Falls and CROs

  1. Identify an area/problem for evidenced-based practice related to improving quality outcomes

Patient falls continue to be a safety issue in the field of healthcare, particularly in the elderly. Falls are defined as an event arising from an individual coming to rest on the ground or at a lower level. Individuals who have had a previous fall are at greater risk for another fall. However, falls are rarely caused by a single factor, but rather, caused by complex factors which may be a mixture of intrinsic, extrinsic and situational factors. Currently, the issue of falls and other fall-related injuries are taken as serious health problems as it can lead to hospitalization and even death. Many individuals, particularly the elderly, require prolonged hospitalization, along with loss of function and independence.

  1. Discuss internal and external factors influencing the delivery of care and outcome’s management related to your identified area/problem.

Intrinsic factors consist of inherent disorders and age-related physiologic decline. These may include increasing age, medical conditions, malnutrition, the ability to see, maintain balance, inability to perform activities of daily living and adequate muscle power. Due to existing medical co-morbidities, the elderly often have complex and multiple drug regimes. In the elderly, drug regimen can be major risk factors for falls (NICE, 2004). In fact, risk of falling increases with the number of medications they are taking due to its side-effects that affect balance and that may cause drowsiness or lethargy.  This risk can further be compounded by extrinsic or environmental factors. Examples of extrinsic factors include new surroundings, living alone, slippery or uneven surfaces, poverty, lack of housing and dependence on another individual. Meanwhile, certain situational factors also increase the risk of falls and other fall-related injuries such as multi-tasking or when rushing things.

As the root cause of falls result from a combination of internal and external factors, programs aimed at prevention should be tailored individually according to each person’s needs. Preliminary medical examination should include assessment of risk factors that may contribute to an incidence of fall. Individuals who report falling should be further assessed in terms of gait and balance.

  1. Discuss four distinguishing characteristics of Contract Research Organizations (CROs)

CROs or Contract Research Organization provides research services to various industries such as biotechnology, pharmaceuticals and the manufacture of medical devices. These services are often on a contractual basis and are most likely to be outsourced. CROs range from small institutions that offer specialized services to large organizations that operate globally. CROs also provide support to research organizations, major universities and even some government establishments. They also conduct clinical studies and provide the necessary support for these clinical trials.

CROs have been largely successful due to their continuous quality improvement, which can be characterized by four major factors, namely: Customer focus, training and empowerment, leadership and statistical thinking.

  1. How do these distinguishing characteristics meet the needs of the consumers?

This industry has been largely driven by its consumers, and for CROs, they must satisfy both the internal customer or sponsors and the external customer at the same time. In terms of training and development, CROs possess a unique role as they have dual roles: serving as a scientific team member and at the same time, having no vested interest in a product’s success or failure. Continuous learning and training is an important value in most CROs as top management takes the lead to drive their vision and involve employees. This characteristic influences performance and work output. The leadership component is of course, undeniable as it is a critical element towards the success of a CRO. These organizations require people who can lead the team and ensure that they are going in the right direction. Meanwhile, Statistical thinking pertains to the ability of CROs to understand statistical treatments and analyze its meaning. CROs are driven by data and can sometimes require whole-scale analysis of trends and data that can measure outcomes and results.


McLaughlin, C. & Kaluzny, A. (2006) Continuous Quality Improvement in Health Care: Theory, Implementations, and Applications. Jones and Bartlett Learning

National Institute for Clinical Exellence (2004, November). Clinical practice guideline for the assessment and prevention of falls in older people. Royal College of Nursing;

Pavlou, M.P. & Lachs, M.S. (2008) Self-neglect in older adults: A primer for clinicians. J Gen Intern Med 23:1841-1846.