1. NU499 Capstone Project Kaplan University Lynette Gullion Professor Joan Haizlip December 13, 2011

2. Location: Silverdale, Washington Preceptor: Susan Hensley Identified Nursing Issue: The need for a fall risk assessment and intervention process in the urgent care treatment room.

3. Assessment PATIENT POPULATION IN TREATMENT ROOM: 65 years of age and older Multiple co-morbidities and/or disabilities Obese Non-compliant Wound care

4. The Problem 30% of community dwelling adults, aged 65 and older fall every year (Salminen, Vahlberg, Salonoja, Aarnio, & Kivela, 2009) Falls are the most common cause of injury in this group (Salminen, et al., 2009) 20% of these cases require medical assessment and intervention (Salminen, et al., 2009) Injurious falls in older adults leads to negative effects on lifestyle, quality of life and good health (Roe, Howell, Riniotis, Beech, Crome, & Ong, 2009).

5. Common Risk Factors for Falls Arthritis, diabetes Visual and hearing problems Unsteady gait or balance problems; use of assistive devices Decreased activity levels Effects of medications such as dizziness or sleepiness (Banez, Tully, Amaral, Kwan, Kung, Mak, Moghabghab, & Alibhai, 2008).

6. Implementation of a fall risk assessment and intervention policy for treatment room patients

7. Interventions Write and get approval for fall prevention policy Implement the Fall Risk Screen outpatient tool studied by Jack C. Montgomery VA Medical Center (Meader, Jones & Healsy, 2010)

8. Dissemination Staff meetings to include all necessary staff members Contact urgent care director to include providers in plan Emails sent to staff for reference EPIC classes arranged Super users Poster boards or hand held cheat sheets

9. Evaluation Evaluation of any intervention or process change is crucial in the nursing process Six month (or less if needed) evaluation of process - Are staff members using the tool consistently? -Collect pre and post policy implementation data regarding falls -Is the process appropriate for this facility (treatment room)? -Staff meetings to obtain staff input, positive or negative -Adjustments as needed and start all over again

10. References Banez, C., Tully, S., Amaral, L., Kwan, D., Kung, A., Mak, K., Moghabghab,R., & Alibhai, S. (2008). Development,implementation, and evaluation of an interprofessional falls prevention program forolder adults. Journal of the American Geriatrics Society, 56(8), 1549-55. Retrieved from http://search.ebscohost.com.lib.kaplan.edu/login.aspx?direct=true&db=rzh&AN http://search.ebscohost.com.lib.kaplan.edu/login.aspx?direct=true&db=rzh&AN =2010255505&site=ehost-live Roe, B., Howell, F., Riniotis, K., Beech, R., Crome, P.,& Ong, B. (2009). Older people and falls: Health status, quality of life, liefestyle, care networks, prevention and views on service use following a recent fall. Journal of Clinical Nursing, 18(16), 2261-2272. doi: 10.111/j.1365-2702.2008.02747.x Salminen, M., Vahlberg, T., Salonoja, M., Aarnio, P., & Kivel, S. (2009). Effect of a risk based multifactorial fall prevention program on the incidence of falls. Journal of the American Geriatrics Society, 57(4), 612-619. doi: 10.1111/j.1532-5415.2009.02176.x