading cause of injuries in hospital, it is imperative that environment safety and fall prevention is addressed in facilities. This change plan will include the need for implementation of a fall risk assessment and fall precautions, barriers to change, factors influencing change and the readiness for change as well as resources available to support change. These changes will be implementing with the help of using, Kurt Lewin’s Change Plan Theory.
Need for the Proposed Change
A fall is defined as an event which there is a downward displacement of a patient’s body from a standing, sitting, or lying position that may result in injury (St Peter’s Hospital, 2012). St. Peter’s Hospital in Albany, New York, is one of the major acute care hospitals committed to promotion of patient safety. Acute care hospitals show that fall rates range from 1.3 to 8.9 falls/1,000 patient days and that higher rates occur in units that focus on eldercare, surgical, neurology and rehabilitation (“National Quality Measures Clearinghouse”, 2013). Due to the high number of patient falls and increased risk factors in the hospital it is imperative to have fall assessments and fall prevention standardized throughout the hospital. Patients’ will be provided an optimal safe environment during care based on the Environment Safety and Fall Prevention Policy and Procedure. Fall prevention strategies are to be executed per standard of care and individualized based on patient assessment within the patient plan of care. Certain patients are considered to be at a greater risk for falls.
Factors such as patients who are 85 years old or older, osteoporosis, anticoagulants treatment, bleeding disorders and patients post-operative. Every patient who is admitted into the hospital is placed on universal fall precautions and nurses will further assess patients based on the Hendrich II Assessment Tool and Get-Up-and-Go Assessment. Patients are also reassessed every shift, with change in condition, after a transfer, and after a fall. The Hendrich II Fall Risk Model is used to assess a hospitalized patient’s risk of falling. Designed to be administered quickly, it focuses on eight independent risk factors: confusion, disorientation, and impulsivity, symptomatic depression, altered elimination, dizziness or vertigo, male sex, administration of antiepileptic (or changes in dosage or cessation), administration of benzodiazepines, and poor performance in rising from a seated position in the Get-Up-and-Go Assessment (Hendrich, MSN, RN, FAAN, 2007).
Along with universal fall precautions, Hendrich assessment and Get-Up-and-Go Assessment, staff members should be monitoring their environment on an ongoing basis for situations that may lead to a fall, such as tubing and equipment posing as a tripping hazard. Staff members must be proactive with assisting patients with unsteady gait, need for assistive devise and patients with weakness to ensure safety. Once a patient is scored a fall risk, the nurse will initiates a fall prevention program and activate fall risk in patient’s plan of care.
A yellow arm band is placed on the patient, special skid resistant slipper socks are provider to the patient and fall precaution sign is placed outside patient’s door and over the bed to ensure all staff members are aware of fall risk. Providing education on preventing falls to both family and patient, placing patients closer to the nurses’ station, providing bed alarms, sitters and hourly rounding are other measures to avoid falls. Patients who score five or greater are considered to be risk for falls and fall interventions will be initiated. Another safety measure important to prevention of falls is to include fall risks in all shift to shift reports.
Barriers to Change
St. Peter’s Hospital is an large organization specializing in Cardiac, Hepatobiliary, Bariatric, Gastrointestinal and Orthopedic Surgeries. Being such a diverse large organization inconsistency throughout the hospital shows to be the major barrier to change. Other barriers are lack of employee involvement, lack of financial resources and poor communication. To overcome such barriers, an awareness of the need for an effectiveness of fall risk assessment and fall prevention program is essential. Employees, patient’s, and family members need to be aware of fall risks, fall precautions and the fall prevention program.
Factors Influencing Change
Increasing patient satisfaction and at the same time preventing and reducing the amount of falls on a daily basis is the key factor. Patient satisfaction is ultimately the driving force behind the changes in the hospital. If patients are not satisfied with care, they will go to another provider and thus the hospital will lose money. In order for St. Peter’s Hospital to remain ranked in the top 10 hospitals, they must ensure all patients are pleased and safe with their care. One way to make certain that the hospital patient safety increases is by implementing changes throughout the hospital to standardized the fall risk assessments and fall prevention program.
In order to be successful with this change, regulatory changes will be necessary to be made in accordance with fall prevention. St. Peter’s Hospital is committed to patient’s safety and ensures all patients are provided with an optimal safe environment during care. Training is required for all employees to guarantee compliance and full understand of the fall prevention program. Evaluation of the program is another regulatory change that is necessary for the success of the program. Monitoring on a regular basis is required to determine effectiveness of program and deciding if changes should be made or modified.
Factors Influencing Readiness for Change
When organizational readiness for change is high, organizational members are more likely to initiate change, exert greater effort, exhibit greater persistence, and display more cooperative behavior (Weiner, 2009). Readiness requires both the capability to make change as well as the motivation to make the change. Readiness is contingent on several different factors throughout the hospital. Several factors for implementing the falls risk assessment and fall prevention program is the high rate of falls throughout the hospital. Readiness is also determined by the financial stand point of the hospital. The hospital must be willing and able to devote extra funds to pay for increased amount of employee training and education.
Theoretical Change Model: Kurt Lewin’s Change Theory
Utilizing Kurt Lewin’s Change Theory can assist St. Peter’s Hospital to make the change, minimize disruption and assure that the change is adopted permanently. Lewin’s three step model of change are as follows: Unfreezing, Changing and Refreezing. Unfreezing is the readiness for change. During this phase St. Peter’s Hospital will prepare the hospital staff for the implementation of the falls risk assessment and falls prevention program. In order to prepare the hospital staff of the need for change, they must first provide information and research regarding the program and the benefits. Once unfreezing is complete, St. Peter’s Hospital would transition into the second phase known as, Change. Change is the actual implementation of the proposed change.
In order to implement these changes, training will be provided and required for all employees to guarantee compliance and full understand of the fall prevention program. Evaluation and monitoring of the program will also be conducted during this phase to ensure compliance as well as understanding. Actually making the falls risk assessment and falls prevention program a permanent entity to the nursing assessment is the final stage of refreezing. During this stage, St. Peter’s Hospital will continue to offer education and support throughout the hospital to standardized the fall risk assessment and falls program.
Recourses Available for Change
It would be virtually nearly impossible to implement an successful change without having the necessary resources. In order to implement such a plan as the fall risk and fall prevention program, St. Peter’s Hospital must have a team of educated employees throughout the many disciplines and be able to train the remainder of the hospital with the new proposed changes. Education would be in the form of class room demonstrations, on the unit in-services in addition to hospital based website education. Finances is another major resource that is required for the change plan. Without the proper means, the hospital is not able to pay the employees and implementation would not be in effect.
Patient education needs to be incorporated into the admission process and continue throughout the hospitalization stay. Education provides the patient with the knowledge of the importance of safety and what part he or she contributes in their care as well as risk factor identified. Fall prevention programs are designed to determine fall risk and prevention strategies while collaborating with the patient’s health care. Informing both the patient and the family will bring an understanding and mindfulness to fall prevention.
Falls are devastating to both the patient and the hospital considering a single fall may result in a downward spiral of reduced mobility with a loss of function and further risk of falls. Along with proper education, fall risk assessments are vital to the fall prevention process. These fall risk assessment are implemented hospital wide and are conducted every shift, change in status, during transfers to different units and at discharge (St. Peter’s Hospital, 2012). Compliance and consistency reduces falls and the overall cost of falls throughout the hospital improving the care.
Center for Disease Control and Prevention. (2012). Falls Among Older Adults: An Overview. Retrieved from August 23, 2014, from http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html Currie, D.N. Sc, M.S.N., R.N., Leanne. (n.d. ). Fall and Prevention. Retrieved August 23, 2014, from http://ncbi.nlm.gov Hendrich, MSN, RN, FAAN, Ann. (2007, November). How to Try This” Predicting Falls. AJN, 107(11), 50 National Quality Measures Clearinghouse. (2013). Retrieved August 23, 2014, from http://www.qualitymeasures.ahrq.gov/content.aspx?id=36944 Environmental Safety and Fall Prevention. (2012). Retrieved August 23, 2014, from http://www.sphcs.org/environmentalsafetyandfallprevention.org Weiner, B. J. (2009, October). A Theory of Organizational Readiness for Change . Implementation Science, 4(67)
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