Examining the Evidence
1. Please, this order is a continuation of (Paper 1 Matrix and Paper 1 Matrix Table attached to this order). So, you do not need new references, use the evidence in the Paper 1 Matrix Table attached or if you think you need more, you can add to the 12 references you already have.
2. Use the same problem “Falls Among the Inpatient Unit Geriatric Population” /PICO Question “Among the geriatric population in the inpatient hospital unit (P), does purposeful hourly rounding of nurses (I), compared to no rounding (C), reduce the rate of patient falls (O)?” In the PICO question of this order, you need to refine it using the instruction from the Rubric.
3. Please follow the Directions and Rubric on the Instructions attached and use the HEADINGS in the paper as in the RUBRIC.
4. Kindly follow the Directions and Rubric as in the “Paper 2 Instruction Examining the Evidence” in the attached files.
5. Please, DO NOT USE First-person.
6. Use APA 7th edition for REFERENCES and INTEXT CITATIONS. Reference MUST be within 5 years.
Examining the Evidence
An increasing number of elderly patients fall while in the hospital, which can cause serious injury or even death. Severe injuries can lead to a longer hospital stay, increased financial obligation for the facility, and a greater risk for placement in a nursing home. A total of thirty-six million falls happen each year among the older population of the United States, as per the Centers for Disease Control and Prevention (CDC) (2020). According to Alshammari et al. (2018), falls are the most common cause of injuries among this particular demographic in the emergency room. For example, they can lead to a variety of health problems such as higher rates of morbidity and mortality, fear, mental illness as well as institutionalization (Strauss et al., 2021). The purpose of this paper is to examine falls among the inpatient unit geriatric population, determine three interventions for falls and develop the best practice or intervention based on the level of evidence.
Elderly patients under hospital care are more vulnerable to falls, which are a major healthcare problem. It is estimated that there are thirteen to twenty-five falls per one thousand inpatient days in the psychiatric emergency department, compared to three to five falls per one thousand inpatient days in conventional acute care hospitals (Pitchai et al., 2019). Falls are a quality and safety issue since people who suffer from these ailments may find it difficult to get around, carry out daily tasks, or even live independently (Prabhakaran et al., 2020). The wrist, arm, ankle, and hip can all be fractured by falls. Head injuries can result from falls. This is especially dangerous if the patient is taking certain medications (like blood thinners) (Schick et al., 2018). Falls continued despite the intensive use of chart and therapeutic treatments, such as leg strengthening and vitamin D supplements, in the inpatient geriatric mental unit’s efforts. The emergency room is a special place because of the wide variety of patients that come through its doors (Walsh et al., 2018). The emergency department is a chaotic, fast-paced, and unpredictable setting where patients are constantly moving about the department. In the patient room, there is a lot of movement between procedural areas and the restroom. Geriatric patients are at risk of falling in the emergency department because of the new surroundings, severe sickness, surgeries, bed rest, drugs, therapies, and the installation of different tubes and catheters (Walsh et al., 2018). In order to develop the best practice or intervention for falls among geriatric patients, the Institute of Medicine (IOM) will be considered. The main aims for quality care that will be considered are effectiveness, efficiency, and patient-centered.
Purpose of the Project
The purpose of this project is to reduce fall-related injuries among geriatric populations, more specifically in the emergency department. The project sought to develop an intervention program (purposely hourly rounding of nurses) to combat the high rate of geriatric patient falls. This project is significant to nursing practices. First, this evidence-based practice will help nurses reduce the rate of patient falls. Secondly, these efforts will be used by nursing personnel to meet the immediate needs of patients and thereby prevent falls. By proactively addressing the problem of reducing patient falls, the purposeful hourly rounding (PHR) technique improves patient safety and satisfaction (Linehan & Linehan, 2018). Patients will be introduced to the hospital environment by nursing personnel in order to ensure that variables such as dangerous sleeping postures are addressed. Thirdly, the project will support the role of nurses as caregivers. It improves the quality of care and strengthens the interaction between nurse and patient. Patients will be actively involved in the care process by having their postures, amount of discomfort, and proximity to belongings periodically assessed by nurses.
Several nursing theories exist that can be used to guide this project. However, since this is a system change, Kirk Lewin’s model of change fits better. Lewin’s model of change identifies the three main steps (unfreezing, change, and freezing) that are required for a successful system change. These three steps will be significant in guiding the change process of this project. First, staff in the emergency department must unfreeze their current perception and process in order to prepare for this project. This will help the team approach this project without bias and with a clean slate. When the staffs are unfrozen, this project will be implemented. Since most of the obstacles will have been addressed in the unfreezing step, the project implementation process will be easy and timely. Finally, the staff in the emergency department will freeze, or accept the change, new practices and assume them as new norms.
Interventions and Strategies
Several interventions and strategies can be used to prevent fall-related injuries in the emergency department. However, the best three supported practices are purposely hourly nursing rounding, setting up bedside alarms, and non-slippery footwear. The above three interventions are supported by level I and II evidence. For instance, Sun et al. (2020) conducted a meta-synthesis study on purposely hourly nursing rounds. Purposely hourly nursing was found to reduce patient falls, decrease call light use and improve patient satisfaction. Similarly, bedside alarms are associated with fewer falls and improved nurse awareness. A systematic review study by Walsh et al. (2018) found that the use of non-slippery footwear reduces the risk of falls by ten percent. This evidence provides enough support that the current measures need to be changed. However, some areas were not well supported in the evidence. For instance, the evidence by Walsh only took part in one institution. The hierarchy of evidence was used to rate the evidence. It is based on the methodological quality of design with systematic review and RCT being on the top.
Patient Care Technology
One patient care technology that can be used to improve fall-related risk is integrated technology. This technology combines devices mounted on walls of patient rooms with an application on nurses’ phones or lanyards on nurses’ badges. This technology will help nurses quickly survey patients at risk of falls, help nurses evaluate them, and help nurses act appropriately (Sun et al., 2021). This technology makes the process of fall prevention effective, efficient and timely.
P- Geriatric population in the inpatient hospital unit
I-Purposeful hourly rounding of nurses
C- No rounding
O- Reduce the rate of patient falls
The clinical question is, “among the geriatric population in the inpatient hospital unit, does purposeful hourly rounding of nurses compared to no rounding reduce the rate of patient falls?”
In searching for the existent evidence, this project focused on various databases such as
Google Scholar, PubMed, and CINAHL. Keywords such as “Fall,” “Risk for falls,” “Risk for falls among geriatrics,” “Purposeful hourly rounding of nurses,” and “Reducing the rate of patient falls” were used. From the search methodology, two hundred sources were identified.
It is possible to reduce the severity of fall-related injuries by preventing them from occurring in the first place. Death, injuries, disability, hospitalization, lack of freedom, and mobility are only some of the consequences of patient falls in the geriatric inpatient unit. In the emergency department, several factors contribute to the risk of falls, including fast pace and movements. The most effective strategy for preventing falls in geriatric inpatient wards, according to studies, is the planned rounding of nurses.
Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F. K.,
Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderly and its relation
with their health problems and surrounding environmental factors in Riyadh. Journal of
family & Community medicine, 25(1), 29–34.
Centers for Disease Control and Prevention. (2020, December 16). Keep on your feet preventing older adult falls. Retrieved February 14, 2022, from https://www.cdc.gov/injury/features/older adult-falls/index.html
Linehan, J., &; Linehan, J. (2018). Fall prevention in long-term care using purposeful hourly rounding. Journal of the American Medical Directors Association, 19(3), B17. https://doi.org/10.1016/j.jamda.2017.12.056
Prabhakaran, K., Gogna, S., Pee, S., Samson, D. J., Con, J., & Latifi, R. (2020). Falling again? falls in geriatric adults—risk factors and outcomes associated with recidivism. Journal of Surgical Research, 247, 66–76. https://doi.org/10.1016/j.jss.2019.10.041
Pitchai, P., Dedhia, H., Bhandari, N., Krishnan, D., D. Souza, N., & Bellara, J. (2019). Prevalence, risk factors, circumstances for falls and level of functional independence among geriatric population – a descriptive study. Indian Journal of Public Health, 63(1), 21. https://doi.org/10.4103/ijph.ijph_332_17
Sun, C., Fu, C. J., O. Brien, J., Cato, K. D., Stoerger, L., & Levin, A. (2020). Exploring practices of bedside shift report and hourly rounding. is there an impact on patient falls? JONA: The Journal of Nursing Administration, 50(6), 355–362. https://doi.org/10.1097/nna.0000000000000897
Sun, C. J., Fu, C. J., Morelli, J. D., & Levin, A. (2021). Improving bedside shift report and hourly rounding using remote surveillance. Journal of Informatics Nursing, 6(2), 16–21. https://doi.org/https://link.gale.com/apps/doc/A668415185/ITOF?u=naal_usam&sid=bookmark-ITOF;xid=3e6da642
Schick, S., Heinrich, D., Graw, M., Aranda, R., Ferrari, U., & Peldschus, S. (2018). Fatal falls in the elderly and the presence of proximal femur fractures. International Journal of Legal Medicine, 132(6), 1699–1712. https://doi.org/10.1007/s00414-018-1876-7
Strauss, D. H., Davoodi, N. M., Healy, M., Metts, C. L., Merchant, R. C., Banskota, S., &
Goldberg, E. M. (2021). The geriatric acute and post-acute fall prevention intervention
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with falls: Protocol for a mixed-methods study. JMIR Research Protocols, 10(4), e24455.
Walsh, C. M., Liang, L.-J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal trends in fall rates with the implementation of a multifaceted fall prevention program: Persistence pays off. The Joint Commission Journal on Quality and Patient Safety, 44(2), 75–83. https://doi.org/10.1016/j.jcjq.2017.08.009