Topic and objective

This presentation will be focusing on the two safety standard that is standard 6 which deals regarding the clinical handover and standard 10, dealing with fall prevention strategies in older adults.  

Clinical Handover describes strategies and schemes for an effective clinic communication whenever effective responsibility and answerability of a patient care had to be transferred (Flemming & Hübner, 2013). In many cases, the clinical setting might not contain advanced equipment or facilities that are required for a specific care approach or during the change in the shift a clinical handover is required following frame work, such that the patient gets a relevant, timely intervention or relive from the clinical condition (Pezzolasi et al., 2013).

Preventing falls and harm from the falls

This standard helps in chalking out the possible strategies to prevent falls and fall related injuries.

In order to meet up to standard 10, particular policies and protocols had to be maintained (Cameron et al., 2012). Records should be kept regarding the sentinel events regarding falls, thee data should be able to assess the severity and the frequency of the fall. Quality improvement strategies and risk management protocols have to be taken up for minimizing the falls and harm in patients.

There should be proper equipments and device in order to prevent falls and minimize harms. The patient s that is more prone to fall has to be identified personally and taken care off.

Who is the audience?

Royal Melbourne hospital.

Board of members:-

Chairman- Mr. Robert Doyle

Other members of the board: Mr. Eugene Arocca, Mrs. Jane Bell, Ms. Penelope Hutchinson, Ms Angela Jackson, Ms. Jennifer Kanis,  Prof Shitji Kapur, Mr. Gregory Tweedly. 

This presentation will be focusing on the two safety standard that is standard 6 which deals regarding the clinical handover and standard 10, dealing with fall prevention strategies in older adults.  We will be discussing a case study in the latter section and will critically analyze whether these two standards have been breached.

For maintaining standard 6

There are some criterions that have to be followed to prevent falls and harms from falling. They are-

1. Establishment and maintenance of the documented process for the clinical handover.

For maintaining standard 10

There are some criterions that have to be followed to prevent falls and harms from falling. They are-

1. Development and the implementation of a multifactorial palm for fall prevention and for addressing the risks in the assessment.
2. The patients prone to falls should be identifies and precautions has to be taken in order to reduce the chances of the fall prevention (Hempel et al., 2013).
3. The hospital staffs should be well informed regarding the chances of the fall.
4. Fall prevention strategies have to be developed by collaborating with the doctors and the caregivers.
5. A regular reviewing of the processes, adopting quality improvement strategies and acting on the events identified from the clinical handover.
6. Actions are taken to reduce the clinical handover incidents.

In order to discuss about the clinical standards and the violation of the clinical standards PowerPoint presentation has been opted as the best option to present the desired topic. 

Reasons for choosing PowerPoint presentation

• It allows to edit, create and show appealing presentations
• Colorful pictures and graphs should be given.
• The informations provided are always to the point and are easily understandable.
• The short sentences are easy to access.
• Adds elegance to the presentation
• They are most appropriate in describing clinical frameworks and the standards, as they are appealing with the vibrant templates and the colors.
• Details of the points can be provided in the speaker notes. 

Speaker notes: An 85 years older patient, who was living in an aged care facility of low standard, and has been admitted to the hospital with a chest infection and has been diagnosed with left lower lobe pneumonia. She was admitted to the hospital with a period of high temperature, chest congestion and shortness of breath. After being diagnosed with Pneumonia, she was administered with intravenous antibiotics, oxygen therapy and the nebulizers. While she was in the hospital under the supervision of the registered nurses, she had a fall from the bed and dislocated her hips.

Hypertension, Hypercholesterolemia, Osteoarthritis, COPD.

Clinical Handover

The given scenario provides us with the fact that the concerned patient had suffered a fall which had lead to the formation of laceration in the forehead. Her IV had been pulled out and she had also been incontinent of urine on the floor. She has dislocated her hips and has sustained an intracapsular fracture on her right neck of femur.

Thus it can be clearly seen that standard 10 had been breached in this case. The hospital staffs and the caregivers could not meet up to the nursing standard of conduct and could not provide proper safety care to the patient. It was clearly evident from the case study that over the night, the patient was calling out for her daughter. One of the nurses just attended her for a while and then again went back to attend other patients. It was also evident from the case study that the patient was shifted to a ward that was quite a distant away from the nurse’s staff room. Knowing that the patient is fall prone, the nurses could have arranged beds for her to their close proximity, so that they are easily available, when required. All these evidences show the breaching of standard 10 (Grol et al., 2013).  

In the given scenario, the registered nurses did not communicate properly among themselves and also with the family members regarding the fall of Betty in the hospital ward. It was evident from the case study that Betty was not administered medications timely. It was also known from the case study provided that Betty was not properly attended by the appointed nurses as she had suffered from a fall, due to the negligence of the staffs (Grol et al., 2013). Hereby it can be clearly seen that standard 6 is being breached in this case.

Candidates name

Categories for evaluation

1. Was the presentation relevant?

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2. Was the case scenario appropriate?

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3. Was the identification of the two standards that has been breached in the case scenario was right?

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4. Did the case scenario breach standard 6 and 10?

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5. The presentation provided excellent knowledge regarding the national standards of health?

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6. Was the literature review appropriate to the topic?

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7. Were the introduction and the conclusion of the literature review succinct?

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8. Did the presentation follow the reference criteria and the marking rubric?

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9. Were the literature reviews understandable? Did it cover all the criteria?

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10. Was the oral presentation appropriately delivered? Did it cover all the important points?

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11. Did the committee question the candidate to obtain a verbal defense of the research?

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12. Is safety approval required?

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13. Is human ethics approval required?

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14. Comments and recommendations:

There are certain barriers that to changes that can be made in clinical practice. A change is always needed for the betterment of a clinical setting. A single approach can never bring out positive outcomes in the patient health. There are several models of health care that can be implemented. This literature review would focus on the various hurdles that come in front of good changes. The literature review will also support the different measures that have to be taken to bring about the changes. Furthermore, it will also support how the barriers and the implementations would impact upon the interventions one wishes to take.

In the paper by (Grol et al. 2013) paper the author had systematically documented the barriers, implementations, comparators, components and the effectiveness of the fall prevention approaches. It has to be kept in mind that it becomes very difficult for the hospital staffs to bring about any changes in the clinical settings. They want to remain in the conventional procedures of the healthcare. The different barriers that can pose threat to the quality care are the time management, lack of clinical education, culture.

There are certain health care strategies that holds one back and fail to provide a clear cut call in action in order to change things from the bottom. Often the intellectual staffs do not have the freedom to create any change. This can leave many staffs demotivated and they can feel afraid of giving their opinion.

Preventing falls and harm from the falls

Lack of communication between the leaders and the normal staffs and the patients also prevents any desirable changes. This may be because of the lack of soft skills training or technical systems for supporting communication.

Another barrier to bring about better change in health care is poor workforce planning. Absence of right mix of skills in the team will lead to inefficient work planning.  This happens most of the times because the organization fails to nurture the staffs and make a right mix of the talents. Having rightly skilled people helps in the quality improvement plan making.

The next barrier is that the senior leaders are trapped in processes that are not flexible. People fails to embrace the methods of participating in low costs, low risk experiments to evaluate the different innovative ideas. Furthermore the poor project management and an inhibiting environment can stop communication and connecting ideas.

The over controlling leadership often does not allow any change in the organization. Despite of the efforts one has to still depend on the command and control leadership.

As per the studies it stated that, 81% identified time as a barrier to researching the articles for the patients to give education or information about evidence based practice (Farahnaz, Tania & Tannaz, 2017, pp. 187–199). Several studies proven that due to lack of education and time, staffs are unable to read research reports at work and to implement new ideas in care. The heavy workload is a major factor in the staff not being able to make time to read literature which could enhance the quality of care being provided. 

Numerous facilitators have been identified from the peer reviewed literatures. The facilitators included the managerial and the peer alliance and support, availability of the time to assess and implement the various research findings, availability of the relevant researches, training opportunities. (Miake-Lye, Hempel, Ganz & Shekelle, 2013).This paper is a systematic review regarding the strategies for the prevention of fall in patient as a safety strategy. Several reviews involving 19 studies suggest the multicomponent programs helps in preventing fall in adults. This review reassessed the pros and the cons of the fall prevention programs in the acute care settings. Harms have not been potentially identified, but the potential harms such as the use of the restraints, use of wrong drugs, decreasing efforts to mobilize the patients. Eleven studies have prove that leadership, involvement of the front line staffs in the program design , interventions of pilot testing, use of information technology for provision of data related to falls, staff education and training, are necessary to prevent falls in health care settings.

According to (Segall et al.,2012) Several other facilitators are there such as practice of the evidence based practice. Five electronic databases have been extensively searched and the author has gathered information’s regarding the fall prevention approaches in different health care settings. The risk ratio and the ratio of fall rate pre intervention are studied and it was found that practice of evidence based research had helped in decreasing the risk ratio. It has to be kept in mind that the in hospital falls are a noteworthy legal, clinical and regulatory problem.

Who is the audience?

As per (Segall et al.,2012) Fall prevention is complex and involves many facilitators like leadership, cooperation of the healthcare staffs. According to the study programs can require specific monitoring tactics in order to ensure that the staffs remain adhered to the proposed protocol. The staffs can be provided with suitable training regarding the role set up and the activities. This can be done with Self-completed questionnaire and semi-structured interviews with facilitators, practicing audit questionnaire, Thematic analysis, Descriptive statistics, Linear and random effects models.

(Melnyk et al. 2014) This paper is based a peer review of literatures supporting the importance of evidence based nursing research on fall prevention among the community dwindling older adults. It has already been widely accepted that evidence based practice improves the quality of the health care, reliability and the outcome of the patient.   Seven national EBP leaders chalked out an initial set of competencies for the RNs. Two rounds of Delphi survey was observed with 80 EBP mentors. Finally the paper recommends the steps of evidence based practice to prevent fall prevention- cultivation of the spirit of enquiry with an EBP environment. Asking of the PICOT question, searching from the evidence and the integration of the evidence with clinical expertise and finally evaluation of the outcomes of the evidence based change. A major facilitator is the imparting of education to the staffs.

(Segall et al., 2012) This paper is a systematic reviews of the literature which discuses about the handover of care starting from the operating room to the intensive care unit or in the general ward.  This paper had systematically reviewed and summarized the processes and the communications recommendations on the basis of the findings.  From about 500 papers, 31 papers have been identified for designing the shift handover. This paper had broadly supported a large number recommendation such as – usage of the protocols and the checklists, completion of the urgent clinical tasks before he shift handovers, patient centered discussions at the time of verbal handovers, requirement of the presence of all the relevant team members (Thomas et al., 2013). Association between sentinel events and poor quality of the handovers has also been identified. These are the facilitators of clinical change regarding the shift handover.

According to (Powell et al., 2012) efforts have been given to detect and develop the test strategies in order to publicize and execute the evidence based practice treatments for fall prevention. This article has brought about more profundity and clarity to execution research and practice by applying a combined compilation of distinct implementation approaches, supported by a review of 205 literary sources published between 1995 and 2011. The compilation includes 68 execution strategies that are classified into six important implementation processes that is planning, educating, financing, managing the quality improvement, and focusing on the policy. These strategies can be used as an example of facilitators by the stakeholders who wish to apply clinical innovations in health care and can assist the development of comprehensive, multilevel implementation plans for patient care.

Recommendations:

According to (Cameron et al., 2012) fall and fall related injuries often bring about morbidities and mortalities in clinical settings. The objective of this peer reviewed literature is to know about the effectiveness of the interventions designed to reduce falls and fall related injury in older patients. This review included 60 randomized controlled trials involving 60,345 participants. Forty-three trials (30,373 participants) were in care facilities, and 17 (29,972 participants) in hospitals. It was found that administration of Vitamin brought about reduction in fall, which might be due to the fact that the residents had low level of Vitamin D. additional physiotherapies also helped in reducing the number of falls in healthcare setting.

(Spoelstra et al., 2012) is a peer reviewed article that explains the different interventions that has to be a taken up in a hospital setting. 13 articles are reviewed that are based on the interventions that would prevent falls. Multifactorial measures which involved assessment of the risks of the falls. Alerts on fall risks, education to staffs regarding patient safety, patient specific medications and added aid to relocate and toileting demonstrate lessening in both falls and fall related injuries in hospitalized patients. Hospitals need to trim down falls by using multifactorial fall deterrence programs using evidence-based interventions to diminish falls and injuries in older adults.

 (Flemming & Hübner, 2013) It is an integrated literature review, where 45 articles have been taken to understand the aspects of the bedside clinical handover. It was recognized that there are a number of clinical handover mnemonic accessible that provide structure to the process and factors such as confidentiality, insertion of the patient and involvement of the multidisciplinary team remain relevant issues for health care experts in executing excellent clinical handover practices.

According to (Thomas et al., 2013) Transitions in patients, which may be due to the shift change over or due to the transfer of the patient, have been detected as the substantial susceptibility from the viewpoint of the quality and proper health care delivery. In 2006 WHO have proposed a proper shift handover as one of the main factor for preventing any catastrophic event.

The objective of the paper by Pezzolesi et al., 2012 is to develop and test a handover performance tool, which can help the clinicians to assess the quality and safety of the sift handovers systematically. This study consists of a mixture of different methods. A review of literature and a Delphi process has been conducted in order to get an idea about how team work, communication and leadership can bring about changes in the clinical setting. The study was conducted in the paedriatics, gynecology ward and changes were monitored and noted.  The work force communication and the team work were found to be directly proportional to the patient outcomes.

Finally it can be concluded that although the there are many barriers that may delay the process of improvement in the clinical settings , but the above mentioned interventions or the acilitators can bring about better outcomes in terms of health care.

References

Cameron, I. D., Gillespie, L. D., Robertson, M. C., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2012). Interventions for preventing falls in older people in care facilities and hospitals. The Cochrane Library. DOI: 10.1002/14651858.CD005465.pub3

Flemming, D., & Hübner, U. (2013). How to improve change of shift handovers and collaborative grounding and what role does the electronic patient record system play? Results of a systematic literature review. International journal of medical informatics, 82(7), 580-592. DOI: 10.1111/jocn.12706

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care: the implementation of change in health care. John Wiley & Sons. Pg. 59-70

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., … & Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494. DOI: 10.1111/jgs.12169

Melnyk, B. M., Gallagher?Ford, L., Long, L. E., & Fineout?Overholt, E. (2014). The establishment of evidence?based practice competencies for practicing registered nurses and advanced practice nurses in real?world clinical settings: proficiencies to improve healthcare quality, reliability, patient outcomes, and costs. Worldviews on Evidence?Based Nursing, 11(1), 5-15. DOI: 10.1111/wvn.12021

Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient Fall Prevention Programs as a Patient Safety StrategyA Systematic Review. Annals of internal medicine, 158(5_Part_2), 390-396.

Pezzolesi, C., Manser, T., Schifano, F., Kostrzewski, A., Pickles, J., Warren, I., & Dhillon, S. (2012). Human factors in clinical handover: development and testing of a ‘handover performance tool’for doctors’ shift handovers. International journal for quality in health care, 25(1), 58-65. https://doi.org/10.1093/intqhc/mzs076

Powell, B. J., McMillen, J. C., Proctor, E. K., Carpenter, C. R., Griffey, R. T., Bunger, A. C., … & York, J. L. (2012). A compilation of strategies for implementing clinical innovations in health and mental health. Medical care research and review, 69(2), 123-157.  December 26, 2011

Segall, N., Bonifacio, A. S., Schroeder, R. A., Barbeito, A., Rogers, D., Thornlow, D. K., … & Mark, J. B. (2012). Can we make postoperative patient handovers safer? A systematic review of the literature. Anesthesia & Analgesia, 115(1), 102-115. doi: 10.1213/ANE.0b013e318253af4b

Spoelstra, S. L., Given, B. A., & Given, C. W. (2012). Fall prevention in hospitals: an integrative review. Clinical nursing research, 21(1), 92-112. August 23, 2011 

Standard, Q. I. G. (2012). Australian Commission on Safety and Quality in Health Care. Retrieved from https://www.safetyandquality.gov.au/wp-content/uploads/2012/10/Standard4_Oct_2012_WEB.pdf

Thomas, M. J., Schultz, T. J., Hannaford, N., & Runciman, W. B. (2013). Failures in transition: learning from incidents relating to clinical handover in acute care. Journal for Healthcare Quality, 35(3), 49-56. DOI: 10.1111/j.1945-1474.2011.00189.x