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Consider and discuss the nurse leader’s role at each stage of your project

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Consider and discuss the nurse leader’s role at each stage of your project. In your introductory paragraph to the paper, summarize the nurse leader’s role in your project in regard to:

• Defining / identifying / assessing the problem or issue (from Week 1)
• Determining the scope / frequency of the problem (from Week 2)
• Providing support for research and the need for the change (from Week 3)
• And supporting with planning and implementation of the project (from Week 4)

In separate sections of the paper (organized using APA Level 1 headings), identify the actions that a nurse leader would take with regards to the following:

• Communication with stakeholders
• Training
• Budget
• Change management
• Include a specific change management theory that is appropriate to this project, and why it is applicable.
• What authority do they have?
• 1 Project Translation and Planning of Preventing Patient Falls in Healthcare Facilities Introduction Healthcare facilities are mainly concerned about achieving an ultimate goal of successful medical treatment and patient recovery. Nonetheless, the patient sometimes comes across situations that risk their lives by exposing them to injuries when they fall. These situations 2 occasionally lead to more patient injuries, which eventually increase the need for even more treatment. Therefore, patients are forced to pay for extra costs to cover the added cost of treating their injuries. In the same way, the healthcare facilities also experience extended patient recovery time, thereby failing to attain their goals within the stipulated timeframe. This paper presents a project translation and planning report indicating the suggested solution for patient fall cases in healthcare facilities. Improvement of Goals, Outcomes and Measures One of the most common strategies to combat this problem is to encourage and monitor healthcare employees to ensure that they offer safe avenues for patients within the facility to eliminate any potential cause of patient accidents through falls. Also, leaders have a massive task of providing the necessary support to nurses and other physicians to manage the risks. The solution that can manage these situations is to establish encouraging and monitoring systems. Therefore, this change would be measured through observation on the improvement of healthcare providers and the services offered to patients. Moreover, it will be essential to determine medical staff effort in minimizing the effects of the two diseases. A reduction in the number of patients who fall and get injured within the facility would indicate the accomplishment of the eradication goal. The expected outcomes in this plan include: ? Healthcare leadership establishes efficient monitoring systems. ? The staff receives adequate medical incentives and equipment to demonstrate unequal effort. ? Health care practitioners provide excellent patient care and consideration. 3 ? Reduction in the number of patients who fall within the facility. The leadership effort will mainly depend on the team leader's efforts. The team leader should be stern and proactive in promoting the proposed monitoring approaches on the patientfalls reduction targeted strategies (Chigudu et al., 2018). Furthermore, the leader is also expected to request the entire health facility leadership system to support the staff with the necessary materials to perform their tasks efficiently. This will also enable the nurses and other practitioners to offer high-quality preventive measures to patients to avoid hazardous moments. The ultimate result would be a reduction in patients who fall and suffer injuries within the respective facilities. Actions The team leaders are supposed to assist by communicating the plan to the facility upper management. This will advise the top management on the appropriate monitoring systems that the facility should establish. It is the responsibility of the team leader to approach top management and ask for its support towards availing necessary equipment and measures to minimize patient falls (Heng et al., 2020). Also, the team members must collaborate with the specific divisions, thereby offering guidance to the nurses and doctors on the best way to achieve the goals. Through this action, the team should be in close communication with the monitoring department to ascertain the expected outcomes. The team members must decide on approaching the relevant stakeholders within and outside the facility. This activity would only require transport and tools costs as the only needed resources. Nonetheless, other logistics include the internet and phones to achieve effective communication. The expected and predetermined rough budget is $5000, which will cater for the 4 delivery services and the personnel, including treasures, three members, assistant leader and the team leader. The team would also require appropriate supplies when they are within the facilities. This equipment would provide effective communication and interactive processes with the hospitals' medical and nursing teams, thereby attaining the preset goals. Milestones and Risk Management Plan One of the milestones in this approach would be establishing a collaborative link between the team members and the stakeholders within the facility. Afterwards, the team must engage the top leaders concerning the work equipment provisions and the monitoring system. Also, the team would monitor the consequences and outcomes from the improved patient care. Finally, the team will record the improvement in the reduced number of patient accidents. These milestones will be measured weekly since the entire project would take one month. Furthermore, monitoring would ensure that each goal is successfully achieved through the efficient management of the available and allocated resources. The planning process must also have a practical risk management approach that focuses on measuring the hazards of each activity towards a goal (Huang et al., 2018). This approach would enable easy risk identification, enabling the team and the facility leaders to deliberate on the best risk management and reduction practices. Personnel Team leader Assistance team leader Treasurer 3 Members Total Source: Author (2021) Roles Advising and consulting the top management Deputizing the team leader Financial manager Consulting the various departments The amount required ($) 3000 200 300 1500 5000 5 Monitoring Progress The progress will be monitored through effective record keeping of all the activities. Every team member will be tasked with an activity each day to determine if the outcomes are attained. The members will also highlight within the record system to identify if they have attained their personal goals. This will be the best way to keep the team members on track, thereby tracing and correcting whenever they are off-track. Evidence-Based Model The Iowa EBP model is ideal in implementing the planning goal with the primary intention of managing and reducing patience falls and associated risks to patients. The main reason for selecting this model is its ability for research. Therefore, the team can use the model to research how to establish and enact the best way of managing patient falls in healthcare facilities. This approach hugely encourages the art of asking questions when implementing this specific medical solution (Duff et al., 2020). Similarly, the team can collect the necessary and required data and make applicable references using the Iowa EBP model. The main reason for using the Iowa EBP motel is to establish healthcare and patient care preferences to ensure that the two main stakeholders are comfortable managing patient falls within the facilities, thereby reducing the related risks. Evaluation The short-term outcome of this plan is to achieve an effective monitoring system. The long-term outcome would be to offer the necessary and required equipment that can effectively reduce the rising cases of patient falls and getting injured within the hospital. Therefore, these evaluations would focus on the high-quality services rendered by healthcare providers in 6 preventing the adverse effects arising from patient falls and accidents. Similarly, the team will also apply the relevant summative assessments to determine the number of reduced patient accident cases within the facility. Therefore, the data collected will be in line with the results from the implementation of the monitoring systems and approaches. Also, the evaluation will focus on the effectiveness of the allotted equipment provided to help prevent patient accidents through falls. Therefore, data will be collected by considering the reduced cases of facing patients within the facility; a significant reduction will indicate a positive effect of the solution. Lastly, the efficiency would also be determined to evaluate the success of the monitoring systems to reduce the number of cases of patient falls and accidents within the facility. 7 References Chigudu, S., Jasseh, M., d’Alessandro, U., Corrah, T., Demba, A., & Balen, J. (2018). The role of leadership in people-centred health systems: a sub-national study in The Gambia. Health Policy and Planning, 33(1), e14–e25. Duff, J., Cullen, L., Hanrahan, K., & Steelman, V. (2020). Determinants of an evidencebased practice environment: an interpretive description. Implementation Science Communications, 1(1). Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC Geriatrics, 20(1). Huang, C.-W., Iqbal, U., & Li, Y.-C. (Jack). (2018). Healthcare improvement measures in risk management and patient satisfaction. International Journal for Quality in Health Care, 30(1), 1–1. 1 Preventing Patient Falls during Hospital Stay Nursing 498 July 12, 2021 2 Preventing Patient Falls during Hospital Stay Problem Definition & Setting According to the WHO, falling is the act of coming to rest unintentionally on the floor, the ground, or on any other lower or flat level (WHO, 2021). Falls are devastating and common occurrences in hospital settings, particularly among elderly patients. They mainly occur in resident and patient rooms and bathrooms. Falls are very common among hospital inpatients, and they often result in serious injuries, including excessive bleeding, subdural hematomas, fractures, and even death. These injuries and others not mentioned here have also been associated with increased healthcare costs. For example, fall victims who sustain injuries spend more on medical care patients who don’t fall. Therefore, fall prevention in healthcare settings is an important public health and patient safety issue. The risk factors for falls during a hospital stay are not different from those identified in community and nursing home studies. These risk factors include sedatives, impaired balance, antipsychotics, altered mobility, visual impairment, dizziness, depression, impaired cognition, and many other factors (Najafpour et al., 2019). Some studies have also documented specific diagnoses and altered elimination patterns as risk factors. However, the risk factors for falling may differ from the risk factors associated with severe injuries. Studies in rehabilitation, longterm care, and community hospital settings have identified chronic conditions, the female gender, low body mass index, and multiple chronic conditions as the risk factors for injurious falls. Why I Chose this Problem I chose patient falls because it has been associated with a high number of unintentional injury deaths. According to the WHO (2021), about 684,000 people die annually from falls, with 3 over 80% being from middle and low-income families (WHO, 2021). The largest number of fatal falls are experienced among older adults aged 60 years and above. As stated above, hospital falls are serious public health and patient safety issues requiring urgent attention because everyone is at risk, regardless of their health, gender, or age. And while falls do not always result in an injury, there are instances when they result in head injury or fractured bones. Serious injuries can make it difficult for an individual to live independently, do everyday activities, or get around. Ethical, Legal, and Regulatory Concerns Patient falls are grounded on ethical, legal, and regulatory imperatives. Hospitals have an ethical duty to ensure the safety of their patients by putting measures in place to prevent injuries or damages from falls (Melin, 2018). Patients come to the hospital so that they can get better, not to get worse. When patients fall, they end up developing additional complications that may require additional costs to treat. As stated above, patients who get seriously injured due to falls end up incurring more healthcare costs than those who do not fall. Hospitals and the healthcare providers that work in those hospitals have an ethical and moral duty to ensure the safety of the patients in their care. While it might be common for patients to fall and suffer injuries during a hospital stay, there are instances when falls can constitute medical malpractices and lead to legal battles. For example, when patients fall due to unsafe conditions in the hospital or other hazards, the hospital in question can be sued for negligence or medical malpractice (Larkin et al., 2020). However, it all depends on what caused the fall and the circumstances that surround a fall. A hospital can be sued for negligence when patients who get injured suffer injuries due to falls in the hospital’s property, such as falling on a puddle of water under a leaky ceiling panel. The conditions for a fall to be considered medical malpractice can be complex, and one may require a lawyer. 4 The US healthcare industry is highly regulated, with many compliance measures, rules, and laws that healthcare providers and institutions are supposed to follow. From a regulatory perspective, one of the legislation that touches patient falls is the “Patient Safety and Quality Improvement Act” of 2005. The law facilitates the gathering of patient safety data. It creates an environment where healthcare providers can anonymously and privately send information about safety events in the facilities where they work. The act signifies the commitment of the federal government to promote patient safety in patient care settings. Strategies to address falls during Hospital Stay Identify Risk Factors - Communicate the degree of fall risk using special identifiers, such as traffic light symbols or colored signs (Victoria State Government, n.d.). - Educate medical staff, patients, and visitors about the meaning of the identifiers. Intentional Rounding - Take regular patient-check rounds to ensure they have everything they need (Victoria State Government, n.d.). Low-low Beds - Use low-low beds for at-risk patients Chair/Bed Alarms - Use chair or bed alarms for patients who require supervision to move about or those who do not wait for assistance Non-Slip Socks - Use non-slip socks to identify at-risk patients, then focus on prevention strategies Patients with Bone Disease 5 Patients with metastatic bone disease, previous fractures, or osteoporosis are at high risk. For these patients: - Ensure they wear hip protectors at all times - Low-low beds: raised during care or transfer activities, low when resting (Victoria State Government, n.d.). Patients with Bleeding Disorders - Use protective helmets - Low-low beds: raised during care or transfer activities, low when resting - Assess the benefits and risks of anticoagulant medications (Victoria State Government, n.d.). Educate Patients, Caregivers, and their Families . - Ask them about their perceptions of risk factors - Talk about their goals for staying in the hospitals - Talk about the things they can do to reduce risks. 6 References Larkin, C. J., Roumeliotis, A. G., Karras, C. L., Murthy, N. K., Karras, M. F., Tran, H. M., ... & Potts, M. B. (2020). Overview of medical malpractice in neurosurgery. Melin, C. M. (2018). Reducing falls in the inpatient hospital setting. International journal of evidence-based healthcare, 16(1), 25-31. Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk factors for falls in hospital inpatients: a prospective nested case control study. Victoria State Government (n.d.). Falls prevention in hospital. WHO (2021). Falls. 1 Enloe Medical Center: Preventing Patient Falls during Hospital Stay Nursing 498 July 18, 2021 Enloe Medical Center: Preventing Patient Falls during Hospital Stay Scope of the Problem 2 Patient safety should be a top priority in all healthcare institutions. Strong healthcare institutions should put measures to prevent potential harm to patients, their families, and medical staff. Unfortunately, some hospitals lack the leaders or teams to ensure that the priority of their patients is prioritized. As a result, such hospitals end up exposing their patients to a range of hazards, including falls. According to Radecki et al. (2018), patient falls are among the most adverse events in clinical settings. They can lead to increased healthcare costs, increased length of stay, and preventable harm. Patient falls can be very expensive, especially those that occur in adults aged 65 years and above. According to the CDC (2020), non-fatal fall injuries cost about $50 billion annually in terms of medical costs, while fatal injuries cost $754 billion. Medicare pays $29 billion each year towards non-fatal falls, Medicaid $9 billion, while out-of-pocket or private payers spend $12 billion (CDC, 2020). Falls injuries and associated costs are expected to grow because older persons in the United States also continue to grow. While most falls occur among older adults, they are also common among middle-aged individuals, younger adults, adolescents, and children. In recognition of the above facts, patient safety is a top priority at Enloe Medical Center. The hospital has put measures in place to achieve zero patient safety events. According to 20182019 global best hospital rankings, the hospital was ranked #34 in California (Enloe Medical Center, n.d.). The hospital’s caregivers are encouraged to public quality surveys and quality improvement initiatives. And judging from the satisfaction of patients that get treatment at the hospital, it is clear that the hospital is committed to both patient safety and quality care; the facility “has averaged at or above the top quartile since 2011.” These consistent results paint the organization’s culture as one that is patient - centered (Enloe Medical Center, n.d.). Applying Six Sigma to Patient Falls Prevention 3 One of the quality improvements tools that Enloe Medical Center can use to address patient falls is the six sigma. This tool works by preventing defects and variations (Antony et al., 2018). When used correctly, the tool can not only lead to increased revenue but also increase patient satisfaction. In healthcare, defects can lead to life and death situations. The hospital will benefit a lot by using the six sigma methodologies because it would eliminate those factors that lead to patient falls. Enloe Medical Center can follow the following steps to apply the six sigma tool to patient falls prevention: Problem Definition This should be the first step or phase, where the organization crafts a goal statement, a problem statement, customer requirements, a process map and a process map centred on fall prevention (Antony et al., 2018). Measure Current Processes After defining the problem, the organization should collect data on the performance of current measures to prevent falls and existing issues. The quality improvement team should ensure that the data they collect is reliable and up to date. They should also ensure to update the project charter whenever the need arises. Analyze Root Causes This is the point when the organization examines the factors that cause the current problem: patient falls. This is done by examining collected data and existing processes to determine the root causes (Antony et al., 2018). Any new information discovered at this phase is then used to update the project charter. Process Improvement 4 After the root causes or the factors leading to patient falls have been defined, the next step is to create solutions that would fix the problem. Process maps based on those new solutions are then created, and steps are taken to implement the new solutions and continually measure improvement. Control The control phase is continuous. It involves ongoing efforts to refine processes, implement them, and monitor their performance. Findings from elsewhere can also be used where possible to improve outcomes. There are many benefits that Enloe Medical Center will enjoy for using the six sigma, besides achieving a reduction in patient falls. For example, the example will be able to achieve costs savings. Patient falls constitute medical malpractice, and they can cost the hospital in terms of legal fees and compensation. But with an effective quality and safety improvement tool, such as the six sigma, the hospital will be able to safety conditions in the facility and avoid situations that would endanger patient safety (Antony et al., 2018). Conclusion The goal of this paper was to examine qualitative and quantitative information about patient falls and propose a quality improvement tool that Enloe Medical Center can use to improve patient safety. As stated above, patient safety should be a priority for hospitals and healthcare teams. Unfortunately, many some hospitals lack the resources, leaders and teams that would advocate for patient safety. As a healthcare issue, patient falls constitute a significant portion of adverse events in hospitals. The most vulnerable patient group are older adults, especially those aged 65 years and above. However, this is not to say that children, adolescents, young adults and middle-aged persons are not at risk. Whether fatal or non-fatal, injuries 5 resulting from falls cost the US healthcare system billions of dollars annually. However, with a quality improvement tool, such as the six sigma, Enloe Medical Center, and other healthcare facilities stand a chance to reduce or eliminate this health issue. References 6 Antony, J., Palsuk, P., Gupta, S., Mishra, D., & Barach, P. (2018). Six Sigma in healthcare: a systematic review of the literature. International Journal of Quality & Reliability Management. CDC (2020). Cost of Older Adult Falls. Enloe Medical Center (n.d.). About Us: Quality & Safety. Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient's perspective: a qualitative study. Applied Nursing Research, 43, 114-119. 1 Nursing 498 July 26, 2021 Study Appraisal 2 Article 1 i. Current Guidelines Patient safety is an important aspect of quality healthcare delivery. By reducing patient falls, there is a reduction of healthcare costs by considering minimizing, reporting, and analysis of incidents that may lead to adverse events. Among the elderly population, patient falls are a common occurrence. Through a literature review, Khalifa (2019) explores various strategies that can be engaged to reduce patient falls rate. Through the search, five key strategies are identified which include engaging patient and staff education by engaging various approaches and strategies to increase risk awareness and best practices. Using patient training and exercise is a key strategy to assist weak patients to gain body strength, improve their balance, and minimize the patient fall risk. Using diagnosis for patients with predisposed medical conditions which could lead to interference with vision and balance function is another key strategy. The environment of the hospital which includes the bed arrangement, floor structure, rail guards, and passageways is another key strategy. The use of information technology through monitoring and alarm devices and offering feedback on the fall and risk situation are key perspectives. ii. Proposed Interventions for the Problem Through the recommended solutions, the use of a program with multiple perspectives is important as a strategy for preventing patient falls in elderly populations. Khalifa (2019), finds that the identified strategies are cost-effective as compared to the adverse effects of patient falls which include extended hospital stays, and the development of complications. To this end, the implementation has to consider some key measures. The input measures such as fall incidents, characterization of falls, and circumstances. The process measures such as incident reporting and 3 usability, acceptance, and compliance. The outcome measures such as adverse patient fall events, fractures, delays in inpatient discharge and length of stay, estimation of patient fall costs, and measures of quality of life after falls. These measures offer the understanding of the best strategies to combine to reduce the rate of patient falls in hospitals. iii. Results in a Solution The strategy will offer a solution by developing sustainable ways by which patient care can engage the healthcare staff and the patients for collaboration. This collaborative effort can assist in better identification of risks and as such, solve the issue. Article 2 i. Current Guidelines The rate of patient falls is a key problem affecting healthcare across the globe. A common strategy for dealing with patient falls is the use of prevention strategies aimed at clinical education, modification of the environment, using assistive devices, engaging hospital systems, review of treatments (Heng et al., 2020). The role of patients in preventing hospital falls is an under-exploited area. As such, Heng et al. (2019), looks to explore the scope of patient fall education in hospital as a strategy used by hospitals to reduce patient falls. The use of patient education looks to increase the awareness of individual factors that increase the risk of patient falls and lead to the provision of strategies that look to mitigate falls in hospitals. Various levels of evidence for patient falls prevention education delivery modes. The key modes of education delivery include using video presentations, posters, handouts, using assistive devices such as bed alarms and sensors, and communication alerts. The use of face-to-face discussion on safe footwear and other interventions is a key aspect. Few studies have engaged an understanding of 4 prevention programs as an evaluation of educational components based on the educational theory. ii. Proposed Interventions The majority of the patient education programs have a focus on the provision of information to individuals on various risks of falls and the ways of preventing the falls. Some education programs have a focus on the risks of patient falls in the hospital setting while others engage at home and in-community strategies for reducing patient fall. The use of call bells for transfer, waiting for nurses to assist in movement, and encouraging the appropriate footwear and assistive walking devices are key topics engaged in patient fall education programs. iii. Result to a Solution This study offers key insights into solutions for preventing patient falls. There is an understanding of the importance of goal setting within patient education. This can assist in conclusive education. There is a need to engage patients in identifying their risks of falls. The use of the teach-back technique is a key strategy that can be used to understand the lessons. This approach can be used to evaluate the appropriate level of teaching and learning. There is a need to understand the gaps in knowledge and to motivate patients as a way of encouraging behavioral change to prevent patient falls. Article 3 i. Current Guidelines Melin (2018) uses the Iowa Model of Evidence-Based Practice (EBP) as a guide to a quality improvement project for reducing patient falls. The seven components of the Iowa EBP 5 are the key processes that are used to define the scope of the problem and the extent of dealing with the issue. Before the quality improvement project, the organization is investigated and found to have some existing policies for fall prevention that are available to all clinical personnel in the facility. The key element that is found missing is the lack of ongoing education on patient falls that was found to be missing the consistent use of bed and chair alarms for patients that are identified as having a high risk of falls. Before the quality improvement project, there are decisions engaged to activate bed and chair alarms based on the nurse's judgment. As a way of improving the consistency of using bed and chair alarms, the standardization process for initiating the alarms was established. ii. Proposed Intervention A patient that is identified as being at risk for patient fall using the Morse Fall Scale is assisted using the automatic activation of the bed and chair alarm. The patients that do not meet the criteria were judged by the nurse to determine the activation of the bed and chair alarm as required. The intervention was widely engaged and the nurses, assistants, secretaries, and nurse managers were educated on the intervention. The existing fall prevention programs were evaluated and staff re-educated on the fall prevention programs. One of the key elements was the focus on the use of the Morse Fall Risk assessment and the interventions to be implemented for the individuals identified to be at risk of falling. The education process had a focus on the utilization of self-assessment as part of the mental status part of the Morse Fall Risk screening tool. The staff was engaged in the quick response of the bed and chair alarms for better outcomes. iii. Result to a Solution 6 The strategy offers a key solution to the patient fall problem based on the results. The process improvement of detecting and responding to patient falls had a positive outcome. The preintervention patient fall rate per 1000 patient days was 8.67 and the average number of falls per month was 6. The postintervention results indicate 5.07 falls/1000 patient days and 3.33 patient falls per month. References 7 Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A-M., Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC Geriatrics, 20(140). Khalifa, M. (2019). Improving Patient Safety by Reducing Falls in Hospitals Among the Elderly: A Review of Successful Strategies. Studies in Health Technology and Informatics 262(1):340. DOI:10.3233/SHTI190088 Melin, C. M. (2018). Reducing falls in the inpatient hospital setting. International journal of evidence-based healthcare, 16(1), 25-31.