A fall refers to a sudden change in position of an individual’s body, either landing on an object situated below the initial position of the body or hitting the ground (Shumway-Cook et al., 2009). There are numerous causes of falls among elderly adults. The predisposing factors to falling include dementia, medications, poor vision, weak muscles and unsteady balance and gait. Other factors that may lead to falls include toilets or beds without handrails, floor cutter, poorly fitting shoes, loose rugs and poor lighting. In addition, medical conditions such as thyroid problem, brain disorders, poorly controlled epilepsy, poorly controlled diabetes, Meniere’s disease, Parkinson’s disease, arthritis, stroke and low-blood pressure increase the risk of falls among the elderly persons (Yamada et al., 2011). The present paper presents a project that was implemented to evaluate the effectiveness of hourly rounding and adequate response to call lights in preventing falls among elderly persons in long-term care (LTC) facilities.

Literature Review

Previous studies have shown that the elderly people living in LTC facilities are prone to fall (Shumway-Cook et al., 2009). Falls are a serious health risk for the elderly persons living in LTCs. The falls may lead to both small and severe injuries such as brain trauma, hip fractures and lacerations. Fractures resulting from falls often occur in the hand, upper arm, pelvis, ankle, arm, forearm, hip and spine. Such injuries may affect the ability of individuals to live independently. In some cases, severe falls may lead to early death (Naqvi, Lee & Fields, 2009). Some studies have shown that proper medication can help to reduce falls (Shumway-Cook et al., 2009). However, others have shown that medication is also a risk factor for falls, especially among elderly persons who take more than three medications in a day (Malafarina et al., 2012).

According to the Center for Disease Control and Intervention, a third of the elderly persons aged 65 and above in the US experience a severe fall each year. In 2011, approximately 2.4 million old persons were treated with injuries. Out of this number, 689,000 elderly persons had severe injuries. More than 10 percent of the injuries were caused by falls (Centers for Disease Control and Prevention, 2014). Further, recent statistics indicates that falls contribute significantly to the increased number of deaths of elderly persons recently. In 2010, for instance, approximately 21,700 old persons in the US succumbed to injuries resulting from unintentional falls. The data also indicated that men are more likely to succumb to injuries resulting from falls than women (Centers for Disease Control and Prevention, 2014). The cost of treating falls in the US is significantly high. In 2010, the direct medical cost for treating all injuries was $30 billion. If the current trend continues, the direct medical costs are projected to reach $67.7 billion by 2020. As such, falls are a serious problem that needs intervention (Centers for Disease Control and Prevention, 2014).

In the past, fall management programs have been implemented in LTCs to prevent falls. The findings indicate that many of the programs have managed to reduce the number of falls within the facilities. For instance, fall prevention program implemented by Kato, et al. (2008) that involved exercises helped to reduce falls among the elderly persons from 41.9 percent to 9.7 percent. The previous studies have also shown that multi-factorial interventions can also help to reduce falls especially among elderly persons with psycho-geriatric problem. As well, the implementation of the best practice guidelines in LTCs can help to reduce falls. However, the best practice can only be successful where there are administration and organizational support and adequate resources and planning (National Guideline Clearinghouse, 2009). Previous studies have also found hourly rounding as an effective strategy of reducing falls (Sherrod et al., 2012; Meade et al., 2006). However, Sherrod et al. (2012) noted that some caregivers oppose hourly rounding on the ground that it is not effective in reducing falls. In this regard, there is a need for more empirical research to determine whether hourly rounding is effective reducing the falls.

Project Description

The purpose of the project was to determine the effectiveness of the hourly rounding and adequate response to call light in reducing falls among the elderly persons in LTCs. The project was implemented at Andover Sub-acute and Rehabilitation Center Park. The project was implemented over a period of two months.

Methodology

Data collection methods

The study involved two steps. The first step involved reviewing previous literature in order to understand the causes, effects and prevalence of falls among elderly persons. Importantly, the literature review helped to determine the effectiveness of programs applied previously in reducing the falls. The literature review found the need for more research to determine the effectiveness of hourly rounding in reducing the falls. Primary data was collected from caregivers using the interview method. Interviews were conducted prior and after the implementation of the project. The interview schedule was designed to examine four main themes; attitude of the staff members towards hourly rounding, response to call light prior and after the implementation of the project and percentage of falls before and after the implementation of the project.

Research Design and Implementation

The implementation process involved two steps. The first involved establishing a baseline in order to ensure changes are effective. In particular, the first step involved selecting a team of individuals that would implement the program. The team included a nurse, physician, a physical therapist, a social worker and administrator. In addition, baseline data about historical trends, age and sex was gathered.

The second step involved implementation, through educating caregivers and other staff members within the facility. A summary of the details of the teaching program is described in the teaching plan. The main barrier expected during the implementation was resistance by the caregivers and staff to the change. However, it was expected that educating the staff members would help to reduce the resistance. In addition to educating the staff, a schedule table was placed next to the call light of every patient for the caregivers to fill after every response.

Data analysis

The data primary data collected was qualitative in nature, and thus, content analysis was applied to it. The information collected gave insights about whether there was a reduction in falls among the elderly persons after the implementation of the hourly rounding project.

Results

Prior to the implementation of the project, interviews were conducted on eleven caregivers and three staff members in the Andover Sub-acute and Rehabilitation Center Park. Six of the caregivers were females, and five were males. Two out of the three staff members were males, and one was a female. After the implementation of the project, interviews were conducted on twelve caregivers and three staff members. The demographic data for the staff members did not change, whereas the number of male caregivers increased to six. The data collected about the elderly persons indicated that there were 119 elderly persons (67 males and 52 females) prior to the implementation of the project. After the implementation of the project, two more male elderly persons had joined the facility. The age set for the elderly persons was 69-91 prior and after the implementation of the project.

Attitude of the Caregivers and Staff Members towards Hourly Rounding,

Prior to the implementation of the project, only five caregivers and two staff members believed that hourly rounding without failure to respond to call lights could help reduce falls among the elderly persons. After the implementation of the project, eleven caregivers and all the three staff members interviewed agreed that hourly rounding and adequate response to call lights can help to prevent the falls.

Response to the Call light

Prior to the implementation of the project, only three caregivers responded adequately to call lights from the elderly persons without failure. The rest often ignored the call light. The situation improved slowly after the initiation of the implementation process. During the last one month of implementation, 9 out of 12 caregivers responded adequately to the call light without failure.

The Fall Rate

Prior to the implementation of the project, 41 percent of the elderly persons had suffered injuries over the past two months resulting from falls. During the two months after the implementation of the project, the rate reduced to 22 percent.

Evaluation

Prior to the implementation of the project, we asked Mrs. Kelly Johnson, an experienced health instructor to evaluate the content and methodology of our project. She noted that our approach was a good and effective. She mentioned that the interview method would help to give a deep exploration of the study themes. However, she advised us to improve the content of the teaching plan by including the attitudes of the caregivers towards the study topic. We also asked the staff members and caregivers to evaluate the effectiveness of the project after the implementation period. 11 caregivers and three staff members who were interviewed indicated that the project was effective and that they were ready to continue implementing its recommendations in the future.

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