St.

Paul University Philippines

Tuguegarao City, Cagayan 3500

SCHOOL OF NURSING and ALLIED HEALTH SCIENCES - GRADUATE SCHOOL

COLLEGE OF NURSING

AAN201– CLINICAL REASONING and TEACHING

EVIDENCE-BASED PROGRAM/INTERVENTION PLAN

Name of Students: CHARISSE TAYLAN - DULDULAO

ID Number: 2021-02-0054
Date of Submission: APRIL 30,2022
Grade: __________________________________________________________

Checked and graded by:

Elinor D. Latupan, MSN

Date:

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A. Introduction (Brief description of the identified health need, problem or risk)
Fall of patients is described as unplanned descents to the floor with or without injury (Oh-Park et al., 2021). It is one of the
leading causes of preventable injury in hospitals and is frequently reported to have serious complications. There are multiple strategies
that were shown in order to reduce the rate; however, shreds of evidence for fall-related injury prevention in the hospitals are still
lacking (Dykes et al., 2020). There are insufficient pieces of evidence to support the utilization of multifactorial interventions to
prevent falls or hospitalization (Morella, et al., 2019). In the aging population, there is a high number of victims of falls due to
insufficient prevention in the hospitals and lack of coordination from other sectors like the maintenance, doctors, physical therapists,
and others.

Thus, limited patient fall prevention and management lead to severe health issues which also contribute to morbidity, death,
immobility, hospitalization, and early entry to long-term care facilities.

B. Review of Literature:
a.) Causes of the problem (at least 3)
Patient fall is a multifactorial issue that leads to multiple injury-related visits to the emergency department in the United States.
Falls can be markers of poor health and declining function and are associated with significant morbidity. The major risk factors
identified are impaired balance and gait, multiple medications, and previous fall history. Other risk factors include old age, female
gender, visual impairments and problems, cognitive decline especially attention and executive dysfunction, and environmental factors
such as flooring and bed frames (Ambrose et.al., 2013).

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 Fishbone Diagram for the causes of patient fall in the units (Figure 1).

Figure 1.

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 b.) Possible solutions or interventions for the problem (at least 3)
Research has shown that focusing on these risk factors can significantly decrease rates of falling. Considerable evidence now
documents that the most effective (and cost-effective) fall reduction programs have involved systematic fall risk assessment and
targeted interventions, exercise programs, and environmental inspection and hazard-reduction programs (Rubenstein, 2006). The
following can be the possible solutions to this problem.

1. A nurse-led fall-prevention tool kit joins evidence-based preventive interventions to patient-specific fall risk factors and is
designed to integrate continuous patient and family engagement in the fall-prevention process (Dykes et al., 2020). Patient fall
assessments need to shift from being clinician-centric to patient-centric. Nurses must develop relationships with patients to
facilitate understanding of their needs. Thus, developing these truly patient-centered programs may reduce the over-reliance on
bed alarms and allow for the implementation of strategies aimed to mitigate modifiable risk factors leading to falls (Radecki et
al., 2018)

2. Also, exercise programs designed to prevent falls in older adults also seem to prevent injuries caused by falls, including the
most severe ones. These special programs for fall prevention reduce the rate of falls leading to medical care (El-Khoury, et al.,
2013). Exercise as a single intervention can prevent falls in community-dwelling older people. The impact of exercise as a
single intervention in clinical groups and aged care facility residents requires further investigation, but promising results are
evident for people with Parkinson's disease and cognitive impairment (Sherrington, et al., 2017)

3. Moreover, Fall prevention policy and programs must pay better attention to the health and wellbeing of family care providers.
Care providing, and kinship relationships mediated family care providers' interventions to prevent falls in older people. The
fall of the dependent relative constitutes a turning point in these relationships. Family care providers are vulnerable to having a
fall themselves and therefore receivers of preventive interventions. (Cuesta-Benjmea, et al., 2021)

Therefore, precautionary measures for patients with a vulnerable cognitive and physical status are essential for quality care (Muray, et
al., 2018)

C. Name or Title of the Program/Intervention Plan (to resolve the health need, problem or risk)
“PATIENT FALL PREVENTION AND MANAGEMENT PROGRAM”

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D. Goal of the intervention or program

●  To have a blueprinted outline of actionable steps in the organization which sustains improvement to reduce patient fall
morbidity and mortality.
●  To focus on overcoming the challenges associated with developing, implementing, and sustaining patient fall prevention
programs through the collaboration of all involved parties.
● To uplift the standard of patient safety and prioritize patient welfare through acknowledging all the causes with specific
solutions.

E.  Program/Intervention Plan

Strategies or Person/s Time Resources Collaborations Outcomes
activities Responsible Frame needed (if needed) (at least 3)
(at least 3)
A. Establishment All nursing 2 weeks Discussion room Staff nurses The group should establish the
of a leaders on the approach or pathways that
Hospital fall risk
standardized floor, units, and they can use for the
policies
approach. departments. implementation of fall risk
(Please see Pamphlets or online QR prevention and management
figure 2.) codes for the fall risk program. Through good
instructions leadership, the staff nurses
will be able to encourage the
nurses to commit to annual
competency education and
awareness about the fall risk
prevention and management
program
b. Involving key The head of the 1-week Emails to the head of Physician team The involvement of all the
members or parties nursing team. other multidisciplinary members will proceed to
Maintenance
for the Patient Fall team patient-centered quality care.

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Prevention Program. team
(Please see figure 3.)
Nursing
Education team
Physical
Therapy team
Patients and
relatives

c. Patient Fall Risk All staff nurses & 2-3 Fall risk ID band Physician team This will let everyone
Prevention health care weeks prioritize the safety of the
Callbells Maintenance
Management and members dealing patient.
team
Intervention. with the patient Scoring sheets for fall
Nursing
(Please see figure 4.) Patient fall risk
Education team
signages
Physical
Therapy team
Patients and
relatives

c. Utilize the Focus Nursing leaders 1 week Fall risk ID band All staff nurses Continuous monitoring and
PDCA method to & health care implementation of fall risk
Callbells
improve the members prevention management will
management of fall. Scoring sheets for fall dealing with the let everyone obey the rules
patient and they will prioritize patient
(Please see figure 5.) Patient fall risk welfare.
signages
Dashboard results of
patient fall

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 STRATEGIES OR ACTIVITIES

A. Establishment of standardized approach

Figure 2.
B. Involving key members or parties for the Patient Fall Prevention Program

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 Figure 3.
C. Patient Fall Risk Prevention Management and Intervention

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Figure 4.

D. Utilize the Focus PDCA method to improve the management of fall

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Figure 5.

Ambrose, A. F., Paul, G., & Hausdorff, J. M. (2013). Risk factors for falls among older adults: a review of the
literature. Maturitas, 75(1), 51–61. https://doi.org/10.1016/j.maturitas.2013.02.009

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 de la Cuesta-Benjumea, C., Arredondo-González, C. P., Lidón-Cerezuela, B., & Abad-Corpa, E. (2021). La prevención de las
caídas de las personas mayores y sus familiares: una síntesis cualitativa [Fall prevention in older people and their families: a
qualitative synthesis]. Gaceta sanitaria, 35(2), 186–192. https://doi.org/10.1016/j.gaceta.2019.10.004

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan,
M., Shaykevich, S., & Bates, D. W. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A
Nonrandomized Controlled Trial. JAMA network open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889

El-Khoury, F., Cassou, B., Charles, M. A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programmes on
fall induced injuries in community dwelling older adults: systematic review and meta-analysis of randomised controlled trials. BMJ
(Clinical research ed.), 347, f6234.

Morello, R. T., Soh, S. E., Behm, K., Egan, A., Ayton, D., Hill, K., Flicker, L., Etherton-Beer, C. D., Arendts, G., Waldron, N.,
Redfern, J., Haines, T., Lowthian, J., Nyman, S. R., Cameron, P., Fairhall, N., & Barker, A. L. (2019). Multifactorial falls prevention
programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis. Injury
prevention : journal of the International Society for Child and Adolescent Injury Prevention, 25(6), 557–564.
https://doi.org/10.1136/injuryprev-2019-043214

Muray, M., Bélanger, C. H., & Razmak, J. (2018). Fall prevention strategy in an emergency department. International journal of
health care quality assurance, 31(1), 2–9. https://doi.org/10.1108/IJHCQA-09-2016-0122

Oh-Park, M., Doan, T., Dohle, C., Vermiglio-Kohn, V., & Abdou, A. (2021). Technology Utilization in Fall
Prevention. American journal of physical medicine & rehabilitation, 100(1), 92–99. https://doi.org/10.1097/PHM.0000000000001554

Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient's perspective: A qualitative study. Applied
nursing research : ANR, 43, 114–119. https://doi.org/10.1016/j.apnr.2018.08.001

Rubenstein L. Z. (2006). Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing, 35 Suppl 2,
ii37–ii41. https://doi.org/10.1093/ageing/afl084

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Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., Cumming, R. G., Herbert, R. D., Close, J., &
Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic review and meta-analysis. British journal of sports
medicine, 51(24), 1750–1758. https://doi.org/10.1136/bjsports-2016-096547

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