Background

The main objective is to provide personalized care to the patients who have been hospitalized. The nursing staff, clinicians, doctors and other health care professionals should provide individual attention and deliver health care services to the patients. It involves putting patients and their family members in the centre that would lead to better outcomes. The health care staff should respect the individual choice, culture, values and traditions of patients and should provide proper treatment to manage their health condition. They should be explained about the precautionary measures to be taken after the treatment and regular follow-ups should be conducted after the surgery. The two safety standards researched in thiscase are that the patients admitted in the ward should be hospitalized close to the workstation of nursing staff and there should be appropriate level of co-ordination between the hospital staff and the family members of the patients. They should make sure that the patients feel comfortable and safe (Hoeve, Jansen & Roodbol, 2014).

But in the case of Mrs. Betty White, she was admitted in a 4 bed ward which was far from the workstation of the nursing staff. This deteriorated the condition of her health and the nursing staff was unaware about the same. It would have resulted in drastic health issues if the fellow patient of her who was admitted in the same ward had not called the nurses in the workstation. The hospital staff did not contact Mrs. Betty’s daughter when her health condition got worsened.

The main objective of The Patient Safety & Quality Committee in a health care organization is to provide an excellent patient experience to all its patients.They keep a check on the nurses and other hospital staff to make sure that they are performing their roles and responsibilities in an efficient manner. There are several members in a Safety & Quality Committee in a health care organisation such as Chief Quality and Patient Safety Officer, Chief Operating Officer,Chief Medical Officer, Chief Clinical Officer, Chief Health Equity Officer, other representatives from population ,GME trainees, nurses, doctors, clinicians who are dedicated to provide quality care to their patients.

There are a few points to be conveyed to the audience to make sure that the patients who visit any health care organization for a treatment are provided a personalized and quality care. Various initiatives and strategies should be taken in order to promote flexible health care services to the patients andproper analysis of the symptoms of a health condition should be done to avoid any adverse ill effects.The health care staff should be well trained to handle different types of patients and must make sure that the health services are accessible to all the patients (Levett-Jones & Bourgeois, 2015). There should be no discrimination among patients on the basis of caste, religion, gender and socioeconomic status. They should be provided proper information about the treatment and the health issue and self-management support from the nurses and the doctors.

The format I would like to choose for this case study is power point as it increases the visual impact and improves the concentration of the audience. Power point presentations involve interaction between the presentator and the audience and also promotes interest in learning different things(Chiarella & White, 2013).

Barriers to Change in Clinical Practice

The method I would like to choose in order to evaluate that the message has been received and understood by the audience that is the safety committee is by using paper survey. A paper survey involves questionnaires with a few options that should be answered by the audience. I have chosen this method because of the reason that many individuals who find themselves quite uncomfortable in face to face discussion with the presentator (Levett-Jones & Bourgeois, 2015).They are unable to answer in a proper manner due to nervousness but can write their feed back if asked through a set of questionnaires.

Studies conducted by researchers over the years have shown that balance exercises and functional strength are helpful in reducing the risk of fall in senior citizens. It is also noticed by different researchers that the repetitive nature of these exercises remains intricately associated with the inherent lack of progress.  This discourages the seniors from exercising at home, thereby proving it ineffective. Different journal articles are thereby providing evidences that that multimodal games and visual feedback are two new methods that can be helpful. They provide successful results in encouraging adherence to home rehabilitation in comparison to standard care; this promotes independence and also improves the quality of life in older adults who remain at higher risk of falling (Blegen et al., 2012). An effective ‘handoff’ for risk of fall can be helpful in providing quality information of seamless care.  This may involve communicating written information from one caregiver to another so that important information of the patient’s current condition as well as care or service needs are accurately communicated).  SBAR is an effective tool which can be used for communicating between health care team mates. This can contain information about a patient’s or resident’s fall risk status .This will also contain the plan of care decided for the patient. SBAR stands for:

Situation: current risk status of the patient

Background:  clinical background of the patient is noted or fall risk factors need to be identified

 Assessment: current situation of the patient is identified or current risk condition ad different fall precautions are also assessed

 Recommendation:  current care plan

Feedbacks can also be obtained from the patient as his or her view regarding the experience during the treatment and the possible loop holes which could be met diligently so that no incidence due to fall occurs

The incidence of fall in different health care centers are found to have been noted for about thrice in comparison to that in the community which equals to rates of about 1.5 to 1.4 falls per bed in one particular year.. The newly acquired risk factors associated with various forms  of falls in the hospital settings (which may be due to hip fracture as well as stroke) and also the factor of unfamiliar surroundings – all may lead to an increased number of falls risk. In stroke rehabilitation wards, it is found that 25% to 46% of patients have faced fall at a minimum of one occasion during the time of their admission. It was reported that an incidence of 6.2 falls have been accounted for about per person in one annum in the department and reabilation of  psycho geriatry (Noe et al., 2015). There is significant mortality and morbidity which remains associated with falls in nursing care facilities and hospitals.  Different statistical studies have shown that different healthcare centres have huge faced huge number of falls which may account to about 70 in 1000 patients in a year. They also report long bone fractures in 35 patients very 1000 persons and head injuries are also reported to be about 214 per 1000 persons in case of women and 433 in 1000 perosn in case of men (Sherrington et al., 2014). Rates of hip fractures occurring due to falls in different nursing health care facilities have been calculated to have reached a number of about 10.5 times higher in comparison to that of the community which accounts to 42% of all hip fractures. Old aged  people who have been seen to suffer from hip fracture during their stay in hospitals have resulted in poor outcomes when comparisons were done with age matched controls who are experiencing same fractures in the community (Dinç & Gastmans, 2013). One of the causes is identified in few cases of visual impairment that may result due to presence of cataract.

Facilitators to Change in Clinical Practice

Majority of falls mainly take place as a result of a number of different combinations of factors acting at a particular time of every fall event. Different researches have shown that various strategies can be applied for preventing falls which are exercise, education, environmental modifications, vitamin D supplementation,and medication optimisation. Many of trials that have been taken at large levels have been mainly based on two particular steps (Hemepel et al., 2013). These are depended on risk assessments of different patients, and then directing those risk factors to prevent the falls in future. Taxonomy has been developed which can help in describing and classifying the types of intervention (Colvin et al., 2013). The objectives include the presence of the best evidence of effective programmes that is developed for reduction of the cases of falls in old patients in hospitals and nursing care facilities (Occonnor et al., 2016).

Interventions in hospitals and nursing care facilities should be strategized in such a way which would help in decreasing the cases of falls

Steps should be taken which would help in targeting a higher number of risk factors should be implemented in comparison to those which would be targeting a particular risk factors.

Strategies should be planned in the nursing care facilities and hospitals. This stragies woud mainly include those of longer duration as well as of higher intensity in comparison to those which are of short duration as well as of low intensity (Rashid et al., 2013).

Strategies which are taken for a patient centered approach targeting different sorts of risk factors and different impairments of older people will be more effective in comparison to those interventions that are allocated as a ‘standard package’ (Alligood, 2013).

The ultimate goal of the healthcare systems should be the promotion of health and wellness by providing physical and emotional support to individuals. Patients should be provided rehabilitation after the treatment and the surgical procedure as it will help in improving the their psychosocial health (Pelt et al., 2014). They should made comfortable so that they can share all the issues they are facing with the  counselor The hospital staff should provide  proper training and  information during  the discharge of patients.

We defined “nursing care facilities participants” as individuals who are actually residents of establishments being engaged in providing rehabilitation services as well as residential nursing. These healthcare centres have a permanent core staff of registered or licensed practical nurses who work along with their team members provide quality person centred care. Two divisions are done due the nursing care facilities. This includes two types of care. One is high level nursing care. The second type of care is intermediate level nursing care. The former one can be explained as centres which deliver health-related care and services to patients who do not require a high intensity of care as those provided by nurses of hospitals and similar others. They mainly required care and services above home care because of their physical or mental condition which cannot be handled by family members (Memstoudis et al., 2014).

Impact of Barriers and Facilitators on Implementing Changes in Clinical Practice

Authors have explained “hospital participants” as patients who is getting care in-patient wards. They did not include emergency departments, and also not any hospital services were provided in community settings. They also did not include outpatient departments which are colloquially described as “hospital in the home”. Subdivisions of the hospitals were done into those which are specialised for providing acute care and those who are delivering subacute care. This care has been explained as medical as well as also skilled nursing services. This is provided to patients who are not suffering acute phase of an illness. They are mainly applied to those who are in need of  level of care higher  in comparison to that which has been  provided in a long-term care setting.

The authors had only incorporated trials that consist of reported raw data or statistics. All the information have been found to be related with the rate or number of falls. They are also found to be related with the number of participants who have sustanied at least one fall. Trials also have found out that number of participants who have fallen more than once.. Trials which depicted specific types of fall like injurious falls were not taken in consideration. Trials that depicted intermediate outcomes like  improvement in balance and strength but could not find out any report falls asa result of an outcome were taken in exclusion category (Katsikitis et al., 2013).

Primary outcomes-

Fall can be defined as the frequency of falls that may be exemplified as rate of fall per person

Fallers can be meant as the number of people who are experiencing the fall

Secondary outcomes-

Severity of falls which may include different categories like fall number causing injury)

Complications of the interventions.

The concerned case study also shows in the view of the above literature survey that the nursing staffs had dereliction after administering the concerned patient with medicine as the medicinal effect might could have caused fall which could be easily inferred by the trained nursing staffs.

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