Fall Reduction and Prevention in Long-term care

Geriatric care in long-term care settings encounters various challenges, which undermines the wellbeing of residents as well as of the staff. It is important to note that geriatrics are susceptible to a plethora of health challenges as their old age makes them frail and not as strong when it comes to responding to physical as well as mental health issues. For this reason, long-term care settings ought to have already measures that cater for the geriatrics holistically, meaning that all their needs are catered for. Quite unfortunately, long-term care settings are associated with falls of the residents due to various reasons, such as low staff-resident ratio, deficiency of resources to deal or mitigate some of the risk factors that can lead to falls, organizational limitations in terms of architectural design, inter alia. Research has demonstrated that residents in LTC settings fall more than once, with about 2.6 falls per individual on an annual basis. Falls have been associated with a number of outcomes such as depression, disability, reduced function, hopelessness as well as a decrease in an individual’s quality of life. Apart from this, one ought to consider that due to aging, older adults are more exposed to issues such as disturbances in gait and balance, poor vision, weakness of the muscles, alongside an array of physical and mental health issues. Based on this understanding, it becomes clear that a fall prevention program, which applies a systematic approach towards LTC settings, is needed urgently with an aim of reducing fall-related injuries as well as hospitalization. These have proven costly not only for LTCs, but also for family members who have their loved enrolled in these institutions. 

When thinking about the need for a fall prevention program in a long-term care facility, one should consider some of the indicators, which support such a proposition. In this case, it is important to assess why a prevention program is needed in the first place. Critical to note is that falls in LTC settings have led to an increase in fall-related injuries as well as hospital admissions. In some cases, these exacerbate the medical conditions that residents are in already leading to multiple comorbidity, in turn increasing the likelihood for even more falls. Therefore, an understanding of the cost of falls is therefore warranted. In support, a group of four researchers, Norman Caroll, Jeffrey Delafuente, Fred Cox and Siva Narayanan (2008) conducted a study, which focused on fall-related hospitalization as well as facility costs. Understandably, the article is about 9 years old, but still has relevance to the topic in question following limited research in the association of fall-related injuries and hospitalization of residents in LTC facilities. Based on their findings, the authors noted that victims were more likely to suffer hospitalization and fractures compared to those who did not fall. Fall-related hospital costs were found to be $6,259 per resident annually. Roughly 60% of the said amount was attributable to higher costs in hospitalization (Carroll, Delafuente, Cox & Narayanan, 2008). The implication of the study was that falls in LTC settings were associated with about $6,200 in hospitalization costs per resident annually. Therefore, such a finding helps demonstrate the need for fall prevention programs in LTC settings in order to avoid such costs. Moreover, the findings provide a substantial foundation for estimating the cost-effectiveness of various intervention measures geared towards reducing the number of falls in LTC settings (Carroll, Delafuente, Cox & Narayanan, 2008). 

The drugs used by the geriatrics is a risk factor to fall either due to polypharmacy, side effects, or drug interactions (Just et al., 2017; Li-MacDonald, Pyhtila, & Brandt, 2014; Damián et al., 2013). Other risk factors include; the presence of a medical condition, urinary urgency (Damián et al., 2013). In an article, “Medication Use and Fall-Related Hospital Admissions from Long-Term Care Facilities: A Hospital-Based Case-Control Study”, Ryan-Atwood et al (2017) conducted a study on the effect of medication use and its association to fall-related hospital admissions with consideration of long-term care settings. The results demonstrated that there was no link between polypharmacy (multiple use of medication) and admissions related to falls in LTC facilities. However, the authors noted that the likelihood for fall-related hospital admissions increased with about 16% for every additional medication given for mitigating the risk of falls (Ryan-Atwood et al, 2017). Furthermore, the data showed that medication, which can cause orthostatic hypotension (low blood pressure when standing) was associated with fall-related admissions. The link between medications, which can cause orthostatic hypotension and admissions due to falls in LTC facilities was found strongest in residents taking multiple medication or those with polypharmacy (Ryan-Atwood et al, 2017). Based on the findings, the authors noted that polypharmacy was not, in itself, an independent risk factor associated with fall-related hospital admissions. While that is the case, medications found to cause orthostatic hypotension were highly linked to fall-related hospital admissions, but among residents who had polypharmacy (Ryan-Atwood et al, 2017). Therefore, the authors recommended that the risk of falls should be of major consideration when physicians are prescribing medication that can lead to orthostatic hypotension. 

Other occurrence of falls among the elderly is aggravated by malnutrition, which positively correlated with general body malaise of the elderly and can contribute increased vulnerability to falls. In support, Linda B. Haas (2014) conducted a study focusing on the various special considerations for older adults suffering from diabetes and who are residents in nursing home facilities. According to Haas (2014), residents in LTC settings who have diabetes are considerably many. For instance, residents with diabetes and who are 65 years and older comprise of about 22.5% and 35.6% in Caucasians and non-Caucasians respectively. Furthermore, compared to others, individuals who have diabetes in LTC settings are more likely to have kidney failure, depression, visual impairment, dependency, cardiovascular diseases and dementia (Haas, 2014). This means that these pool of residents has special needs, which must be addressed. One of these needs is nutrition, which LTC facilities should consider through screening and assessment of residents with diabetes for malnutrition. Such an assessment can entail a look at a resident’s medical and surgical history as well as a history of weight and nutrition behavior. As an example, regular monitoring of residents’ body weight is considered a useful tool of screening for malnutrition. It is important to note that weight loss has been associated to increased levels of morbidity and mortality and that a body mass index of less than 18.5kg/m 2 , which can be signals of malnutrition (Haas, 2014). Therefore, malnutrition detection tools are recommended as they can help “ predict undernutrition and assesses declines in food intake, weight loss, mobility, psychological stress/acute illness, neuropsychological problems, and BMI,” (p. 37). 

Fall is prevalent among the geriatrics especially those residing in the long-term care facilities, yet it is a preventable phenomenon. The annual incidence of fall among the elderly population is 700,000 cases per 1 million hospitalized geriatrics and it is unfortunate that about 1/3 of the aforementioned falls are preventable (Campbell, 2016). It is indeed acknowledged that falls among the geriatrics is higher representing about a fall occurrence of approximately a half of the hospitalized adults as indicated by a rate of 1 fall in 3 geriatric residents (Taylor et al., 2014). In light of the abovementioned statistics, National Council on Aging (2017), reported that 1 out of 4 Americans who are older than 65 years fall annually, after each 11 second, a fall of an elderly is managed at the emergency department in the hospital. Every 19 minute an elderly person succumbs to death from a fall etiology. Ayoung-Chee et al. (2014) concurs with National Council on Aging by affirming that the hazardous impact of fall among the geriatric population, this causes multiple injuries which contributes significantly to morbidity as well as mortality. In order to effectively prevent fall among the elderly, there is need for identification of the predisposing factors. Although fall among the geriatrics is commonly associated with changes related to the aging process such as muscles atrophy and gait problems, the strongest risk factors include previous history of falling, improper use of a walking devices (Deandrea et al., 2013). Gait disturbance such as not shifting the weight appropriately, stumbling, and slipping contributes to fall among the elderly (Robinovitch et al., 2013). Assertively, in the long-term care setting, fall reducing and prevention is an important factor that will enhance the high level of elderly activity of daily living. For instance, the long-term care facility will reduce the cost that is used in the management of fall related injuries. According to National Council on Aging (2017), in the year 2014, 31 billion was utilized in the management of fall related injuries and the amount is expected to increase in the year 2020 to 67 billion due to the increase in the elderly population. 

Purpose 

Based on gathered data, it is evident that falls are a reality in long-term care settings and lead to costs on the facilities themselves as well as on residents. With the information acquired, it is evident that residents in long-term care experience various health challenges. For instance, those with diabetes are associated with a high risk of developing other illnesses such as cardiovascular diseases, kidney failure, visual impairment, muscle weakness, inter alia. In such a case, these individuals develop comorbid conditions, which require special treatment for them to have minimal impact on the resident thereby allowing them sufficient functioning although assistance should be provided at all times. A resident with comorbid conditions means that he or she will have to take multiple medications to help treat the various health issues they are suffering from. This means that such an individual is subjected to polypharmacy. While taking multiple medications is not considered a strong risk factor for falls in LTC settings, it becomes a cause for concern when it leads to orthostatic hypotension. Furthermore, comorbid conditions are likely to lead to malnutrition as is the case with individuals suffering from diabetes. Falls are some of the expected outcomes of malnutrition in residents, which means that residents should be screened and assessed for undernourishment. Such a synthesis provides a basis for the research in question, which focus on propose a program that can be used to prevent and reduce falls among geriatric residents in a long-term care facility. 

Setting assessment 

The setting is the long-term care facility for the resident geriatrics. The major service provided is rehabilitation for the geriatric residents (because they live in the nursing home they are residents and not patients). A comprehensive and holistic nursing care is also given to the resident depending on the identified individualized needs. The long-term care facility has total of 136 censuses. The facility has a total of 7 managers, 6 Registered Nurses, 30 Licensed Practical Nurses, and 54 Certified Nursing Assistants. Regarding the work processes and structures, the staff work in three shifts days, evenings and nights. During the day shift, there are 3 unit managers, 6 charge nurses, and 12 certified nursing assistances. The evening consists of 6 charge nurses, 12 Certified Nursing Assistants, 2 supervisors, and a non-nursing manager. The night shift consists of 1 supervisor 4 charge nurses and 8 certified nursing assistances. 

The number of falls recorded from January 1, 2017 through August 2, 2017, was significantly high at 81 falls. After review of the resident accident/incident data with the fall incident reports, it is determined that the most falls are occurring in the patient rooms and hallways, and mostly on the evening shift . It was concluded that the facility was adequately staffed. Staff education will be crucial for successful fall prevention, however education is not a preventative measure. This will need proper approach and strategy for continuous prevention. The facility must adopt a model that can be implemented for fall reduction and prevention. It will be important to understand the risk factors and the correlations between these factors. 

Month No. of falls Census

January 9 133

February 8 130

March 11 134

April 10 135

May 12 134

June 9 136

July 12 134

August 10 136

Aims and outcome measures 

Notable from the data gathered is that, the chosen setting is not limited when it comes to staffing. This demonstrates that there is no need for hiring more staff as this would alleviate the issue at hand. Furthermore, it is also evident that there is no mention of organizational limitations, such as lack of funding or access to necessary resources. Based on this understanding, the setting in question would operate effectively following a proposal about clinical practice guideline. There is mention of an education program for employees, which should not be considered as the approach to prevent falls in the LTC setting in question. Therefore, a clinical practice guideline (CPG) would act as a resource for education, probably demanding that employees receive training and coaching on how to deal with elderly residents who present various medical issues. As an example, a study was references, which focused on how long-term care nurses could consider the nutritional status of elderly residents with diabetes. In such a case, such a setting should have an already established platform on which employees receive sufficient training on how to handle patients with their respective and unique medical conditions. It is important to note that a clinical practice guideline would consider the uniqueness of each case and propose measures that can be taken to provide optimal supervision to some residents compared to others. 

As mentioned, the issue is not with lack of sufficient staff and this means that the problem exists within the setting’s organizational culture. In this regard, establishing a clinical practice guideline would be effective in that it would consider all employees to respond proactively. A major strength in focusing on formulating a clinical practice guideline bases on the fact that it does not discriminate between and among employees when it comes to rank position in the setting in question. For instance, the guideline could explain measures that an employee could take to ensure that they, or another individual of higher capacity, monitor elderly residents in their various activities. An outcome measure, which will be used to measure the success of the CPG is the response attitude of employees, and how this translates to the number of falls recorded in a particular month. 

The Institute of Medicine describe clinical practice guidelines as statements, which are developed systematically to aid practitioner as well as patient decisions about appropriate health care for specific clinical situations. Such a definition encompasses the role of both employees and patients. This is considerably important as it allows the input of both residents and employees when it comes to reducing the likelihood of falls in the setting in question. It was noted that most falls take place in the rooms, hallways and in the evening shift. A clinical practice guideline would recommend steps that both employees and residents can take to ensure that if a resident needs something, they are able to request for assistance, which is provided in the shortest time possible. Hence, communication will be of central significance in the said clinical practice guideline. The following is the aim statement of the proposed clinical practice guideline: 

Specific : the specificity of the clinical practice guideline is evident in its needs and emphasis on promoting a more informed employee body, as well as encouraging the communication of residents whenever they are in need of a service. 

Measurable : the central aim is to reduce falls. Through application of a clinical practice guideline, it will be possible to assess the rate at which falls are recorded on a monthly, potentially in about three months to allow for some time to assess the effectiveness of the said proposal. 

Achievable : a clinical practice guideline is achievable as it considers how systems in the setting interact with other. For instance, it will consider the role of both employees and residents when it comes to providing an atmosphere and culture that can reduce the number of falls. Since it would recommend resident-specific approach, the clinical practice guideline would indeed provide a substantial foundation to assess its effectiveness following employee response. 

Relevant : the proposed intervention approach is relevant as it taps into already existing gaps in the manner in which services are provided in the LTC setting in question. One ought to note that the various statements in a clinical practice guideline contain recommendations that are evidence-based from a rigorous systematic review as well as synthesis of already published medical literature. 

Time-bound : the CPG would demand that employees get acquainted with it as soon as they can in order to make it practical and apply in their provision of care services to residents at the long-term care facility under review. 

Literature review 

Falls are one of the leading causes of injury among older adults. Most of the falls occur when these individuals are denied proper care. The falls can also be witnessed in long-term care facilities despite the constant monitoring of the older adults. The scholarly and medical communities recognize the importance of developing interventions for reducing falls in long term care facilities. The huge volume of information that focuses on effective fall prevention measures serves as evidence of the dedication of these communities. In the discussion below, light is shed on the insights that various members of the scholarly and medical communities have shared regarding effective fall prevention strategies. 

Search strategy 

A robust strategy was adopted to facilitate the literature review. Peer-reviewed journal articles that are available online were the focus of the literature review. Google Scholar is the main database that was relied on for the literature. This database contains dozens of recent articles that examine various interventions used to reduce the number and severity of falls in long-term care facilities. The main search phrase that was used is “prevention of falls in long term care facilities.” This phrase yielded a number of relevant and helpful results. Apart from Google Scholar, other databases were also consulted. These databases include Science Direct and Wiley Online Library. They also contain a huge selection of relevant and credible journal articles. 

Literature review 

The search yielded various articles which outline the different strategies that hold promise for reducing falls in long-term care facilities. The article that Raimunda Silva penned with her colleagues is among those that were found to be relevant. In this article, Silva and her team examine the effectiveness of physical exercise in reducing falls in long-term care facilities. They find that this intervention is indeed effective. These researchers conclude that “combined, frequent and long-term exercise programs are effective to prevent falls in long term care facilities” (Silva, Eslick & Duque, 2013). The study that Silva and her colleagues conducted takes the form of a meta-analysis where they examined publications that focused on randomized controlled trials. 

Silva and her team are not the only scholars who have focused their efforts on identifying effective strategies for tackling falls in long-term care facilities. Jacques Neyens joined forces with a team of other researchers to explore the experiences of older adults in long-term care facilities. They observed that there is a link between malnutrition and the frequency of falls. They note that “malnutrition is associated with an increased risk of being a faller” (Neyens et al., 2013). They go beyond identifying malnutrition as among the risk factors for falls among older adults. These researchers add that “malnourished residents who receive nutritional intervention have a lower risk of being a faller” (Neyens et al., 2013). Here, the researchers essentially endorse nutrition programs as effective interventions for tackling falls. The study that Neyens and his team conducted is of the cross-sectional type. 

Technology is increasingly playing a vital role in enhancing care for older adults. In their article, Mei and her colleagues examine the impacts of an electronic fall reporting system on the wellbeing of the residents of a long-term care facility (Mei et al., 2013). While the article does not necessarily indicate that the reporting system helps to combat falls, Mei and her team note that facilities attending to older adults can adopt this system in their bid to enhance the outcomes of their residents. Ellen Vlaeyen and her colleagues sought to shed further light on the effectiveness of fall prevention programs in long-term care facilities. In their systematic review and meta-analysis, they focused on a range of interventions that included training and intervention. Their findings are somewhat disappointing. They established that the “meta-analysis failed to reveal a significant effect of fall prevention interventions on falls or fallers” (Vlaeyen et al., 2015). However, they make it clear that “fall prevention interventions significantly reduced the number of recurrent falls by 21%”. 

The articles discussed above are clear indication that the scholarly and medical communities are committed to tackling falls among older adults in long-term care facilities. Rebecca McCarthy collaborated with two other nursing practitioners to add their voice to the discussion on the prevention of falls in long-term care facilities. In their article, they highlight policy guidelines that shed light on effective interventions. They note that assessment, education and physical exercise are some of the strategies that have proven effective (McCarthy, Adedokun & Fairchild, n.d). Environmental modification and the administration of medication are other interventions that practice guidelines recommend. Mara Ferris is another nursing professional who sought to broaden the knowledge on effective fall prevention strategies. She identifies constant monitoring and the creation of a safe environment as some of the effective interventions (Ferris, 2008).

It is important to outline the rationale for the exclusion of the records that were not included in the final review. Some of these articles lacked relevance while others were of questionable authority. For example, there were two articles which were authored in 2005. While they provide important insights, it was determined that they were too old to be relevant. Other articles contained admissions of conflict of interest and this was the reason for their exclusion. Another reality that informed the exclusion of other articles is that they focused on populations that are too different from that of the US. The inclusion of these articles would have made it difficult to derive practical and relevant insights. There is full confidence that the six articles that were part of the final review offer a true reflection of the huge volume of records on the various interventions for preventing falls. 

Strength of evidence 

A range of articles were consulted for evidence on the different interventions that hold the key to tackling falls among older adults in long-term care homes. Overall, the evidence strongly supports the assertion that there are various effective interventions. The evidence obtains its much of its strength from the fact that the literature consulted went through a rigorous peer-review process. All the articles examined are from peer-reviewed journal articles. Another source of strength for the evidence is the fact that some of the articles confirm what was seen in other articles. For example, both Ferris and McCarthy and her team confirm that environmental modification is among the most effective strategies for preventing falls. The designs of the studies that yielded the evidence are another source of strength. While some of the studies were primary research, others involved meta-analyses of extensive research. The inclusion of articles with varying research designs offer multiple and deep perspectives on the different fall prevention interventions. 

Summary of evidence 

All the evidence collected point to the availability of numerous interventions for preventing falls in long-term care facilities. The evidence also sheds light on the different strategies that these facilities can implement. These strategies include educating residents on the need for caution and creating an environment that allows for safe and easy movement. Other effective strategies are constant monitoring of the elderly residents and the administration of medication. While most of the evidence underscores the effectiveness of different fall prevention programs, some of the evidence raises questions about how effective these programs are. After examining dozens of articles, Vlaeyen and his colleagues established that there is no clear evidence that different fall prevention interventions achieve their purpose. Their position runs counter to the evidence presented in the other articles that were reviewed. This conflict underscores the need for further study to conclusively establish if the fall prevention interventions yield the intended outcomes. Overall, there is overwhelming evidence that whichever strategy that they implement, long-term care facilities will witness a significant decline in falls. 

Successful interventions 

The literature that was reviewed details numerous interventions that were implemented and studied and found to be successful. In their article, Silva and her team examine publications in which fall prevention interventions were documented. They found that various scholars implemented and assessed balance training exercises. These scholars determined that these exercises were indeed successful. Mei and her team also implemented a successful intervention that involved a fall reporting technology. This technology was well received and proved to be effective. It is true that Vlaeyen and his colleagues found that fall prevention programs did not have any significant impact for the first time. However, they observed that for recurrent falls, the interventions had an impact. These interventions included education and training. It can be concluded therefore that training and educating residents is a successful fall prevention strategy. Overall, essentially all prevention interventions are effective. 

Summary table 

Source	Type	Level	Sample/Study description	Purpose	Results
Ferris, M. (2008). Fall Prevention in Long-Term Care: Practical Advice to Improve Care. Topics In Advanced Nursing, 8 (3). Retrieved 10 th December 2017 from  https://www.medscape.com/viewarticle/579951_4	Expert opinion	VII	Study focuses on a case and offers policy guidelines	The purpose of the study is to identify most effective interventions for prevnting falls.	Education, environment modification and monitoring are among the most effective strategies.
McCarthy, R., Adedokun, C. W. & Fairchild, R. M. (n.d). Preventing Falls in the Elderly Long Term Care Facilities. Journal of Nursing. Retrieved 10 th December 2017 from http://rn-journal.com/journal-of-nursing/preventing-falls-in-the-elderly-long-term-care-facilities	Policy guidelines	VII	Paper examines literature to identify effective fall prevention measures.	Goal of the study is to determine the strategies that work.	Assessment, exercise, medication and education are among most effective techniques.
Mei, Y. Y., Macquard, J., Jacelon, C. & DeFao, A. L. (2013). Designing and Evaluating An Electronic Patient Falls Reporting System: Perspectives for the Implementation of Health Information Technology in Long-Term Residential Care Facilities. International Journal of Medical Informatics, 82 (11), e294-e306.	Descriptive/qualitative study	V	Analysis of a prevention technology in a long-term care facility.	Purpose of study is to evaluate the adoption of fall reporting technology.	Most stakeholders endorse the fall prevention technology.  The technology holds promise for tackling falls among older adults.
Neyens, J., Halfens, R., Spreeuwenberg, M., Meijers, J., Luiking, Y., Verlaan, G. & Schols, J. (2013). Malnutrition is Associated with an Increased Risk of Falls and Impaired Activity In Elderly Patients in Dutch Residential Long-Term Care (LTC): A Cross-Sectional Study. Archives of Gerontology and Geriatrics, 56 (1), 265-269.	Cross-sectional study	III	Study was a cross-sectional data analysis. Participants were 6828 residents of a Dutch long-term care facility.	Purpose of the study is to establish link between malnutrition and falls. Researchers also sought to determine the effectiveness of nutrition programs in preventing falls.	Nutritional interventions are effective in fall prevention.
Silva, R. B., Eslick, G. D. & Duque, G. (2013). Exercise for Falls and Fracture Prevention in Long Term Care Facilities: A Systematic Review and Meta-Analysis. Journal of the American Medical Directors Association, 14 (9), 685-689.	Meta-analysis	II	The researchers examined articles describing randomized controlled trials. A total of 12 studies which analyzed 1292 subjects were examined.	The main goal was to explore the impact that physical exercise has on fall prevention.	Frequent exercise is effective in fall prevention.
Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D..,  Denhaerynck, K., Goemaere, S., Wertelaers, A., Dobbels, F., Dejaeger, E. & Milisen, K. (2015). Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Journal of the American Geriatric Society, 63 (2), 211-221.	Systematic review and meta-analysis of RCTs.	I	Studies involving 22,915 nursing home residents were examined.	Purpose was to establish how effective fall prevention programs are.	Meta-analysis did not reveal that the programs are effective.  The prevention interventions found to help reduce recurrent falls.

Analysis of literature 

The literature review reveals interesting insights regarding the fall prevention strategies that are in use. However, there are some limitations in the literature. The main limitation concerns the lack of a clear position on the effectiveness of fall prevention programs. As has been observed earlier, Vlaeyen and his team noted that the effectiveness of the interventions was limited for the first time and that these interventions delivered positive outcomes only for recurrent fallers. This position appears to contradict the conclusions that other scholars have made. All the other scholars whose works were reviewed established that the interventions were effective in all situations without exception. It should be noted that this limitation does not do much damage to the argument that fall prevention interventions are largely effective. Even Vlaeyen and his colleagues admit that the interventions are effective but add that they are only successful in reducing recurrent falls. There is a clear need for further investigation to identify strategies that will deliver benefits for all residents in long-term care facilities. 

Critical to note is that already available research demonstrates that fall prevention program are effective in dealing with recurrent falls. This means that there is no anticipation for new falls, which is a major limitation in already existing fall prevention programs. Different from a CPG approach, one would consider a standard of practice or development of a policy that guides, in particular, the role of staff in ensuring that there is reduction in the number of falls. However, a standard of practice or policy would be limited as these measures are based on a specific approach and do not allow consideration for various independent and potentially effective measures, which could lead to positive outcomes. A standard of practice or policy would hinder staff members to apply their experience-based approach on improving care for residents through, for instance, routine room checkups, sharing of contact information such that a resident can make a personal call to a staff member for assistance, among other approaches. A CPG is merely a set of statements, which provides recommendations for practice and allows members of staff to respond to situations in a manner that advances their understanding of the unique and special needs of residents. 

A potential unexpected outcome would be ineffective use of an organization’s resources as employees are allowed the freedom to make decisions based on the situations they are facing. Therefore, although a measure might reduce the likelihood of falls, an employee might misuse resources, thereby undermining a facility’s overall effectiveness, in the long-term, of dealing with the issue at hand. An important factor to consider when developing a CPG is to note potential negative outcomes, which are likely to occur during its application. 

Cost-benefit analysis 

According to Mazrou (2013) a CPG approach is considered influential as well as effective in promoting evidence-based intervention methods in the healthcare setting. Such a measure is not only a means of controlling clinicians, but also provides an opportunity to improve the quality of care through reducing variation of practice and recommending adherence to standards of efficient care. Apart from this guidelines are applicable in a wide range of settings, for instance, during the introduction of new services or procedures, encouraging the adoption of cost-effective medical interventions as well as improving both timing and processes when patients are being discharged from hospital. Through effective use of clinical guidelines, there is a high likelihood of improving clinical outcomes, reducing a patient’s length of hospitalization, the frequency of monitoring among other costs (Mazrou, 2013). 

Already gathered literature has demonstrated that falls lead to injuries and in some cases, residents are admitted to hospital. This is costly for the facility, which caters for the wellbeing of a resident during their period of hospitalization. It was noted that fall related costs per person per year stood at $6,200. However, through application of a CPG approach, the long-term care facility in question could avoid such cases through promoting efficiency in services provided. The guidelines would act as common denominator of guiding the behavior of staff, requiring them to weave their behaviors with the organization’s expectations. This means that they are expected to promote their employer’s goals and objectives through ensuring that not only is there a reduction in the number of falls, but also prevention of anticipated falls. This would ensure focus is not limited on recurrent falls, as the LTC setting understands that the risk of falling among residents is imminent and employs measures to prevent them from falling. The aim would be to experience zero falls at a minimum. Personal interaction between residents and staff could help create a platform on which residents feel free and secure when expressing themselves to their caregivers. This could help the elderly residents to develop a sense of belonging and affiliation thereby opening up about various risks that might jeopardize their wellbeing. One ought to consider that the input of residents is particularly important in establishing an efficient system that works towards reducing the number of falls as well as preventing any from occurring. While a CPG approach is likely to increase the time of routine check-ups, hence increasing the likelihood of employee fatigue, it provides an opportunity to experience a reduction in the number of falls in the facility. 

Potential barriers 

Abrahamson and Doebbeling (2012) noted that social and organizational factors can affect the effective application of clinical practice guidelines. For instance, in a study, the authors noted that a considerable number of barriers, alongside facilitators, of the use of clinical practice guidelines were external. This means that employees’ effectiveness in their respective duties is subject to factors beyond their control. In support, identified barriers were such as ineffective communication, lack of sufficient training and education, as well as staffing and workload (Abrahamson & Doebbeling, 2012). Similarly, there are expectations of such issues in the long-term care facility in question. Communication challenges are expected to prevent employees from making effective use of the CPG approach recommended. Moreover, demands from the top management, for instance, requiring constant monitoring of residents could lead to fatigue and burnout as there is no proposal for an increase in staff. Therefore, this would risk the likelihood of employee turnover following lack of satisfaction with the organization’s culture and approach towards employees especially when there is no additional compensation, rewards or incentives for extra work done. However, this can be deal with through the organization’s board seeking measures to improve CPG approach in a manner that it aligns with the current capacity and ability of the institution to achieve its goals without sacrificing the wellbeing of its employees. Therefore, a team of qualified personnel could help evaluate the potential outcome of applying a CPG approach on both employees as well as on the organization’s mission and vision.   

The implementation of the fall prevention program requires developing a consensus on the motives that the program is needed. The development of an agreement entails five steps. First, it may be useful to recognize the reasons for falls and it is essential to narrow down and focus on specific cases that relates to the specific healthcare to address issues unique to the facility (Wieland, 2013). Second, it is critical to define the need for the organization management and interests in the field of fall prevention to assess some efforts required to attain and maintain their support. Third, cooperating with employees on all different levels, health and medical fields. 

The roles involved in the fall-prevention implementation initiative may go a long way in the assessing the need for process modification within the long-term nursing facility. It may include taking into account the opinions of 10 to 30 employees directly involved in the change initiative. From the contributions of the different interested, clarifications of mutual reasoning which justify the need for change needed to reduce fall. Fourth, it may be crucial to assess the level of how the health care facility employees other than those participating in the fall prevention program comprehend the need to have an inclusive change initiative (Bargal & Schmid, 2012). Such an assessment can be undertaken in several ways such as carrying out surveys, studying quality problems highlighted by the members of the facility, and calling for small group discussions. 

Engaging members of an organization in the critical aspects of the changes needed for the fall prevention program is vital to ensure the development and attainment of change objectives. In any healthcare facility, every unit and department has its own organizational culture with some willing to adopt new change while others may show reluctance and difficulty in embracing any changes. Consequently, the success of any change initiative necessitates the support and resident and the reputation of the facility. Finally, it will be crucial to isolate a single department which is most zealous to minimize falls or where the problem of falls is more prevalent. It is because the members in such a unit are in a better position to understand the urgency of the change in the fall prevention program and getting their opinion is important in justifying the need for change. 

References 

Abrahamson, K. A. & Doebbeling, B. N. (2012).Facilitators and barriers to clinical practice guideline use among nurses. The American Journal of Nursing, 112(7): 26-35. DOI: 10.1097/01.NAJ.0000415957.46932.bf 

Ayoung-Chee, P., McIntyre, L., Ebel, B. E., Mack, C. D., McCormick, W., & Maier, R. V. (2014). Long-term outcomes of ground-level falls in the elderly. Journal of Trauma and Acute Care Surgery , 76 (2), 498–503. https://doi.org/10.1097/TA.0000000000000102 

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