Healthcare

Respond to classmates post below. Use sources 5 years or less.

“The Agency for Healthcare Research and Quality (AHRQ), is the lead federal agency which advises on and educates improving safety and quality of our healthcare system (about, 2021). AHRQ develops the knowledge , tools and data needed to improve the healthcare system and help consumers, professionals and policy makers make evidence based health decisions

 

At my facility we have identified an issue with a group of residents and frequent falls. The residents are range in age from 65 to 103; average age is 86 years old. Majority of the residents are female and have multiple comorbidies. The Director of Resident Services in conjunction with our full time, onsite physician has implemented several different programs and strategies to reduce falls, but there remains a consistent and persistent number of the same residents with continued falling. There is also lack of consistency and completeness in staff reporting of falls. 

 

In the research article Improving Staff Reports of Falls in Assisted Living (Silva-Smith et al., 2013), studied data reported by staff on incident reports in 34 instances. Identification of multiple fallers, total of 34 fall involving 15 residents, with a median age of 84. The need for accurate data reporting of fall characteristics, use of assistive device and medications that are considered high risk were analyzed. Also identified by Silva-Smith et al., (2013) was the omission of these certain criteria in the incident reports. These omissions can lead to decreased health outcomes and an inability for the patient centered team to appropriately address the fall (Silva-Smith et al., 2013).

Medication use in the reported 34 incidents had contributing factors, in particular high risk medication. Benzodiazepines given within the preceding 24 hours to the fall may also be a factor. Deprescribing benzodiazepines allows the prescriber to reduce the dose of medication under a supervised process. This process is also has a goal to reduce medication burden and harm, while maintaining and even improving quality of life (Pottie et al., 2018). Other high risk medications that were administered daily, such as psychotropic, diuretics and cardiac and their side-effects were assumed contributory to residents falling (Silva-Smith et al., 2013). The physician at the facility does a medication review after a fall and every 180 days, this is consistent with AHRQs evidence based guidelines for fall prevention.

 

Silva Smith et als (2013) research directly related to the clinical problem identified at my facility. The suggestions identified and the heightened awareness about staff knowledge and training are crucial to the reduction of falls, using evidence based clinical practice guidelines. Understanding of high risk behavior, either around use or non-use of assistive devices and consumption of high risk medications is essential to staff training. This heightened awareness will allow for better reporting and essentially in better health outcomes.

Falls are prevalent in older adults and frequently have serious consequences including injury, hospitalization, reduced mobility and independence, and increased health-care costs. A broad range of risk factors predispose older adults to falling, including underlying medical conditions, balance and gait instability, polypharmacy, and environmental hazards. The development of a multifactorial fall risk assessment including fall history, physical exam, gait and balance evaluation, and environmental assessment will be developed under my capstone for older adults who live in the facility for an evaluation with multiple falls and identified balance and gait problems. Evidence-based fall risk screening tools will be developed for the community to aid in fall risk evaluations (DeCarlo & Bradley, 2019).