Program evaluation is an important part of leadership, especially in the clinical arena. You will be identifying and evaluating a formal program. There are examples of various programs that can be subject to a formal program evaluation in the class text. Reflecting on your practice area (current or former), identify a program to evaluate. Please identify a clinically based program with some kind of patient outcome. Examples include a cardiac rehabilitation program, falls prevention program, vaccination program, or even a graduate nurse residency program if the outcomes can be tied to patient safety. You will want to choose a program that is narrow enough in scope to be easily evaluated but not so narrow it is not considered a program. For the chosen program, discuss the following:
Describe the program and its purpose.
Who are the key stakeholders with whom you would need to communicate?
What program evaluation methods would you use to gather information to include in the evaluation? Keep overall outcomes in mind when selecting types of information to gather.

Falls Prevention Program Evaluation in the Long-Term Skilled Rehabilitation Facility

Falls in long-term skilled rehabilitation centers is a major patient safety concern. This is because in these facilities it is elderly frail patients who are taken care of. According to Guirguis-Blake et al. (2018), patients who are 65 years old and above are at an increased risk of accidental falls that may cause them to suffer life-threatening injuries such as concussions, fractures, intracerebral hemorrhage, bruises, and other internal injuries. Unfortunately, payers such as the Centers for Medicare and Medicaid Services (CMS) view falls as preventable sentinel events that should not occur and so they do not reimburse for services rendered to falls victims since 2008 (Fehlberg et al., 2017). This means that it is the facility or the provider that has to foot the bill for the care given to falls patients. Thus falls are a quality improvement issue that must be prevented. The national benchmark for falls in the United States is 3.44 falls per 1,000 patient stays (Venema et al., 2019). The purpose of this paper is to evaluate a falls prevention program in a long-term skilled rehabilitation facility.

The Program and Its Purpose

The falls program in this case was started with the purpose of reducing the rising falls rate that had reached 4.1 falls per 1,000 patient stays. This was already above the national benchmark and was threatening to place the organization’s reputation in jeopardy. The number of elderly residents at the skilled facility who were suffering accidental falls was rising and the possibility of litigation for negligence was also becoming real by the day. This would also cost the facility money in terms of compensation for damages awarded by the courts.  Falls Prevention Program Evaluation in the Long-Term Skilled Rehabilitation Facility Essay Paper

The program involved the strict application of evidence-based interventions for fall prevention. These were adopted after a thorough clinical inquiry process that led to the discovery of evidence in support of a bundled approach of three main interventions (Melnyk & Fineout-Overholt, 2019). These are:

1. The training and education of the nurses working at the skilled care facility on how to identify the patients who are at risk of falls and what to do to prevent the falls. This intervention also included educating the patients also on the risk of falls.
2. The conducting of purposeful hourly rounding by the nurses in every shift to identify and forestall the risk of falls through troubleshooting.

• The use of intelligent bedside alarms that would warn the nurses every time a patient attempted to get out of bed without assistance (Guirguis-Blake et al., 2018).

The Key Stakeholders to Communicate With

In carrying out the above program and evaluating its effectiveness and progress, the key stakeholders to communicate with are the nurses, the patients, the relatives of the patients, and the nurse leaders. The patients are the main stakeholders and communication with them would be paramount so that they become aware that they are at risk of suffering potentially life-threatening falls. In order for this communication to be fruitful, it would be important to assess the cognitive functions of each patient on a case to case basis. The reason for this is that many of the patients in the skilled care facility are quite elderly as already mentioned above. Most elderly patients have several comorbidities including neurocognitive disorders such as dementia and Alzheimer’s disease that reduce their cognitive abilities. In such cases, educating the patient or communicating with them about the falls risk may not achieve much. These are the patients who will be seen often wandering aimlessly about and risking to slip and fall or fall from stairs while lost. They therefore require round the clock monitoring from the nurses and nurse aides.

The nurses are the other set of stakeholders with which one has to communicate when evaluating the falls prevention program. They are the ones tasked with implementing the evidence-based measures mentioned above that will prevent falls. One has to make sure they know how to assess the risk of falls and what to do in the event that they identify a resident at risk of falls. How well they are informed and knowledgeable about this will give an indication of how successful the falls prevention program is.

The relatives of the patients are the other stakeholders to be communicated with. This communication will seek to find out whether they are aware that their patient is a fall risk. If they do, it would also be beneficial to know if they are aware that the skilled care facility has a program for preventing falls. Their knowledge of the program and support for it will indicate that the program is a success and that it is achieving the objective for which it was started. Lastly but not least are the nurse leaders who are also important stakeholders representing the skilled facility’s administration. The communication with them will focus on finding out what measures they have put in place to ensure that the evidence-based bundled interventions to prevent falls are carried out consistently and correctly.

Program Evaluation Methods Used to Gather Information for the Evaluation

The program evaluation methods used to gather information for the evaluation include calculating the falls rate every month to compare with the baseline of 4.1 falls per 1,000 patient stays, documenting the morbidity and mortality rates that would be attributable directly to accidental falls every month, and carrying out a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey every month to find out the levels of patient satisfaction with the services (including falls prevention measures) at the skilled care facility.

Conclusion

Falls are an ever-present risk for elderly frail patients especially in skilled long term care facilities for rehabilitation. Luckily, there are a number of evidence-based falls prevention measures and strategies that can be used to prevent falls. These can be implemented in an orderly program in the skilled care facility and the program’s effectiveness evaluated at specific times.

References

Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036

Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962

Melnyk, B.M., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice, 4^th ed. Wolters Kluwer.

Venema, D.M., Skinner, A.M., Nailon, R., Conley, D., High, R., & Jones, K.J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19(348), 1-10. https://doi.org/10.1186/s12877-019-1368-8

Falls Prevention Program Evaluation in the Long-Term Skilled Rehabilitation Facility Essay Paper