Geriatric Care: Quality Improvement Initiatives

Executive Summary

Quality improvement initiatives are critical programs that are implemented in healthcare settings to enhance the delivery of care. Educational programs must develop a competent approach and an appropriate workplace culture that would directly help manage the central issue. This report will present a quality improvement initiative program aimed at fall management of geriatric patients in hospital settings.

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Purpose

Falls among geriatric patients is one of the leading causes of morbidity in hospital settings. Falls occur in up to one-third of patients aged 65 and older with 20-30% resulting in injury. The direct medical costs of an acute fall injury averages to $17,483 with the annual costs exceeding $30 billion nationwide (Carande-Kulis, Stevens, Florence, Beattie, & Arias, 2015). Injuries occurring due to falls can lead to disability, functional impairment, and at the very least, pain and discomfort for patients.

In rare cases, it can cause death. As a result, falls significantly increase costs for the hospital which must take upon the expense of treating any additional injuries, increased length of stay, and potential litigation expenses. Therefore, the main aspect of this program is to implement protocols and patient education through nursing care, which is considered the primary factor in reducing the incidence of patient falls (Spetz, Brown, & Aydin, 2015).

Target Audience

The program is multifactorial, targeting both staff and patients. Frontline nurses working in the geriatric section of the hospital are the primary staff that would be trained under this initiative. In order for the fall management program to be successful, it must be actively adhered to by relevant staff. Nurses will be taught new practices and potential modifications to protocols. Nurses will have to recognize the roles and responsibilities that hospital staff has in fall prevention, which practices extend beyond the unity, and operational nuances or processes of implementing any new protocols.

In terms of patients, individuals aged 65 and older will be the target audience of educational and physical therapy sessions. This age group has the highest risk for in-hospital falls due to impaired mobility and stability. Issues with balance, vision, and musculoskeletal weakness can be attributed to poor physical fitness and impairment in this age group. Anticipated physiological falls account for 78% of all potential accidents, suggesting that they could be foreseen and prevented with a proper intervention aimed at the geriatric population (Gu, Balcaen, Ni, Ampe, & Goffin, 2016).

Cost

The cost of the program depends on the number of participants, the time spent on instruction, and time spent on implementing individual training with the patients. The suggested program would train nursing staff working with geriatric patients, with the need for retraining every 24 months. Nurse leaders would run sessions with groups of long-term, non-emergency geriatric patients. The total cost of the program is estimated at approximately $50,000 annually with specific expenses outlined below.

Activity Resource Type Type Annual Cost Cost Per Participant (400 patients)
Marketing Labor and Materials Advertising $500 $1.25
Training Lead Trainer Instruction $700 $1.75
Material Manual and equipment $500 $1.25
Intervention Nurse training Instruction $10,000 $25.00
Education Sessions with Patients Instruction $15,000 $37.50
Evaluation Analysis and Data Collection $1,000 $2.50
Total $27,700 $69.25

Benefits

A fall prevention program provides a significant financial return on investment. The cost of a fall per patient averages out to $115 with an extended length of stay by as long as five days. However, post-intervention, the average cost per patient falls to as low $47.15 (Spetz et al., 2015). Depending on the setting, age group of patients, and effectiveness of the program, the ROI can range from 36-64%, exceeding program implementation and delivery costs (Carande-Kulis et al., 2015).

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A multifactorial approach to education and improvement of care has generally demonstrated to be effective in reducing fall rates. Not only is a fall prevention program potentially cost-saving, but it also helps to re-evaluate a hospital’s processes and unique factors which may lead to patient injuries. Nurse leaders must evaluate fall patterns, inadequate training of staff, and lack of patient education which may be potential causes of recurring incidences of falls in vulnerable geriatric populations.

Even if the program fails to produce a financial return on investment, a fall prevention initiative is critical for the protection of patients and hospital reputation. It would improve quality of care in the hospital as well as a long-term function that leads to better quality of life in patients. Improvement programs impact adherence of staff to fall-prevention protocols and widespread adoption of competent practices which are essential to any healthcare provider (Spetz et al., 2015).

Basis of Evaluation

For the program to ensure funding and sustainability, it requires objective measures which can be used for evaluation of its effectiveness. Evaluation should provide data to show that the program is benefiting patients and improving quality of care, presents a level of financial return on investment, maintains scientific and evidence-based integrity, and attracts interests from all involved stakeholders. Evaluation does not have to be perfect and can provide opportunities for improvement and optimization of the initiative (Centers for Disease Control and Prevention, 2015).

The table below outlines some critical components of evaluation that will be used:

Component Outcome
Effectiveness Reduction in fall rates
Program attendance
Number of nurse instructors trained
Self-responses and observation of functional abilities of patients after the program
Financial Feasibility Decreased costs of treating in-hospital falls
Return on investment rate from the program
Competency Evaluation Scientific and evidence-based merit maintained with program instruction
Stakeholders have shown positive response and satisfaction with program progress

Approval

The program has significant merit, and the report has proven its significance, both in terms of patient care and organizational responsibility, as well as financial feasibility. Most likely it would receive approval from nursing leaders, the hospital administration, and community stakeholders. The issue of fall management has received significant attention in recent years, and healthcare providers are seeking effective methods and an expansion of current programs to reduce fall incidences. Furthermore, the increased costs of healthcare and litigation have made it necessary to address the potential outcomes of patient falls. Since the provided research and statistics indicate that a majority of falls are preventable, it is likely an intervention program which proactively seeks to address causative factors, will be approved.

Strengths and Weaknesses

The strength of the proposal is that it provides concrete and well-researched data to support the program. A convincing argument is built around the practical and theoretical aspects of fall prevention. Furthermore, a strong emphasis is made on financial feasibility and return on investment, which is one of the primary aspects for consideration for any hospital initiative. The weak point of the proposal is that it does not explicitly outline the structure of the program. While it is clear that staff will be trained and then patients will participate in educational and physical therapy sessions, there is no definitive structure outlined. Furthermore, this may impact the accuracy of the program’s cost prognosis and potential outcomes.

References

Carande-Kulis, V., Stevens, J. A., Florence, C. S., Beattie, B. L., & Arias, I. (2015). A cost-benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52, 65-70. Web.

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Geriatric Care: Quality Improvement Initiatives
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Centers for Disease Control and Prevention. (2015). Preventing falls: A guide to implementing effective community-based fall prevention programs. Web.

Gu, Y., Balcaen, K., Ni, Y., Ampe, J., & Goffin, J. (2016). Review on prevention of falls in hospital settings. Chinese Nursing Research, 3(1), 7-10. Web.

Spetz, J., Brown, D. S., & Aydin, C. (2015). The economics of preventing hospital falls. The Journal of Nursing Administration, 45(1), 50-57. Web.

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