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An Investigation of A Clinical Governance or Clinical Practice Issue Assignment Sample

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An Investigation of A Clinical Governance or Clinical Practice Issue

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Relevance of clinical governance to the project

Clinical government is considered as a systematic approach that helps in maintaining and improving the quality of patient care within a health care system. It is a basic framework through which health care organizations are can continually improve the practices through adding quality aspects in the service provision (Pearce, Phillips, Dawson and Leggat, 2013). High standard of care services can be added in the care dimension which creates an environment in which excellence in clinical care could be flourished. The three major attributes of clinical governance is recognising high standards of care, managing transparent responsibility and accountability for health care standards and adopting constant dynamic of improvement. Since, it applies only to health and social care organizations; therefore the concept is entirely related to delivery of care to the patients.

The concept of clinical governance is relevant in the present case as application of the concept could assist health care entities to adopt new and preventive measures to reduce the issue of falls in the aged care facility. Further, this is also useful in improving the quality of care and at the same timethe issue of falls in Australian aged care facility can be managed. In this case, the major components of clinical governance can also be applied; hence all the risks and uncertainties can be managed respectively (Halton and, 2016). Risk management is essential to include about it is all about identifying the factors that influence the care provision. Hence, appropriate actions can be taken to minimize the identified risks. Further, clinical auditing could also be developed wherein practitioners should appropriately measure the quality of care they offer. Health care practitioners must get prominent training and education so that they can emphasize more on professional development.

As per the guidelines determined by The National Institute for Health and Clinical Excellence, health care entities should provide evidence – based care to the patients so that to promote good health for the patients. In the issue of falls, staffing and staff management should be appropriate so that to provide high- quality care. Lastly, the pillar of clinical governance articulates that feedback should be included in carer experience so that areas of improvements can be identified.

Problem is Worth Solving

Falls is a major issue prevailing in Australian aged care facilitiesand it is also regarded as one of the adverse events; however it is preventable if appropriate actions are taken. In the year 2009 – 2010, there were about 20,000 cases wherein falls were recorded as major issues in health service area (Sherringtonand, 2016).

In order to minimize the issue of falls in aged care facility, Australian Commission on Safety and Quality in Health Care have developed several provisions for the purpose of coordinating improvements in the safety and quality of health care nationally. Falls are one of the largest causes of harm in aged care facility and during care episodes, older people needs to go through a period of intercurrent illness because of unfamiliar setting (Sherrington and, 2016). Residents in a residential aged care facilityexperienced an incidence of falls nearly five times more than people of same age in their own home. In the year 2005 – 2006, 21% of serious falls occurred in residential aged care facility; hence this is considered as the one of the most frequent places to fall.

Every year around 30% of the Australians above the age of 65 years fall wherein 10% of these falls leads to injury. However, it has also been analysed that the 80% of falls- related cases remain in home. In terms of impact, this increases the issues of decreased muscle tone along with physical inactivity (Dugue and, 2016). Moreover, falls rates in residential aged care facilitydiffer from 4 to 10 per 1000 resident bed days; while on the other rates between one and five falls per resident per year have also reported. Fall injury rates in residential aged care facilityin people over the age of 65 years and older are approximately 7200 falls per 1,00,000 people. The hip and thigh are the most common injured areas in both men and women sustaining falls. Falls may increase the risk of complications which also includes the likelihood of getting a fear of falling or loss in confidence while standing, walking and other activities (Preventing Falls and Harm From Falls in Older People. 2009).

Additionally, it has also been observed that the total estimated health cost is attributed to falls- related injury and this also keeps on increasing almost threefold from A$ 500 million. In order to maintain the current health costs, there is a need to reduce the incidence of falls- related hospitalizations. In this context, proper communication is required to be followed in the health care entities so as to address the issue of falls. Registered nurses should give more consideration to intrinsic and extrinsic factors because that increases risk of falling in residential aged care facilities (Falls prevention in Australia. 2012). Australian Government Aged Care Quality Agency have developed varied accreditation standards so as to enhance the quality of services as it includes management systems, staffing and organizational development. Focus has also been laid on physical environment and safe systems. However, at the same time, specific concern should be given to service user's rights and responsibilities.

Key Stakeholders

Stakeholders like registered nurses, practitioners, patients, management of (RACF) residential aged care facility and family members play crucial role in promoting the health standards and as a result it can prevent falls related issues (Hewitt and, 2014). Patients are one of the main stakeholders of residential aged care facility as they are the sole users of the health care amenities. Patients have to ensure that registered nurses are providing all the appropriate sources and assistance while moving from one place to another. Further, patients can also give their feedback regarding the services as that can also assist in facilitating improvements in the care provision (Lee and, 2013). In residential aged care facility, patients fall because of many reasons; thus it is crucial for the registered nurses to ensure that they are providing appropriate assistance to the care users in all spheres.

Registered nurses are significant stakeholders in residential aged care facility as they are entirely responsible to provide prominent services to the patients. Hence, it is vital for the registered nurses to ensure that walking aids, bed rays and other facilities are provided to the patients. Registered nurses should always assist them while moving from one place to another so as to reduce the probabilities of falls (RNs in aged care: stakeholders make their case to inquiry. 2015). They are required to play diverse roles in the care practices and they should also adopt new practices to improve the issues of falls in the registered aged care facilities. Further, practitioners working in the same area also need to ensure that proper medication is being provided to the patients so that their health issues could be reduced. Similarly, practitioners should also analyse the measures that are followed in the residential aged care facilityfor the purpose of encouraging the efficiency of health care services (Towne and, 2016).

Management of residential aged care facilityshould also ensure that appropriate tools and mechanism are being followed at the time of moving the patients to different places. Management has to develop several health standards and that needs to be prominently adhered by the practitioners so that the issue of fall can be prevented (Silva, Eslick and Duque, 2013). Management should also adopt new practices for monitoring the practices of nurses so that the possibilities of falls can be minimized in the residential aged care facility. Along with better quality service provision, it is also crucial for management to adopt new practices so that they can minimize the issues related to falls.

Further, family members also play crucial role in the same domain wherein they have to ensure that patients are getting safe and secured residential services while staying in aged care facility (Duque and, 2016). It is also their responsibility to observe the improvements coming in the patients. They also have to prominently guide the patients to adopt proper measures to reduce the possibilities of falls. Hence, in this way health standards can be promoted to higher extent.

CPI Tool

In order to reduce the issues occurring from falls in residential aged care facility, it is essential to make certain changes in the clinical practice improvement. Several new practices needs to be adopted as CPI tools which can also assist in delivering better services to the patients. In this respect, Program of Experience in the Palliative approach can be adopted which empowers health professionals to deliver quality end of life care. It offers free placements, free workshops, reverse Program of Experience in the Palliative approach and etc (Sherrington and, 2016). It can be adopted in Australian residential aged care facility for the purpose of promoting the full integration and utilization of advanced nursing practice knowledge, skills and expertise from all role dimensions that are associated to clinical practice, education, research, organizational leadership and professional practice. It is also essential in promoting ongoing advanced nursing practice role development and model of care enhancement through evaluating outcome- based goals on continuous manner (Tiedemann, Sherrington and Lord, 2013).

Further, in the same area, Plan-Do-Study-Act can also be adopted since it is a useful tool for documenting a test of change. Hence, residential aged care facility could analyse all the activities through testing it on regular basis. This is highly important for the purpose of facilitating improvements in the care plan (Cassell and Clapperton, 2013). Several other interventions and strategies can be adopted to enhance the level of practices in nursing. In order to overcome the injuries, it is vital for the management of residential aged care facility to adopt all such interventions. This is also crucial in promoting the health standards especially for aged people.

Summary of Proposed Intervention

It can be stated that the above mentioned tools can be adopted to underpin the standards of health care services in residential aged care facility. In terms of intervention, registered nurses are required to adopt consistent tools of assessment wherein proper monitoring and controlling is required. Staff management of residential aged care facilityalso needs to provide suitable education and training to the staff members (Vlaeyen and, 2015). At the same time, nurses should also identify the risk factors that leads to falls as according to that only, the issues of falls can be prevented. Coordinated multi-disciplinary approach can also be adopted to analyze the practices that can be included to reduce the risks of falls prevailing in older people in residential aged care facility. Moreover, CPI should be promoted on higher extent to reduce the same risk (Aama, 2011).

Barriers to implementation and sustaining change

While implementing the above mentioned interventions, several barriers and constraints may occur that could also hamper the sustainability of change. Registered nurses might resist for this change due to lack of support from other practitioners or from management. At the same time, resistance could also come due to unavailability of financial resources that not only hinders the service capability; but also it may enhance the cases of falls in residential aged care facility. However, at the same time patients (residents) may also resist for this; hence in order to overcome this aspect, registered nurses need to consider stern actions (Kuys and, 2014).

Evaluation of the project

The success of the project will be identified on the basis of collecting data about the effectiveness of the intervention and fall prevention strategies. Information will be included about the patients who are getting benefitted from these strategies (Balzer and, 2012). This will assist in identifying the benefits of the strategy and along with that, focus will also laid on feedback from the registered nurses who provide residential care to residential aged care facilitypatients. Furthermore, in this respect statistics will be collected regarding the number of patients that are protected due to all the mentioned fall prevention strategies.


Cassell, E. and Clapperton, A., 2013. A decreasing trend in fall-related hip fracture incidence in Victoria, Australia. Osteoporosis international. 24(1). pp.99-109.

Falls prevention in Australia. 2012. [Online]. Available through: < >. [Accessed on 13th January 2017].

Halton, K., Hall, L., Gardner, A., MacBeth, D. and Mitchell, B. G., 2016. Exploring the context for effective clinical governance in infection control.American Journal of Infection Control.

Hewitt, J., Refshauge, K.M., Goodall, S., Henwood, T. and Clemson, L., 2014. Does progressive resistance and balance exercise reduce falls in residential aged care? Randomized controlled trial protocol for the SUNBEAM program. Clinical interventions in aging. 9.

Kuys, S.S., Peel, N.M., Klein, K., Slater, A. and Hubbard, R.E., 2014. Gait speed in ambulant older people in long term care: a systematic review and meta-analysis. Journal of the American Medical Directors Association.15(3). pp.194-200.

Pearce, P., Phillips, B., Dawson, M. and Leggat, S. G., 2013. Content of clinical supervision sessions for nurses and allied health professionals: a systematic review. Clinical Governance: An International Journal. 18(2). pp.139-154.

Preventing Falls and Harm From Falls in Older People. 2009. [Pdf]. Available through: <>. [Accessed on 13th January 2017].

RNs in aged care: stakeholders make their case to inquiry. 2015. [Online]. Available through: <>. [Accessed on 13th January 2017].

Sherrington, C., and, 2016. Exercise and fall prevention self-management to reduce mobility-related disability and falls after fall-related lower limb fracture in older people: protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised controlled trial. BMC geriatrics. 16(1). p.1.

Silva, R. B., Eslick, G. D. and Duque, G., 2013. Exercise for falls and fracture prevention in long term care facilities: a systematic review and meta-analysis. Journal of the American Medical Directors Association. 14(9). pp.685-689.

Tiedemann, A., Sherrington, C. and Lord, S. R., 2013. The role of exercise for fall prevention in older age. Motriz: Revista de Educação Física. 19(3). pp.541-547.

Vlaeyen, E. and, 2015. Characteristics and Effectiveness of Fall Prevention Programs in Nursing Homes: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Journal of the American Geriatrics Society. 63(2). pp.211-221.



Author / Year / Country

Aim of the study

Sample setting

Design/ Methods

Main findings

Strengths and Limitations

Article 1

Lee, A. D. and, 2013.

To assess the effectiveness of patient education in reducing falls, promoting behavioural change and the uptake of prevention activities in older adults during and after hospitalization.

A systematic search of five health science databases

Systematic review and meta-analysis.

Falls prevention programmes that contained patient education were effective in reducing fall rates amongst hospital inpatients and post-discharge populations

With secondary research, suitability of tools have identified.

Article 2

Balzer, K and, 2012.

To ascertain falls prevention in elderly

31 Literature reviews were searched

Systematic literature searches were performed in 31 databases

Positive effects of exercise interventions may be expected in relatively young and healthy seniors, while studies indicate opposite effects in the fragile elderly.

Effectiveness of intervention techniques are identified.

Article 3

Aama, T. A., 2011.

To provide family physicians with a practical, evidence-based approach to fall prevention in the elderly

Literature reviews were researched

MEDLINE was searched using relevant terms

family physicians have a pivotal role in screening older patients for risk of falls, and applying preventive strategies for patients at risk

Article 4

Duque, G and, 2016

Treatment of Osteoporosis in Australian Residential Aged Care Facilities: Update on Consensus Recommendations for Fracture Prevention

Participants were selected by the scientific committee on the basis of their practice in an residential aged care facilityand/or major published articles

This article provides an update on the most relevant evidence on osteoporosis in older people living in residential aged care facilitygraded according to its level, quality, and relevance

Article 5

Towne, D. S and, 2016.

To examine demographic, interpersonal, institutional, and community factors associated with injurious falls in RCFs

(n = 733,309) of RCF residents

conducted analyses using a nationally representative sample (n = 733,309) of RCF residents

Residents needing assistance with activities of daily living were more likely to experience injurious falls

Analysed all forces that leads to elderly falls.

Article 6

Dugue, G and, 2016.

 To address some of the issues

relating to the treatment of older residents with osteoporosis in residential aged care facility

Participants were selected

by the scientific committee on the basis of their practice in an residential aged care facilityand/or major published article

This article provides an update on the most relevant evidence on osteoporosis in older people

Living in residential aged care facilitygraded according to its level, quality, and relevance.

Article 7

Sherrington, C. and, 2016.

to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects

99 comparisons from 88 trials with 19 478 participants were available

Update of a systematic review with random effects meta-analysis and meta-regression.

Exercise as a single intervention can prevent falls in community-dwelling older people

Exercise programmes that challenge balance and are of a higher dose have larger effects

Article 8

Sherrington, C. and, 2016.

To evaluate the effects of an exercise and fall prevention self-management intervention on mobility-related disability

350 people aged at least 60 years with a recent fall-related lower limb or pelvic fracture that led to a hospital admission

A randomised controlled trial

Identified the effects of exercise on falls

The study does not give result for overall population.

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