STEADI Implementation Plan Sample Paper
Older adult falls have been a leading cause of injuries and deaths in the United States (Stevens et al. (2017). Ironically, fall present as one of the major reasons why older adults ae 65 year and above are admitted to hospital, and they fall in the hospitals too. Accordingly, the American and British Geriatrics Societies practice guidelines recommend individualized fall prevention measures to prevent falls among older adults (The American Geriatrics Society, 2011). Hospitals need to implement fall prevention measures by integrating them into their care systems. However, as per Shaw et al. (2021), healthcare providers report that they have inadequate knowledge on fall prevention, neither are they aware of clinical fall risk assessment procedures. Research by Thomas et al. (2019) also highlighted that some providers do not spend enough time with patients.
To address these safety implementation barriers, scientists at the US Centre for Disease Control and Prevention (CDC) developed an evidence-based Stopping Elderly Accidents, Death, and Injuries (STEADI) intervention (Lohman et al., 2017), which has largely been described to be based on Wagner’s Chronic Care Model (Nguyen et al., 2021) and largely depends on input from healthcare providers. This essay discusses the implementation plan for the STEADI project proposal.
The Care Setting
The United Health Services (UHS) is a healthcare center in Broome County and a regional non-profit healthcare institution that serves the local community. The hospital has more than 500 physicians with 29 primary care centers spread across Tioga, Broome, Delaware and Chenango counties. The project will be integrated into UHS already existing fall prevention programs (In Balance, Stepping On, and Tai Chi) in the elderly care department, which is also the unit of project implementation.
Integrating STEADI into the Unit’s Electronic Health Record (EHR) System
A major step in implementing STEADI will be to integrate its components into the unit’s existing clinical workflow and make any necessary modifications on the HER. These integration efforts will be supported by a team of 2 nurses, 2 physicians, and 3 clinical office staff, one of them being a clinical health supervisor. Under the leadership of a change champion, the team will identify any necessary workflow changes to ensure that all the clinical staff within the unit could incorporate STEADI into their daily office visits.
The team will also work with the hospital’s IT department to integrate STEADI into the HER system. However, to ensure effective use of STEADI, a few fall risk questions will be added to the nursing staff’s current patient admission forms, which then will be automatically become part of the recurring questions asked when admitting any patient into the unit.
STEADI Training
The project will also include a training session for all clinical staff and their supervisors. At the core of the training program is to personalize the clinical issue of patient falls. By asking the trainees about their friends and relatives who have experienced fall episodes and the injuries or deaths that occurred from those episodes, the trainers, the trainees will be keen to understand the magnitude of the issue.
The trainers will also present evidence-based data on the high incidence of fall cases both locally and internationally. This will be followed by a presentation by the trainers on how to conduct a fall risk assessment as well as how to notify a patient that they are at risk of falling. Final, the trainees will be educated on the fall prevention resources available within the unit and how the clinicians can access them. The training will be delivered within one session, and then a member of the UHS nursing administration will follow up with the unit staff to answer questions and discuss any issues arising.
Screening
Through the EHR module, the unit nurses will be required to screen all patients of age 65 years and older for any fall risk. The screening will also evaluate whether the individual had experienced two or more fall within the past one year, whether they had experienced at least one fall over the past one year with an injury, whether they had experienced at least 1 fall in the past year with balance or gait problems, whether they had any gait or balance problems, or whether they were presenting with an acute fall. Any patient who tests positive in the screening phase would proceed to another evaluation, where a nurse would the patient’s balance or gait using the Timed Up and Go (TUG) screening tool (de Oca et al., 2021). the individual’s TUG results will then be recorded on the HER.
As part of the STEADI intervention, the older adults and their caregivers will receive educational materials. Patients who test positive on TUG will receive several informational brochures including What You Can Do to Prevent Falls, Home Safety Checklist, and a Check for Safety reading materials, all retrieved from CDC’s website. The nurse will also be required to check all the boxes in the HER confirming that the patient received the materials.
Also, for patients who test positive, the nurse will be required to forward a Fall prevention referral form to the physician for completion during the medical examination. The form will contain various fall prevention strategies including medication management and review, referral to physical therapy, vitamin D supplements, community fall prevention program or an occupational therapy program.
Medical Assessment
The second stage of the STEADI implementation process will be a medical assessment by a physician based on the earlier screening results, medical condition and TUG test outcomes. Physicians will be encouraged to make a habit of asking their patients why they think they are at risk of falling. Physicians will also be encouraged to monitor how patients walk and then based on earlier assessment results, they will develop a care plan that includes various fall prevention interventions such as referral to physical therapy, vitamin D supplements, community fall prevention program or occupational therapy program.
Upon examining the patient and addressing their issues of fall risk, the physician will then develop a care plan while checking off the recommended interventions on the Fall Prevention Referral Form earlier forwarded to them by the nurse. They will also mark the fall prevention referral as ‘done’ on the EHR.
A care coordinator will then scan the referral forms before adding them to patients’ charts. They will also be responsible for scheduling appointments, providing educational materials and conducting patient follow-up. STEADI guidelines require that the patient is followed-up every 30 days after the beginning of the care plan.
Change Implementation
Incorporating the STEADI intervention into the unit practices will change the way both nurses and physicians operate, which is difficult, while the STEADI intervention will involve minor changes, the implementation champion will need to do a few things to ensure that the change is successfully implemented. For instance, the champion will ensure that all the nurses understand their roles in implementing the STEADI intervention, why those roles are important and have the necessary tools to execute those roles. This will be taken care of by the earlier-mentioned training.
The champion will also need to reduce resistance by ensuring that the staff understand the need for STEADI intervention, and then agree to the fact that change is needed. To help the staff accept the setoff changes that accompany STEADI, the staff must understand that STEADI contributes to quality care delivery and such quality care is the supervisor’s main agenda.
More importantly, the champion will need to identify and eliminate all practical barriers to the STEADI intervention, including lack of computer hardware and software. For instance, the champion will need to ensure that the HER system is updated before integrating the STEADI system into it. Lastly, the champion should engage the staff at all levels to gain their buy-in so that they can tailor their practices to enhance fall prevention
Monitoring the Implementation Progress
The implementation team, with the change champion’s leadership, will develop an ongoing monitoring and evaluation system to ensure that STEADI is effectively implemented. Part of the monitoring process will involve gathering feedback from clinicians and other staff through questionnaires (qualitative design), which are then discussed by the change team for further action. Furthermore, the monitoring process should include the monitoring of key quantitative metrics such as a change in the number of falls. These metrics should be communicated to the staff by the implementation team to create an information loop whereby the implementation team reports to the unit on what they did to effect the change.
References
- de Oca, M. K. M., Reid, H., Spinosa, D., Watson, C., & McNally, L. (2021). Perioperative risk stratification using the timed up and go test. Gynecologic Oncology, 162, S234.
- Lohman, M. C., Crow, R. S., DiMilia, P. R., Nicklett, E. J., Bruce, M. L., & Batsis, J. A. (2017). Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample. J Epidemiol Community Health, 71(12), 1191-1197. http://dx.doi.org/10.1136/jech-2017-209769
- Nguyen, K. H., Fields, J. D., Cemballi, A. G., Desai, R., Gopalan, A., Cruz, T., & Lyles, C. R. (2021). The role of community-based organizations in improving chronic care for safety-net populations. The Journal of the American Board of Family Medicine, 34(4), 698-708. DOI: https://doi.org/10.3122/jabfm.2021.04.200591
- Shaw, L., Kiegaldie, D., & Morris, M. (2021). Educating health professionals to implement evidence-based fall screening in hospitals. Nurse Education Today, 101, 104874. https://doi.org/10.1016/j.nedt.2021.104874
- Stevens, J. A., Smith, M. L., Parker, E. M., Jiang, L., & Floyd, F. D. (2017). Implementing a Clinically Based Fall Prevention Program. American journal of lifestyle medicine, 14(1), 71–77. https://doi.org/10.1177/1559827617716085
- Thomas, E., Battaglia, G., Patti, A., Brusa, J., Leonardi, V., Palma, A., & Bellafiore, M. (2019). Physical activity programs for balance and fall prevention in elderly. Medicine, 98(27), e16218. https://doi.org/10.1097/md.0000000000016218
- The American Geriatrics Society. (2011). AGS/BGS Clinical Practice Guideline: prevention of falls in older persons. Accessed 14th November from http://www.alabmed.com/uploadfile/2014/0504/20140504033204923.pdf. www.americangeriatrics.org/education/prevention_of_falls.shtml