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BSBPMG522

Project Title: Falls Prevention Assessment Training

Project Sponsor: St. Basil's Homes/ Nursing Manager
Project administrator: Fatmata Stella Bangura

Project Stakeholders:
Nursing manager, Staff, Residents, Visitors, Suppliers, Families and other Health
and Allied Professionals.

To prevent falls and injury in the aged care facility.

It is aimed at implementing a phased evidence-
Purpose: based falls prevention project that reduces falls
and falls related injury across all St Basil's homes
Australia wide.
To examine the views and suggestions of Health
care professionals, staff and family members on
the causes of residents falls and the prevention of
falls practices across all St Basil's facilities.
Objective:
To reduce the risk of falls and falls related injuries
allowing the elderly people to maintain their
independence and good quality of life for as long
as possible.
The project complements St. Basil’s 2020
Strategic Plan to optimize the work, health and
safety practices in order to meet the current and
emerging health needs of residents, staff and
visitors.
1. It is now an accepted fact that all residents in
aged-care facilities as well as in home care are at
risk for falls.
2. Providing education, training and information
Scope statement about falls prevention for residents and carers.
3. As nurses, we must rely on our clinical
expertise and judgment to engage in population
specific falls- and injury-prevention programs as
part of an interdisciplinary team approach.
4. An interdisciplinary approach is key because
the evidence is clear: Falls-prevention programs
that include only nurses are not effective because
it takes a team to make a difference.

Target audience: Staff, Residents, family and Management

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Budget: $250,000.00

Proposed project timeline:

Start date 01/08/19

End date 04/07/20

Approval 29/07/19

Approved by ST. BASIL'S HOMES CEO

Signature:

Date: 28/07/19

3. Consultation methods
The stakeholder analysis determines the likely relationship between them and the
project and helps to identify the appropriate consultation methods for each stakeholder
group during the life of the project. Some of the methods I used to consult stakeholders
include phone calls and email, one-on-one interviews, workshops, focus group
discussions, public meetings, distribution of pamphlets, newsletters, magazines and
radio. As consultation is the process of gathering information or advice from
stakeholders, I took these views into account when making my project decision and it
helped me in setting goals, targets and defining strategies.

4. Documents and resources

Starting any project needs documentation and resources. Therefore, it is always
prudent to consider what resources are required in order to get the job done. For my
project, there are three essential resources that I had to consider. I need human, capital
and material resources of all types.
The Human resources include the clients, staff and families. The clients are the old
people living in the nursing home facilities or home care, in this case, particularly those
being cared for by St Basil's homes. The employees play a vital role in that they are the
ones providing and delivering the care. Thus, the employees need to be well equipped

with the skills and materials needed to carry out their work effectively and in an
appropriate manner. Giving employees the right training is essential. As it is often

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recommended to strategise the staff training program to include primary carers, team
leaders and registered nurses, because they deal with the clients directly, the project
was implemented to meet this requirement. Also, family members involved in the caring
of their loved ones are trained in the use of materials needed for the caring of the aged.
Most importantly, the project needs money at almost all stages because I will need to
pay for things and services. Thus, a budget is set up for the project to help keep things
on track. The money is used to buy assets or goods and resources. The appropriate
materials needed for falls prevention include hip protectors, falls risk assessment tools,
chair and bed alarm sensors, floor mats, appropriate shoes and socks, standing up
alarm systems etc. Also needed is a coping audit tool which was modified for use during
the project implementing phases for the project facilitators to monitor their practice in
accordance with evidence-based guidelines.

5. Issues and concerns- potential risk factors to the project. It is a fact that even the
most carefully planned project can run into problems. Unexpectancy is a common
occurrence when it comes to projects. These include team members getting sick, ill-
disposed, non-compliant or quitting; equipment tools malfunctioning; resources running
out. Managing risks on my project is a process that include risk assessment and a
mitigation strategy for those risk factors. Risk assessment included both the
identification of potential risks and the evaluation of the potential impact of the risk. The
potential risks on the project include technical problems, meeting cost schedules,
environmental issues and the influence of politics and administration.
The nursing team has an important role to play in preventing falls and harm from falls in
older people in the aged care facility. Nurses are well placed to recognise a change in
the residents' risk of falling and therefore can play an integral part in communicating it to
all members of the health care team. Nurses are also well placed to prevent falls
through a multidisciplinary team approach to planning, implementation and evaluation
on individualised falls prevention plans. Physiotherapists play a role in assessing
residents' mobility and prescribing mobility aids and specific exercise programmes to
promote the dynamic balance, muscle strengthening and safe walking. The
occupational therapists provide education on the risk factors contributing to falls during
the performance of daily activities and training in strategies to promote independence
and prevent falls. The Medical staff and pharmacists modify and review medications that
have the potential to cause falls, such as medications that affect the brain, lower
pressure and blood sugar levels. Dietitians provide education about healthy nutrition
and hydration for optimum health. Thus, each team has a role to play to prevent falls.
This normally starts at the facility and continues throughout their stay and where
needed.

Risk Identification Level of Risk Consequence Strategy

Risk Risk Level of Consequence Strategy

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# Risk
1 Tertiary Low- Inability to develop Preapprove the training
providers not medium training package pack.
willing to
participate in Limited influence on
project future workforce
initiatives

2 Project Team Medium Delay of project and Advertise both externally

positions not potential not to and internally. Advertise
filled meet with recruitment firms.
agreed time frames
3 Lack of staff Medium Staff will not be Register with Nursing
to support trained in time and Agencies to access
training project may be casual workers
delayed
4 Hardware not Low Staff will be unable Install, test and deploy
installed to use Hardware hardware prior to project
correctly and the project will Go Live. Have
be delayed manufacturers support
from installation until
after.

6. The sequence of tasks and activities supporting each objective: Sequencing can be
performed by utilizing the project management software or by using manual or
mechanised procedures. The sequence activities process concentrates on converting
the project activities from a list to a diagram to act as a first step to publish the schedule
baseline. Sequenced activities are the process of identifying and documenting
relationships among the project activities. Thus, the fundamental reason for the
sequence activities process is to finalise the interrelationship of activities to finish the
project scope and achieve the task objectives.

7. The critical milestone of the project.

A project milestone is a management tool that is used to prove a point in a project
schedule. These points can note the start and finishing points of the project which also
marks the major phases of the work. Milestones provide a way to accurately estimate
the time it will take to complete the project, making them essential for project
scheduling. They are often used in scheduling methodologies such as the critical path
method. Milestones are also a flexible tool for scheduling and with some imagination,
can do more than just act as signposts for project phases. I used milestone to always
keep a reminder

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about project Board Meetings and other important events including workshops. It is a
great way to make sure that everyone is aware of what is happening and of upcoming
meetings.

Using the scoping information from my report and documentation, I was able to develop
a Project Plan Gantt Chart using MS Word and MS Excel that includes timelines, task
breakdown structure and task durations, task assignments, checkpoints and deadlines.
Project Timeline:

Sustainment

Implementation

Preimplemention

FRAT tool Training

Hardware Training
project Tasks

User Testing
Start Date
Duration (days)
Hardware Installation

Hardware Audit

Future State Readiness

Current State Readiness

Preparatory Phase

19-Jul 7-Sep 27-Oct 16-Dec 4-Feb 26-Mar 15-May 4-Jul

St. Basil's Homes Falls Risk Prevention Project Timeline Gantt Chart

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Project Tasks Start Date End Date Duration (days)
Preparatory Phase 19/07/19 29/07/19 10
Current State Readiness 29/07/19 13/08/19 15
Future State Readiness 30/07/19 26/08/19 28
Hardware Audit 06/08/19 05/09/19 30
Hardware Installation 23/08/19 23/11/19 40
User Testing 16/09/19 30/11/19 60
Hardware Training 23/10/19 20/12/19 40
FRAT tool Training 05/11/19 15/12/19 40
Pre-implemention 15/12/19 04/01/20 20
Implementation 05/01/19 21/03/20 70
Sustainment 14/02/19 14/05/20 100

Figure 1. Timeline of Fall Prevention Program Activities

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Pre-
Pretraining Training implementation Implementation Sustainment

Approximately 1 Approximately 4 months Approximately 8 to Ongoing

month 12 months

Review FRAT Continue with

Develop biweekly
Toolkit. Conduct in- implmentation Continue with
meetings.
Complete person Hardware plans/action meetings;
pretraining and Assessment plans. Regularly analyze determine best
assessment tool training data. intervals for your
Transition to
tools. sessions. team and facility.
biweekly calls Update action
Schedule in- View training with Project plans and Regularly analyze
person training webinars as Team. implementation data.
sessions. needed. checklist.
Complete
Conduct weekly implementation
check-in calls readiness
with QISs. checklist.
Gather/review
baseline data.

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Pre-implementation Checklist
Tasks Completion

Initial Post-Training Priorities

Identify pilot units 19/07/19

Establish various teams
Multidisciplinary
Pilot unit managers on Implementation Team
Conduct process mapping
Use fall knowledge assessment
Create action plan outline Yes
Continue to watch webinars Ongoing
Primary Pre-implementation Priorities

Draft action plan

Prioritize list of improvement opportunities Completed
Conduct resource needs assessment Completed
Select improvement practices Ongoing
Determine goals for improvement
Develop aim statement Completed
Develop staff education/assessment plan Ongoing
Create plans to roll out new standards/practices Ongoing
Assign staff person to monitor implementation Ongoing
Determine how to measure performance
Determine data collection process Achieved
Collect/assess process measure data Ongoing
Collect/assess outcome measure data Ongoing
Create sustainment plan Done
Final Preimplementation Priorities

Finalize implementation action plan Ongoing

R- Responsible (Performs the activity or makes the decision)

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A- Accountable (Is accountable for the accomplishment of the activity or decision)
C- Consulted (Is consulted before the activity is accomplished or the decision is made)
I - Informed (Is informed upon completion of the activity or decision)
Activity or C C Project Project Engineer Nurse Nur Resid
Decision E F Director Traine Hardware Manage ses ents/
O O r r Carer
s
Current and
Future State C C R R C C I I
Readiness
Project Plan C C R A C C C I
Risk A I R R R R R I
Management
Plan232
Budget A R R R C C I I
Select Pilot I I R A R R C C
Facility
User Testing C I R I R C C C
Prepare C I R R R R C I
Training Manual
Book Training I I R R C R I I
Venue
Hardware Audit C R R C R I I I
Hardware I R R C R I I I
Installation
User Testing C C R R R C R R
Hardware I C R R R I I I
Training
FRAT Tool C C R R R C C I
Training
Pre- I I R C R C R C
implementation
Checklist
Implementation R I R C C R I I
Date
Evaluate R C R C R R R R
Project

Tasks-

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Task Personnel Responsible. Time frame

Plan project Project Director 1 week

Finalize date CEO 1 day

Determine budget CFO and CEO 1 day

Selection of staff Project Director and CEO 2 weeks

Determine pilot
Project Director 2 days
project facility

Book venue
for training of Project Director 1 day
implementors

Prepare training CEO, Nursing manager and

2 weeks
manuals Project Director

Prepare
Nursing Manager and Project Director 1 week
presentation

Send invitations Promotions team 5 days

Meetings and
All personnel Every week
emails

Final list of
Project director 1 week
participants

Evaluate Project CEO and promotions teak 1 week

Summary
The key findings from this work are that majority of the resources allocated for the
prevention of falls are consumed in the areas of physiotherapy treatment aimed at falls
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prevention, continuous patient observers, falls prevention assessment/screening by
professions other than nursing and falls prevention alarms. Several of these activities
may be viewed as “multi-purpose” activities that address multiple aims simultaneously,
of which falls prevention was one. The largest resource allocation category that could be
classified as being entirely specific to falls prevention is the use of falls prevention
alarms, where on average about 15% of falls prevention resources were directed. This
category exceeded the resources consumed even by falls risk assessment tool
completion by nursing staff. The employment of constant patient observers was part of
the falls- prevention strategy at all the services and accounted for about 14% of overall
expenditure on falls prevention. Most requests for constant patient observers for falls
prevention were also for other reasons, such as high patient acuity and /or cognitive
impairment. Falls have been found to increase “marginally” when the impact of having
constant patient observers was evaluated across all the acute inpatient wards.
Informal falls prevention patient education accounted for about 10% of the total
expenditure on falls prevention. The number of falls per hundred bed days has been
found to be not significantly different between groups provided with falls prevention
material and usual care. So far, during the process of data analysis, several limitations
to the data collection method became apparent. Mapping the time spent throughout the
health services on risk management around falls incidents was challenging. Estimations
by clinical staff of the time spent were possible, as well as that spent by the quality and
risk staff, and have been included in the budget estimates where possible. However, we
were not able to estimate the time spent by line managers of these staff and this cost
may be significant. For instance, we were unable to estimate the cost of constant
patient monitoring due to the potentially large costs involved. Rather, we used an
average of the costs per bed spent by the other health services to extrapolate a figure,
in order to include an estimation in the overall cost and the percentages of the total cost
of each activity. We randomly selected one medical, one sub-acute and one dementia
ward at each home care facility service.
The amount of time spent by staff in falls prevention varies between ward types. At one
care ward, an acute assessment unit was selected and was then compared to an acute
dementia ward. These differences were then magnified by the process of calculating
whole service costs by multiplying per bed cost by bed numbers. There are no activities
being undertaken on the wards selected that were not identified by the staff
interviewed. We provided prompts about the kind of equipment that may be used and
about specific activities, such as patient education, to avoid the perception that we did
not suggest activities that should be undertaken. Staff found estimating how much time
and how frequently they performed tasks as very challenging. Next steps, a meeting of
the advisory and consumer groups is to be held sometime in February next year. This
data is to be presented, followed by a presentation of the existing evidence about the
effectiveness of each of the strategies used by the healthcare services to prevent falls
and harm from falls. The stakeholder and consumer reference group have already
identified some key areas where large amount of resources been directed. There were
also areas identified where resources are being directed towards strategies where there

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is an absence of evidence indicating whether the strategies are effective or not. The
reference group are investigating whether that step should now be taken to stop
investing from areas where there is known evidence of the ineffectiveness of the
intervention and yet there are large resources being spent in the area. The group will
now work on developing proposals to attract partnership funding to facilitate
disinvestment in these activities.
This report will be tabled to all the stake holders by mid-December, this year to
determine whether the actual deliverable meets all the clients’ average requirements as
compared with the deliverable described in the project scope. In the final report outline
at the end of the project, I will take into consideration the following, with regards
deliverables:
• what variations, if any, in terms of the total costs of running the entire
project
• whether the deliverables meet all the clients’ requirements
• whether it meets its functions and potential impact on the development of
St Basil's Homes
The estimated cost to maintain the system report will be distributed to the key
stakeholders by mid-December this year, as stated above and will be kept in the project
documents file for future references. The final status report will be filed at the end of the
project cycle in July 2020. this report will contain recommendations for future
expansions of the project or the commencement of a similarly related project.

REFERENCES

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1.
https://www.racgporg.au/download/Documents/AFP/2012/December/201212waldron.pd
f
2. https://www.academia.edu/32374037/The_Effect_of_Enhanced_Supervision_on_
Fall_Rates_in_Residential_Aged_Care
3. https://bmcnurs.biomedcentral.com/articles/10.1186/1472-6955-13-4
4. https://www.health.gov.au/contacts/aged-care-quality-and-safety-commission-
acqsc
5. https://melvillecares.org.au/stay-on-your-feet-falls-preventions/
6. https://thenewdaily.com.au/news/2019/08/06/aged-care-garry-linnell/
7. https://fallsnetwork.neura.edu.au/
8. http://www.health.vic.gov.au/agedcare
9. https://wwwteamgantt.com/what-is-a-gnatt-chart
10. https://www.projectsmart.co.uk/project-planning-step-by-step.php
11. https://project-management.com/top-10-best-project-management-books-to-
keep-within-reach/
12. https://pmworldlibrary.net/new_in_the_library/bc-open-textbook-project-
management-by-adrienne-watt/
13. https://project-management-knowledge.com/definitions/s/scope-planning/
14. https://www.projectengineer.net/components-of-a-scope-management-plan/
15. https://www.ahrq.gov/patient-safety/settings/long-term-
care/resource/injuries/fallspx/man2.html
16. https://www.rn.com/featured-stories/patient-falls/
17. http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodica
ls/OJIN/TableofContents/Vol-18-2013/No2-May-2013/Fall-Program-Measurement.html
18. https://journals.lww.com/ajnonline/Abstract/2018/05000/AHRQ_Resources_for_P
reventing_Falls_in_Hospitals.30.aspx
19. https://monashpartners.org.au/wp-content/uploads/2017/12/Monash-Falls-
Prevention-Alliance-Falls-Mapping-Project-Report-2017.pdf

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