Running head: GUIDED IMAGERY AND PROGRESSIVE MUSCLE RELAXATION
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Change Project
Amisadai Mederos
Denver College of Nursing
NUR445: Capstone
Sharon Bator
December 6, 2021
Change Project
Background
An interview with the nurse director, Aleycia, revealed vital information regarding the change project. Patients above 50 years of age are at a higher risk of falls compared to younger individuals. It is because they do not metabolize anesthesia faster like younger people. Medications take a longer time to leave the system. Generally, individuals under anesthesia within the first 24 hours are at a high risk of falls. The JHFRAT has been effective in reducing falls in the hospital. Aleycia suggests more education for nurses and the implementation of new alarms that are specific for every room to help nurses get to the rooms faster.
Research Question
Are geriatrics who have gone under anesthesia and are receiving pain medication compared with those without receiving anesthesia and pain medication at a higher risk for falls over the first 48 hours after surgery?
Literature Review
(Daoust et al., 2018) examines the risk of falls of older adults under opioid use. The article includes patients above 65 years. The results show that opioid use results in a greater risk of falls for older patients, which leads to injury or death among the patients (Daoust et al., 2018). The article by (Mazur et al., 2016) includes patients above 79 years. Patients’ advanced age and delirium history are associated with higher fall risk. Also, patients having a higher BMI are at a lower risk of geriatric falls. According to (Wu et al., 2021), polypharmacy is associated with delirium and geriatric falls. Patients hospitalized due to fall injuries currently use BZDs (Yu et al., 2017)). Therefore, anesthesia medication is associated with the risk of geriatric falls.
Stages of Project Implementation
The first step in Lewin’s change theory is unfreezing, where the problem is identified. Communication is required to ensure the problem is well known and the need for change is established. The second step would be to implement change in the system and implement a system where the alarms are identifiable for each room. Finally, the refreezing process involves the identification of any potential errors and ensuring nurses understand the system.
References
Daoust, R., Paquet, J., Moore, L., Emond, M., Gosselin, S., Lavigne, G., Choiniere, M., Boulanger, A., Mac-Thiong, J. M., & Chauny, J.-M. (2018). Recent opioid use and fall- related injury among older patients with trauma. CMAJ: Canadian Medical Association Journal, 190(16), E500+. https://link.gale.com/apps/doc/A535816357/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=fe728eb5
Mazur, K., Wilczyhski, K., & Szewieczek, J. (2016). Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clinical Interventions in Aging, 11, 1253+. https://link.gale.com/apps/doc/A503296118/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=4876a981
Wu, H., O’Donnell, L. K., Fujita, K., Masnoon, N., & Hilmer, S. N. (2021). Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions. International Journal of General Medicine, 14, 3793+. https://link.gale.com/apps/doc/A673020801/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=941ecb3a
Yu, N.-W., Chen, P.-J., Tsai, H.-J., Huang, C.-W., Chiu, Y.-W., Tsay, W.-I., Hsu, J., & Chang, C.-M. (2017). Association of benzodiazepine and Z-drug use with the risk of hospitalisation for fall-related injuries among older people: a nationwide nested case-control study in Taiwan. BMC Geriatrics, 17(1). https://link.gale.com/apps/doc/A511320776/HRCA?u=lirn54469&sid=bookmark-HRCA&xid=446b7aa2
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