Final Assignment for PHE5PDE 2019

Final Assignment for PHE5PDE 2019

Background – Problems identifiedHigh mortality, morbidity and costs associated with falls amongst high care residents across 6 residential facilities with a total of 360 high care places. All of these 6 residential facilities are part of one large aged care organisation (Organisation A).

Each year, the 6 facilities have about 540 falls. The falls result in:

• 10 fractured necks of femur (NoFs), 8 Colles fractures, 20 head injuries. The incidents result in
  • about 65 hospitalisations, and
  • 3 residents with #NoFs died within 12 months of the injury;
• 350 hours of additional nursing and monitoring
• Total cost of $700,000 per year

A fall prevention program “Hip Fracture Prevention” has been designed to reduce the morbidity, mortality and costs associated with falls

Assignment Background – Program Details

Aim the program

To reduce morbidity, mortality and costs associated with falls amongst residents in 6 residential facilities in Organisation A.

The program has two phases:

• Preparation and implementation of project – 12 months
• Ongoing phase – from 13^th month onwards

Phase one – The preparation and implementation of project – 12 months

Project Objectives

1. To increase all at risk resident’s balance & strength by 40% within 8 months
2. To reduce falls incidence by 80% within one year
3. To reduce fractured necks of femur by 80% within one year
4. To reduce health care costs for falls by $560,000 within one year

Project Strategies

1. To reduce facility physical risk factors for falling across the 6 residential facilities by the end of the 2^nd months;
2. To provide training to all staff to ensure that they all have the competence in conducing falls screening and prevention and correctly following the FRAM and Risk Register processes by the end of the 3^rd months;
3. To implement a Falls Risk Assessment Method (FRAM) and Risk Register to all 6 residential facilities and to ensure they are included in the care plan for each resident by the end of the 4^th month
4. To identify patients at risk of falling or rolling out of bed and provide low-low-bed with an adjacent floor mat to all of these patients by the end of the 6^th months;
5. To identify patients with bone conditions who are at greatest risk of fracture following a fall and provide them with hip protectors by the end of 6^th months;
6. To educate and support patients who are using hip protectors to ensure they wear the hip protectors correctly by the end of 6^th months;
7. To provide regular remedial physiotherapy and strengthening programs to all residents throughout the 12-month project period.

In addition to activities that are important to implement the above strategies, the project will also

• Appoint and train a ‘Falls Guru’ for each residential site who will monitor the implementation of the project and provide support to staff in the 1^st month;
• Provide ongoing support to staff in applying the Fall Risk Assessment Method and Falls Register in care plan for residents throughout the project;
• Purchase of hip protectors when needed;
• Purchase of low-low bed with adjacent floor mat when needed;
• Design and commence interventions such as Tai Chi and strength classes for residents that can improve residents’ balance and physical strength.

The project budget allocations for the following inputs to implement the project

1. 6 residential facilities to collaborate with appropriate staffing to implement the strategies;
2. $160,000 for staffing, development and implementation of falls risk assessment method/process & monitoring system;
3. $180,000 for staff training in falls screening and prevention ($30,000 per institution);
4. $27,000 for provision of hip protectors (for 180 residents);
5. $57,000 for provision of low-low-bed with adjacent floor mat (for 150 residents);
6. Providing regular remedial physiotherapy and  strengthening programs to all residents $8,000;
7. $50,000 for a one-off evaluation.

Phase two – Ongoing program phase

Main activities

1. Training of new staff on the use of risk assessment method and risk register in care plan;
2. Hip protector checkup, maintenance and replacement;
3. Hip protectors to newly identified high risk residents;
4. Provision of low-low-bed with adjacent floor mat to patients who are at risk of falling or rolling out of bed;
5. Regular remedial physiotherapy and strengthening programs to all residents throughout the project.
6. Ongoing monitoring;

Annual budget $90,800

1. Training of new staff $25,000/year
2. Maintaining the assessment system across the organization $40,000
3. Hip protectors checkup, maintenance and replacement $7,000
4. Purchase of low-low-bed with adjacent floor mat 10,800
5. Providing regular remedial physiotherapy and  strengthening programs to all residents $8,000

Assignment requirements

• To design an appropriate evaluation for the Preparation and Implementation Project;
• To design an ongoing monitoring plan in the first two years of the Hip Fracture Prevention Program;
• Your evaluation plan should be no more than 3000 words. Students can discuss the assignments with other fellow students, however students should write up the assignment individually and independently.

The evaluation plan for the Preparation and Implementation Project should specify:

1. The purpose of the overall evaluation of the Preparation and Implementation Project;
2. Details of process evaluation and impact evaluation (please use the two tables provided)
3. The strategies that will be employed to control for internal and external validity;
4. Potential issues or difficulties that evaluation may encounter / face

*Process and Impact evaluation tables are developed below for use

Ongoing monitoring during the ongoing program phase (2^nd phase)

5. What should be the focus of the ongoing monitoring of the program annually? You will need to provide details of types of indicators to be collected and frequency of collection.