AUDIT PROPOSAL
Introduction:
A fall is an event where a patient comes to rest inadvertently on the lower level or ground. Falls are one of the common causes of pediatric injury after being admitted in the hospitals and leading to emergency department visits. Commonly falls are the largest category of incident reported in the hospitals. The rate of injury and fall in hospital varies due to the patient risk factor, patient population, presence of programs for fall prevention and interventions (Jones, W, J et.al, 1991; Barbieri, E. B. 1983). Usually the cost of fall is expensive and leads to increasing expenditure in health care. According to the CDC, the cost of injuries for aged old citizens is expected to increase about 19 billion dollars of the fatal falls. Moreover, falls have a grave and serious complications and effects on the ability of the person to function as a productive part of the community, society and family. Research studies indicate that the patient fall is the second most frequent case of causing harm in hospitals and is one of the largest categories of reported incidents in hospitals. Thus patient fall can lead to financial and personal costs for both patients and facilities. Thereby, prevention of patient fall is essential for bringing about safe clinical environment, bring about effective and efficient recovery and improve quality of life in patients.
Clinical audits are a process of quality improvement which seeks to improve patient outcome and care through systematic review of care against implementation of care and explicit criteria. Usually the main component for clinical audit is review of performance to bring about improvements of quality care through structured peer review (NHS 2002). The main principles of clinical audit is defining objectives of the organization and identifying the mission statement. Usually the clinical audits are effective when conducted within a structured program with staff participation, effective leadership and emphasis on tem support and work. Second is developing ways or standards to measure the audit quality. Finally monitoring the changes and standards, identification of the gaps and further taking appropriate action for rectifying the gap can bring about improvement (NHS 2002).Clinical audits are one of the measures for ensuring high quality of health care system and to benefit the patient care. The audit proposal evaluates whether all patients are assessed for the risk of falling within twenty-hours of admission into the hospitals and whether the risk is documented.
Audit Question:
Are all patients assessed for risk of falling on admission to hospitals?
The purpose of the audit is to assess the patients for the risk of falling with twenty-four hours of hospital admission and whether the risk is documented.
Background:
Adverse patient incidents in hospitals including patient fall compromise and inflate the costs of services in the hospital and quality of patient care. Usually the adverse patient incidents represent the less ideal care quality. Furthermore, the obligation of the health care sector to treat patients from injuries and other problems results in increased rate of insurance, lawsuits and claims, increased liability to rate of insurance etc. contributes to the health care delivery costs. Fall of patient in hospitals have been recognized as a potentially avoidable and important in hospital settings. The incident of patient fall ranges from 25-89% of the hospital incidents. According to the research studies, about 30% of the patients face the risk of serious injury with falls. Usually the older people with multiple problems face minor injuries which lead to impaired rehabilitation, fear of falling, loss of confidence, longer stay and majority of patients moving to home care. The aim of care is to maintain or establish independence thereby the efforts to prevent fall should not delay maintenance of autonomy in patients or rehabilitation procedure. The common risk factors of fall (Jones, W, J, Simpson, J, A 1991) include environmental hazards, muscle weakness, previous fall, postural instability, visual impairment, confusion, inconsistency in urination, prescribed medications and symptoms of agitation and stress.
According to the Rhymes and Jaeger (1988) the fall prevention measures have been categorized into four different areas. This include reduction of common hazards, education of the patient and staff concerning the risk factors, appropriate and timely identification of the patients having high risk and modification of risk factors for patients with increased risks. Hospitals also consider other preventive measures such as educating the nurse’s and the health care staff in taking part in educational prevention programs. Commonly falls usually occur during day time but falls from bed usually occur during night. This can lead to presence of unstable furniture, improper use of side-rails, poor fitting, glossy floor surfaces and inadequate lighting (Walshe, Rosen 1979).Furthermore, age of the patient, diagnostic status of the patient, medication level and mobility status of the patient can also influence the risk of falling. Thereby the hospital-based fall prevention program establishes both educational and medical measures to reduce fall prevention in medical settings.
Methods:
• Settings and Population:
The audit process will be conducted in the surgical ward of a metropolitan private hospital in Australia containing 20-30 registered nurses working in the surgical ward. The sample is recruited from the 30-40 post-operative patients and 40-50 patients who are 65 years and older who are admitted in the ward during the one-week period.
• Data collection:
The data is collected by checking the documentation such as checking the nurse’s notes, case notes of physicians and health care professionals, admission sheet and medications. Also questionnaire is provided to the registered nurses employed in the hospital ward and few patients including older people who are employed in the surgical wards during the one week- period. Moreover, the data collected involves collection of statistics containing the number of patients admitted in the hospital ward and who did not have the risk of falling after admission. Furthermore, the questionnaire and data collection sheet that uses the tick boxes on all items to be audited is completed by the patient for data analysis.
• Data Analysis:
The data is analyzed through counting the responses filled by the nurse or the patient and summarizing the common responses to the end-questions present in the questionnaire.
• Permission
The audit is permitted and conducted under the supervision of nurse unit manager.
References:
Barbieri, E. B. 1983, ‘Patient falls are not patient accidents’, Journal of Gerontological Nursing, vol. 9, no. 3, pp.167-73. Berry, G. R. H.
Jones, W, J et.al 1991, ‘Preventing falls in Hospitals’, CINAHL Plus, vol.63, no.3, pp.30.
Jones, W. J , J. A. Johnson 1988, ‘An analysis of patient incidents and related variables in a large urban hospital’, Journal of the Tennessee Academy of Science, vol. 63,no. 1,pp. 1-3.
NHS 2002, Principles of best practice in clinical audit, Retrieved 4 April, http://www.nice.org.uk/media/796/23/BestPracticeClinicalAudit.pdf.
Walshe, A and H. Rosen 1979, ‘A study of patient falls from bed’, Journal of Nursing Administration, vol. 9, no.5, pp. 31-35.
Appendices:
Questionnaire: Multi-factorial risk audit assessment tool
1. Local Strategies and commissioning
1.1. Commissioning Strategy
1.1.1. Is there a commissioning strategy which covers issues regarding to prevention of falls?
If yes, strategy includes:
1.1.2. Commissioning of care home residents?
1.1.3. Commissioning medication review for care home residents?
1.1.4. Is there any public health analysis for fall contribution and commissioning strategy?
1.2. Is there a lead within the commissioning body that is responsible for services including fall?
1.3. Is there any local population-based report regarding the health care needs and outcomes which are relevant to fall?
1.4. Does the hospital follow the NICE guidelines, patient safety, national patient safety agency and national service framework for aged citizens for effective fall prevention?
1.5. Is there any local, integrated, multi-agency and multi-professional agency regarding fall services?
1.6. Does the hospital facility provide the patient or an individual the opportunity for assessment and interventions related to fall prevention with direct clinical involvement of trained medical staff?
1.7. What are some of the root causes for frequent fall of patients in hospital settings?
1.7.1. What is the diagnosis and identification of patient specific risk factors for falls due to the medical condition of the patient?
1.7.2. Standardized balance, gait and mobility assessment?
1.7.3. Standardized assessment of psychological consequences of fall that might limit dependence?
1.8. Documentation of medicines?
1.9. Assessment of potential hazards within the patient home?
1.10. Is the home hazard assessment conducted by the occupational therapist?
1.10.1. If yes what validated home hazard assessment is used?
a. Westmead assessment of home safety
b. Safety assessment for rehabilitation
c. Other
1.11. Assessment of difficulties in activities of daily living which places older persons at risk?
1.12. Are the intervention focused on fall prevention such as training of balance and strength and supervised exercise?
1.12.1. What evidence based exercise program is used?
1.12.2. Are the patient provided appropriate education for effective fall prevention?
1.13. What is the frequency of supervised session between the patient and health care professionals?
