Evidence-Based Practice Intervention Project Proposal

Evidence-Based Practice Intervention Project Proposal

Introduction

Falls among hospitalized patients is common. With the numerous adverse consequences associated with patient falls, implementing and assessing evidence-based interventions to reduce the incidence of falls is crucial (Frieson et al., 2018). This project examines the effectiveness of a fall prevention bundle consisting of staff education, hourly rounding, and bed alarms in minimizing the occurrence of falls, compared to the use of bed alarms only. The project highlights the overview of the problem, the project’s background, significance, and the PICOT question. It will also focus on the literature review and its critical appraisal. Implementing this project will be highly significant to our health organization and the entire nursing profession as it will underscore cost-effective, evidence-based interventions that reduce the incidence of falls among hospitalized patients. Knowledge gained from the project will thus be applicable to all nurses Evidence-Based Practice Intervention Project Proposal.

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Overview of the Problem

By definition, patient falls are unplanned descents to the floor with or with no injury to the patient. While falls are common among hospitalized patients, the elderly are at higher risk. Patient falls have numerous consequences. These include fall-related injuries, trauma, fractures, and even death. Further, falls lengthen hospital days and increase costs. Falls also result in a self-imposed limitation of activity among older patients. Exploring patient falls is worth as it provides an insight into factors behind the high rates of falls and strategies for minimizing the rates in health facilities. According to Venema et al. (2019), older adults are treated in the emergency department for falls every 11 minutes in the US. Falls are also the leading causes of trauma-related admissions and fatal injuries among elderly patients. Overall, the proposed project will contribute to nursing practice, as the findings will be vital in promoting patient safety.

Project purpose statement

Accidental patient falls in healthcare institutions present a major healthcare quality failure that is both costly and unethical. Evidence-based interventions need to be implemented in the healthcare institutions such as hospitals to reduce the patient fall rates to the least possible numbers.

Background and significance

The established patient fall rate in hospitals in the United States is between 3.3 and 11.5 falls for every 1,000 hospital stays (Bouldin et al., 2013). Because of this, many patients who suffer falls are left with chronic injuries that are costly and life-changing. Understandably, the majority of these fall victims are older adults above 65 years of age. Since it is a quality issue that can be prevented through better and more vigilant nursing care, the Centers for Medicare and Medicaid Services or CMS adopted since 2008 a policy of not reimbursing services rendered to fall victims in hospitals (Fehlberg et al., 2017). This means that hospitals have to spend their own resources to care for these patients Evidence-Based Practice Intervention Project Proposal.

The potential impact of the project

This project will come up with sound interventions that are backed by scholarly evidence for efficacy (evidence-based practice or EBP) in the reduction of patient falls in hospitals. They will improve patient safety and outcomes by increasing patient satisfaction, reducing readmission rates, shortening the length of hospital stays, and lowering healthcare costs.

The PICOT question

The target population for this PICOT inquiry is nurses and nurse managers in all healthcare institutions caring for patients across the lifespan. The intervention is a nursing fall prevention bundle of bed alarms, nurse education, and hourly patient rounds. The alternative intervention or comparison is the use of nurse education alone. The expected outcome is no patent falls while the timeframe for implementation is six months. The PICOT question therefore is:

For nurses and nurse managers in healthcare institutions (P), does using the nursing fall prevention bundle of bed alarms, nurse education, and hourly patient rounds (I) compared to nurse education alone (C) lead to the eradication of the problem of patient falls (O) within a period of six months (T)? 

Literature Review

The search involved studies in four databases, namely Cochrane Library, Pubmed, LILACS, and CINAHL up to September 2020. The search approach included controlled and uncontrolled descriptors. Controlled descriptors were based on the MeSh and DeCs standards, while uncontrolled primary search words were focused on the synonyms of the controlled descriptors and were also guided by past studies on relevant topics. Some of the controlled descriptors used included “accidental falls, fall injuries, nurse education, patient safety, hourly patient rounds, and a bundle of bed alarms.” The uncontrolled search terms included “acute care, elderly, life quality, and geriatric.” The search resulted in 76 studies that were subsequently narrowed down to five studies which fulfilled all the requirements of the inclusion standards of the review Evidence-Based Practice Intervention Project Proposal.

Cuttler, Walker & Culltler (2017) conducted research aimed at assessing the efficacy of patient education videos and fall prevention visual signaling icons when attached to bed exit alerts in reducing acutely hospitalized medical-surgical inpatient falls and level of injuries. This was a performance enhancement study including historical control, which involved four medical-surgical departments in one United States community acute care facility, and participants included adult medical-surgical inpatient. According to this study, the number of fall incidences reduced by 20 percent to 3.80 from 4.78 per 1,000 patient days (Cuttler et al., 2017).

Bayen et al. (2017) conducted a study to examine how constant video surveillance and examination of dementia falls would promote greater quality of healthcare. This was a pilot observational analysis performed at a memory care center in California. According to this study, a decrease in falls numbers was noted in the final month of the research, leading to the conclusion that video surveillance provides a greater capacity to promote quality care in memory care centers (Bayen et al., (2017).

Another research by Subermaniam et al. (2017) aimed to examine the efficacy of a modular bed absence sensor (M-BAS) in sensing bed exits in older hospitalized patients. In this study, acute geriatric ward patients aged 65 years and over who was able to move with or without assistive devices and physical support were enrolled in the research. The sensitivity of the M-BAS was 100 percent, with a prognostic value of 68 percent and a disturbance alert level of 31 percent. At the completion of the period of intervention, there was a substantial decline in the overall NASA-TLX workload score. 83 percent of nurse practitioners found the strategy helpful for mitigation of falls, 97 percent discovered that it was convenient, and 87 percent will want to use it more. The research demonstrated that M-BAS could detect bed absence events in geriatric hospitalized patients and notify nurses immediately (Subermaniam et al., 2017)Evidence-Based Practice Intervention Project Proposal.

Another research by Slade et al. (2017) aimed to assess the efficacy of fall avoidance strategies to minimize falls in hospitalized adults. Researchers also outlined the elements of successful fall prevention strategies. This is a systematic review with meta-analysis of controlled clinical trials, quasi-randomized trials, or randomized controlled trials. Participants aged 21 years of age or hospital workers were involved in the study.

Daniels (2016) also conducted a study to enhance patient safety and satisfaction by introducing nursing rounds that are meaningful and prompt. The study used the Joanna Briggs Institute’s Practical Application of Clinical Evidence System and Getting Research into Practice audit tool. To test punctuality and use of a procedure while rounding, close monitoring of nursing staff on a medical-surgical unit in the US was used. The study found that the rounding rate almost doubled during sleeping and awake hours at defined intervals. The utilization of a rounding system improved adherence from zero substantially to 64 percent. With a large sub-element rise in toileting (41 percent), hospital personnel responsiveness improved marginally (15 percent) and patient falls declined by 50 percent (Daniels, 2016)Evidence-Based Practice Intervention Project Proposal.

Critical Appraisal 

Using the critical appraisal skills system guide, the critical appraisal of the five studies listed above was conducted. The strength of the Cuttler, Walker & Culltler (2019) study is that the strategy was multifactorial, which is considered to be the most productive strategy, well designed at the local and national level, enforced after staff training and education, and fully endorsed by the management. The drawback is that there is a need for randomized clinical trials to validate the usefulness of icons and video strategies and exit alerts. What is known from the evidence is that patient education is effective in minimizing falls, but there is a knowledge gap where the extent of efficacy of other interventions is still uncertain (Cuttler et al., 2019).

The strength of the study conducted by Bayen et al. (2017) is that It explicitly and coherently demonstrated how improved care quality can be facilitated by consistent video monitoring and analysis of falls of dementia patients. Its weakness is that the researchers did not assess the impact of the approximation of diversity of patients, such as demographic and clinical characteristics, therapeutic effects, or resource usage. What is known from the current evidence is that for successful treatment and subsequent mitigation in cognitively disabled persons, early diagnosis and access to the fall history is critical. However, there is a knowledge gap where many falls are unwitnessed, and it is difficult to comprehend how and why a fall happened. (Bayen et al, 2017).

The strength of the study by Subermaniam et al. (2017) is that it employed the use of bed alarm systems while no other hospital unit had ever considered them. Its weakness is its temporary design that results in the lack of authentic fall results and the potential to cause bias in collecting alarm event information. The existing evidence suggests that in sensing bed exits, the modular bed absence sensor system is efficient. There is a knowledge gap in the outcome of the particular falls related to the use of the system.

The strength of the research undertaken by Slade et al. (2017) is that the existing evidence for the efficacy of hospital falls reduction interventions has been consistently identified and objectively assessed. Another strength is that by using a priori inclusion/exclusion procedure, data collection methods, and risk of bias analyses, the research sought to minimize bias. Its drawback is that, due to a shortage of translating services, the use of only English-language journals indicates that there is a possibility of cultural and publishing bias. The prevention of falls is guided by an understanding of risk factors for reverse falls and proper risk recognition. The degree to which enhancement of falls prevention mechanisms`, patient self-management programs, and evidence-based practice prevent hospital falls has not been confirmed (Slade et al., 2017)Evidence-Based Practice Intervention Project Proposal.

In the research by Daniels (2016), the drawback of the research was the lack of randomization, and the absence of detailed statistical intervention measures, rendering it impossible to establish the explicit impact of nursing rounds. Its strength is that it showed how hard-wiring current workflow-related procedures take a lot of time as workers accept reform and learn how best practice approaches enhance patient outcomes significantly. What is known from the current evidence is the most effective way to minimize call lights and accidental falls and improve both patient satisfaction and care quality is by hourly rounding. However, there is a gap in knowledge where nurse awareness as to the meaningful rounding and services championing punctuality is still scarce (Daniels, 2016).

EBP Standard

It will be better to adhere to certain clinical practice standards that support the perspective of the health provider and patient while evaluating patient engagement in ensuring this evidence-based practice work effectively. Getting feedback from the healthcare professional would be essential when we trust that the needs of the patient are taken into account as we come up with fall prevention intervention. This research proposal is closely connected to the advances in patient compliance to actively participate in this program.

In this evaluation, over a period of five weeks, the healthcare provider will gather the data from the initial fall incidences. The participants will have some understanding of the purpose of the research and will have the motivation and attitude to adjust to their features. After receiving the data obtained by all qualified participants, it will be stored in a repository where everyone can view a pattern of progress. A cumulative improvement will be seen in a graph and categorized into three categories: falls, fall injuries, and severe fall injuries. It will provide direction for the control of falls. In order to see the most effective interventions, the variable interventions for mitigating accidental falls in the healthcare facility will be graphed Evidence-Based Practice Intervention Project Proposal.

Implications

Research

This study is particularly useful for future studies in the nursing profession. There are numerous incidences of patient falls worldwide and this is a significant problem for the health sector. There is a knowledge gap on the most appropriate intervention to minimize the accidental fall in patients. This study will therefore provide an incentive for prospective researchers willing to partake in related thematic fields, particularly the feasibility of various interventions in the events of falls in healthcare facilities. This research would reflect a given sampling of a field or area — for example, the field of nursing, which would thus lead to additional studies on the identification of any of the current problems or concerns contributing to a rise in patient falls rates.

Education

This study is significant as it will direct care providers in preventing patient falls in hospitals and other healthcare facilities. It will also be essential in providing education o patients about how to be safe when they are hospitalized and how they can individually handle themselves in packed healthcare facilities to minimize the incidence of accidental falls.

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Practice

This study presents a chance to reflect on certain evidence-based practices to better decrease the occurrence of patient falls in hospitals and other healthcare facilities. It forms the basis for the best practices that healthcare providers can utilize to strengthen their clinical practice.

References

Bayen, E., Jacquemot, J., Netscher, G., Agrawal, P., Tabb Noyce, L., & Bayen, A. (2017). Reduction in fall rate in dementia managed care through video incident review: Pilot study. Journal of Medical Internet Research, 19(10), e339.

Bouldin, E.D., Andresen, E.M., Dunton, N.E., Simon, M., Waters, T.M., Liu, M…. & Shorr, R.I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13–17.

Cuttler, S., Barr-Walker, J., and Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ Open Quality, 6(2), p.e000119.

Daniels, J. (2016). Purposeful and timely nursing rounds: A best practice implementation project. The JBI Database of Systematic Reviews and Implementation Reports, 14(1), 248.

Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7.

Frieson, C. W., Tan, M. P., Ory, M. G., & Smith, M. L. (2018). Editorial: Evidence-based practices to reduce falls and fall-related injuries among older adults. Frontiers in Public Health, 6.

Slade, S., Carey, D., Hill, A., & Morris, M. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: Protocol for a systematic review with meta-analysis. BMJ Open, 7(11), e017864.

Subermaniam, K., Welfred, R., Subramanian, P., Chinna, K., Ibrahim, F., Mohktar, M., & Tan, M. (2017). The effectiveness of a wireless modular bed absence sensor device for fall prevention among older inpatients. Frontiers in Public Health, 4.

Venema, D. M., Skinner, A. M., Nailon, R., Conley, D., High, R., & Jones, K. J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19(1). doi:10.1186/s12877-019-1368-8 Evidence-Based Practice Intervention Project Proposal

Week 8: Signature Assignment – Evidence-Based Project Proposal Web Page Task: View this topic Points: 200 | Due Date: Week 8, Day 7 | CLO: 2, 5 | Grade Category: Assignments Assignment Prompt The purpose of the signature assignment is for students to apply the research and EBP concepts they have learned in this course and develop a framework for the initial steps of the student’s capstone project. The assignment allows the student to initiate the steps for planning, researching and developing an evidence-based practice intervention project proposal. On or before Day 7, of week eight each student will submit his or her final proposal paper to the week eight assignment link in D2L. This formal paper will include and expand upon work completed thus far in prior assignments. Essential Components of the Final Project Proposal will include: Introduction– Provide an introduction to your topic or project. The introduction gives the reader an accurate, concrete understanding what the project will cover and what can be gained from implementation of this project. Overview of the Problem – Discuss the problem, why the problem is worth exploring and the potential contribution of the proposed project to the discipline of nursing. Project Purpose Statement – Provide a declarative sentence or two which summarizes the specific topic and goals of the project. Background and Significance – State the importance of the problem and emphasize what is innovative about your proposed project. Discuss the potential impact of your project on your anticipated results to the betterment of health and/or health outcomes. PICOt formatted Clinical Project Question(s)– Provide the Population, Intervention, Comparison, Expected Outcomes and Timeframe for the proposed project. Literature Review – Provide the key terms used to guide a search for evidence and discuss at least five (5) summaries of relevant, credible, recent, evidence-based research studies to support the project proposal. Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and what gaps in evidence were found from the appraisal of evidence-based research studies. Develop an EBP Standard – Describe two to three interventions (or a bundle of care) from the evidence and discuss how individual patient preferences or the preferences of others will be considered. Implications – Summarize the potential contributions of the proposed project for nursing research, education and practice.