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
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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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