Factors preventing the successful implementation of a Fall Prevention Programme (FPP) in an acute care hospital setting in Abu Dhabi, United Arab Emirates

Haripersad, Vasanthee (Stellenbosch : University of Stellenbosch, 2011-03)

Thesis

ENGLISH ABSTRACT: The Joint Commission International Accreditation (JCIA) has included a patient safety goal as part of the standards for the accreditation of hospitals. Goal number six states the need to “reduce the risk of patient harm resulting from falls”. An acute care hospital setting in Abu Dhabi, United Arab Emirates had implemented a multifaceted, multidisciplinary fall prevention programme (FPP) in preparation for accreditation by the JCIA. The achievement of the above goal is dependent on compliance with JCIA standard requirements and the hospital’s FPP. This study was undertaken to identify the factors preventing the successful implementation of the existing FPP in an acute care setting. The FPP is recognised to be in its development stages and therefore has opportunities for improvement for better patient safety outcomes, more so by reducing the incidence of falls and the severity of injuries from falls. Literature studies by Gowdy and Godfrey (2003:365) and Hathaway, Walsh, Lacey and Saenger (2001:172) suggests that the most successful approach to reducing falls and the severity of injuries from falls among patients in an acute care setting is that of a multifaceted, multidisciplinary approach. The nurses, who were primarily responsible for completing the initial fall risk assessment, expressed feelings of being overwhelmed by more safety standards being required for the JCIA. Patients with a high risk for falls were not referred to the physicians and physical therapists, nor were they referred to the clinical pharmacists for the review of high-risk medications. In addition, fall risk assessments were sometimes not done in the afternoon and during the night shift. The existing programme also did not consider bedbound, long-term patients, who require less frequent assessment. There furthermore was observer evidence to suggest that the existing FPP was not being implemented correctly. The aim of this study was to describe factors preventing the successful implementation of the existing FPP. The objectives were to identify areas being implemented successfully, to identify any barriers to successful implementation and to identify aspects of the existing FPP that may need revision. A quantitative descriptive approach was applied. The population was healthcare providers (HCPs), including both registered and practical nurses, physicians, physical therapists and pharmacists, working in an acute care setting in the United Arab Emirates. The respondents were 118 (86%) from a stratified sample of n = 137 (20%) from 684 HCPs. A specifically developed structured questionnaire was used for data collection. Reliability and validity were assured through the use of experts in questionnaire design and statistical consulting, in addition to pre-testing of the questionnaire. Ethical approval was obtained from the University of Stellenbosch Committee for Human Research and the Ethics Committee of the hospital where the study was undertaken. The respondents’ completion of the questionnaire served as voluntary consent to participate. The data were analysed and are presented in frequency tables. The mean and standard deviation were used for the statistical analysis. Correlational analyses were not done because of the descriptive approach to the study. It was considered most practical to focus on the professional groups and not on the variables, as the initial analysis indicated weak correlations. The results show those aspects of the FPP that were successfully implemented and those areas that need improvement if the JCIA requirements are to be met. Policy revision to include a clearly defined referral process for the high-risk patients, in addition to consistency of the environmental safety rounds and greater involvement and support of the unit managers/supervisors, will contribute to the greater success of the FPP. The hallmark of a successful FPP is staff education, which should be the key step in addressing the identified barriers. The human need for safety and the patient’s right to safe care and a safe environment must be integrated into staff orientation, and education and safety training programmes for all HCPs. Increased compliance may occur when HCPs are more aware of the hospital’s commitment to the patient’s right to safety. Compliance with JCIA standards and the FPP will contribute in the achievement of the accreditation.

AFRIKAANSE OPSOMMING: Die Joint Commission International Accreditation (JCIA) het ’n pasiëntveiligheidsdoelwit as deel van die standaarde vir die akkreditasie van hospitale ingesluit. Doelwit nommer ses lui: “verminder die risiko vir leed aan die pasiënt as gevolg van val”. ’n Akute sorg hospitaal in die Verenigde Arabiese Emirate het ’n veelvuldig gefasetteerde, multidissiplinêre program vir die voorkoming van val (fall prevention programme (FPP)) geïmplementeer ter voorbereiding vir akkreditasie deur die JCIA. Die bereiking van bogenoemde doelwit is afhanklik van nakoming van die standaardvereistes van die JCIA en die hospitaal se FPP. Hierdie studie is onderneem om die faktore wat die suksesvolle implementering van die bestaande FPP in die akute sorg omgewing verhinder, te identifiseer. Daar word erken dat die FPP nog in die ontwikkelingstadium is en dat daar dus geleenthede vir beter pasiëntveiligheidsuitkomstes is, veral deur die aantal valvoorvalle en die erns van beserings as gevolg van val te verminder. Literatuurstudies deur Gowdy en Godfrey (2003:365) en Hathaway, Walsh, Lacey en Saenger (2001:172) stel voor dat die suksesvolste benadering tot die vermindering van val en die erns van die gevolglike beserings onder pasiënte in ’n akute sorg omgewing ’n veelvuldig gefasetteerde, multidissiplinêre benadering behels. Verpleërs, wat die primêre verantwoordelikheid vir die voltooiing van die aanvanklike assessering van die risiko vir val het, het daarop gewys dat hulle oorweldig voel deur bykomende veiligheidstandaarde wat vir die JCIA vereis word. Pasiënte met ’n hoë risiko vir val is nie na die geneeshere en fisiese terapeute verwys nie, en ook nie na die kliniese aptekers vir die beoordeling van hoë-risiko medikasie nie. Assessering van die risiko vir val is soms ook nie in die middag en tydens die nagskof gedoen nie. Die bestaande program het ook nie bedlêende, langtermyn pasiënte wat minder gereelde assessering benodig, oorweeg nie. Daar is verder ook waargeneem dat die bestaande FPP nie korrek geïmplementeer word nie. Die doel van hierdie studie was om die faktore te beskryf wat die suksesvolle implementering van die bestaande FPP verhoed. Die doelwitte was om areas wat suksesvol geïmplementeer word, te identifiseer, sowel as hindernisse tot suksesvolle implementering en aspekte van die bestaande FPP wat hersiening benodig. ’n Kwantitatiewe beskrywende benadering is gebruik. Die populasie was gesondheidsorgverskaffers, insluitend beide geregistreerde en praktiese verpleërs, geneeshere, fisiese terapeute en aptekers wat in ’n akute sorg omgewing in die Verenigde Arabiese Emirate werk. Daar war 118 (86%) respondente uit ’n gestratifiseerde steekproef van n = 137 (20%) uit 684 gesondheidsorgverskaffers. ’n Spesiaal ontwikkelde, gestruktureerde vraelys is vir dataversameling gebruik. Betroubaarheid en geldigheid is verseker deur die gebruik van kundiges in vraelysontwerp en statistiese raadgewing, sowel as die vooraftoetsing van die vraelys. Etiese goedkeuring is van die Universiteit Stellenbosch se Komitee vir Menslike Navorsing, en die Etiekkomitee van die hospitaal waar die studie onderneem is, verkry. Die voltooiing van die vraelys deur die respondente het gedien as vrywillige toestemming om deel te neem. Die data is geanaliseer en in frekwensietabelle voorgesit. Die gemiddelde en standaardafwyking is vir die statistiese analises gebruik. Korrelasie-analises is as gevolg van die beskrywende benadering nie onderneem nie. Daar is besluit dat die mees praktiese benadering sou wees om op die professionele groeperinge te fokus en nie op die veranderlikes nie, aangesien die aanvanklike analise swak korrelasies aangedui het. Die resultate identifiseer daardie aspekte van die FPP wat die suksesvolste geïmplementeer is, sowel as dié gebiede wat verbetering benodig om aan die JCIA-vereistes te voldoen. Faktore wat sal bydra tot die groter sukses van die FPP is beleidshersiening wat ’n duidelik bepaalde verwysingsproses vir hoë-risiko pasiënte insluit, sowel as konsekwentheid in die omgewingsveiligheidsrondtes, en meer betrokkenheid en ondersteuning deur die eenheidsbestuurders/toesighouers Die waarmerk van ’n suksesvolle FPP is personeelopvoeding, wat die belangrikste stap in die aanspreek van die geïdentifiseerde hindernisse moet wees. Die menslike behoefte aan veiligheid en die pasiënt se reg op veilige sorg en ’n veilige omgewing moet in personeeloriëntering, personeelopvoeding- en veiligheidsopleidingsprogramme vir alle gesondheidsorgverskaffers ingesluit word. Verhoogde nakoming sou moontlik plaasvind indien gesondheidsorgverskaffers meer bewus was van die hospitaal se verbintenis tot die pasiënt se reg op veiligheid. Nakoming van JCIA-standaarde en die FPP sal bydra tot die verkryging van die akkreditasie.

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