Post Replies Reply separately to two of my peer’s posts (See attached peer’s posts, post#1 and post#2).  INSTRUCTIONS: Using the SWOT Analysis Resource,

Post Replies Reply separately to two of my peer’s posts (See attached peer’s posts, post#1 and post#2). 
INSTRUCTIONS:

Using the SWOT Analysis Resource, (https://www.clearpointstrategy.com/swot-analysis-examples/) review the two classmates’ posts. (See attached posts)
Identify two items from each of the four components (S,W,O,T) that is relevant to the problem your classmate identified. Explain your reasoning for each.

To reply to the example in the initial post, you could select advantages of the proposition and financial reserves from the Strengths quadrant. Elaborate on the advantages of following the recommendations—for example, following professional standards of equal care, decreasing cost by not ordering unnecessary diagnostic tests, and increasing revenue from shorter visit times.
Items you might identify from the Weakness quadrant could include processes and systems, and morale commitment and leadership. These items are weaknesses because of the need to train providers on national recommendations and to create a system within the EMR to track PAP smears.
You should then choose two items from both the Opportunities quadrant and the Threats quadrant and include them in your reply posts.
Your responses should be in a well-developed paragraph (300-350 words) to each peer, and they should include evidence-based research to support your statements using proper citations and APA format!
Note: DO NOT CRITIQUE THEIR POSTS, DO NOT AGREE OR DISAGREE, just add new informative content regarding to their topic that is validated via citations. 

Please, send me the two documents separately, for example one is the reply to my peers Post #1, and the second one is the reply to my other peer Post #2.
Minimum of 300 words per peer reply.

Background: I am a Registered Nurse, I work in a Psychiatric Hospital (Crisis & Stabilization). POST # 1 AYME

Practical/ Clinical Issue

     Working with elderly /geriatric patients with a history of diagnosis of psychiatric illness presents one of the major quality issues in clinical practice in the form of falls and related injuries. When an elderly patient is diagnosed with a psychiatric illness, they became more vulnerable than others. Most of them become confused, disorganized, and need continuing redirection. The geriatric patient is a very sensitive and vulnerable population and will become aggressive with any psychiatric illness. When we work with old people, we must make sure that they get the best care because they decompensate easier than others. Within nursing homes such as our workstations or any place where I do my clinicals, we deal with a unique group of patients. The elderly population is recognized as the greatest consumers of healthcare services across the U.S as compared to any other age-matched group (Nunan et al., 2018). Most of the time they are very needed, and they request help easily compare with others. These high rates of consumption of healthcare services have been occasioned by two key factors. Firstly, the adoption of the Affordable Care Act has increased enrollment for Medicare especially among groups that were previously underserved such as the elderly. Thus, the healthcare system is now dealing with a larger volume of elderly patients due to increased access to care (Society for Healthcare Epidemiology of America, 2018). The second factor is related to the reality of multiple co-morbidities in a majority of the elderly population. These individuals present with cognitive and physical comorbidities that significantly impact their response to environmental stimuli. The prevalence of falls among elderly people is highest as compared to any other age-matched group. This high prevalence is linked to the multiple co-morbidities and their impact on decision-making, judgment, and actual response to stimuli (Nunan et al., 2018). After a human gets older most of the systems are starting to decrease in function and the person will need double attention compared with a younger population.

     At the facility, there has been a challenge in controlling the rates of falls. Fall is very common in all populations and after a fall a patient will get disabled compare with other populations. The organization has adopted universal fall precautions such as clear pathways, immediate wipe-up of spills, use of nonskid footwear, and access to call bells/alarms. However, these precautions do not indicate any significant change in the occurrence of falls. The facility is facing unprecedented times from a budget perspective considering the current regulations by the Center for Medicare and Medicaid Services (CMS) on hospital-acquired infections including falls and related injuries. The CMS identified that it would not reimburse for costs associated with any HAIs including falls and healthcare facilities would have to shoulder that burden henceforth (Society for Healthcare Epidemiology of America, 2018). The policy was informed by the need to increase the level of responsibility at facility and staff levels concerning safety and quality of care. Healthcare facilities and their staff would begin to identify innovative evidence-based techniques to control or prevent falls (Society for Healthcare Epidemiology of America, 2018). 

      At the facility, there is an inherent gap in policy to prevent falls. The universal fall precautions are not only insufficient for the task but also extremely generalized. While elderly patients in a nursing home may be considered to share a wide range of attributes, it should be recognized that each patient presents with a unique set of needs (American Association of Colleges of Nursing, 2012). The development of interventions for these patients should be driven by the policy of patient-centered care to allow effective addressing of specific needs (Nunan et al., 2018). Preventing falls will give better patient care. 

     The policy and process gap at the facility is related to the inability to gather sufficient patient data and information that can inform patient-centered interventions in fall prevention. One of the missing elements in the procedure is the admission process. A comprehensive admission process should identify the specific needs of each patient regarding the risk of falls (Vlaeyen et al., 2017). However, our current admission process does not assess the risk of falls for patients and assumes that existing universal fall precautions will be sufficient and viable for all patients. During admission, it is very important to get the correct information and do the best assessment to provide patient care and avoid any situation with falls.

     A comprehensive fall risk assessment on admission is the best strategy to resolve the policy and process gap at the facility. This intervention provides the care team with rational information on whether the patient is at risk of falling while also allowing the care team at the facility to categorize patients based on their level of risk. A good assessment will provide a good intervention and will give the best care to the patient. Once categorization is done, the care team can decide how to allocate available resources across the patient categories based on their needs as identified via the fall risk assessment scores (Vlaeyen et al., 2017). The fall risk assessment tools such as the STRATIFY, the Schmid Fall Risk Assessment, and the Morse Fall Scale allow the care team to identify the underlying factors that affect the fall-risk level for each patient. For instance, in some patients, the underlying factors could be multiple physical co-morbidities/diseases. In others, it could be a result of their compromised mental status. Mental status is very important because a patient that is confused will be at more risk to fall compared with others. In other cases, medications, and situational conditions such as unfamiliar environments could be causative factors. Fall-risk assessment tools provide data that can influence decisions and clinical judgment thus not only preventing falls but improving the overall patient experience (Lucero et al., 2019).

References

American Association of Colleges of Nursing. (2012). Graduate-level QSEN competencies: Knowledge, skills and attitudes. Washington: American Association of Colleges of Nursing.

Lucero, R. J., Lindberg, D. S., Fehlberg, E. A., Bjarnadottir, R. I., Li, Y., Cimiotti, J. P., … & Prosperi, M. (2019). A data-driven and practice-based approach to identify risk factors associated with hospital-acquired falls: Applying manual and semi-and fully-automated methods. International journal of medical informatics, 122, 63-69.

Nunan, S., Brown Wilson, C., Henwood, T., & Parker, D. (2018). Fall risk assessment tools for use among older adults in long‐term care settings: A systematic review of the literature. Australasian journal on ageing, 37(1), 23-33.

Society for Healthcare Epidemiology of America. (2018, July 4). CMS policy to reduce hospital-acquired conditions had minimal impact. Infection Control Today. https://www.infectioncontroltoday.com/view/cms-policy-reduce-hospital-acquired-conditions-had-minimal-impact

Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., … & Milisen, K. (2017). Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. International journal of nursing studies, 70, 110-121.

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