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Evidence-Based Practice Proposal - Section B: Problem Description Problem Description A geriatric-psychiatric unit, is an inpatient hospital unit which treats elderly people who suffer from medical and emotional or psychological disorders. It deserves more attention to the fall …show more content…
prevention because physical and mental well-being is the two over-arching reasons behind the increased number of falls in geri-psych units.
In over-all, 65 years and older suffer from many geriatric symptoms, due to psychotropic and anti-psychotropic medications, including Electroconvulsive therapy (ECT), mobility challenges, incontinence, poor balance, disorganization and confusion which all lead to high falls. According to a study in the International Journal of Geriatric Psychiatry, patients with the highest risk for falls presented with one or more of the following variables such as Parkinson’s syndrome, Dementia, female gender, mood stabilizers, cardiac arrhythmia, and ECT. Edmonson et. al established, “The Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) specific to the psychiatric, geriatric population and found initial testing of EPFRAT to have higher sensitivity in assessing fall risk in the geri-psych inpatient population” (Edmonson, Robinson, & Hughes, 2011). This project purpose is to investigate and explore whether an Edmonson Fall risk assessment Toll decreases patient falls in inpatient geri-psych units. Stakeholders and Change …show more content…
Agents The stakeholders are an agency, institution or organization. Stakeholders can be effective change agents. According to Schneider et. al, 2016), “Stakeholder engagement strategies should include plans to utilize positive and influential stakeholders to help drive organizational change” (para 2). The role of the stakeholders is guided, coordinate, and support changes during the pilot stage and work with staff, clinicians, middle managers, and senior leaders. The organizations should possess an awareness of implementing Evidence-based practice (EBP), and able to provide enough funding for the expenditures related to adoption of EBP. The Joint Commission (TJC) requires health care organizations to pay more attention to fall and fall- related injuries and to implement proven prevention strategies. National Quality Forum (NQF, 2013) recommended, “the American Nurses Association’s (ANA) NDNQI quality measures to improve patient safety in hospitals - patient fall rate and patient falls with injury” (para 3). The Center for Medicare and Medicaid Services (CMS) acknowledges falls as a preventable hospital conditions. They have set certain guidelines for the facility to avoid or reduce incidents of fall. Since inpatients falls are mostly preventable by the health care facility they don’t not provide the expenditure of care (Radey, & LaBresh, 2012). PICOT Question In patients ages 65and older (P), how does the use Edmonson psychiatric fall risk Assessment tool (I), compared to not using the Edmonson psychiatric fall assessment tool (C), reduce the incidents of fall (O), over two months (T)? P: Age 65 years and older. I: The use of Edmonson Psychiatric Fall Risk Assessment Tool. C: Compared to not using the Edmonson Psychiatric Fall Risk Assessment Tool. O: Reduce the incidents of fall. T: Over two months. The Purpose and Project Objectives This project purpose is to investigate and explore whether an Edmonson Fall risk assessment Tool decreases patient falls in inpatient geri-psych units and to increase an awareness and educate health care members regarding significance of maintaining a safe environment for geriatric patients from falls, assist with recognizing population who are high risk of fall, provide the tools to educate health care members of the potential risk of falls, and outline strategies to develop individualized management plans of care to reduce risk for high risk patients (Lach, Krampe, & Phongphanngam, 2011).
The key objective of the project is to produce a report on fall among the geriatric population, which will help to improve an awareness and knowledge of the importance of lessens falls in elderly and encourage action to lower falls and related
complications. Nursing Relevance All accrediting agencies requires nurses to be knowledgeable, and skillful to provide best possible care to the clients improve the quality and safety of the healthcare system within which they work (QSEN, 2016). As registered nurses, we should recognize the area we work in and be able to observe and examine our practice to better serve our patient population since what may work for one patient may not work for another patient. The Quality and SFTEY Education for Nurses (QSEN) plan reveals that, “one of the competencies for registered nurses is patient-centered care where we as nurses recognize the patient as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values and needs” (2016, para. 1). References Edmonson, D., Robinson, S., & Hughes, L. (2011). Development of the Edmonson psychiatric all risk assessment tool. Journal of psychosocial nursing and mental health services, 49(2), 29-36 Lach, H. W., Krampe, J., & Phongphanngam, S. (2011). Best practice in fall prevention: roles of informal caregivers, health care providers and the community. International journal of older people nursing, 6(4), 299-306. Radey, L.A., & LaBresh, K.A. (2012). Evidence-based guidelines for selected and previously considered hospital-acquired conditions. Centers for Medicare and Medicaid Innovation. Retrieved from: www.cms.gov/Medicare/Medicare-Fee-for-Service Payment/HospitalAcqCond/Downloads/Evidence-Based-Guidelines.pdf Schneider, E. C., Smith, M. L., Ory, M. G., Altpeter, M., Beattie, L., Scheirer, M. A., & Shubert, T. E. (2016). State fall prevention coalitions as systems change agents: an emphasis on policy. Health promotion practice, 17(2), 244-253. Quality and Safety Education for Nurses. (2016). QSEN competencies. Retrieved from http://qsen.org/competencies/pre-licensure-ksas/#safety Quigley, P., & White, S. (2013). Hospital-based fall program measurement and improvement in high reliability organizations. OJIN: Online J Issues Nursing, 18(2).
In this paper I will be comparing the visit to the State Mental Institution and the
Psychiatric hospitals, also known as mental hospitals and mental asylums, are hospitals or wards specializing in the treatment of serious psychiatric diseases, such as clinical depression, schizophrenia, and bipolar disorder. Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialize only in short-term or outpatient therapy for low-risk patients. Others may specialize in the temporary or permanent care of residents who, as a result of a psychological disorder, require routine assistance, treatment, or a specialized and controlled environment. Patients are often admitted on a voluntary basis, but people whom psychiatrists believe may pose a significant danger to themselves or others may be subject to involuntary commitment.
Peel, N. M., Travers, C., Bell, R. R., & Smith, K. (2010). Evaluation of a health service delivery intervention to promote falls prevention in older people across the care continuum. Journal Of Evaluation In Clinical Practice, 16(6), 1254-1261. doi:10.1111/j.1365-2753.2009.01307.x
Falls in nursing homes residents are associated with morbidity, mortality, and healthcare costs. The centers for Medicare and Medicaid indicate falls as the quality indicator. (Leland, Gozalo, Teno, Mor, 2012). Factors such as new environment, medication, cognition, and non-compliance contribute to falls. A significant number of falls occur from wheelchairs. (Willy, 2013). Newly admitted residents to long-term care facilities are confused with the change. The new environment and the new unfamiliar faces increase the level of anxiety. Pain may also contribute to falls. In order to take tailor made preventative measures, fall risk factors for each resident should be evaluated periodically. Tools scoring risk factors can be utilized.
The prevention of falls in the long term care facility is one of the most important interventions the health care team can do to ensure the safety of loved ones under their care. According to the Summary Data of Sentinel Events Reviewed by the Joint Commission (2016), there were 806 falls between 2004-2015 with 95 of those occurring in 2015 . As health care providers, we have a responsibility to incorporate interventions that will help protect the patient while under our care. Interventions as simple as ensuring the use of a gait belt by any team member that transfers the patient, to making sure all team members are aware of the medications that can make certain patients more of a fall risk, will help in the prevention of falls.
The nurse would firstly identify if Mrs Jones is at risk of falls by conducting a falls risk assessment using an evaluation tool such as the Peninsula Health Falls Risk Assessment Tool (FRAT) (ACSQHC, 2009). The falls risk assessment enables the nurse to identify any factors that may increase the risk of falls (ACSQHC, 2009). The falls risk assessment tool focuses on areas such as recent falls and past history of falls; psychological status for example, depression and anxiety; cognitive status; medications including diuretics, anti-hypertensives, anti-depressants, sedatives, anti-Parkinson’s and hypnotics; as well as taking into account any problems in relation to vision, mobility, behaviours, environment, nutrition, continence and activities
This paper will review the many aspects of long-term care problems and many challenges there are within Long-Term care. We will look at rising costs within long-Term Care, patient abuse, will look at the quality of life, shortages of nurses and demand that the elderly are putting on the medical field. The type of care that Long-Term Care had been giving to its patients and the changes within Long-Term Care.
This document’s purpose is to assist nurses to identify elderly patients at risk for falls and to implement interventions to prevent or decrease the number of falls and fall related injuries (RNAO, 2005). The target population are elderly adults in acute or long-term care. The recommendations are to help practitioners and patients make effective healthcare decisions, support nurses by giving educational recommendations, and to guide organizations in providing an environment receptive to quality nursing care and ongoing evaluation of guideline implementation and outcomes. These guidelines stress and interdisciplinary approach with ongoing communication and take patient preferences into consideration.
Falls can happen at any time and place in a hospital setting. It is a major patient safety issue causing injury, distress and even death. According to Debra Hain (2012), “In 2010, there were 2.35 million emergency room visits for non-fatal injuries in older adults with over 25% requiring hospitalization” (pg. 251). Falls can interrupt a person’s quality of life but also have a financial effect on the healthcare system (Hain, 2012). Falls are preventable and in order to reduce the rates for falls nurses must be more vigilant in their assessments to identify patients that are at risk, especially for those undergoing hemodialysis.
A fall is an “untoward event which results in the patient coming to rest unintentionally on the ground” (Morris & Isaacs, 1980). When it comes to patient safety in health care, there isn’t any subject that takes precedence. Patient falls are a major cause for concern in the health industry, particularly in an acute-care setting such as a hospital where a patient’s mental and physical well being may already be compromised. Not only do patient falls increase the length of hospital stays, but it has a major impact on the economics of health care with adjusted medical costs related to falls averaging in the range of 30 billion dollars per year (Center for Disease Control [CDC], 2013). Patient falls are a common phenomenon seen most often in the elderly population. One out of three adults, aged 65 or older, fall each year (CDC, 2013). Complications of falls are quite critical in nature and are the leading cause of both fatal and nonfatal injuries including traumatic brain injuries and fractures. A huge solution to this problem focuses on prevention and education to those at risk. ...
Describes life within a psychiatric hospital. Fascinating account of diagnosis and treatment with facility. Portrait of the inner workings of the psyche. Treatment controversies and economic pressures.
A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization (Swartzell et al. 2013). Because the multi-etiological factors contribute to the incidence and severity of falls in older society, each cause should be addressed or alleviated to prevent patient’s injuries during their hospital stay (Titler et al. 2011). Therefore, nursing interventions play a pivotal role in preventing patient injury related to hospital falls (Johnson et al. 2011). Unfortunately, the danger of falling rises with age and enormously affect one third of older people with ravages varying from minimal injury to incapacities, which may lead to premature death (Johnson et al. 2011). In addition, to the detrimental impacts on patient falls consequently affect the patient’s family members, care providers, and the health organization emotionally as well as financially (Ang et al. 2011). Even though falls in hospital affect young as well as older patients, the aged groups are more likely to get injured than the youth (Boltz et al. 2013). Devastating problems, which resulted from the falls, can c...
Every older people suffering from dementia or any mental illness should contribute to decision-making process if able on about the services the resident gets and is empowered to practice choice and control over his or her way of life. Healthcare professionals need to offer residents with dementia significant parts in making their own particular care plans. We should give the majority of the residents as much decision as possible around both their care and environment.
When taking steps to analyze and apply intervention strategies for falls, we must examine the factors that cause these occurrences. There are numerous reasons that falls occur, such as intrinsic and or extrinsic risk factors. Intrinsic risk factors for falls may be due to changes that are part of the normal aging process and acute or chronic conditions. According to Zheng, Pan and Hua et al. (2013), about 35-45 percent of individuals who are usually older than 65 years and other 50 percent of the elderly individuals report cases of fall every year. Extrinsic factors are those related to physical environment such as lack of grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices (Currie). Patient falls is not an easy thing to eliminate. With many clinical challenges, there’s no easy answer to the challenges posed by patient falls; howe...
Taking care of the individuals that are getting older takes many different needs. Most of these needs cannot be given from the help of a family. This causes the need of having to put your love one into a home and causing for the worry of how they will be treated. It is important for the family and also the soon to be client to feel at home in their new environment. This has been an issue with the care being provided for each individual, which has lead to the need of making sure individuals have their own health care plan.