Week 3 Practicum discussion.
Increased fall rates among the elderly, especially in long-term facilities, are a current problem and are the leading cause of many injuries and even death. This affects the quality of life and care of many of our elderly. For this week’s practicum discussion, I will discuss how to implement the FADE quality improvement model to the above practicum problem. FADE is a quality improvement model for F-focus, A-analyze, D-develop, and E-execute.
F-focus. The process to be improved is the fall rates in the elderly population living in long-term care facilities. Falls pose a severe risk for the elderly living in long-term care facilities. An average nursing home with 100 beds reports 100 to 200 falls annually. Each year, 3 million older people are treated in emergency departments for fall injuries. Each year at least 300,000 older people are hospitalized for hip fractures. Moreover, approximately 1,800 older adults living in long-term care facilities die each year from fall-related injuries, and many of these falls go unreported (Centers for Disease Control, 2009). This is a call for concern.
A-Analyze. In this step, I will discuss some of the root causes of these falls. There are several reasons why older adults fall more. Some Predisposing factors include unsteady gait and balance. Muscle weakness and gait problems are the most common causes of falls among elderly residents, accounting for about 24% of nursing home falls (nursinghomeabusecenter.com, 2023). Other causes include weak muscles, poor vision, medications, dementia, hypotension, stroke, Parkinson’s disease, arthritis, epilepsy, and poor eyesight and hearing. Other reasons can be loose rugs, clutter, inappropriate footwear, belongings placed too far to reach, and wandering patients. Some of the causes of these falls are a lack of staff, a high patient-to-nurse ratio, poor bed placement for high-risk patients, and a lack of accurate fall assessments. Here are some facts or statistics about these falls. Between 50% and 75% of nursing facility residents fall each year. About 5% of US adults aged 65 and older reside in nursing homes, and deaths due to falls make up 20% of deaths in the same age group. Between 2%-6% of nursing home falls result in some fracture. Between 16%-27% of nursing, home falls are caused by environmental hazards, such as equipment in the hallways. About 35% of injuries due to falls occur in residents who cannot walk on their own (nursinghomeabusecenter.com, 2023).
D-develop. This step is where action plans to solve the problem are developed and communicated. The first step is to do fall risk assessments upon admission and reassess quarterly or as needed. They’re creating a fall prevention plan or program, considering predisposing factors. For example, assessing patient cognitive abilities, gait, locomotion, vision and hearing tests, medications that may trigger sedation, Range of motion, evaluating footwear for proper fit and nonskid, and checking for environmental clutter. Most importantly, it is to look into patient staffing needs and ensure that staff-to-patient ratios are not too high, impeding quality of care. Reassess the location of increased fall-risk patients and provide placement closest to the nursing station.
E-execute. In the phase of the model, fall prevention plans or programs are put in place or executed. Establish a fall committee where the members are committed to leading the initiative. Assign a dedicated clinical resource nurse who will provide support, clinical expertise, mentorship, and leadership ( McCarthy et al., 2023). Teach staff fall prevention strategies and educate residents about falls, their causes, and prevention. Fall precautions are implemented for all fall-risk patients, like bed alarms, monitors, and every 2-hour patient rounding. Bed placement closets to the nursing station and beds on lowest positions when the patient is in bed and fall mats at the bedside. Installing nightlights in every room and proper functioning call lights. Ensure staff is answering call lights promptly, and check call light logs every shift. Toileting and changing residents to avoid falls from urgency, frequency, or discomfort. Ensure therapy referrals are made for patients with a decline or change in ROM or gait. Keep wheelchairs, call bells, phones, and essential belongings within reach. Communicate with providers regarding medication reconciliation for medications triggering sedation in patients. Making sure patients get their yearly vision and hearing test.
Center for Disease Control and Prevention (2009). Falls in nursing homes. Retrieved on November 8, 2009, from http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.htmlLinks to an external site..
McCarthy, R., Adedokun, C., Fairchild, R. (2023). Preventing Falls in the Elderly Long-Term Care Facilities. Journal of Nursing. Retrieved from: https://rn-journal.com/journal-of-nursing/preventing-falls-in-the-elderly-long-term-carefacilities#:~:text=Falls%20pose%20a%20serious%20risk,death%2C%20and%20in%20older%20peopleLinks to an external site..
Nursing home abuse Center: Protecting Our Seniors, (2023). Nursing Home Falls. Retrieved from: https://www.nursinghomeabusecenter.com/nursing-home-injuries/falls-fractures/#:~:text=Muscle%20weakness%20and%20gait%20problems,of%20themselves%20and%20getting%20around
The Assignment you will submit this week will combine the work you completed in Week 1 (Introduction) and Week 2 (Analysis of Existing Evidence) and this week’s assignment, the Quality Improvement Process. These three sections, when combined, will complete Part I of your Capstone Paper.
RESOURCES
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
To prepare for this Assignment:
Review the Capstone Paper Assignment GuideDownload Capstone Paper Assignment Guide
Locate the most current version of your Week 1 and Week 2 Assignment. You will add this section to that document.
Review the new expectations for Use of evidence and Credit to Source:
http://academLinks to an external site.icguides.waldenu.edu/writingcenter/scholarlyvoiceLinks to an external site.
http://academicguides.waldenu.edu/writingcenter/webinars/scholarlywriting#s-lg-box-2773859Links to an external site.
Review the Walden University Writing Center webpage: Using Evidence: SynthesisLinks to an external site.
Review the Week 3 Assignment Rubric
For this Assignment
Describe the quality improvement process and the Quality model that will be used. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2018) chapter 6 for examples.
Explain why the specific process was selected and document your explanation with references.
For the Week 3 Assignment, you will combine your Week 1, 2 and 3 assignments and submit a 3-4-page paper that addresses the following:
Practice Problem (Completed in Week 1)
State the practice problem in measurable terms and that reflect quality indicators. Include data that suggests a practice problem exists. Do not use anecdotal experiences or opinions.
Provide a purpose statement including the importance of improving patient outcomes.
Analysis of the Existing Evidence (Completed in Week 2)
Summarize the findings from the evidence analysis that support your practice problem. Include minimum of at least 5 evidence-based practice sources that support your practice problem. Identify research, clinical guidelines, expert opinions, and other relevant information. You must include two-three research studies in your analysis. Using your own words synthesize the evidence that supports your identified practice problem. There should be no quotes or personal opinions included in this section.
Quality Improvement Process (Completed this Week) (Approximately 2-3 paragraphs)
Describe the quality improvement process and the quality model that will be used. This is not your entire quality improvement plan, only a description of the quality improvement process and the quality model you chose. You will develop your specific quality improvement plan in week 4. Include a description of a quality improvement tool(s) that you will use in your quality improvement plan. See Spath, (2018) chapter 6 for examples.
Explain why the specific process was selected and document your explanation with references.
Conclusion
BY DAY 7
Submit your Assignment.
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Rubric
NURS_4220_Week3_Assignment_Rubric
CriteriaRatingsPtsThis criterion is linked to a Learning OutcomeRequired Content: Identified the quality improvement practice problem in measurable terms that reflect quality indicators.10 to >8.0 ptsExcellentProvided a fully developed quality improvement problem in measurable terms that reflect quality indicators with insightful analysis of concepts and related issues.8 to >7.0 ptsProficientProvided a developed quality improvement problem in measurable terms that reflect quality indicators with reasonable analysis of concepts and related issues.7 to >6.0 ptsBasicProvided a minimally developed quality improvement problem in measurable terms that reflect quality indicators with limited analysis of concepts and related issues.6 to >0 ptsNeeds ImprovementProvided an under-developed quality improvement problem or is not in measurable terms that reflect quality indicators with little or no analysis of concepts and related issues.10 ptsThis criterion is linked to a Learning OutcomeRequired Content: Included data that suggests a practice problem exists.10 to >8.0 ptsExcellentProvided a fully developed description of data that suggests a practice problem exists with insightful analysis of concepts and related issues.8 to >7.0 ptsProficientProvided a developed description of data that suggests a practice problem exists with reasonable analysis of concepts and related issues.7 to >6.0 ptsBasicProvided a minimally developed description of data that suggests a practice problem exists with limited analysis of concepts and related issues.6 to >0 ptsNeeds ImprovementProvided an under-developed description of data that suggests a practice problem exists with little or no analysis of concepts and related issues.10 ptsThis criterion is linked to a Learning OutcomeRequired Content: Provided the purpose statement/rationale for selecting the practice problem including the importance of improving patient outcomes.20 to >17.0 ptsExcellentProvided a fully developed purpose statement/rationale for the quality improvement problem with insightful analysis of concepts and related issues.17 to >15.0 ptsProficientProvided a developed purpose statement/rationale for the quality improvement problem with reasonable analysis of concepts and related issues.15 to >13.0 ptsBasicProvided a minimally developed purpose statement/rationale for the quality improvement problem with limited analysis of concepts and related issues.13 to >0 ptsNeeds ImprovementProvided an under-developed purpose statement/rationale for the quality improvement problem with little or no analysis of concepts and related issues.20 ptsThis criterion is linked to a Learning OutcomeRequired Content: Synthesize the findings from the analysis of evidence that support the practice problem and meets all requirements.40 to >35.0 ptsExcellentProvided a fully developed synthesis of findings from the analysis of evidence.35 to >31.0 ptsProficientProvided a developed synthesis of the findings from the analysis of evidence.31 to >27.0 ptsBasicProvided a minimally developed synthesis of the findings with limited analysis of the evidence.27 to >0 ptsNeeds ImprovementProvided an under-developed synthesis with little or no analysis of the evidence.40 ptsThis criterion is linked to a Learning OutcomeRequired Content: Applied a quality improvement process and quality model to the practice problem and explain why they were chosen.25 to >22.0 ptsExcellentProvided a fully developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with reasonable analysis of concepts and related issues.22 to >19.0 ptsProficientProvided a developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with reasonable analysis of concepts and related issues.19 to >17.0 ptsBasicProvided a minimally developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with limited analysis of concepts and related issues.17 to >0 ptsNeeds ImprovementProvided an under-developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with little or no analysis of concepts and related issues.25 ptsThis criterion is linked to a Learning OutcomeRequired Content: Chose a specific quality improvement tool that will be used throughout the project and explain why it was chosen.15 to >13.0 ptsExcellentProvided a fully developed discussion of the selected quality improvement tool including a justification of its selection with reasonable analysis of concepts and related issues.13 to >11.0 ptsProficientProvided a developed discussion of the selected quality improvement tool including a justification of its selection with reasonable analysis of concepts and related issues.11 to >10.0 ptsBasicProvided a minimally developed discussion of the selected quality improvement tool including a justification of its selection with limited analysis of concepts and related issues.10 to >0 ptsNeeds ImprovementProvided an under-developed discussion of the selected quality improvement tool including a justification of its selection with little or no analysis of concepts and related issues.15 ptsThis criterion is linked to a Learning OutcomeProfessional Writing: Clarity, Flow, and Organization10 to >8.0 ptsExcellentContent is free from spelling, punctuation, and grammar/syntax errors. Writing demonstrates very well-formed sentence and paragraph structure. Content presented is completely clear, logical, and well-organized.8 to >7.0 ptsProficientContent contains minor spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates appropriate sentence and paragraph structure. Content presented is mostly clear, logical, and well-organized.7 to >6.0 ptsBasicContent contains moderate spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates adequate sentence and paragraph structure and may require some editing. Content presented is adequately clear, logical, and/or organized, but could benefit from additional editing/revision.6 to >0 ptsNeeds ImprovementContent contains significant spelling, punctuation, and/or grammar/syntax errors. Writing does not demonstrate adequate sentence and paragraph structure and requires additional editing/proofreading. Key sections of presented content lack clarity, logical flow, and/or organization.10 ptsThis criterion is linked to a Learning OutcomeProfessional Writing: Context, Audience, Purpose, and Tone10 to >8.0 ptsExcellentContent clearly demonstrates awareness of context, audience, and purpose. Tone is highly professional, scholarly, and free from bias, and style is appropriate for the professional setting/workplace context.8 to >7.0 ptsProficientContent demonstrates satisfactory awareness of context, audience, and purpose. Tone is adequately professional, scholarly, and/or free from bias, and style is consistent with the professional setting/workplace context.7 to >6.0 ptsBasicContent demonstrates basic awareness of context, audience, and purpose. Tone is somewhat professional, scholarly, and/or free from bias, and style is mostly consistent with the professional setting/workplace context.6 to >0 ptsNeeds ImprovementContent minimally or does not demonstrate awareness of context, audience, and/or purpose. Writing is not reflective of professional/scholarly tone and/or is not free of bias. Style is inconsistent with the professional setting/workplace context and reflects the need for additional editing.10 ptsThis criterion is linked to a Learning OutcomeProfessional Writing: Originality, Source Credibility, and Attribution of Ideas10 to >8.0 ptsExcellentContent reflects original thought and writing and proper paraphrasing. Writing demonstrates full adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references.8 to >7.0 ptsProficientContent adequately reflects original writing and paraphrasing. Writing demonstrates adequate adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references.7 to >6.0 ptsBasicContent somewhat reflects original writing and paraphrasing. Writing somewhat demonstrates adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references.6 to >0 ptsNeeds ImprovementContent does not adequately reflect original writing and/or paraphrasing. Writing demonstrates inconsistent adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and reference.10 ptsTotal Points: 150