Clinical Governance And Practice Improvement For Falls Prevention
Falls prevention is the type of actions taken to reduce the amount of accidental falls that are suffered by the aged people. Injuries related to falls are the most common and serious medical problems that are experienced by the aged population. It is evident that annually, the incidence of falls among the older population is one-third and half of them are known to fall more than once (Haines et al. 2014, pp.136-144). The Australian Commission of Safety and Quality in Healthcare has taken quite a number of national initiatives for reducing the incidences of falls and prevention of the associated harm. It has been recognized by the commission that falls are the largest harm-causing incident in the country for healthcare and is a national priority for quality and safety, as it is responsible for the fifth common cause of death in the older adults (Safetyandquality.gov.au 2016)Clinical Governance And Practice Improvement For Falls Prevention.
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Resources have been developed for reducing the incidence of falls that are experienced by the aged people and the associated harm endured. In 75% of the cases of hip fracture, the overall health deteriorates as the recovery is incomplete. According to WHO, about 28-35% of the aged population over the age of 65 years is becoming prone to falls by 32-42% every year and it is increasing worldwide. The average cost per fall in Australia per year is AUS$ 6500 and this causes serious repercussions on the lives of the friends and families of the patient as well (World Health Organization 2016). Several government bodies in Australia provide online support for management and prevention of falls for the carers, general practitioners, health professionals and the public. From these aspects, it can be stated that fall prevention is an important issue of healthcare that has to be considered and this assignment will explore the issue through relevant literature. The assignment will critique the searched articles and summarize the findings and synthesize them by the application of a critical appraisal tool.
A summary table has been framed for succinctly and accurately summarizing the relevant information from the searched research articles and represents the various parameters of critical analysis. The summary table has been provided below Clinical Governance And Practice Improvement For Falls Prevention.
Table 1: Research Articles Summary Table
| Article No. | Author Details | Aims / Purpose | Sample / Setting
Or Role of the Key Stakeholders |
Design / Methods
Or Type of Paper |
Main Findings
Or Primary Argument |
Strengths and Limitations of the Paper |
| 1. | Haas and Haines (2014, pp.283-292) Australia | Examination of the impact and acceptability on the sustained participation in the activities of falls prevention of a combined education and exercise falls prevention program | 23 participants were recruited for the study out of which, 12 participated in the home programs and 11 participated in the group programs | For this qualitative study, semi-structured telephone interview was used for data collection | The reported benefits of the program of falls prevention included balance and mobility, improvements in the flexibility of joints and enjoyment was derived from the socialization and exercises | Strengths: Few key areas were identified that were found to be supportive of the future falls prevention program. Limitations: The multi-dimensional program for falls prevention was not sufficient to bring about the long-term change in health behavior. Cultural needs were ignored |
| 2. | Stephenson et al. (2015, p.113) Australia | Assessment of the practices of falls prevention in the hospitals of Australia and implementation of promotion for promotion of the best practices | One clinical leader from every hospital and nine acute care hospitals were selected from Australia | For this quantitative study, conducted audits for data collection | Feedback and clinical audit were found to be an effective strategy for promoting quality improvement in the practices of falls prevention in the settings of acute hospitals | Strength: Utilization of the audit criteria that was evidence based demonstrated quality improvement in the practices of fall prevention. Limitation: The specific and common factors responsible for the fall rates variation were not identified and some of the references were as old as 1998. |
| 3. | Church et al. (2012, pp.241-248) Australia | Evaluation of the cost-effectiveness of the strategies that are designed for preventing falls among the aged people | The samples for the study were general, high-risk and specific population of the aged community-dwelling Australians | For this qualitative study, data was collected from various sources like published literature and government reports | The incremental cost-effective ratios for the various interventions were determined and Tai Chi was found to be the most effective intervention for fall prevention | Strength: Cost effective interventions were designed that were effective for falls prevention among the older adults. Limitations: Uncertainty exists regarding certain parameters of the model and the ethical consideration was ignored |
| 4. | Johansson et al. (2015, p.153) Sweden | Evaluation of the effectiveness of a client – centered and multi – disciplinary fall prevention program on the autonomy and experiences of participation in the everyday occupations of the older adults who are community dwellers | The study participants were 131 older adults who were above the age of 65 years from 9 different areas of primary care in Stockholm | For this quantitative study, two instruments were used that were IPA-S and OGQ | Autonomy and perceived participation seemed to be subjective experiences and varied according to the individual | Strengths: The study offered an initial examination for the impact of an intervention of fall prevention. Limitation: The impact of the prevention program was not measured |
| 5. | Khong et al. (2015, p.1) Australia | Exploration of the perspective of the peer educators regarding their role in delivering the education on peer-led falls prevention for the older adults who are community dwellers | The study sample included older adults who were community dwellers in the metropolitan areas of Perth, Western Australia. | Data collection for this qualitative study was done by focus group interviews | Peer educators are able to deliver the education for falls prevention to the older adults. This influences the acceptance of the message as peer to peer connection for facilitating optimal engagement | Strength: This study provided the knowledge about adult learning principles and the feedback for the delivery of the presentations of falls prevention. Limitation: The large-scale evaluation was not carried out for determining the effectiveness of the approach n peer education for the falls prevention |
For critiquing the literature, CASP (Critical Appraisal Tools Program) tool was used for enquiring the study validity, investigation of the results and determination of the usefulness and relevance. The tool was implemented for appraising the articles and determining which was the rigorous and accurate study method and design (Nadelson & Nadelson 2014, pp.344-346). According to the study conducted by Haas and Haines (2014, pp.283-292), the study design was qualitative and the method implemented was making a move program which was an initiative for falls prevention including an educational and exercise program. The study conducted by Stephenson et al. (2015, p.113) was a quantitative study that was based on the intervention of patient and staff education. The study conducted by Church et al. (2012, pp.241-248) was qualitative and the applied method was Markov model of intervention which has been designed to prevent falls whereas the study conducted by Johansson et al. (2015, p.153) was a quantitative study and the falls prevention program was implemented that was client centered and multi disciplinary Clinical Governance And Practice Improvement For Falls Prevention.
The study conducted by Khong et al. (2015, p.1) was qualitative and the applied method was a two-stage constant comparative design. All these studies had different designs and methodologies for falls prevention among older adults. The study conducted by Stephenson et al. was limited to the patients of the hospital and did not consider the broader aspect of the community in fall prevention. The study conducted by Church et al. was a better attempt to provide cost effective fall preventions strategies but all the parameters were not appropriately verified for its implementation in the community. The study conducted by Haas and Haines had a small study sample which was not enough to determine the change in behavior in the entire community dwellers of older adults. The study conducted by Johansson et al. was individual dependant and the subjective experiences were found to vary. Therefore, the objective and subjective experiences were not measured which is essential for determining the efficacy of the program. Finally, the study conducted by Khong et al. was found to be the most rigorous of all as the peer educators are considered to possess the potential for effective delivery of the fall prevention education among the older adults of the community in two stages. The researchers conducted a thorough background study and found that 26% of the older adults receiving peer education on fall prevention have exhibited significant reduction in their falling risks. Some of the studies even revealed that after the uptake of actions for falls prevention, there was no significant reduction in the falls. The authors identified a gap in the relationship and role of the peer educators and their associated coordinating organization. Therefore, the authors took up the study for exploring the perspectives of a peer educators group regarding their role in delivering education on falls prevention that are peer led for the community dwelling adults. This study had the intention of preventing falls which was much interactive when compared to other studies as it involved peer led education Clinical Governance And Practice Improvement For Falls Prevention.
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Study findings from the study of Stephenson et al. there was no differences which were statistically significant between the various settings which revealed that the fall rates remained unchanged despite the practice improvements whereas the study of Haas and Haines found that the participation and completion of the falls prevention program were inconsistent. The findings of the study by Johansson et al. stated that no statistical differences were observed between the two groups and the subjective experiences had limited effects whereas the study by Church et al. found that Tai Chi was the most cost-effective intervention for falls prevention. The findings from the study by Khong et al. stated that the development of an optimal peer connection is essential for educating the audience, considering the various factors. Therefore, on a comparative note, it can be said that the studies by Church et al. and Khong et al. had the findings that can be implemented in an effective and cost-effective manner in the community for falls prevention Clinical Governance And Practice Improvement For Falls Prevention