Evidence-based practice performances are known to be always available for various conditions such as asthma, diabetes, and heart diseases, among others. Nonetheless, these practices are consistently implemented in care delivery as well as variation in practices abound. According to modern day literature, inpatient falls form one of the most serious patient safety and quality problems in nursing homes. Besides, meta-analyses of randomized controlled trials give evidence that various intervention programs are both important and effective in reducing the risk and the rate of falls (Healey, 2016). Therefore, based on this context, the core intent of this essay is to provide an evidence-based practice performance improvement plan consisting in an internal QI cycle to reduce or ensure safe performances for falls in nursing homes.
With regard to the Evidence-based intervention of inpatient falls, the literature supports the use of a multi-faced fall prevention program. This is considered as one of the most successful interventions for reducing as well as preventing in-patient falls. To begin with, a multi-faceted fall prevention plan has to start with both a valid and a reliable Falls Risk Assessment Tools (FRAT). Despite the fact that modern-day literature suggests the use of different FRATs, numerous studies substantiate that the Morse Fall Scale (MFS) is one of the most reliable tools for predicting and addressing the risk of patients due to falls. The following are the steps of the evidence-based practice performance improvement plan that is effective in addressing the issue of falls in patients.
Describe the Problem
Being the initial step in this practice performance improvement plan, the description of the problem very crucial. In this context, falls that result in injury is a prevalent patient safety problem. Having identified this as the problem, it is, therefore, evident that any patient, regardless of the age or physical ability can risk falling due to various medical procedures such as surgery, physiological changes, and medication, among many others.
Formulate a Focused Clinical Question
Once the general problem area is identified and described, nurse practitioners can formulate a clear clinical question that will be used as a guide in the performance improvement work. According to research, this component of the Evidence-Based Practice performance improvement plan is drawn from the conventional EBP paradigm and also makes use of the PICO format (Levin, Keefer, Marren, Vetter, Lauder, & Sobolewski, 2010). Therefore, in this regard, a focused clinical question that can be drawn from the issue of falling patients is such as, Should multiple interventions tailored to the population or individual be used to prevent fall-related injuries in the elderly? This particular clinical question identifies the elderly as the primary population in question (P) and the outcome (O) is Prevent fall-related injuries.
Search for Evidence
Under this phase, the search for retrieval of the evidence in question is approached systematically. This way primarily tries to find the highest level of proof first and later proceeds methodically through the hierarchy of evidence to answer the focused clinical question that was identified. However, there is the refutation that, not all evidence is created equal. Therefore, in this improvement process, it is essential to ensure that the evidence obtained is the best since it significantly guides on the specific clinical decision used for patient care.
Develop an Aim Statement
In this regard, an aim statement is crucial since it is used for directing attention to the specific outcomes desired. This includes a measure of achievement and an operational goal. For example, concerning the clinical question identified in this case, a possible aim statement would be; reduce the number of patient falling instances in X nursing home by at least 50% within five months. Thus, the measure here may be the number of falling patients in this particular nursing home before the implementation of the Evidence-Based Practice Improvement plan up to five months afterward (Sung et al., 2015).
Disseminate Best Practices
Usually the last phase of the improvement plan. The dissemination of the best practices is considered appropriate once the process of implementing the practice change is perfected. Also, this process includes the sharing of best practices which are supported with measurable outcomes, to the external professional community.
The process of implementing change in evidence-based practice requires that individual elements are put in place. Some of the resources needed to support this kind of change in practice are such as, personal time, falls risk assessment tools and staff cooperation among others. Notably, the Morse Fall Scale is an essential resource that is used in this case. Usually, the MFS is a simple but effective method of assessing the likelihood of a patient to fall. Besides, this tool can be used to identify the different risk factors for falls in hospitalized patients (Majid et al., 2011).
Similarly, the amount of personal time invested in this evidence-based practice improvement plan is crucial for change to happen. For instance, despite the fact that evidence-based practice provides nurses with a method to use scientifically proven evidence for the delivery of quality healthcare, the nurses and the patients ought to dedicate their time and the right attitude towards the adoption of EBP. Besides, the nurses and the staff need to cooperate to encourage adoption and also deal with those factors that are likely to create barriers to the adoption of the evidence-based practice performance improvement plan (Gesme & Wiseman, 2010).
In conclusion, it is evident that falls leading to injuries continue to be a considerable challenge in many healthcare facilities. Nonetheless, like all other healthcare conditions, fall requires an interdisciplinary approach such as the evidence-based practice improvement models. Thus, since no particular individual can exclusively prevent falls, it requires the involvement of all stakeholders. Effective fall prevention requires an organization structure and operational practices that promote teamwork and communication as well as individual expertise.
Gesme, D., & Wiseman, M. (2010). How to Implement Change in Practice. Journal of Oncology Practice, 6(5), 257-259. doi:10.1200/jop.000089
Healey, F. (2016). Preventing falls in hospitals. BMJ, i251. doi:10.1136/bmj.i251
Levin, R. F., Keefer, J. M., Marren, J., Vetter, M., Lauder, B., & Sobolewski, S. (2010). Evidence-Based Practice Improvement. Journal of Nursing Care Quality, 25(2), 117-126. doi:10.1097/ncq.0b013e3181b5f19f
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y., Chang, Y., & Mokhtar, I. A. (2011). Adopting evidence-based practice in clinical decision making: nurses' perceptions, knowledge, and barriers. Journal of the Medical Library Association : JMLA, 99(3), 229-236. doi:10.3163/1536-5050.99.3.010
Sung, Y. H., Cho, M. S., Kwon, I. G., Jung, Y. Y., Song, M. R., Kim, K., & Won, S. (2013). Evaluation of falls by inpatients in an acute care hospital in Korea using the Morse Fall Scale. International Journal of Nursing Practice, 20(5), 510-517. doi:10.1111/ijn.12192
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