Clinical Governance and its Seven Pillars
Clinical governance is one of the most effective practice frameworks that can be used in the health care scenario to enhance the clinical safety of the care services that are being provided to patients and maintain the continuous improvement of the overall care services (Vordenberg et al. 2018). This systematic framework holds the each and every care provider accountable and responsible for the safety and efficacy of the care activities they are engaging in. This project has aimed to reduce the rate of falls in the health care facility by improving the awareness and knowledge of the bedside nurses regarding the fall prevention policies and practices, the project relates to a number of pillars of the clinical governance (Van Zwanenberg and Edwards 2018).
There are 7 pillars of clinical governance, which relates to different interconnected aspects of improvement of the clinical care services. The seven pillars of clinical governance in practice, they are clinical performance and evaluation, clinical risk management, patient experience and involvement or consumer value, resource effectiveness, communication, strategic effectiveness, and professional development and management. Among the seven pillars, there are four pillars or principles of clinical governance which relates intricately with the care services that are being provided to the health care professionals. First and foremost, the first pillar of clinical effectiveness and performance is associated with the implementing evidence based practice to ensure providing safe and effective care services to the patients (Vordenberg et al. 2018). This project aims to build on the knowledge and expertise among the nurses regarding fall prevention in the facility with respect to interventions that are derived from the best practice evidence available. Along with that, it has to be mentioned that health care associated falls are linked with many adversities and can even lead to fatal consequences for the critical care units. Hence, falls and the related injuries are a very important clinical risk which this project is aiming to address (Vlaeyen et al. 2017).
Similarly the pillar of professional development and management is the pillar which addresses the need for education and training among the existing staff. In this case as well, the intervention being proposed in this case refers to the training and educating the nurses regarding the fall prevention policies and practices, hence, the project is addressing the third pillar effectively as well. Lastly, the fourth and final pillar that the project is addressing is the consumer voice. Elaborating further, the project will involve the interventions that are going to be implemented in the health care facility will also incorporate the consumer representatives to ensure their perception, wishes and grievances is taken into consideration regarding the implementation of the interventions (Van Zwanenberg and Edwards 2018). Hence, overall, it can be easily stated that the project that has been designed follows these 4 essential pillars of clinical governance effectively.
Evidence That the Issue/Problem is Worth Solving
Among the different health risks that cause a massive influx in thee mortality rates of the older adults or critically ill patients, falls account for a major portion of the clinical risk (Coppedge, Conner and Se 2016). The impact of a fall is multifactorial, the falls that the patients in the health acre facility not just leads to injuries, pain and suffering, but it also affects the emotional and psychosocial wellbeing of the patients altering the sense of safety and security while staying in the facility (Dykes et al. 2017). Hence, the impact of falls encompasses both physical and emotional wellbeing of the patients, and undoubtedly it is one of the greatest public health priorities for the health care professionals worldwide.
Discussing the prevalence and predominance of falls in the health care environment, falls has become a major contributor to the mortality and morbidity in the health care environment (Vlaeyen et al. 2015). Considering the data from the South Australia, in the year of 2017, the rate of hospitalization admission due to fall and related injuries had been 22576 people and among the alarming number of people, 400 had been dead due to fall related injuries (Aihw.gov.au 2018). As derived from the statistical data that had been gathered, there had been 34000 incidents of fall that had occurred in the health care facility which complicated the disease, enhanced the number of days of hospice care and also added to the cost of hospital based care. Hence, the fall and fall related injuries has become a grave concern, especially for the elderly patients and critically ill patients with mobility restrictions. Hence, the topic of concern for this project is relevant, and addresses one of the most impactful aspects associated with patient safety in the health care environment after health care associated infections (Matarese et al. 2015).
The first internal stakeholder that is needed to be discussed in the context of fall prevention is the nurses elderly and critical care unit. Nurses are the primary point of contact for the patients and they carry out the most of the patient care as well. Hence, the most important stakeholder for this case will be nurses of the elderly or critical care units.
The nurse manager will be the leader of the intervention program, and will be supervising the entire program completion. The compliance of the selected staff and smooth operation of the educational intervention sessions will be monitored by the nurse manager.
Nursing Workforce
The consumer voice will be the representative of the patients and their family members and will be sharing their set of recommendations and suggestions along with any grievances or wishes.
The safety risk coordinator will monitor that the educational intervention is not affecting the patient safety in the ward selected and whether the care services or programs are going smoothly.
CPI stands for clinical practice improvement which is a systematic project framework which can be easily employed to the care scenario to improve the current status of the care services or to minimize the incidence of any clinical risk (Taylor et al. 2014). Elaborating more, the CPI project can be defined as the framework that is utilized in planning, implementing and evaluating any change that has been introduced to the health care scenario. The CPI project format helps in introducing a format of continuous improvement cycle which is maintained throughout and can be integrated in the care practices of the facility on a large scale basis. The CPI project requires the implementation of any CPI tool which will help in the implementation of the project that has been designed. The CPI tool helps in the designing and successfully implementing the change into the target group successfully. In this case thee chosen CPI tool for this project is the PDSA cycle. PDSA cycle stands for Plan-do-study-act cycle which is also one of the most renowned change implementation tools used in the health care environment. There are various benefits to using this cycle. First and foremost, the most important aspect for a pilot project is timely completion and minimal resource usage. In this case as well, the project will involve only 30 bedside nurses practicing in either elderly care units or critical care units. Hence, using the PDSA cycle will ensure that the project is completed in a timely manner utilizing as minimal resource as possible. Along with that, as mentioned by Rodda et al. (2017), the utilization of the PDSA cycle as a change implementation tool, also helps in better staff management, optimal resource utilization and also facilitating better teamwork approach to achieve better outcomes in the project. Hence, we have chosen the PDSA cycle as the choice of CPI tool for the project.
The first phase of the PDSA cycle is planning and will take the first and second month of the project. The preliminary step will be preparatory and will involve extensive research to gather data from the research that has been published in the past. The research will incorporate the incidences of falls, the contributing factors to falls, the innovative techniques for fall prevention, and the knowledge and awareness in the nurses regarding these techniques. Based on the research training and educational content will be prepared, which will contain both recent fall prevention policies and fall prevention practices such as fall prevention bundles, use of Morse fall scale, fall signage, and patient/family fall teaching contract (Pfortmueller, Lindner and Exadaktylos 2014). The training will be given by head intensive care nurses, nurse managers and leaders along with lead physiotherapists.
Consumer Voice
Do: The next phase is actual implementation of the intervention which will take up 5 months of the total allotted time of the project. In this case, the intervention will be designed in a twice a month pattern. The 30 bedside nurses from two wards, aged care ward and intensive care ward, randomly. The training will be provided after shifts so that the patient care is not affected in any manner. Each session will be of 45 minutes and after each activity the nurses will be given informative pamphlets for future reference. A demonstrative workshop of using Morse fall scale and fall signage will be conducted every two months during the project to help the nurses get a clear idea regarding the fall prevention.
Study:
The outcome measurement will be done by calculating the rate of falls in the units and comparing it with the rate before commencement of the CPI project. The nurse manager will also monitor the compliance rate of the nurses that have participated in the training to the different fall prevention guideline on the patients. The patient perception and feedback will also be shared by the consumer representative at the end of the project.
Act:
The last stage of the project will be action which will be based on the data that has been gathered and the analysts will check whether the fall rate in the selected wards has reduced as expected from the aims and objectives of the assignment. Based on the data, the verdict will be decided that this pilot project should be replicated on a large scale or ceased.
The most important intervention to be provided to the bedside nurses that has been selected from both the wards will be the education and training on the fall prevention bundle. The educational session will be an interactive presentation, and the content of the presentation will be fall prevention policies, why and how falls occur, its impact, fall prevention techniques, fall risk assessment using Morse fall scale, usage of fall signage and other interventions.
The participants will also be given informative pamphlets to keep a track of everything that is being taught to them so that they can keep using these resources to rekindle their knowledge in the future.
The next step of the intervention will be integrative tests or open question answer sessions to analyse the extent of improved understanding which will be conducted after each two months of intervention session. The participant nurses will be given the opportunity to improve the gaps left behind after the test results in a form of one to one doubt clearance sessions.
Safety Risk Coordinator
Lastly, the education and training committee will also arrange two demonstrative seminar workshops where each participants will be given the opportunity to practice whatever is being taught to the nurses and apply the theoretical knowledge. The demonstrative workshop will be supervised by the nurse manager and the head RN. This sessions will be simulation activities allowing the nurses to implement their learnings in the controlled and supervised environment.
There will be many challenges that the project will encounter while implementing the project in the facility. First and foremost, staffing issue will be the most fundamental challenge. Due to the alarming nurse to patient ratio in the aged and critical care units, the project might require additional staffing or it might jeopardize the patient care (Rodda et al. 2017).
The next most important challenge will be limited resource such as time, money and training resources. The lack of willing trainers to educate the participant nurses can also be a notable challenge
Along with that, the last challenge disinterest among the selected nurse and resistance to change implementation due to emotional and physical exhaustion, burnout and extra of aged and critical care units.
Other possible barriers to successful accomplishment of the project includes Change champions, feedback, comparative data, and lack of flexible organizational culture in the facility (Rodda et al. 2017).
The project will be evaluated using a variety of parameters to ensure that the intervention solution being proposed is relevant and optimized. The most notable parameters will be audits, such as chart audits and evaluation audits which will measure the rate of fall incidents in the unit every month and compare the data with the fall rates in the previous months. At the end of the 6 months, the collective data will be pooled and gathered to arrive at the exact rate of reduction after the completion of the project. If the collected data addresses all of the best practice criteria successfully such as stakeholder involvement, timely completion, clinical governance, risk minimization, and relevance and authenticity, the project will be considered successful and worth being replicated on a large scale.
References:
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CPI Tool: PDSA Cycle
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