Literature Review and Critical Appraisal Essay Paper
Project Title
What evidence-based interventions are effective for reducing the incidence of accidental patient falls in hospitals and other healthcare institutions?
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 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.
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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).
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).
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).
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).
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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.
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.
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.
Week 7: Assignment – Part 3: Literature Review and Critical Appraisal Web Page Task: View this topic Points: 100 | Due Date: Week 7, Day 7 | CLO: 5 | Grade Category: Assignments Assignment Prompt This week’s first assignment is STEP 3 – Literature Review and Critical Appraisal. The student will complete the following items and submit a Word doc to the assignment link. Provide a title that conveys or describes the assignment. Literature Review – Provide the key terms used to guide the search for the evidence and provide at least five (5) summaries of research studies to support the evidence. Critical Appraisal of Literature – Discuss the strengths and weaknesses of the evidence, what is known from the evidence and any gaps in knowledge from the research evidence. References – Cite a minimum of five scholarly references in APA 6th ed format. Expectations Due: Monday, 11:59 pm PT Format: Completed paper with references in APA 6th ed. format File name: Save the file with Student First Name_Last Name_Part 3 Literature Review and Critical Appraisal Essay Paper