Digital Repository Masters Projects Spring 2023 Understanding the Effectiveness of Fall Prevention Measures in Long-Term Care Facilities Sandra L. Garcia Weber State University Follow this and additional works at: https://dc.weber.edu/collection/ATDSON Garcia, S.L. 2023. Understanding the effectiveness of fall prevention measures in long-term care facilities. Weber State University Masters Projects. https://dc.weber.edu/collection/ATDSON This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact scua@weber.edu. 1 4/5/23 05/24/2023 2 Understanding the Effectiveness of Fall Prevention Measures in Long-Term Care Facilities Sandra L. Garcia, BSN, R.N., MSN Student Weber State University Annie Taylor Dee School of Nursing Tamara Berghout, RN, EdD 3 Abstract Accidental falls and fall-associated injuries are critical factors in patient safety among older and fragile adults. The risk for accidental falls is considerably higher among patients residing in long-term facilities. Accidental falls are associated with severe health consequences such as fractures, skin impairment, impaired mobility, pain, loss of independence, depression, and increased healthcare costs. Furthermore, accidental falls are the second leading cause of accidental injury-related death. However, falls can be prevented or decreased when education is provided to increase awareness among patients, caregivers, and healthcare team members. This project aims to promote patient safety by decreasing accidental falls and fall-related injuries by developing an educational program involving nurses, patients, caregivers, and other care team members. This educational program will include resources to help nurses and patients identify and recognize patients’ fall risks and design strategic interventions to prevent fall events. Therefore, the program can benefit nurses by providing tools to increase their effectiveness in planning and caring for their patients. This program can also benefit patients by empowering and encouraging their active participation in their care plan and proactively working to decrease their risk for falls and related injuries. Finally, it can help the healthcare system by reducing the cost associated with falls and treating fall-related injuries. Keywords: Falls, older, elderly, injuries, nurses, education, fall-related injuries, fractures, depression, death, fragile, accidental falls, long-term, patient education, long-term facilities, skin impairment, impaired mobility, loss of independence, cost of healthcare. 4 Understanding the Effectiveness of Fall Prevention Measures in Long-Term Care Facilities Falls and fall-associated injuries remain a significant problem among older populations, and approximately 30% of older adults in the U.S. experience a fall each year (Hogan-Quigley, 2021). According to the World Health Organization, accidental falls are the second leading cause of accidental injury-related death worldwide (Finnegan et al., 2019). Other consequences of accidental falls include fractures, skin impairment, impaired mobility, pain, loss of independence, depression, and financial burden on the healthcare system. Additionally, the risk for accidental falls and fall rates are higher in long-term facilities among patients with greater fragility levels (Montero-Odasso et al., 2021). However, accidental falls can be preventable when patients and their caregivers commit to and engage with fall-prevention plans and initiatives. Moreover, multifactorial approaches have become a key element in preventing falls. Multifactorial approaches, patient empowerment, and engagement strategies are associated with increased patient satisfaction, safety, and quality of care (Montero-Odasso et al., 2021). Consequently, implementing effective fall-prevention interventions, especially in long-term care settings, must be a priority. Statement of Problem Accidental falls among residents of long-term care settings are everyday events that cause severe outcomes. Approximately half of the long-term residents in the U.S. experience at least one fall per year (Hogan-Quigley, 2021). Accidental falls frequently lead to significant injury and even death, especially in older and frail patients (Hogan-Quigley, 2021). Nursing professionals have diligently developed and implemented several fall risk screening tools, such as the MORSE scale. Additional interventions such as nutritional assessment and interventions (Esquivel, 2018), interviews/evaluation with nurses and physicians (Bruce et al., 2021), fall- 5 prevention exercises (Finnegan et al., 2019), bed alarms (Mileski et al., 2019), video monitoring (Votruba et al., 2016), virtual sitters (Hogan-Quigley et al., 2021), and screening of patient's perception and compliance (Kiyoshi-Teo et al., 2020), have also been extensively utilized. Most recommendations suggest stratifying the individual's fall risk and developing interventions based on gait and balance evaluation. Other important aspects to be included in this analysis are current medications, fall prevention exercises, and environmental and chronic health conditions such as cardiovascular problems, osteoporosis, and vision impairment (MonteroOdasso et al., 2021). Additionally, footwear intervention, physiotherapy, patients' perception of their fall risk, compliance with fall-prevention interventions, and management of fractures should be considered (Montero-Odasso et al., 2021). However, nurses need to understand the benefits and limitations of traditional fall prevention interventions compared to fall prevention approaches based on the use of technology. Therefore, this MSN project aims to decrease patient falls by creating an educational program for nurses that incorporates evidence-based technology for the staff working at a long-term care facility in northern Utah. Ways Project Contributes to Intended Recipients This project can benefit long-term care facilities, their nurses and staff, and the patients and their families. To accomplish this fall-prevention project, healthcare personnel must understand the differences between technological fall-prevention measures and nontechnological interventions. This understanding can help long-term facilities, nurses, physical therapists, and other care team professionals by providing the education they need to plan and develop a fall prevention program. An evidence-based fall prevention program could benefit physicians, patients, and families because fewer falls can decrease unnecessary suffering and improve patient and family satisfaction and well-being. Further, a fall-prevention program could 6 also benefit the facility by decreasing healthcare costs related to falls and fall-related injuries (Tricco et al., 2017). The Rationale for the Importance of the Project This project is essential because accidental falls can result in significant adverse outcomes for patients, clinicians, and healthcare institutions (King et al., 2018). The proposed nursing education has the power to increase nursing and staff knowledge and improve patient safety and intervention effectiveness. This project can also decrease liability and fall-related treatment costs. According to the World Health Organization, $240 billion will be the global economic expenditure for fall-related healthcare injuries by 2040 (Ott, 2018). Therefore, it is crucial to educate nurses on how their interventions can help prevent accidental falls. Nurses must also understand that preventing falls improves patient safety and decreases facility costs (Koh et al., 2022). Further, recent studies indicate that fall-prevention education creates a positive culture related to fall risk and prevention. In addition, nurses and patients perceive implementing strategic plans to manage patients' fall risk and prevention interventions as helpful and a promoter of teamwork and patient goal accomplishment (Hill et al., 2016). Similarly, data indicates that patients that receive fall-prevention education are significantly more likely to adopt behaviors that reduce their fall risk. They are more likely to complete fall-prevention training, such as exercise programs (Hill et al., 2013). In summary, a well-structured fall-prevention teaching program is essential to improve patient safety goals, decrease healthcare financial costs, and increase patient satisfaction (Okechukwe, 2016). Literature Review and Framework 7 This review focused on analyzing scientific, peer-reviewed articles not older than five years to understand the effectiveness of traditional and electronic fall prevention measures in long-term facilities. The Revised Iowa Model (IMR) was adopted as the framework model for this literature review. Framework The framework that will be used to guide this project is the Revised Iowa model (IMR) of evidence-based practice. The IMR is a recognized framework that contributes to the evolution and success of change initiatives and improvement in healthcare (Buckwalter et al., 2017). The model was developed in 1994 and revised in 2001 and 2015 as a guided algorithm to support nursing-related research and its implementation to improve the quality of care (Cullen et al., 2018). The IMR includes seven essential components including (Iowa Model Collaborative, 2017): 1. Identifying triggering issues/opportunities 2. State the question or purpose. 3. Form a team. 4. Assemble, appraise, and synthesize the body of evidence. 5. Design and pilot the practice change. 6. Integrate and sustain the practice change. 7. Disseminate results. The steps of the IMR were carefully considered in developing this MSN project. First, the identification of the problem was completed. Then, a PICO question was formulated. The PICO question was, are electronic tools more effective than traditional methods to prevent falls in long- 8 term facilities? The model also identified factors contributing to the problem and opportunities to improve patient safety by applying interventions to decrease falls. Further, based on the model, this project aims to educate and enhance nurses' understanding of the efficacy of traditional fall risk interventions compared to technological approaches. Similarly, relevant scientific evidence was gathered, appraised, and analyzed to support findings. Finally, the results of this project will be disseminated and serve as an educational tool for longterm nurses and nurse leaders and will promote future research. Strengths and Limitations The IMR's strengths include that it helps the change agent to develop problem-solving skills and strategies using the best scientific evidence, clinical expertise, and patient values and preferences. Another strength of the model is its simplicity and friendly application. Some disadvantages of the Iowa model include the potential cost of building a research team and the need for a robust goal-achievement measuring tool (Cullen et al., 2022). This project aims to educate nurses, clinicians, and residents of long-term facilities regarding accidental falls, fall risk, and the effectiveness of traditional and technological fall prevention initiatives and interventions. The findings of this project will serve as the foundation for a fall-risk management system. It will also support nurses as they decide the appropriateness of fall-prevention interventions and the benefits of implementing such interventions. Additionally, this project can reduce fall-related costs and the financial burden of fall-related injuries affecting long-term facilities. Another limitation of the IMR is that it does not consider the patient's perspective during the planning process. Therefore, the next step would be to design an evaluation tool to measure patient engagement and the effect of empowering them to be active agents in changing their fall risk. 9 Analysis of Literature Accidental falls among patients in long-term facilities are a significant safety concern. Fall-related consequences such as reduced quality of life, increased morbidity and mortality, increased healthcare cost, and legal ramifications are significant considerations for nurses and the healthcare community (Roigk et al., 2018). Therefore, the nursing community has developed and implemented several initiatives to manage and reduce patients' fall risk (Roigk et al., 2018). Forty-five peer-reviewed articles and reputable sources of scientific data and clinical research were selected during the literature examination of this project. These forty-five articles support this project's analysis of the effectiveness of traditional fall prevention intervention compared to technological measures. Search Strategies A literature search using Google Scholar, CINAHL, MEDLINE, PsychINFO, EBSCO, and Weber State University's Stewart Library's Advanced Search, was conducted to identify current evidence on the topic, allowing access to multiple databases. The search included the following keywords and terms: falls among older adults, falls in long-term facilities, "residents' falls in long-term, fall prevention, fall prevention technological tools, fall prevention screening, fall-related injuries, fall risk screening, fall risk evaluation, fall risk nursing interventions, fall prevention exercises, older adults perception of fall risk, falls in fragile older adults, traditional fall prevention methods, fall prevention interventions, electronic fall prevention interventions, most accepted fall prevention interventions in long-term, fall rates in long-term, consequences of falls in older adults, fall risk factors in long-term settings, evidence-based fall prevention interventions, cost of falls in long-term facilities, and technological fall interventions. Additionally, the search only included articles published in the last five years. 10 Several combinations of the above-described terminology and Boolean operators resulted in comprehensive results of available evidence. The primary language of the included articles was English. Non-English articles were excluded. Three major themes were identified in the literature search: First, traditional fall prevention measures such as primary screening, exercise, and other non-electronic fall-prevention interventions. Second, technological fall-prevention interventions and tools. Third, the patient's response to fall-prevention interventions and the care team's understanding of the patient's response. Traditional Fall Prevention Measures Many traditional fall prevention initiatives have been developed and utilized in modern nursing (Montejano-Lozoya et al., 2020). Some of these initiatives include the MORSE fall-risk scale, nurses' education programs, referral to fall prevention treatment, exercise programs, motivational prevention interviews, medication reviews, and the application of a nurse-led, patient-centered fall prevention tool kit. According to the U.S. Agency for Healthcare, Research, and Quality, it is crucial to understand that effective fall prevention requires a multidisciplinary approach (Agency for Healthcare, Research, and Quality, 2019). Therefore, several disciplines, such as nursing, podiatry, physicians, pharmacists, physical and occupational therapy, and the patient and the family, must collaborate to identify risk factors and develop effective fall prevention strategies (Government of Western Australia Department of Health, 2020). Some research evidence indicates that multifactorial, multi-component, and multidimensional interventions are more effective in preventing accidental falls among patients in long-term care facilities (Albasha et al., 2022). Scientific evidence supports that multifactorial interventions effectively help to reduce falls among patients in long-term care facilities (Albasha 11 et al., 2022). The Agency for Healthcare, Research, and Quality also stated that screening tools such as the MORSE fall scale help identify risk factors and patients' likelihood of falling. However, they also highlighted that developing a care plan sensitive to fall prevention is crucial in preventing falls and improving quality of life (Agency for Health, Research, and Quality, 2021). Similarly, evidence indicates that providing nurses with education and implementing individual and customized fall prevention plans are vital to prevent falls and fall-related injuries (Albasha et al., 2022). However, evidence also indicated that primary screening & referral to fall prevention treatment did not reduce fractures (Bruce et al., 2021). On the other hand, fall prevention exercise programs, which were cheaper, reduced falls and delivered the best results when the patient was compliant (Finnegan et al., 2019). Unfortunately, the literature indicated that preventive exercise programs are rarely maintained over time (Finnegan et al., 2019). Additionally, the literature showed that it is crucial to understand the barriers and facilitators for older adults to continue with fall-prevention exercise programs to succeed (Kiyoshi-Teo et al., 2020). Likewise, nurses' understanding of the patient's rationale for compliance with their exercise programs was critical for the healthcare team to develop and adjust strategies to ensure patient compliance (Finnegan et al., 2019). Furthermore, data indicate that fall Prevention Motivational Interviews [FPMI] are practical tools for fall prevention (Kiyoshi-Teo et al., 2020). Another critical finding is that lower fall rates and fewer fall-related injuries were associated with implementing a nurse-led fall-prevention screening tool kit. Specific risk factors are identified with the help of the screening tool kit, allowing nurses to individualize the plan of care of patients at high risk for falls, which reduces the rate of fall events and related injuries. 12 The research findings also suggest that the screening kit tool increases the effectiveness of nursing assessment, fall prevention interventions, and patient engagement (Dykes et al., 2020). Patient's Response to Fall-Prevention Screening and Interventions Research results indicate that many patients need help understanding their own risk for falls, do not perceive themselves at risk, or have limited knowledge or a vital level of misconceptions about accidental falls and their health consequences (Solares et al., 2022). Data also indicates that appropriate teaching regarding fall risk and prevention can significantly influence the perception of patients and their families (Shuman et al., 2016). Further, understanding older adults' perceptions of their fall risks, prevention strategies, and the likelihood of them following a fall-risk-self-identity and previously learned fall prevention strategies is essential to engage and succeed in lowering their risk of falls (Kiyoshi-Teo et al., 2020). Similarly, comprehending the older adults' response to fall-prevention interventions and the variables affecting their perception and approach to such measures is critical for obtaining the target outcomes (Kiyoshi-Teo et al., 2020). Therefore, these findings suggest that healthcare professionals must engage, provide, and reinforce falls-related knowledge and provide clarity regarding prevention interventions (Shuman et al., 2016). In contrast, studies demonstrate that nurses recognize that preventing falls in fragile patients is challenging as fall prevention interventions are often ineffective (Ayton et al., 2017). Similarly, nurses acknowledge that several fall prevention interventions are available but only sometimes used in practice (Wilson et al., 2016). Consequently, quality education regarding fall risk and prevention is vital to increase nurses' engagement and application of prevention practices. Furthermore, nurses with sufficient education can decrease patient-specific fall risk factors (Wilson et al., 2016). Finally, research supports the need for educational and motivational 13 interventions to change patients', families, and healthcare professionals' perceptions of a patient's fall risk and contribute to the multidisciplinary and multirole engagement in the proposed fall prevention plan (Dolan et al., 2021). In summary, understanding the patient's response to their fall risk, designing flexible screening tools for the individual's characteristics, and teaching practical fall-risk management techniques are highly effective measures to lower fall events and related injuries in long-term facilities (Dolan et al., 2021). In addition, technological advances are currently implemented in many long-term facilities worldwide to lower their patient's risk for falls (Oh-Park et al., 2021). Technological Fall-Prevention Interventions and Tools. Some of the most used technological tools in fall prevention are computerized fall risk analysis, body positioning alarms, remote video monitoring, personal emergency response system, wearable sensors, virtual reality, and supportive robotics (Oh-Park et al., 2021). Research suggests mixed results in the use of body alarms. Although alarm sounds may alert staff members of impending fall risk, they can also create a dangerous environment for soundsensitive patients (Oh-Park et al., 2021). Alarms can also promote staff fatigue and emotional distress (Oh-Park et al., 2021). Nonetheless, better results have been obtained with customizable care systems that detect movement and alert the delegated care staff member(s) through individual beepers or monitors (Vandenberg et al., 2017). Although alarms may create awareness of impending fall danger, they can also be stressful for patients and staff. On the other hand, the effects and results of video monitoring and remote sitters are successful strategies for maintaining safety, preventing, and reducing falls and related injuries, and achieving high-quality patient care (Hogan-Quigley et al., 2021). Conversely, video 14 monitoring, remote sitters, wearable sensors, and supportive robotics are successful tools in lowering and preventing falls (Hogan-Quigley et al., 2021). Summary of Literature Review Findings and Application to the Project The literature review identified several fall prevention interventions and guidelines for fall-risk management. These interventions include traditional screening tools, fall risk interviews with nurses and physicians, fall-prevention exercises, bed alarms, video monitoring, virtual sitters, and screening of the patient's perception of their fall risk and compliance with interventions (Mileski et al., 2019). Most recommendations suggest using risk stratification and interventions based on risk evaluation of gait and balance, medication review, fall-prevention exercises, environmental improvement, and management of chronic conditions such as cardiovascular problems, osteoporosis, and vision impairment (Tricco et al., 2017). Additionally, appropriate footwear, physiotherapy, understanding of the patient's perception of fall risk and their compliance with the interventions, and management of fractures are interventions considered by this project (Tricco et al., 2017). Additionally, appropriate footwear, physiotherapy, understanding of the patient's perception of fall risk and their compliance with the interventions, and management of fractures are interventions considered by this project (Tricco et al., 2017). Comparatively, evidence indicates that fall-prevention interventions are more effective and can be associated with reduced fall rates when patients and their caregivers commit to and engage with the fall-prevention plan and initiatives (King et al., 2018). Moreover, multifactorial approaches have become a key element in preventing falls. Multifactorial approaches, patient empowerment, and engagement are associated with patient satisfaction, improved patient safety, and higher-quality care (Solares et al., 2022). Similarly, some of the most recommended fall 15 prevention interventions include fall risk stratification, fractures, and osteoporosis management, medication review, environment and vision management, proper footwear, and cardiovascular assessment (Bruce et al., 2021). Less popular interventions included vitamin D supplementation, management of cognitive problems, fall prevention education, hip protectors, and technological tools (Montero-Odasso et al., 2021). Project Methodology This MSN project aims to prepare long-term registered nurses to work effectively in identifying, preventing, and reducing accidental falls and fall risk within the patient population of long-term facilities. These goals will be accomplished by providing direct education and supporting materials to nurses, patients, and caregivers. This project will also prepare long-term registered nurses to educate patients, families, and caregivers of long-term facilities to help them identify the patient’s fall risk and utilize interventions to reduce risk, fall events, and fall-related injuries. Three deliverables were created to promote this project’s objectives and implementation. The deliverables include (a) A PowerPoint presentation featuring education on fall risks, prevention, risk management, nursing interventions, and teaching strategies for long-term nurses. (b) A handout containing fall risk identification and management information for patients and caregivers of long-term facilities. (c) A PowerPoint for nurses includes the Johns Hopkins Fall Risk Assessment Tool (Johns Hopkins Medicine Institute, 2007), the MORSE fall risk scale, and the Centers for Disease Control and Prevention algorithm for fall risk screening, assessment, and intervention (CDC, 2019). This presentation will also contain patient teaching points that support the program’s implementation and suggestions on assessing patient and caregiver understanding. Description and Development of Project Deliverables 16 Three teaching tools, including two PowerPoint presentations and a handout, were developed to support the implementation of this project. A detailed explanation of these teaching tools and their relevance will be provided in this section. Additionally, the deliverables are included as part of the appendices of this project. Fall Risks Screening, Interventions, and Teaching Strategies for Nurses Working in LongTerm Facilities This deliverable was developed using PowerPoint software (see Appendix A). This PowerPoint presentation aims to offer learning and teaching tools for nurses on how to effectively assess their long-term patient fall risk, potential interventions to minimize the patient’s fall risk, and teaching strategies to increase awareness and compliance among their patients and their families or caregivers. The presentation will help nurses to develop a deeper understanding and to build a fall risk prevention culture. The presentation includes a brief review of various fall screening methods, factors affecting fall risk, and an overview of research findings regarding older adults’ perceptions of their fall risk (Dolan et al., 2021). This item will also provide insight into interventions such as nutritional assessment (Esquivel, 2018) and fall prevention exercises (Finnegan et al., 2019). Similarly, the perception and role of healthcare professionals in fall prevention (Government of Western Australia Department of Health, 2020) will be explored. Finally, teaching points will be provided to support the development of a positive culture around fall prevention (Hill et al., 2016) and increase patients’ engagement in fall prevention strategies (Hill et al., 2013). Identifying Long-Term Patient’s Fall Risk and Management The next deliverable (Appendix B) is an educational handout for patients and their families. The handout will educate patients and their caregivers about fall risks and the 17 associated injuries. This tool was developed based on peer-reviewed literature about fall risks and fall prevention among patients in long-term facilities. The handout will include a list of factors that can contribute to an increased risk for falls (Tricco et al., 2017). The handout will also describe potential health consequences related to falls (Roigk et al., 2018) and list interventions that can be used to decrease the risk of falling (King et al., 2018). The nurses can use this handout to teach their patients and caregivers and reinforce their willingness to engage in fall prevention interventions. This handout will benefit patients and caregivers by empowering them with the knowledge and tools to decrease and avoid potentially catastrophic fall events. It also has the potential to reduce the cost of fall-related injuries. Fall Risk Assessment Tools and Prevention Algorithm This PowerPoint presentation (Appendix C) will be used to educate and encourage nurses to utilize available fall screening tools such as the Johns Hopkins Fall Risk Assessment Tool (Johns Hopkins Medicine Institute, 2007) and the MORSE fall risk scale. The teachings of this presentation will also help nurses to interpret the results of such tools and to develop strategic fall prevention interventions. Equally important, this presentation will provide nurses with essential information regarding official algorithms to decrease their patients’ fall risk and encourage them to adopt evidence-based interventions. Lastly, this presentation will provide information for nurses to develop teaching strategies to support their patients’ and caregivers’ participation and engagement with their fall prevention programs. Plan and Implementation Process This master’s Science Nursing project will be implemented following the approval of the local long-term facility in Ogden, Utah. Management staff, including the director of nursing (DON) and two assistant directors of nursing (ADONs), will be active participants and 18 supporters of the project. The deliverables developed as part of this project and an explanation of the goals and objectives of the project will be presented to the facility's nursing force during the bi-monthly meeting. Education reinforcement will be provided during the nurses' weekly educational meetings. These educational sessions will take place in the conference room of the facility. The facility's directors understand that obtaining the nurses' support is essential for the success of the program and the generation of change. Therefore, management is committed to inspiring, promoting, and nurturing the development of a fall prevention culture by including the concept of fall risk reduction and prevention as a principle of their goals and standards. In addition, the nurses will receive training regarding teaching strategies during the educational sessions to ensure they are prepared to teach the patients and their families. Finally, the nurses will receive handouts to support their patient teachings interactions. Interdisciplinary Teamwork Interdisciplinary collaboration is critical to achieving common goals, increasing patient safety and satisfaction, and the overall success of this fall prevention project. This project’s implementation team will include the following staff members. Facility’s director: The facility’s director has a healthcare management administrator degree and oversees and coordinates all relevant administrative processes. The director must approve the plan of change before the implementation phase. This person is also responsible for allocating and approving training time for the staff members, budget, and resources. The director’s support and advocacy for the program’s success are vital to obtaining the desirable change. Director of Nursing: The DON’s support is essential for the success of the project. The DON will incorporate program elements into the nurses’ tasks and interventions. This person 19 will also direct and motivate the nursing staff to embrace the proposed change and validate the project’s relevance to increase patient safety and satisfaction and decrease cost and liability. Assistants Directors of Nursing: ADONs will reinforce the directions given by the administrator and the DON to ensure the achievement of the project’s goals. Nurses: The nursing staff is the most crucial element in the project’s implementation phase. Nurses will ultimately be responsible for screening their patients’ fall risk, completing fall-prevention interventions, monitoring the progress, and providing feedback regarding the program’s impact on fall reduction. They will also be educated to provide their patients with relevant information and valuable teaching. The nurses are also critical because they will help the patients and their families to understand the importance of fall prevention protocols. Certified Nursing Assistants (CNAs): Because CNAs are in constant contact with the patients, they are a valuable source of information about the factors affecting and increasing their patients' risk of falling. They could also offer important feedback regarding the implementation of the program. Physical and Occupational Therapist: PT and OT play a vital role in the fall prevention interventions design and implementation phase. For example, PT is responsible for evaluating and designing physical exercise strategies to increase the patient’s strength and decrease fall risk. Similarly, OT can help by providing recommendations to increase environmental safety measures, such as removing clutter and fall hazards, wearing appropriate footwear, and modifying behavior that can increase the risk of falls. Social Worker: The facility's social worker will help identify and allocate resources to support the program's development, implementation, and evaluation. They could also provide 20 feedback regarding the patient's and caregiver's perception of the patient's fall risk and the program's practicality and effectiveness. Physicians: Physicians are also fundamental to ensuring the accomplishment of the program’s goals. They are responsible for approving medical interventions. For example, they oversee ordering medications. This consideration is essential because medications could potentially increase or decrease the patient’s risk of accidental falls. Timeline A clear and organized timeline (see Appendix D) will facilitate the timely accomplishment of each phase and task of the program. The timeline will also provide periodical information regarding the need for adjustments. This data will aid the decision-making process, thus contributing to achieving the desired outcomes. A summary of the timeline is described below. a. Once the program is approved, a one-hour meeting will be scheduled with the facility’s administrator, the DON, and the ADONs. This meeting will take place during the first week after acceptance. b. By Monday of the second week, roles and responsibilities will be assigned. c. The program, including goals, interventions, training strategies, budget, and proposal of resources, will be presented, adjusted, and approved by the facility’s management team during a two-hours meeting that will take place three weeks after acceptance. d. A one-hour meeting with stakeholders, including nursing staff, physical therapists, occupational therapists, social-worker, physicians, and certified nursing assistants, will be scheduled the week after the meeting with management to present the program, goals, benefits, and objectives. 21 e. The implementation phase will last three months. Training will be provided during this phase, continuous feedback will be gathered, and any decisions to adjust the process will be addressed during weekly stakeholder meetings. f. The evaluation phase of the project will be executed at the end of the intervention stage. A comprehensive report, including an analysis of results and statistical data, will be presented to the facility’s management members for review and approval. Plan for Evaluation of Project This project and its effectiveness will be evaluated by comparing the rate of accidental falls before and after the program implementation. Additionally, the patients’ and caregivers’ pre- and post-program perceptions of their fall risk will be compared qualitatively and quantitatively by using a pre-designed corporate survey. Further, the rate of patient compliance with interventions will be measured and compared with the compliance rate goal. The patient’s compliance will be measured using existing organizational metrics tabulated and scored for quantification and analysis. Similarly, stakeholders, including the interdisciplinary team, will be presented with a pre-and post-implementation survey. This survey will identify and measure the healthcare team’s perception and response to fall-prevention screening and interventions. Finally, the nursing team will complete a pre, and post-survey to identify the training efforts’ strengths and weaknesses and the effectiveness of the education they received. Ethical Considerations The implementation of this program includes several ethical considerations. However, the most relevant ethical consideration is the vulnerability of older and fragile patients in long-term settings. Many of these patients require extensive assistance with activities of daily living, which expose them to negligence and abuse. Additionally, an inadequate nurse-to-patient ratio is often 22 seen in long-term facilities, significantly increasing their risk of becoming victims of involuntary negligence. Therefore, every effort should be made to protect the facility's patients and to promote patient safety among the healthcare team. This project is important because it empowers patients, caregivers, and healthcare workers to recognize their vulnerability to accidental falls and empowers them to adopt fall-prevention strategies efficiently and proactively. This project is also committed to respecting and honoring the patient's right to refuse to participate in the program and protecting the patient's privacy to the highest standards. Further, staff members will be motivated to attend training and complete surveys by management. A recorded video will be provided for staff members who could not attend the inperson training, and the surveys will be available for the director of nursing. The privacy of all participants will be rigorously protected. Access to their personal information and the results of these surveys will be limited to members of the program and the care team. Discussion Falls and fall-associated injuries continue to pose a significant threat to the health and functionality of older populations (Hogan-Quigley, 2021). The risk for accidental falls is considerably higher among long-term facilities patients, especially those with greater fragility levels (Montero-Odasso et al., 2021). Fall-related injuries can have devastating consequences on the elderly, including fractures, skin impairment, impaired mobility, pain, loss of independence, depression, financial hardship, and death (Finnegan et al., 2019). However, accidental falls and fall-related injuries can be prevented or decreased when education increases awareness in patients, caregivers, and healthcare team members (Montero-Odasso et al., 2021). The fallprevention program developed for this MSN project addresses the urgent need for patients, 23 caregivers, and healthcare professionals to engage and participate in strategic fall-prevention interventions and initiatives (Melnyk et al., 2019). One key to this project's success is ensuring the nurses receive appropriate education on fall-prevention interventions (Hill et al., 2016). Education is vital because nurses must understand, implement, and advocate for falls-prevention strategies to improve patient safety and satisfaction and decrease healthcare costs (Tricco et al., 2017). The following section will discuss the benefits and limitations of this project, the literature review findings, and subsequent evidence-based recommendations. Evidence-based Solutions for Dissemination Dissemination of this project will take place after the designing and approval phases. The results of the pre-and post-implementation surveys will be shared with the patients and disseminated at the corporate level through a written report. The information in these reports will help the facility leaders determine the relevance and usefulness of the program, which will be considered to decide whether to continue with the program. The survey results, subsequent analysis, and comparing the pre-and post-program fall rates will help corporate leaders determine the appropriateness of implementation in other facilities owned by the company. Finally, this MSN project will be disseminated to Weber State University faculty and peers through a written paper and a poster presentation. Significance to Advance Nursing Practice This program will advance the nursing profession by promoting interventions to prevent falls and fall-related injuries, which can increase patient safety and support patient-centered care standards (Ott, 2018). Additionally, this project can benefit nurses working in long-term and rehabilitation settings to improve their knowledge of fall prevention measures and increase their 24 ability to provide excellent and safe patient care (King, 2018). Furthermore, this change can also benefit nurses by educating them on screening and identifying fall risks. Finally, this project can enable nurses to adopt and create new individualized strategies and interventions to prevent accidental falls (Ott, 2018). Implications The strengths of this project are that it can prepare nurses to assess and manage their older patients' risk for falls. Additionally, this program will provide nurses with strategic tools to educate patients and caregivers regarding the patient's risk for falls, factors increasing the risk, and interventions to decrease the likelihood of fall events. It will also promote patient and caregiver adherence and compliance with proposed fall-prevention strategies and interventions. Further, fall-related healthcare costs and liability will be decreased, and patient satisfaction levels will be improved. Another strength of this project is that corporate leadership members support it due to the urgent need to reduce fall rates, fall-related injuries, and the associated cost. Additionally, a proficient training team supports this project by providing project plans, strategies, and goals. Limitations to this project include a small-sized sample and geographical restrictions because the program will be implemented in a single long-term facility. Nonetheless, this program has the potential to be disseminated to other long-term facilities if it is successful. Another limitation may be a need for more acceptance, proper implementation, and lack of engagement from nurses and other health team members. Moreover, the patient's wrong perception of their risk for falls can increase the likelihood of fall events. Another limitation is that the patients and caregivers may be unwilling to participate in the fall-prevention program. These limiting factors can be minimized by delivering and reinforcing training often. The leaders 25 must provide support to promote acceptance, embracement, and adherence to the program's strategies and goals. Recommendations The findings from the literature review indicate that prompt and adequate fall-risk screening of older patients in long-term settings is an urgent matter (Dykes et al., 2020). The literature also suggested that fall-prevention strategies should be individualized, and nurses must use a combination of strategies to optimize fall-prevention results (Esquivel et al., 2018). Similarly, evidence suggested that fall-prevention screening and interventions are significantly more effective when patients and caregivers are receptive and engaged in the fall-prevention plans (Hill et al., 2016). However, the evidence did not identify a fall prevention strategy or suggest a screening tool. Since more needs to be known, additional research should be conducted to determine the effectiveness of traditional screening tools compared to electronic ones (Hogan et al., 2021). Conclusions Accidental falls among patients in long-term care facilities are everyday events with potentially severe and even fatal consequences (Hogan-Quigley, 2021). Multifactorial and individualized approaches, patient empowerment, and healthcare team members' engagement are associated with fall-risk reduction, lower rates of falls, decreased healthcare cost, patient satisfaction, patient safety, and higher-quality care (Solares et al., 2022). 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Western Journal of Nursing Research, 38(8), 1012-1034. https://doi.org/10.1177/0193945916644995 33 Appendix A 34 35 36 37 38 Appendix B 39 Appendix C 40 41 42 43 Appendix D Timeline Week 1 Week 2 End of First Month ● Meeting ● Delivera ● A onewith bles are printed hour meeting management to out and ready for with review program distribution. management to and strategies. (1 day) evaluate (1 hour) progress and adjust. ● Pre● One-hour implementation meeting with surveys will be ● Adjustme stakeholders to processed. nts are present the implemented. program, goals, ● Training benefits, and meetings with ● Weekly objectives. nurses and staff training members have meetings continue ● Roles are begun. (1 hour per week assigned and for the next 8 published. weeks) Training meetings schedule are also announced. (2 days) End of Second Month ● Weekly training meetings end. ● Postimplementation surveys are processed. End of Third Month ● Surveys and statistics are tabulated, and results report is produced. ● A twohour meeting with ● Evaluatio management to discuss results n phase begins. and ongoing plans.