Implementation of ICT based intervention program istoppfalls in the geriatric ward to minimize falls by 50% within the next 4 months
Project Aim:
The aims and objectives of the CPI project includes:
· To explore the effectiveness of implementation of the ICT education in the elderly communities.
· To evaluate the effectiveness of ICT program on reducing the rate of falls in the geriatric unit.
· To understand the change in responsiveness and perception of the elderly populations to ICT based fall prevention devices
Among the various approaches that have been taken to ensure optimal quality in the care services that are being provided to the patients, the concept of clinical governance had been one of the greatest aspects (O’Brien, 2015). Clinical governance can be defined as the systematic framework which helps in facilitating continuous improvement to the care services being provided to the patients and achieving best clinical outcomes for the patients in all circumstances. It has to be mentioned in this context, implementing any change to the care services in an attempt to improve the care services or minimize any risk is directly linked to the concepts of clinical governance.
There are four key principles of clinical governance, the first element is clinical performance and evaluation which is associated with utilizing, monitoring and disseminating the evidence based clinical practice into the care services to improve practice or avoid any risks. The area of concern for the project is preventing the incidences of falls for the elderly patients in the facility, the intervention proposed will be based on the trail studies that have been published before. The second pillar is professional development and management, which facilitates clinical development and maintenance of the professional standards by the means of implementing different innovative changes (Pearson, 2014).
The third pillar is the consumer value which encourages the care service providers to involve the consumers in the improving the care practices and the care services that are being provided to the patients. The project has also incorporates the perception and voice of the consumers while implementing the change and incorporated the fall prevention standards of the NHSQS into designing the intervention. The fourth pillar of clinical governance is clinical risk, which concentrates on minimising risk and improving the overall clinical safety of the services (Uhb.nhs.uk, 2018). The falls is a major clinical risk to the elderly patients and hence the project also aligns effectively with the fourth pillar of the clinical governance.
There is mounting evidence that indicates at fall related fractures being one of the greatest contributing factors leading to hospitalization for the elderly population all across the world. as peer the statistical data, it has to be mentioned that the percentage of older adults suffering a fall in the residential aged care centres is close to 50%, and 40% of the number of falls are recurrent falls (Barry et al., 2014). Considering Australian statistics, 30% of the total number of adults aged 65 years or living in Australia have encountered at least one fall per year. Along with that, it has to be mentioned that 40% of the total injury related deaths reported for this age group relates to the incidences of falls (Ww2.health.wa.gov.au, 2018).
Falls is a very common challenge that the older adults have to encounter, and there are a variety of contributing factors that trigger falls for this target population (Bullo et al., 2015). Thus, prevention of falls and fall related injuries in older people has become a public health priority. It has to be mentioned that there have been many intervention options that are available to avoid instances of falls such as bed rails, non-skid footwear, and physical environment de-cluttering. Although, as discussed by Kojima (2015), the impact of these interventions are effective in the health care setting, for the home based setting the impact of these interventions are limited. On the other hand, the ICT based interventions can be adapted to the home setting as well empowering the elderly population to avoid the risk of falling without the need for being admitted to an aged care facility (Hawley-Hague et al., 2014). Hence, this project has aimed to enhance the awareness and education of the elderly population of the local area regarding the implementation of ICT devices such as istoppfalls in their homes to reduce the rate of falls in the elderly population.
The community nurses will the agent of change implementation who will be the individuals providing the educational interventions to the elderly population regarding the implementation of ICT.
ICT specialists:
The ICT specialist technicians will also collaborate equally to the educational programs with the community nurses to provide education to the target elderly population regarding how to install the device and how to use it effectively.
Nurse managers:
The nurse managers will lead the educational intervention workshop team and will supervise the entire arrangements, manage the scheduling of the staff that will be involved in the program and ensure evidence based practice of the program.
Target population:
The participants of the program will be the community dwelling elderly people aged 65 and above selected randomly.
Interviewers and data analysts:
The survey and interview post the implementation of the educational intervention will be carried by the interviewers and the data collected will be statistically analysed taking the assistance of the interviewers and data analysts.
Consumer voice:
The consumer voice will be the representative of the elderly and their spouse to share the perception, doubts, preferences and grievances.
Clinical practice improvement is a project framework that is utilized on the health care scenario to improve the current status of the care practices or implement a change to avoid a clinical risk. There are various CPI tools to implement the change, although, for this particular project we will be utilizing the PDSA or Plan-Do-Study-Act cycle to design the intervention program and implement it successfully in the chosen population (Gschwind et al., 2014). In order to justify the use of the PDSA cycle as the tool for this CPI project, it can be mentioned that PDSA cycle helps in testing and implementing continuous improvements in the context of quality control in the health. Along with that PDSA tool helps in optimal resource allocation and systematic and time completion of the project as well (Knudsen et al. 2018). There are four elements of the PDSA tool:
Plan:
The project will continue for 4 months, the first month will be devoted to the multidisciplinary team researching the incidence of falls in the local community, the contributing factors behind the incidences of falls, and lastly the awareness and knowledge among the target population regarding the ICT devices using the primary and secondary resources. Based on the research, a random sampling of the target population will be selected with respect to the baseline data collected and informed consent will be taken from them regarding the program to ensure abiding by the ethical code of conducting the research on human subjects.
Do:
After the selection and preparation of the target population of 50 elderly individuals belonging to the age group of 65 years and above, the implementation of the project intervention will commence. The educational intervention will be given on a bi-monthly basis and each of the participants will be given an interactive seminar workshop regarding the ICT programs like istoppfalls and its implementation to help avoid the risk of falls in the home setting.
Study:
This is the phase where the impact of the intervention implemented is assessed (Taylor et al., 2014). This will be done on the basis of monthly follow up interviews and surveys to assess how many individuals have invested in ICTs and the rate of reduction in the incidences of falls. Finally, after the completion of intervention, data will be collected from the local clinics and facilities to assess the reduction rate in the number of hospitalization due to fall injuries.
Act:
This is the phase where the progress of the project will be assess and the success of the project will be determined based on the evidence based best practice principles such as timeliness, appropriateness, involvement of stakeholders, and clinical governance. The team of data analysts will decide whether or not the project has succeeded to reduce the rate of falls and enhanced the use of ICT to understand whether the project should be replicated on a larger scale or else it should be ceased.
The proposed intervention will be an educational campaign which will focus on enhancing the awareness of the target population regarding the implementation of the ICT devices to avoid the risk of falling among the elderly populations.
The educational intervention will be given to the target population by the community nurse in collaboration with the ICT specialists (Oepen et al., 2018). The educational workshops will be arranged every alternate week on the Sundays and participation will be absolutely free of costs.
After each session, the participants will be given informative pamphlets on the use of ICT devices, easy installation and FAQ regarding the implementation of the services. The pamphlets will also contain information of istoppfalls installation and usage.
Lastly, after each session, the participants will be allowed to have a one to one interaction session where the participants will be able to clear any doubts they have regarding the ICT device istoppfalls.
Barriers to implementation and sustaining change:
There are various challenges that are associated with implementation and sustainability of the changes that have been implemented. First and foremost, the lack of staffing and resources will be the most important challenge. The community nurses are often dealing with additional workload due to short staffing, making time for participating in the program will be a very important challenge (Nyman et al., 2013). Along with that the limited availability of time, money and other resources will also be a considerable challenge for the project. Lastly, resistance to change will also be a very important challenge. The non-compliance among the target group to participate in the program can also act like a notable threat to successful completion of the project (Qin & Baccaglini, 2016).
Evaluation of the project:
The last phase of the project will be the evaluation of the intervention or change that has been implemented in the health care scenario. The evaluation will be based on the survey data after the completion of the program on incidence of falls and installation of the ICT devices. Along with that, data will also be collected from the local clinics on the instances of falls that has been reported and the rate of reduction after the intervention has been implemented (Barry et al., 2014). Lastly, the data will be analysed and co-related with respect to the best practice principles, timeliness, appropriateness, involvement of stakeholders, participant’s experience on intervention, and clinical governance. This will help in understanding whether or not the project has achieved the selected outcome or goal that has been set for the project.
References:
Barry, E., Galvin, R., Keogh, C., Horgan, F., & Fahey, T. (2014). Is the Timed Up and Go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC geriatrics, 14(1), 14.
Bullo, V., Bergamin, M., Gobbo, S., Sieverdes, J. C., Zaccaria, M., Neunhaeuserer, D., & Ermolao, A. (2015). The effects of Pilates exercise training on physical fitness and wellbeing in the elderly: a systematic review for future exercise prescription. Preventive medicine, 75, 1-11.
Gschwind, Y. J., Eichberg, S., Marston, H. R., Ejupi, A., de Rosario, H., Kroll, M., … & Aal, K. (2014). ICT-based system to predict and prevent falls (iStoppFalls): study protocol for an international multicenter randomized controlled trial. BMC geriatrics, 14(1), 91.
Hawley-Hague, H., Boulton, E., Hall, A., Pfeiffer, K., & Todd, C. (2014). Older adults’ perceptions of technologies aimed at falls prevention, detection or monitoring: a systematic review. International journal of medical informatics, 83(6), 416-426.
Knudsen, S. V., Laursen, H. V. B., Bartels, P. D., Johnsen, S. P., Ehlers, L. H., & Mainz, J. (2018). Can Quality Improvement improve the Quality of Care? A systematic review of effects and methodological rigor of the Plan-Do-Study-Act (PDSA) method. Bmj Quality and Safety.
Kojima, G. (2015). Frailty as a predictor of future falls among community-dwelling older people: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 16(12), 1027-1033.
Nyman, S. R., Ballinger, C., Phillips, J. E., & Newton, R. (2013). Characteristics of outdoor falls among older people: a qualitative study. BMC geriatrics, 13(1), 125.
O’Brien, K., 2015. Clinical governance and patient safety. Core Topics in Obstetric Anaesthesia, p.219.
Oepen, D., Fleiner, T., y Hausmann, A. O., Zank, S., Zijlstra, W., & Haeussermann, P. (2018). Falls in hospitalized geriatric psychiatry patients: high incidence, but only a few fractures. International psychogeriatrics, 30(1), 161-165.
Pearson, B. (2017). The clinical governance of multidisciplinary care. International Journal of Health Governance, 22(4), 246-250.
Qin, Z., & Baccaglini, L. (2016). Distribution, Determinants, and Prevention of Falls among the Elderly in the 2011–2012 California Health Interview Survey. Public Health Reports, 131(2), 331-339.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Qual Saf, 23(4), 290-298.
Uhb.nhs.uk. (2018). The main components of clinical governance. [online] Available at: https://www.uhb.nhs.uk/clinical-governance-components.htm [Accessed 21 Nov. 2018]
Ww2.health.wa.gov.au. (2018). Falls Prevention Model of Care. [online] Available at: https://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Health%20Networks/Falls%20prevention/Falls-Prevention-Model-of-Care.pdf [Accessed 21 Nov. 2018].
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