Question

How to make process improvement of reduction of fall related injuries in memory care residents? This will include maintaining their dignity while improving fall reduction protocols.

Who are stakeholders at hand? In the analysis, describe your professional ethical dilemma with a brief background of the situation (as you would in a case study) and justify why this issue is considered an ethical dilemma. Next, identify stakeholders, describe influences and apply four different lenses (theories and principles) to examine resolution options. Conclude your paper by identifying a chosen position for dilemma resolution.

Answer 1

Falls are the leading cause of both fatal and nonfatal injuries among aged people. A fall is defined as an “unexpected event in which the participant comes to rest on the ground, floor, or lower level”. Detecting a fall early and in an ongoing manner provides significant potential for reduced morbidity and mortality in patients and system-wide savings. As most of the elderly fallers experience recurrent falls , detecting the first fall and taking preventative action provides significant potential for reducing fall risk, fall-related injuries, and fall consequences at large. A rapid detection of fall limits the long-lie (ie, the amount of time fallers spend lying on the ground), which has been shown to be a predictor of worse independent walking capacity and autonomy and longer length of hospitalization. Real-time diagnosis of falls might result in a more accurate identification and care of direct fall-related injuries (eg, traumatic brain injury and orthopedic fractures) and in lowering short-term indirect consequences (eg, pressure sore, hypothermia, and phlebitis) as well as long-term fall-related consequences (eg, fear of falling again, loss of autonomy as a result of postfall restrictions, and social isolation).

A significant portion of recent health technology innovation regarding fall management has been driven by industry and has taken place in the commercial space. To date, the most well-known commercial solutions include wearable alert systems, which demonstrate limited success in dementia care because individuals forget or refuse to wear a device; nonwearable fall detection systems, which are based on radar and optical sensors, are under development but not commercially available in the United States yet and have not demonstrated robustness through evidence-based medical studies; fall mats and bed alarms, which are prevalent solutions in memory care but suffer from high false alarm rates and are mainly targeting those residents who should never be walking independently; and accelerometer-based fall detection, which provides meaningful information about the biomechanical features of fall but fails to give a holistic and clinically useful picture of falls (including assessment of environmental hazards). Overall, none of these strategies allow care providers to identify globally how and why a fall occurs and thus leverage this information to enhance safety in residents and improve quality of care practice in the facility staff.

The video technology can be used to review real-world falls in memory care facility, as well as biased information about falls gathered from individuals’ recalling the fall or from administrative record. The extent to which video monitoring and fall review can impact quality of care practice and health outcomes is in fact a relatively new and unexplored field.

The primary outcome measure is the count of the total number of residents’ falls occurring in the video-covered areas of the facility over the period of video recording (allowing us to compute a fall rate per month). This count can be further compared with the cases of falls that the facility health board independently reported in its daily routine care for each known occurrence of fall (ie, administrative report regardless of the video recording) before video deployment (baseline occurrence).

The secondary outcome measures qualitatively assess the use of video recording and replay possibilities for care practice. This entails (1) acceptability of video monitoring by residents and facility staff and use of fall review by facility staff to support care practice and quality of care; and (2) the analysis of falls and of fall-related injuries, leveraging video replay to depict intrinsic and extrinsic factors, and environmental circumstances contributing to the falls Acceptability and impact of video review on care practice were assessed through semidirected interviews which can be carried out during bimonthly meetings with the care facility staff.

Falls Grading Scale can be used to stratify fall severity in near-fall (Grade 1), fall with no need for medical examination (Grade 2), fall requiring medical attention (Grade 3), and fall requiring hospital admission (Grade 4).

Wall-mounted cameras could be deployed in all common areas and private rooms of consenting residents and families in accordance with the following privacy and ethical guidelines. Video data can be transmitted using Wi-Fi to local network attached storage (NAS) devices.A customized mobile device app can too be provided for viewing video from the previous 72 hours, the mobile device app can be used for accessing the live video from each camera.

The videos of fall events that had been depicted by the research team can be made available to be viewed by the executive director of the facility who would decide to discuss them with the staffs. The meetings between the facility staffs and the monitoring team can be carried out twice a month over a period of time in a rather flexible way and using semidirected interviews. The main purposes of these meetings can be listed as follows: (1) to be sure that no unanticipated issues or concerns with residents, surrogates, and/or staff arose and (2) to observe the use (or no use) of the videos and what were the changes in care practice that were reported. During these meetings, the research team may be asked about the use of the videos in a neutral way (ie, observing the potential uptake of the recording without pushing attitude). Privacy and consent procedures must be developed.