Background
Patient falls after sedation is a significant part of nursing care (Oliver, Healey & Haines, 2010). Given that the nurses spend more time with patients, they hold the key to addressing the clinical problem related to patient falls. Patient falls after sedation is a common occurrence in most institutions. Research indicates that the only possible remedy to the issue of patient falls is adopting workable preventive measures (Tricco et al., 2013). However, preventive measures can only be effective if nurses are aware of the issues surrounding patient falls as well as the injury risks that are posed by the falls.
Patient falls have a multi-factorial set of causes with both transient and fixed factors. The fixed factors include visual changes among the at-risk patients as well as increased body weakness. The fixed factors increase the risk of falling among these individuals. The transient factors evolve over time during the hospitalization period (Tricco et al., 2013). Temporary factors include dehydration, body temperature, medication changes as well as changes in the patient’s room. Nurses who understand the causal factors in patient falls recognize the complexity of the issue. As such nurses can adopt the right combination of interventions that can adequately address the issue of falls in the at-risk population.
Even though the current practice in dealing with the problem of patient falls is to adopt a combination of different interventions, there is no standardization in the interventions that nurses should employ. According to the available literature, patient, falls not only affect the patients and their families but the nurses as well. As such communication between the three groups is essential to preventing patient falls and in building and enhancing a culture that promotes patient safety. According to Tricco et al. (2013) an important aspect of fall prevention involves the active participation of the staff in the fall prevention strategy. The staff should also do follow up on the patients who have experienced falls during their hospitalization period. The current practice in falls prevention requires that the hospital should define the term patient fall since this has been shown to improve the practice of fostering patient safety (Quigley et al., 2010).
Problem Statement
The rationale for studying patient falls in the outpatient setting stems from the fact that there is not enough literature to guide nursing care in this area of clinical practice. The study will form a basis to help nurses who work in the outpatient set up to identify correct interventions that can be applied to prevent patient falls (Melynk & Fineout-Overholt, 2011). The study will provide a standardization of the appropriate care to be accorded the at-risk patients.
Provision of a set of standards to be followed in falls prevention will help improve nursing care, as well as patient outcomes. Hospital operations will be enhanced by the members of staff who are involved in care for the patient will have a sense of direction on what they are required to do when handling the at-risk patients (Quigley et al., 2010). The expenditure in the hospital will be streamlined as it will be easy to plan for the interventions required to prevent patient falls, unlike the current situation.
Literature review
There are evidence-based interventions in managing patient falls in literature. One of the interventions that can be employed to tackle patient falls is the adoption of a culture that promotes patient safety (Oliver, Healey & Haines, 2010). Provision of adequate resources that prevent the patient falls is one of the evidenced based methods documented in the literature which can be employed to reduce patient falls (Tricco et al., 2013). Application of appropriate nursing leadership is also fundamental to falls prevention.
The nurse needs to establish a culture that allows report on falls to be made and evaluated without apportioning blame to either party. Such a culture allows for open communication among the caregivers. Quigley et al. (2010), argues that if a culture promotes patient safety, the processes as well as the systems put in place serve as the causes of errors. Hence, individual nurses will not be blamed for any error leading to patient falls. Nurses will report patient falls and any related injuries without fear, ensuring that there is enough time to rectify the related injuries. As such, the patient-reported, as well as nurse-assessed risk factors will be easily addressed (Oliver, Healey & Haines, 2010). By employing a patient safety culture that promotes openness the nurses can determine the appropriate interventions, post patient falls. The intervention is useful when the number of report on the patient falls are increased and become more detailed. For the intervention to be effective more training of the current nursing staff is required which can lead to delayed results.
As one of the evidence-based methods of tackling patient falls, resource provision is also effective. The resources include item such as assistive devices, hip protectors, environmental adjustments as well as patient exit alarms. The hospital also needs to provide the adequate human resources by ensuring there is adequate nursing staff to prevent falls among the adult patient population (Quigley et al., 2010). Nursing staff play a pivotal role in ensuring that the fall prevention programs are implemented effectively. Having adequate nursing staff allows the nurses to allocate time for conducting patient safety rounds so as to assess the state of patients who fall under the at-risk group. The nurses can also do role play as they practice to enhance their skills in handling patient fall in their facility. To evaluate if the intervention has been successful, the nurse assesses the increase or decrease in injuries resulting from patient falls as well as the number of patients using assistive devices (Tricco et al., 2013). The intervention has immediate effects on reduction of patient falls given that it only requires a short training for proper implementation to be executed.
Through appropriate nursing leadership, the data on patient falls is collected and later analyzed to provide a clear picture of the situation. Nursing leadership allows adequate support to be granted to the staff so that they can obtain appropriate training in the area of patient safety. Appropriate nursing leadership ensures that the nursing staff shares the responsibility for patient falls (Tricco et al., 2013). The nurses can incorporate the patient’s family in the education since the decisions made are shared by the team, as opposed to having imposed care decisions. Teamwork prevails, and each nurse becomes a unit based fall prevention champion. Quigley et al. (2010) indicates that the approach to patient falls acquires an interdisciplinary team approach when proper leadership is employed. The result is the adoption of better strategies to prevent patient falls. To determine the effectiveness of the intervention, the nurse can evaluate the changes related to issues regarding patient falls. The motivation of the team in addressing cases of patient falls is also a good indicator of the effectiveness of the interventions. The intervention takes time to be effective since it requires several organizational changes.
Workplace Application
As a nurse who works in the outpatient department, the topic on patient falls during sedation of essence as it offers guide to appropriate care. It is not uncommon for sedated patients to fall during the provision of care. Developing the standards of falls prevention will find an appropriate application as nurses attempt to provide quality care for their patients. The results of the study will help nurse as well as other caretakers to identify the at-risk patients, which is the first step in falls prevention (Tricco et al., 2013). The results will help nurses to understand the factors that predispose patients to falls after being sedated.
The hospital’s mission and vision are to reduce the incidence of falls and provide leadership in research towards the prevention of falls in all the patients (Quigley et al., 2010). The results of the study will offer standardization on the practice of falls prevention in the outpatient set up for the patients who have been sedated. The study will outline the composition of the team that will be able to offer appropriate preventative measures and as such allow nursing managers to be able to plan effectively. The results of the study will also outline the manner in which reports on patient falls will be relayed (Tricco et al., 2013). The establishment of a sound reporting system is the essential to enabling nurses’ to deal with the problem conclusively as the causal factors are shared among all the caretakers. The study results will also be applicable to future research.
Professional Collaboration
Literature review indicates that it is necessary to create interdisciplinary teams to help deal with the clinical problem of patient falls following sedation. Nurses as well as nurse managers are an integral part of the falls prevention team. The team also needs to include the physiotherapist who will help to care for patients and prevent patient falls those related to reduced mobility especially. The pharmaceutical staff also form an integral part of the falls prevention team. The role of the pharmaceutical team is crucial in that they can prevent falls that are related to sedation medication in the outpatient department. The nutritionist is also an integral part of the falls prevention team. Some of the patient falls have been shown to be related to their nutritional intake. As such it is a fundamental need to provide appropriate nutritional care for the at-risk patients.
Conclusion
Standardization of care to ensure the reduction in incidences of patients falls in key in nursing care. The standard care needs to focus on preventative measure for it to offer a sustainable solution. Education of the nursing and other members of the falls prevention team is integral in enabling any meaningful advances to be made in this area. Given that patient’s fall have a multi-factorial causes, it is necessary that an inter-disciplinary team is created to provide care for the at-risk patients (Quigley et al., 2010). Hospitals need to establish a culture for reporting patient falls. It is also important that the necessary resources are availed to tackle the problem of patient falls. To provide a lasting solution to the issue of patient falls, it is important that appropriate leadership is provided to guide the whole process (Quigley et al., 2010).
References
Melynk, B.M., & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare: A guide to best practice. Philadelphia: Lippincott Williams & Wilkins.
Oliver, D., Healey, F., & Haines, T. (2010). Preventing falls and fall-related injuries in hospitals. Clinical Geriatric Medicine, 26, 645-692.
Quigley, P., Bulat, T., Kurtzman, E., Olney, R., Powell-Cope, G., & Rubenstein, L. (2010). Fall prevention and injury protection for nursing home residents. Journal of the American Medical Directors Association, 11(4), 284-293.
Tricco, A., Cogo, E., Holroyd-Leduc, J., Sibley, K., Filedman, F., Kerr, G.,… Straus, S. (2013). Efficacy of falls prevention interventions: protocol for a systematic review and network meta-analysis. Systematic Review, 2 (38), 1-6.