Capstone Project Change Proposal

Capstone Project Change Proposal

Falls have become a serious problem in hospitals. Statistics indicate that about 900,000 people fall in the hospital in the United States each year (King et al., 2018). Inpatients are at a high risk of falling. About half of residents in nursing homes fall each year in the United States. Falls result in significant negative healthcare impacts which may affects the recovery process of the patients. However, studies indicate that most of this fall can be prevented. Over the past few years, numerous approaches have been developed to prevent falls in hospitals however, they seem to be ineffective. This paper presents an effective approach to preventing most of the falls that occur in hospitals. Capstone Project Change Proposal

Clinical Problem Statement

About one third of hospital falls result in serious injuries such as internal bleeding, head trauma, fractures and lacerations resulting in increased utilization of healthcare. Serious injury of death resulting from falls in the hospital is considered a never event. Not all falls result into injury. However these falls may have significant health impacts. As noted by King et al., (2018) “even supposedly ‘no harm’ falls can cause distress and anxiety to patients, their family members, and health care staff, and may mark the beginning of a negative cycle where fear of falling leads an older person to restrict his or her activity, with consequent further losses of strength and independence.”

Purpose of the Change proposal

This change proposal aims to reduce preventable falls in the hospital, by implementing various strategies, the proposal will provide ways in which patients, families and healthcare professionals should conduct themselves in the healthcare facilities to prevent falls. In addition, the proposal provides best practices for nurses and physicians when dealing with inpatients to prevent falls and improve safety in the hospital. Ultimately the proposal will provide knew knowledge for researchers and healthcare providers to improving the safety of patients in the hospitals. Capstone Project Change Proposal

PICOT Question

Among patients admitted in the hospital (P), how effective is providing a safe hospital environment (I) as compared to conducting standardized assessments (C) in preventing falls (O) within the period of stay in the hospital (T)?

Literature Search strategy

After writing the research question, key words were identified. The Key words were used to search for scholarly articles in various databases including Google Scholar, Cinhal and PubMed. Articles that were less than five years old were included in the study. The articles that did not match this search criterion were excluded in the study.

Literature Evaluation

The hospital environment is critical in preventing falls among patients admitted in the hospital. Keeping patient environment safe can help in preventing falls. This involves familiarizing the patients with the environment and training them how to use the call light (King et al., 2018). Providing a safe environment also entails having sturdy handrails in the hallway, bathrooms and rooms of patients and keeping hospital bed breaks locked. Multiple studies indicate that providing an effective hospital environment plays a significant role in preventing falls among patients (Cameron et al., 2018). A safe hospital environment not only safeguards patients but also staff members and visitors in many areas. Capstone Project Change Proposal

Nursing Theory utilized

Neuman’s Systems model is the theory that was utilized in this study. According to the theory, an individual is an open system that responds to stressors in its immediate environment. The variables of the individual in this model are spiritual, developmental socio-cultural, psychological and physiological (Fawcett & Foust, 2017). The system consists of core or basic structures protected by a resistance line. Normally, health level is identified as the normal line of defense. This line is usually protected by a flexible line of defense. When the flexible line of defense if broken into by stressors, the system is invaded and this activates the resistance line. The system is the reconstituted if there is enough energy to restore the line of defense.


Proposed Implementation Plan

Providing a safe hospital environment will involve familiarizing the patients with their immediate environment once they are admitted in the hospitals. The nurses then will help the patients practice the use of call lights. The call light will be maintained within the reach of the patient to make it easy for them to switch it on. Sturdy handrails will be installed in the patients’ hallways, bathrooms and rooms. Hospital bed brakes will be kept locked at all times and ensure the beds are low enough especially when the patients are resting. The floors of the patient rooms will be kept clean and dry at all times to prevent patients from slipping. Hourly rounding will be carried out by nurses as well as nurse assistants to ensure a safe hospital environment (Gu et al., 2016). Capstone Project Change Proposal

It is expected that this program will increase awareness of the adverse effects of falls among patients. In addition, the program is expected to encourage healthcare workers to create a safe environment for all patients admitted in hospitals. Ultimately the program is expected to reduce the rate of falls among inpatients. A safe hospital environment can also reduce the rate of falls among healthcare workers and also families visiting the hospitals.

Use of Evidence based Practice

Numerous studies indicate that safe hospital environment is the basis of patient safety. This applies to all areas of healthcare setting to prevent falls. According to Morris & O’Riordan (2017), “Maintaining a safe and comfortable environment is the responsibility of the hospital independent of a patient’s particular risks for falls, because failure to do so can put any patient at risk”. This intervention plan has been informed by the fact that studies show that patient safety begins by providing a safe hospital environment. While there are other effective approaches for preventing falls, they may be ineffective without a safe hospital environment. Capstone Project Change Proposal

Plan for Evaluation

The effectiveness of this program will be determined by the number of falls that have been recorded since the implementation of the program. A reduce number of falls among inpatients will indicate that the program has achieved its objectives. If the number does not change from the previous rate of falls, it will show that the program has not been effective. Increased consciousness about the patient environment by inpatients will indicate that the program has partly achieved its objectives. Data concerning fall rates will be evaluated using various statistical approaches including mean, median and variance

Potential Barriers

There are various barriers to the implementation of this program one of them is lack of knowledge among staff members on fall prevention. This barrier will be overcome by providing training programs for creating a safe hospital environment among healthcare professionals. Lack of access to resource facilities is also another barrier to the implementation of the program. When health care professional are not able to access certain resources necessary for creating a safe hospital environment it may be difficult to implement the program effectively. This barrier can be overcome by granting access to the resources by all healthcare professionals (Morris & O’Riordan, 2017).

Another key barrier to the implementation of the program is lack of enough nurses in hospitals. Nurse shortage is a key problem in the US healthcare system. The ratio of nurse to patient is not acceptable as nurses have to care for many patients compromising the services provided. This barrier can be addressed by recruiting nurses and their assistants to improve service delivery to the patients. This will make hourly rounding achievable as there will be adequate nurses and assistants to do so. The nurses should also be trained to ensure that they understand the need to implement the program effectively.Capstone Project Change Proposal


Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane database of systematic reviews, (9). Retrieved from

Fawcett, J., & Foust, J. B. (2017). Optimal aging: a Neuman systems model perspectiveNursing Science Quarterly30(3), 269-276. Retrieved from

Gu, Y. Y., Balcaen, K., Ni, Y., Ampe, J., & Goffin, J. (2016). Review on prevention of falls in hospital settings. Chinese nursing research3(1), 7-10. Retrieved from

King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist58(2), 331-340. Retrieved from

Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine17(4), 360. Retrieved from Capstone Project Change Proposal

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