Evidence Based Practice: Fall Prevention
Instructions: A. Write a brief summary (suggested length of 2–3 pages) of the significance and background of a healthcare problem by doing the following:
1. Describe a healthcare problem.
2. Explain the significance of the problem.
3. Describe the current practice related to the problem.
4. Discuss how the problem impacts the organization and/or patient’s cultural background.
B. Complete the attached “PICO Table Template” by identifying all the elements of the PICO.
1. Develop the PICO question.
C. Describe the search strategy (suggested length of 1–2 pages) you used to conduct the literature review by doing the following:
1. Identify the keywords used for the search.
2. Describe the number and types of articles that were available for consideration.
a. Discuss two research evidence and two non-research evidence sources that were considered (levels I–V).
D. Complete the attached “Evidence Matrix” to list five research evidence sources (levels I–III) from scholarly journal sources you locate in major medical databases.
E. Explain a recommended practice change (suggested length of 1–3 pages) that addresses the PICO question within the framework of the evidence collected and used in the attached “Evidence Matrix.”
F. Describe a process for implementing the recommendation from part E (suggested length of 2–3 pages) in which you do the following:
1. Explain how you would involve three key stakeholders in the decision to implement the recommendation.
2. Describe the specific barriers you may encounter in applying evidence to practice changes in the nursing practice setting.
3. Identify two strategies that could be used to overcome the barriers discussed in F2.
4. Identify one indicator to measure the outcome related to the recommendation.
Solution
Evidence Based Practice: Fall Prevention
Healthcare Problem
Falls refers to “an unexpected event in which a person comes to rest on the ground.” In a hospital setting, falls refer to tripping, slipping, collapses of patients in a healthcare setting (Healey & Darowski, 2012). Healthcare facilities experience patients fall frequently. Research suggest that 1800 older patients die yearly due to fall-related injuries as those who survive endure injuries which result in physical deformation and reduced quality of life. The most common causes of falls in healthcare facilities include muscle weaknesses or gait problems, which have accounted about twenty-four percent of all falls in nursing homes. Also, environmental hazards such as slippery floors, poor lighting system, and incorrect bed-heights have been a leading cause of falls as well as well as improperly fitted wheelchairs. Most of the patients in nursing homes are weak and have chronic conditions that present difficulty in walking. Falls are so frequent in the healthcare industry now as compared to the past (Dykes, Carroll, Hurley, Benoit, & Middleton, 2009).
Significance of the Problem
Falls have recently been reported in UK hospitals each year, predominantly affecting older patients with vulnerability factors like impaired mobility, delirium, dementia, and effects of long-term medication. For example, thirty percent of falls in hospital results to injury on patients in the UK. Reportedly, 280,000 falls occur in Wales and England annually. According to Healey and Darowski, (2012), it is evident that falls majorly are caused by the complex interplay between the unfamiliar environment of the healthcare facility, the type of care provided by the healthcare facility and the individual risk factors that predispose one to fall such as frailer individuals. Additionally, falls have been a significant problem for the elderly in nursing homes. Falls are amongst the utmost commonly occurring post-discharge adverse events. In a study in Australia, 333 older patients were examined on their perceptions about fall prevention. It was noted that many older patients have little or no knowledge of the strategies to avert falls both at home and in the hospital setting (Shuman, et al., 2016).
Current Practice
Current practices in the UK stipulates that there be common evidence-based programs that advocate for fall prevention. Some practices are put forth in the conventional healthcare setting advising the old to practice Tai Chi, gardening, and dancing as a way to prevent falls. This method reduces the risk of falls, mostly in younger adults who have not experienced falls. Other plans that have been put in place to prevent falls in the healthcare industry include chair Postural stability and Otago where each exercise presents an intervention to solve the falls issues among older patients. Furthermore, there are exertions to assess the efficacy of the fall prevention interventions. According to (Tzeng & Yin, 2014) staff’s perception about the commonly used interventions to prevent falls in hospital, has been inconsistent. Consequently, such inconsistencies might have been present as a result of unrecognizable nature of staff concerning the fall prevention interventions. Educating both the nursing staff and the patients on fall prevention techniques is essential for its fruitful outcomes as patients will not frequently experience falls.
Impact on Background
The Healthy People 2010 fall-prevention aim, which focuses on reducing the number of death due to falls has not yet been achieved. Fall-related injuries are now frequent in health care settings. These falls are costly in that they account for more than 15 percent of re-hospitalizations in the initial month after discharge from a healthcare facility. Notably, $16 billion has been spent on non-fatal cases of falls, and approximately $170 billion has been spent for fall-related deaths across the healthcare sector. Also, inpatient fall prevention has been an area of concern in the nursing field for the past fifty years. Falls are classified to be adverse events due to its avoidable nature concerning the anecdotal incident-based reports.
Fall injuries have been associated with the quality of nursing care in health care settings. Therefore, such incidences are closely monitored by nursing associations across the country. Most countries classify fall-related injuries as a form medication error as staff fails to administer the stipulated prevention measures associated with fall prevention (Hughes, 2008).
Keywords
The keywords used for research were:
-Falls, fall prevention, healthcare professionals, nursing staff, and fall reports, fall-related and best practices-
Number of research articles
PICOT TABLE
P-Population- Older patients
I- Intervention- fall prevention knowledge and expertise
C- Comparison- Frequent falls
O- Outcome- Quality Care (Fewer death cases due to falls)
T- Time- Stay at the healthcare facility
PICOT Question
When caring for older patients in a healthcare facility how do fall prevention knowledge and expertise compared to frequent falls influence quality care during their stay in the nursing homes?
This research utilized four research articles and three non-research articles. Totaling to seven articles.
- Coyle, R., & Mazaleski, A. (2016). Initiating and Sustaining a Fall Prevention Program. Nursing2016, 46(5), 16-21.
- Healey, F., & Darowski, A. (2012). Older Patients and Falls in Hospital. Clinical Risk, 18(5), 170-176.
- Hughes, R. (2008). Fall and Injury Prevention. In Patient safety and quality: An evidence-based handbook for nurses (Vol. III). Rockville MD: Agency for Healthcare Research and Quality.
- Shuman, C., Liu, J., Montie, M., Galinato, J. G., Todd, M. A., Hegstad, M., & Titler, M. (2016). Patient Perceptions and Experiences with Falls during Hospitalization and after Discharge. Applied Nursing Research, 31(1), 79-85. doi;10.1016/j.apnr.2016.01.009
- Dykes, P. C., Carroll, D. L., Hurley, A. C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? The Journal of Nursing Administration, 39(6), 299. doi:10.1097/NNA.0b013e3181a7788a
- Quigley, P. A., Barnett, S. D., Bulat, T., & Friedman, Y. (2016). Reducing Falls and Fall-Related Injuries in Medical-Surgical Units: One-Year Multihospital Falls Collaborative. Journal of nursing care quality, 31(2), 139-145.
- Tzeng, H. M., & Yin, C. Y. (2014). Most and Least Helpful Aspects of Fall Prevention Education to Prevent Injurious Falls: A Qualitative Study on Nurses’ Perspectives. Journal of Clinical Nursing, 23(17-18), 2676-2680.
Non-Research and Research Articles
The research came up with two non-research and research articles that were essential.
Research Articles
- Patient Perceptions and Experiences with Falls during Hospitalization and after Discharge. Applied Nursing Research, 31(1), 79-85. doi: http://dx.doi.org/10.1016/j.apnr.2016.01.009
In this study, focused on how to describe older patient’s (above 60 years) perceptions about their fall risks, fall prevention interventions, and fall prevention discharge. As an exploratory study utilizing a qualitative approach, the research suggested that healthcare providers need to engage fully with the patients and families in understanding fall prevention procedures and the factors contributing to falls during hospitalization and at discharge.
- Coyle, R., & Mazaleski, A. (2016). Initiating and Sustaining a Fall Prevention Program. Nursing2016, 46(5), 16-21.
In this research, the Six Sigma methodology was used to identify the causes and develop possible solutions to prevent falls at an 188-bed healthcare facility in New Jersey. Results suggest that the culture of preventing falls has improved even though the fall rates increased. Therefore, this research suggests that the fall prevention rates have improved as compared to pre-implementation rates.
Non-research Articles
- Healey, F., & Darowski, A. (2012). Older Patients and Falls in Hospital. Clinical Risk, 18(5), 170-176.
In this literature review, it is discussed that healthcare professionals must acknowledge the scale and complexity of each and every problem concerning falls. Also, it advises the clinicians to be committed to improving falls prevention. Effective falls prevention cannot be delivered by a single healthcare professional working in isolation, but it obligates a multidisciplinary teamwork to develop local practice and policy.
- Hughes, R. (2008). Fall and Injury Prevention. In Patient safety and quality: An evidence-based handbook for nurses (Vol. III). Rockville MD: Agency for Healthcare Research and Quality.
In this handbook, it provides a best practice guideline that is systematic to assist practitioners and patients about decisions that are appropriate in healthcare. Additionally, it helps the nurses to identify factors for falls, methods to decrease fall incidences and fall injuries.
Evidence-based matrix (attached excel file)
Recommended Practice Change and Implementation
After reviewing the literature, the committee integrated the PICOT question on how fall prevention can reduce the cases of falls in the healthcare setting. Best practices guidelines as stipulated by (Hughes, 2008) must be implemented fully by the organization so as to reduce the death rates by falls in healthcare facilities. Additionally, nurses and patients should be educated and trained thoroughly of the best practice approach to fall prevention techniques during hospitalization and after discharge. Also, nursing ethics recommend that clinicians should not cause harm to the client. Nursing associations have classified fall-related injuries as a form of medication error. Therefore it is advisable that nurses in the organization must be committed to these guidelines to prevent falls in a hospital facility. Implementation was successful as nurses and patients co-operated fully to the new project. The recommended change was implemented fully, and it greatly impacted the organization. The following changes were observed in the organization.
- Patients perception of fall prevention greatly improved as they were able to take Otago classes and were able to inform each other during their interactions.
- Nurses in the facility were positive about the plan and attended to it fully to improve quality care.
- The reputation of the organization was elevated, and its ranking increased in the healthcare facilities ranking board.
- Costly charges of re-hospitalization drastically reduced.
Key Stakeholders
All the stakeholders mentioned below will fully take part in advocating for fall prevention techniques to avoid fall-related deaths and injuries. The CNO (Chief Nursing Officer) informed the nurses in the organization of the plans to educate and train them on fall prevention guidelines. The CNO tabled a proposal to the CEO for the budget involved in training nurses on this phenomenon. The CEO approved the proposal to fund the project. The staff were positive about the change and realized their ethical requirements and provide quality care to patients. Nursing supervisors were able to educate the new nurses and families fully.
Barriers and Strategies
There were no evident obstacles during the implementation of the evidence-based recommended the practice. The most common barriers detected emerged from cases of language barriers as other patients were not able to understand the English language. To counter this problem, the management were able to hire language translators and used representative approaches in educating patients and respective families.
Indicator for Outcome
The device used to indicate outcome change was based on a survey of patients and nurses. It was reported that 90% of nurses were contented with the project, and 100% found it to be helpful in their career. Also, nurses reported the accurate implementation of the project as the patient reports suggested that the nursing staff were able to involve them actively in the process.
Conclusion
Falls have been a critical issue in a healthcare setting. Falls are preventable, and nurses must take into
considerations the best practices in preventing it. Research suggest that fall
prevention best practices guidelines have been helpful to some institutions.
According to this research paper, it is
evident that fall prevention is achievable and efficient in any healthcare
setting. Healthcare facilities must implement these techniques to prevent the
rising number of deaths and injuries associated with falls (Quigley,
Barnett, Bulat, & Friedman, 2016).
References
Coyle, R., & Mazaleski, A. (2016). Initiating and Sustaining a Fall prevention Program. Nursing2016, 46(5), 16-21.
Dykes, P. C., Carroll, D. L., Hurley, A. C., Benoit, A., & Middleton, B. (2009). Why do patients in acute care hospitals fall? Can falls be prevented? The Journal of Nursing Administration, 39(6), 299. doi:10.1097/NNA.0b013e3181a7788a
Healey, F., & Darowski, A. (2012). Older Patients and Falls in Hospital. Clinical Risk, 18(5), 170-176.
Hughes, R. (2008). Fall and Injury Prevention. In Patient safety and quality: An evidence-based handbook for nurses (Vol. III). Rockville MD: Agency for Healthcare Research and Quality.
Quigley, P. A., Barnett, S. D., Bulat, T., & Friedman, Y. (2016). Reducing Falls and Fall-Related Injuries in Medical-Surgical Units: One-Year Multihospital Falls Collaborative. Journal of nursing care quality, 31(2), 139-145.
Shuman, C., Liu, J., Montie, M., Galinato, J. G., Todd, M. A., Hegstad, M., & Titler, M. (2016). Patient Perceptions and Experiences with Falls during Hospitalization and after Discharge. Applied Nursing Research, 31(1), 79-85. doi: http://dx.doi.org/10.1016/j.apnr.2016.01.009
Tzeng, H. M., & Yin, C. Y. (2014). Most and Least Helpful Aspects of Fall Prevention Education to Prevent Injurious Falls: A Qualitative Study on Nurses’ Perspectives. Journal of Clinical Nursing, 23(17-18), 2676-2680.
