The Background Question
Falls are a common problem among older adults, which leads to various adverse health outcomes and increases the cost of care. According to Smith et al. (2017), falls are the major cause of death from injuries in patients aged 64 and over and the main cause of hospital admissions because of trauma. Studies show that exercise can be a possible intervention for fall prevention in older adults (Sherrington et al., 2008). Based on this information, the PICOT question was constructed to find evidence that supported the effectiveness of exercise for fall prevention and would underpin the practice improvement project designed to reduce the number of falls.
The PICOT Question
The PICOT question consists of five elements, determining the scope of the evidence to be found and discarding any irrelevant findings. They include the patient, the intervention, the comparison, outcomes, and the time frame. This practice improvement project involves elderly individuals (aged 65 and over) who often call for an ambulance as patients and regular physical exercise as the intervention, which is compared to a lack of exercise. The expected outcomes are a reduction in fall rates and emergency room visits, and the time frame is 12 weeks. Thus, the evidence was searched for to answer the following PICOT question: In elderly patients who frequently call the ambulance, does regular exercise, compared to a lack of exercise, reduce the rate of falls and emergency room visits in 12 weeks?
The Change Model to Guide the Project
For guiding the implementation of the practice improvement project, which aims to reduce fall rates through the exercise intervention, the Iowa Model will be used. The advantage of using this model is that it allows for implementing change based on research evidence and with regard to organizational process, philosophy, and priorities (McCarty et al., 2018). The first step in this model is to identify the trigger for practice improvement, which is patient falls. The second step is to collect, evaluate, and select research (McCarty et al., 2018). This stage is necessary to make sure the improvement project is aligned with the best existing evidence. The next step is to design the practice and evaluate its feasibility (McCarty et al., 2018). In the given project, the practice will be the development of an exercise program for the elderly. The last three steps in the Iowa Model include determining the appropriateness of practice, implementing change, and monitoring outcomes (McCarty et al., 2018). Thus, this model covers all the necessary stages of change implementation, from the preparation to application and control, which makes it appropriate for guiding the improvement project.
Best Evidence-Based Practices
As was mentioned earlier, evidence showed that exercise was an effective intervention for fall prevention in the elderly. Research also suggests several best practices that should be included in the exercise intervention. In particular, the effectiveness of exercise programs for fall prevention is affected by balance training, the absence of walking, and exercise dose (Sherrington et al., 2008). The exercise programs that involved balance training reduced fall rates by17%, and such exercises were safe for patients when they were prescribed and supervised appropriately (Sherrington et al., 2008). Regarding exercise dose, the best practice is to administer a program that involves exercise twice a week for over 25 weeks (Sherrington et al., 2008). Finally, walking should be included in an exercise program for fall prevention only if it includes enough balance training of proper intensity (Sherrington et al., 2008). Thus, a practice improvement project should take into account all the mentioned evidence-practices to ensure the program’s effectiveness.
The Role of Evidence in Designing the Practice Improvement Project
The identified evidence will be of great help when designing the practice improvement project because it contains valuable recommendations. In particular, evidence will guide the content of the exercise program because it shows what types of exercise are of the largest benefit for fall prevention. Research also provides guidance on the appropriate intensity and duration of exercise programs, and this information will be used when developing the improvement project.
Outcomes to Be Measured
The outcome measures will include general health status, preconditions for musculoskeletal disorders, elderly patients’ falls and calls to an ambulance before the intervention, and elderly patients’ falls and calls to an ambulance after the intervention. Assessing the general health status will help to determine existing and potential chronic diseases and the physical capability of the elderly. Evaluation of the risk of developing musculoskeletal disorders is necessary to identify individuals for whom the exercise program will be ineffective or contraindicated. Assessment of patients’ falls and ambulance calls will allow for understanding the severity of the problem. Finally, the same assessment after the intervention will show the effectiveness of the exercise program.
The Change Model to Motivate Stakeholders
For motivating stakeholders to support the change implementation, Lewin’s change model will be used. This model includes three stages: unfreezing, change, and refreezing, and involves strong leadership efforts to guide the change implementation (Hussain et al., 2018). The role of a leader in this process is to motivate stakeholders to support the change. At the unfreezing stage, the organization should develop a plan for change and identify stakeholders. During the change stage, there is a need to explain the importance of change by providing information to stakeholders and partnering with them (Hussain et al., 2018). The refreezing stage requires the organization to gain stakeholders’ commitment, which can be achieved through information sharing and the provision of resources and support (Hussain et al., 2018). Thus, to motivate stakeholders, the organization should inform them about the details of the change and provide them with the necessary support during change implementation and maintenance.
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123–127. Web.
McCarty, C. A., Woehrle, T. A., Waring, S. C., Taran, A. M., & Kitch, L. A. (2018). Implementation of the MEDFRAT to promote quality care and decrease falls in community hospital emergency rooms. Journal of Emergency Nursing, 44(3), 280–284. Web.
Sherrington, C., Whitney, J. C., Lord, S. R., Herbert, R. D., Cumming, R. G., & Close, J. C. T. (2008). Effective Exercise for the Prevention of Falls: A Systematic Review and Meta-Analysis. Journal of the American Geriatrics Society, 56(12), 2234–2243. Web.
Smith, P. D., Mross, P., & Christopher, N. (2017). Development of a falls reduction yoga program for older adults—A pilot study. Complementary Therapies in Medicine, 31, 118–126. Wev.