InterventionProgramsforFallsandRates2.docx - Running head PICOT Statement and Literature Search PICOT Statement and Literature Research Grand Canyon

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Unformatted text preview: Running head: PICOT Statement and Literature Search PICOT Statement and Literature Research Grand Canyon University Intro to Nursing Research NRS-433V September 08, 2018 1 PICOT Statement and Literature Search 2 PICOT Question: Do patient education and hospital fall prevention policies/protocols influence a decrease in patient falls for those patients who have been identified as a high risk for falls during their hospital stay? 1. Type of research study: Qualitative Quigley, P. A., & White, S. V. (2013, May 31). Hospital-based fall program measurement and improvement in high reliability organizations. The Online Journal of Issues in Nursing, 18(2). Abstract: Falls and fall injuries in hospitals are the most frequently reported adverse event among adults in the inpatient setting. Advancing measurement and improvement around falls prevention in the hospital is important as falls are a nurse sensitive measure and nurses play a key role in this component of patient care. A framework for applying the concepts of high reliability organizations to falls prevention programs is described, including discussion of the core characteristics of such a model and determining the impact at the patient, unit, and organizational level. This article showcases the components of a patient safety culture and the integration of these components with fall prevention, the role of nurses, and high reliability. Advancing measurement and improvement around falls prevention in the hospital is important as falls are a nurse sensitive measure and nurses play a key role in this component of patient care (AHRQ, 2012; Quigley, Neily, Watson, Strobel, & Wright, 2007; White, 2012). A framework applying the concepts of high reliability organizations to falls prevention programs is for described including determining the impact at the patient, unit, and organizational level. This article showcases the components of a patient safety culture and the integration of these components with fall prevention, role of nurses, and high reliability. Methods: All organizations PICOT Statement and Literature Search 3 involved with the study emphasized nursing’s contributions to patient safety by assessing fall risk and designing patient-specific fall prevention interventions. The study looked at how each organization defines falls and injuries. Results: Research showed that the most successful fall prevention programs have both multifactorial and interdisciplinary components. Conclusion: Extensive literature documents the burden of falls to individuals, healthcare organizations, and society. Falls are categorized as an adverse event and usually further classified as accidental. Increasing regulatory and reimbursement changes challenge the health care industry to reduce hospital adverse conditions. Yet the measurement systems utilized for performance remains at the aggregate level, not affording precise evaluation of program changes and measurement. We assert that measurement must change by setting up program evaluation that examines organizational, unit, and patient level data. Our proposed model for program evaluation, applied in this article to a fall prevention program, enables robust evaluation and better depicts a high reliability organization (HRO). This model could be applied to any hospital adverse condition. We assert that a changed model such as the one described here would better support identification of best performance and showcase safe hospitals. 2. Type of Research Study: Quantitative Slade, S. C., Carey, D. L., Hill, A., & Morris, M. E. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: Protocol for a systematic review with meta-analysis. BMJ Open, 7(11). Abstract Introduction: Falls are a major global public health problem and leading cause of accidental or unintentional injury and hospitalisation. Falls in hospital are associated with longer PICOT Statement and Literature Search 4 length of stay, readmissions and poor outcomes. Falls prevention is informed by knowledge of reversible falls risk factors and accurate risk identification. The extent to which hospital falls are prevented by evidence-based practice, patient self-management initiatives, environmental modifications and optimisation of falls prevention systems awaits confirmation. Published reviews have mainly evaluated community settings and residential care facilities. A better understanding of hospital falls and the most effective strategies to prevent them is vital to keeping people safe. Methods and analysis: This protocol has been registered. The systematic review will be informed by Cochrane guidelines and reported according to the Preferred Reporting Items for Systematic review and Meta-Analysis statement. Inclusion criteria: randomised controlled trials, quasi-randomised trials or controlled clinical trials that evaluate falls prevention interventions for use by hospitalised adults or employees. Electronic databases will be searched using key terms including falls, accidental falls, prevention, hospital, rehabilitation, emergency, mental health, acute and subacute. Pairs of independent reviewers will conduct all review steps. Included studies will be evaluated for risk of bias. Data for variables such as age, participant characteristics, settings and interventions will be extracted and analysed with descriptive statistics and meta-analysis where possible. The results will be presented textually, with flow charts, summary tables, statistical analysis (and meta-analysis where possible) and narrative summaries. Conclusion: We have presented the rationale and design of a systematic review of interventions designed to reduce falls in hospitalised adults. The review will identify effective processes and their elements. The results will inform research into optimal fall risk assessment procedures and effective prevention interventions. It shall also shed light on how best to promote the uptake and implementation of best practice and how to educate patients and clinicians to prevent falls and associated injuries. PICOT Statement and Literature Search 5 3. Type of Research Study: Quantitative Tzeng, H., & Yin, C. (2015). Patient engagement in hospital fall prevention. Nursing Economics, 33(6), 326-334. Retrieved from ? vid=8&sid=b35f5cea-b15a-40ac-acb2-21bd9eeccdf0%sessionmgr4006 Abstract: Injurious falls are the most prevalent in-hospital adverse event, and hospitalized patients are at a greater risk of falling than the general population. Patient engagement in hospital fall prevention could be a possible approach to reducing falls and fall-related injuries. To engage patients, bedside nursing staff must first understand the concept of patient centeredness and then incorporate patient centeredness in clinical practice. Clinicians should move from being experts to being enablers. To conceptualize the knowledge gaps identified, a conceptual model was developed to guide future research and quality improvement efforts in hospital settings. This model could be used as a guide to advance nursing leadership in hospital fall prevention via promoting patient engagement (e.g., developing patient-centered fall prevention interventions with patients' input). Methods: A main conceptual model based on Donabedian’s framework of structure process and healthcare outcomes; Carman and associates’ patient and family engagement framework for understanding the elements and developing interventions and policies was developed to guide future research and quality improvement methods for inpatient settings. This research study is an example of a quantitative experimental design. The researchers used randomization to place qualified participants into three groups: Control group, group that was given fall education material only, and complete group which received written and verbal education and one-to one follow-up with a physical therapist. Independent variables, such as verbal and written fall educational material and the use of a physical therapist were introduced PICOT Statement and Literature Search 6 into certain groups and compared to the control group. Results: Hospital patients aged 60 years and older, who were admitted to acute and sub-acute inpatient units, were recruited before they were within 3 days of anticipated discharge. ) The patient-reported fall rates per 1,000 patient days did not differ significantly between the three groups (control, 9.27; materials only, 8.61; and complete program, 7.63). Fall incidents for patients who were cognitively intact were statistically significantly less frequent in the complete program group (4.01 per 1,000 patient days) than the materials-only group (8.18), and the control group (8.72). Conclusion: Decreasing in-hospital fall injuries and sustaining the effort and impact of fall prevention continue to be a challenge at the bedside. Empowering patients to become active participants in fall prevention during hospitalization could be the answer. This means inpatients are entitled to receive quality health care in fall prevention depending on their risk for falling and such patient centeredness could lead to safe hospital stays. To engage patients, bedside nursing staff must first seek understanding of the concept of patient centeredness and then incorporate patient centeredness into clinical practice by moving from being experts to being enablers in hospital fall prevention. 4. Type of Research Study: Quantitative Couman, M., Fusco-Gessick, B., & Wright, L. (2016). Improving patient safety through video monitoring. Rehabilitation Nursing, 4(2), 111-115. Abstract: Falls are a major safety issue in rehabilitation settings. Patients receive mixed messages-try to be as independent as possible, but don't do anything in your room without calling for assistance. Despite the use of multiple falls interventions at this facility, the fall rate remained high. To impact this rate, the facility implemented a video monitoring system. This system allows for patients at risk for falling to be monitored from a remote location. The monitor PICOT Statement and Literature Search 7 technician is able to speak to the patient directly and/or contact staff members to respond to the room, preventing a fall. Methods: Fifteen video monitoring units were installed on high risk units in a 115-bed Inpatient Rehabilitation Facility. Total falls and falls rates were tracked and reported pre- and post-implementation. Results: Over a 21-month period prior to implementing the video monitoring system, the average hospital-wide rate of falls was 6.34 per 1,000 patientdays (SD = 1.7488). After a year of usage that average has decreased to 5.099 falls per 1,000 patient-days (SD = 1.524). The reduction in falls was statistically significant. In addition, there have been significant cost savings by reducing sitter usage. Conclusion: Video monitoring can improve patient safety by decreasing falls, decreasing sitter usage and cost, and improving patient, family, and staff satisfaction. 5. Type of Research Study: Quantitative Leone, R. M., & Adams, R. J. (2015). Safety standards: Implementing fall prevention interventions and sustaining lower fall rates by promoting the culture of safety on an inpatient rehabilitation unit. Rehabilitation Nursing, 41, 26-32. Abstract: The purpose of this article is to review a quality improvement project aimed to examine how nurse leaders in an inpatient rehabilitation (IPR) unit can reduce the number of patient falls by implementing multiple fall prevention interventions and sustain their results by promoting a strong culture of safety on the unit. Methods: A retrospective review of IPR fall rates was performed. Quarterly fall rates were then compared with implementation dates of fall prevention interventions (safety huddles, signage, and hourly rounding). Culture of safety scores were also examined to assess the effect of an enhanced culture of safety on the sustainability of lowered fall rates. Results: The safety huddles were effective as the total fall rates per 1,000 PICOT Statement and Literature Search 8 patient days (Table 1) in the second through fourth quarters of 2011 (4.02, 4.64, 2.92) remained lower than presafety huddle levels (6.06). This trend toward better outcomes was transitory as the fall rate rose again in the first quarter of 2012 (4.47). Supplementing the safety huddles with the falling star signage only resulted in a negligible decrease in falls from the first to second quarter of 2012. Although each fall prevention intervention reduced fall rates upon initial implementation, all failed to sustain a reduction in the overall fall rate, even when used collectively. Hourly rounding proved to be an effective intervention as the total fall rate for first quarter 2013 fell significantly to less than one (0.65) per 1,000 patient days (Figure 1). The fall rate significantly increased approximately six fold from 0.65 in the first quarter of 2013 to 4.13 in the second quarter of 2013. A positive trend was seen again in late 2013 as fall rates declined again in the third and fourth quarters, 3.47 and 0.88, respectively (Figure 1). Despite efforts to strengthen the culture of safety in late 2012, the IPR unit scored unfavorably overall on the AHRQ Hospital Survey on Patient Safety Culture in December 2012 and June 2013. Of note, survey questions pertaining to the feedback and communication about error, communication openness, handoffs and transitions, and nonpunitive response to error all had a greater than 5% increase in score, reflecting positively on the culture of safety on the unit. IPR unit response rates for December 2012 and June 2013 were 61% and 60%, respectively. Conclusion: This QI project has exposed the value of concurrently employing multiple fall prevention interventions and culture of safety enhancement practices in reducing fall rates. Further research in the correlation between falls and other IPR specific variables, such as FIM scores, would be valueadded to future fall prevention programs on the IPR unit. Moreover, additional studies comparing fall prevention programs focused on identifying patients at high risk for falls to programs aimed at injury risk and injury prevention would be advantageous to nursing practice. Incorporating a PICOT Statement and Literature Search 9 fall prevention program that is evidence-based and tailored to the specific patient population will recognize the contributions of nurse leaders, DCNs, NAs, and CAs to best practice and patient safety. 6. Type of Research Study: Qualitative Dyck, D., Thiele, T., Kebicz, R., Klassen, M., & Erenberg, C. (2013). Hourly rounding for falls prevention: A change in initiative. Creative Nursing, 19(3), 153-158. Retrieved from 1?accountid=7374 Abstract: Fall-related injuries are a particular concern within the elderly population, and trends toward an aging demographic will keep this issue at the forefront in health care. We are challenged to develop creative strategies to significantly reduce harm and fall rates among the elderly. This article describes the process of establishing an hourly rounding initiative in a health care facility. Hourly rounding is supported by the literature as an effective strategy for falls prevention and patient safety. When the initiative was not successfully adopted initially, the implementation process was critically examined and an innovative sustainability plan was developed to ensure that the change would be embedded in the organization's culture. Through this opportunity, nurses and allied health members from all levels were able to collaborate on strategies for this patient safety initiative. Methods: A tracking tool was invented to identify patients who were considered a high risk for falls and then based off this tool the high-risk patients were validated through the Falls Risk Assessment Tool. An hourly rounding algorithm was developed with team input as to the interventions that were deemed necessary during hourly rounding to make it purposeful. Results: Hourly rounding is supported through literature as an PICOT Statement and Literature Search 10 effective strategy for falls prevention and patient safety. The findings are simply based upon trial and error. No data to back up implementing hourly rounding, just the simple fact that when patients are seen on an hourly basis this alone cuts down on falls. Conclusion: Hourly rounding is not a new concept, but the creativity that was employed in reimplementing it at DLC made it a highly anticipated intervention. The overarching innovative strategy was the way in which our working group revisited and addressed the various aspects of our previously failed attempt at establishing hourly rounding by using new approaches to develop a sustainable program. We determined that the key factors in developing a sustainable program included allowing sufficient preparation time, soliciting assistance from experienced organizations, fostering interprofessional collaboration, adopting a creative approach to implementation, and engaging staff throughout the process. An early result from one of our trial units has shown a reduction in fall rates. ...
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