Step 1 Select a change theory that would work best for your proposed change project. In one- to two-pages, summarize the main theoretical notions and concepts of the selected theory. Then discuss the various stages of implementation of the proposed project based on the selected theory.
Using Lewin’s Change Theory
I interviewed the director on the unit I work on, surgical/ortho. The director’s name is Aleycia Wilkerson-Coleman MSN, RN, NEA-BC. The interview started with me thanking Aleycia for the time she put aside to allow me to interview her. We talked about ways to prevent falls, the interventions we have in place, interventions she would like to see change, and our numbers of falls since the beginning of the year. Aleycia was also kind enough to print out a detailed power-point of how to use the assessment tool to identify a patients fall risk score.
The first question I asked Aleycia was what she believed the main reason for patient falls on our unit was. Aleycia responded by saying the population we take care of on unit. Majority of our patients are over the age of fifty. Aleycia explained that with an older population and the medication they are receiving is the main reason for our falls. Patients over the age of fifty cannot metabolize narcotics or anesthesia like a younger patient would. It takes them longer to get those things out of their system. These medications, including the anesthesia can cause confusion in most of our patients, which can be the reason they try getting out of bed without calling.
We use the John Hopkins Fall Risk Assessment tool (JHFRAT) that we document on every shift. Aleycia printed out a power-point that went over the John Hopkins Rall Risk Assessent tool. In the power-point it states that the JHFRAT reduced falls at John Hopkins hospital by 21% and reduced fall injuries by 51%. I asked Aleycia if she believed the John Hopkins Fall Risk Assessment tool is helpful in identifying if a patient is a high fall risk. Aleycia responded by saying, “yes, if it is used properly.” According to the JHFRAT, if a patient scores 0-5, they are considered a low fall risk; if they score a 6-13, they are considered a moderate fall risk; and if the score >13, they are considered a high fall risk. Usually, the patients that have gone under anesthesia within 24 hours are considered high fall risk, no matter what they have scored before the procedure. Aleycia and I spoke about how in depth the JHFRAT goes into in contrast to the Morse Fall Risk Assessment tool. The JHFRAT considers the patients age, the type of medications they are on, if they have any equipment such as IV’s or SCDs placed.
Currently the interventions being placed for our high fall risk patients are what we call our fall bundle. Aleycia explained that our fall bundle consists of a yellow bracelet that says “Fall Risk”, yellow socks, a yellow poster to put outside of the patient’s door, a yellow sticker for their chart, a yellow sign that says “Call, Don’t Fall” to place in their room, and of course making sure the bed or chair alarm is on and working. One of the interventions Aleycia would like to improve is awareness and education. Although it may be difficult for our patients to understand the education given, Ale
PICOT Question – Etiology
Are geriatrics (P), who have gone under anesthesia and are receiving pain medication (I) compared with those without receiving anesthesia and pain medication (C) at a higher risk for falls (O) over the first 48 hours after surgery (T)?
6
Annotated Bibliography
Amisadai Mederos
Denver College of Nursing
NUR445: Capstone
Dr. Sharon Bator
November 15, 2021
Annotated Bibliography
Recent opioid use and fall-related injury among older patients with trauma
Inclusion criteria refer to the prospective characteristics that subjects should have before they are included in a study while exclusion criteria are the characteristics that disqualify prospective subjects. The inclusion criteria that was used in the search included age, opioid use and fall-related injury. Age and type of medication were used as exclusion criteria. Terms such as opioid use and fall-related injury were used in the search and date range was set between 2016 and 2021. The search engines used for the search is Gale OneFile: Health and Medicine from LIRN: Online Library Resources. One of the research components that is valuable to the creditability of this article include the authors’ expertise in the area.
The article examines the association between opioid use and risk and clinical outcomes of fall-related injury in a large trauma population of older adults. It hypothesizes that fall related injuries mostly occur with recent opioid use that injuries that occur from other mechanisms. The study included patients aged between 65 years and older and found that recent opioid use is associated with increased risk of fall and death among older patients.
Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors
The main inclusion and exclusion criteria used in the search is age and key terms such as geriatric inpatients, delirium, and body mass index. The date range for the search was between 2016 and 2021. The search engines used for the search is Gale OneFile: Health and Medicine from LIRN: Online Library Resources.
The article covers an area of concern in healthcare by evaluating factors that are associated falls in geriatric inpatients after implementation of the fall prevention program. It establishes that inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality. The authors of the article are experts in geriatrics thus contributing to the creditability of the study.
The authors conduct an observational study on 778 consecutive patients aged 79 years and above and classifies them into low, moderate, and high fall risk groups. The study then finds that delirium history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program and that patients with a high BMI are unlikely to experience geriatric falls.
Deprescribing in the Older Pa
Recent opioid use and fall-related injury among older patients with trauma
Daoust, R., Paquet, J., Moore, L., Emond, M., Gosselin, S., Lavigne, G., Choiniere, M., Boulanger, A., Mac-Thiong, J. M., & Chauny, J.-M. (2018). Recent opioid use and fall-related injury among older patients with trauma. CMAJ: Canadian Medical Association Journal, 190(16), E500+. https://link.gale.com/apps/doc/A535816357/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=fe728eb5
Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors
Mazur, K., Wilczyhski, K., & Szewieczek, J. (2016). Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clinical Interventions in Aging, 11, 1253+. https://link.gale.com/apps/doc/A503296118/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=4876a981
Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions
Wu, H., O’Donnell, L. K., Fujita, K., Masnoon, N., & Hilmer, S. N. (2021). Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions. International Journal of General Medicine, 14, 3793+. https://link.gale.com/apps/doc/A673020801/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=941ecb3a
Association of benzodiazepine and Z-drug use with the risk of hospitalization for fall-related injuries among older people: a nationwide nested case-control study in Taiwan
Yu, N.-W., Chen, P.-J., Tsai, H.-J., Huang, C.-W., Chiu, Y.-W., Tsay, W.-I., Hsu, J., & Chang, C.-M. (2017). Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case-control study in Taiwan. BMC Geriatrics, 17(1). https://link.gale.com/apps/doc/A511320776/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=446b7aa2
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