NURS FPX6011 Assessment 3: Implementing Evidence-Based Practice Essay

NURS FPX6011 Assessment 3: Implementing Evidence-Based Practice Essay

Assessment 3: Implementing Evidence-Based Practice

Background to Clinical Problem: Patient Falls

Patient falls are a serious issue, with outcomes ranging from minor bruising and scratches to puncture wounds, fractures, brain injuries, and even mortality. Research by Cuttler et al. (2019) shows that every year, over one million patients admitted to US hospitals suffer from falls during a hospital stay, representing approximately 85% of all hospital-acquired illnesses. Inpatient fall and injury rates vary by unit, with medical-surgical patients being at a higher risk than critical care patients (Cuttler et al., 2019). In the United States, medical-surgical facilities report between 3.67 and 6.26 falls per 1000 patient days. Approximately 20% of the medical-surgical unit falls result in some form of injury, with 2% resulting in catastrophic injuries (Cuttler et al., 2019).  Because of recently changed mobility, pharmacological side effects, a history of past falls, and regular going to the toilet, the acute care patient may be at higher risk of falling.

According to Cuttler et al. (2019), towards the end of 2014, the Agency for Healthcare Research and Quality found that hospital falls were basically unaltered from 2010 levels. This paper aims to investigate the initiatives of medical-surgical departments to reduce patient falls.

PICOT Question

Among adult patients in acute care settings (P), does the introduction of patient-centered treatment (I), compared to the use of patient bands and door signs ©, help lower the risks of falls (O) over a six-month period (T)?

Would the introduction of patient-centered treatments among adult patients in the acute care context be more successful than the Fall Risk patient bands and sign on patients’ doors in lowering the incidence of falls 6 months following implementation?

Stakeholders

Given the constant volume and severity of patient falls, stakeholders come together to discuss ways of preventing and reducing avoidable falls in the medical-surgical unit. Strategies to be employed include protecting vulnerable patients, restricting the movement of patients, putting up patient aid walks, and sedating mentally ill patients (Keuseman & Miller, 2020).   Fall risk is viewed as an indicator that additional assistance during ambulation may be required rather than a barrier to ambulation.

Since nurses are basically the primary caregivers in a ward setting, nurses have to account for everything that happened before, during, and after the fall. This includes information on the patient, if safeguards, such as designating the patient as a fall risk and installing a bed alarm on the patient were in place, and what occurred shortly before the accident; nurses are the topmost stakeholders in preventing patient falls. Championing safe maneuverability is a patient care tech strategy to ensure patients walk and can be accomplished by using ambulatory equipment such as a gait belt and walking device and enlisting additional assistance through a patient care tech. Nurses can further champion against falls by removing tethers like intravenous lines and drains that can inhibit movement.

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Physicians should be aware of their patients’ fall risk factors and fall history. Tools for assessing fall risk can be used, but they should be supplemented by a clinician’s tailored assessment of patient-specific, circumstantial, and environmental risk factors (Keuseman & Miller, 2020). Medication discontinuation is known to raise the chance of falling. In the hospital, sedative-hypnotics should not be used to treat insomnia. Any medicine that might impair mental state should be used with care. Antihypertensives can cause orthostatic hypotension; hence orthostatic vital care should be performed. Evaluate the need for, and timing of, diuretics and laxatives that enhance patients’ need for toileting or develop safety plans of care that anticipate toileting urgency or frequency. Recognize patients’ fall risk, urge early aided mobility, reinforce safety strategies, and communicate.

Action Plan

• Reacquaint the patient with their surroundings.
• Handrails should be installed in patient bathrooms, rooms, and hallways.
• Lock the hospital bed brake
• Use night lights or additional illumination.
• Maintain clean and dry floor surfaces. Clean up any spills as soon as possible.
• Use safe patient-handling techniques.

Barriers

Adherence to guidelines requires appropriate knowledge and attitudes, but they are not adequate. Practitioners may still face obstacles to implementing guideline recommendations as a result of the guideline itself, patients, or social/environmental variables (Koh et al., 2020). Furthermore, adhering to rules may need adjustments outside the practitioner’s control, such as purchasing resources. Lack of equipment or resources, and inadequate personnel are other barriers. a  lack of facilities and equipment, such as bed alarms, are also barriers to implementing recommendations.

The enormous volume of research and the rising emphasis on evidence-based practice make it challenging for any practitioner to be aware of, comfortable with, and capable of critically applying every relevant patient fall guideline to practice. According to Koh et al. (2020), in Singapore, 19% of nurses have a Bachelor’s or Masters’s degree, while the majority of nurses (65%) are certificate-trained or have only a diploma in nursing from a polytechnic, resulting in a lack of knowledge. Throughout their training, these nurses were not introduced to research or evidence-based practice.

Outcome Measures

Healey (2022) states that every year, between 700,000 and 1,000,000 persons in the United States suffer from hospital falls. Outcome measures should indicate a reduction in the number of falls progressively for the 6 months implementation period. This aims to reduce falls and related injuries.

 References

Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2019). Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms. BMJ Open Quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119

Healey, F. (2022). Preventing falls in hospitals. BMJ (Clinical Research Ed.), 532, i251. https://doi.org/10.1136/bmj.i251

Keuseman, R., & Miller, D. (2020). A hospitalist’s role in preventing patient falls. Hospital Practice (1995), 48(sup1), 63–67. https://doi.org/10.1080/21548331.2020.1724473

Koh, S. S. L., Manias, E., Hutchinson, A. M., Donath, S., & Johnston, L. (2020). Nurses’ perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals. BMC Health Services Research, 8(1), 105. https://doi.org/10.1186/1472-6963-8-105

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Assessment 3 Instructions: Implementing Evidence-Based Practice
• PRINT
• Create a poster presentation to communicate an implementation plan to bridge the gap between the evidence you will research and clinical practice. You will then record audio of no more than five minutes presenting your poster.
Introduction
Master’s-level nurses need to be able to think critically about the evidence, outcomes data, and other relevant information they encounter throughout their daily practice. Often the evidence or information that a nurse encounters, researches, or studies is not presented in the exact context of that nurse’s practice. A key skill of the master’s-level nurse is to transfer evidence from the context in which it was presented and apply it to a different context in order to maximize the benefit to patients in that new context.
Professional Context
Master’s-level nurses understand the importance of utilizing evidence-based practice in their healthcare setting. The challenge is bridging the gap between the evidence and clinical practice. “This is the way we’ve always done it,” is a common response and may not indicate evidence-based practice is being utilized. Furthermore, when a practice problem is identified, what are the steps to communicate the need for change with the interprofessional team?
One way to communicate the need for quality improvements, as well as your plans for achieving specific changes, is through a presentation poster. This type of communication tool is used both in the workplace and at professional and academic conferences. Being able to convey the essence and value of a project in a compelling and succinct way is a valuable skill, and it is vital within the constraints of a single poster.
Scenario
You have been asked to give a poster presentation based around your work and research on a clinical problem in your practice setting. The purpose is to lay out the evidence and a potential implementation plan to your colleagues in order to bridge the gap between the evidence and the practice to improve the quality and outcomes of care.
Instructions
Identify a clinical problem in your work setting and develop an implementation plan to carry out your evidence-based practice proposal using a poster presentation. You may use the Poster Presentation Template [PPTX] to help structure and organize your assessment submission.
Your Implementation Plan should include the following:
• Background on the clinical problem.
• PICOT question.
• Stakeholders that will be impacted.
• Action plan for implementation.
• Potential barriers to project implementation.
• Baseline data that will be needed to evaluate outcomes.
• Search strategy and databases used.
• Summary of the evidence with a critical appraisal of its quality.
The bullet points below correspond to the grading criteria in the scoring guide. Be sure that your poster presentation addresses all of them.
• Develop a PICOT question for a chosen clinical problem.
o Include a graphic that is relevant to the clinical problem.
o Provide a background on the clinical problem identified.
• Outline an action plan to implement the EBP project that includes:
o The recommended practice change.
o Proposed timeline for implementation.
o The tools or resources that will be needed to support the project.
• Identify the stakeholders and potential barriers to project implementation.
o Who are the stakeholders that will be impacted?
o What are the potential barriers, such as a lack of knowledge, time, skill level, motivation, or resources that could impact project implementation?
• Propose outcome criteria to evaluate the evidence-based practice project.
o How will outcomes be measured?
o How do your outcomes align with the Quadruple Aim?
• Evaluate the evidence that supports the need for practice change.
o In the notes section of your poster presentation:
o Describe your search strategy and databases that were used.
o Summarize your findings with a critical appraisal of the quality and relevance of your resources.
• Convey purpose of the poster presentation in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.
o Integrates relevant and credible sources of evidence to support assertions, using current APA style.
If you choose not to use the provided template, there are templates in PowerPoint or on the Internet that can help you get a start designing your poster.
Before starting to record your presentation make sure you have:
• Set up and tested your microphone and headset using the installation instructions provided by the manufacturer. You only need to use the headset if your audio is not clear or high quality when captured by the microphone.
• Practice using the equipment to ensure the audio quality is sufficient.
• Consult Using Kaltura for guidance on how to record your presentation and upload it in the courseroom.
• Microsoft PowerPoint also allows you to record your narration with your slides. If you choose this option, simply submit your presentation to the appropriate area of the courseroom. Your narration will be included with your stories.
• Remember to practice delivering and recording your presentation multiple times to ensure effective delivery.
Note: If you require the use of assistive technology or alternative communication methods to participate in this activity, please contact Disability Services at DisabilityServices@Capella.edu to request accommodations.
Submission Requirements
• Font and font size: Appropriate size and weight for a presentation, generally 24–28 points for headings; no smaller than 18 points for bullet-point text. Use a suitable professional typeface, such as Times or Arial, throughout the presentation.
• Length of presentation: No more than five minutes.
• Number of references: Cite a minimum of 3–5 sources of current scholarly or professional evidence that support your evaluation, recommendations, and plans. Current source material is defined as no older than five years unless it is a seminal work.
• APA formatting: Resources and citations are formatted according to current APA style.
Competencies Measured
By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and scoring guide criteria:
• Competency 1: Apply evidence-based practice to plan patient-centered care.
o Outline an action plan to implement the evidence-based practice project that includes the recommendations for practice change, a timeline, and tools or resources needed.
• Competency 2: Apply evidence-based practice to design interventions to improve population health.
o Identify the stakeholders and potential barriers to project implementation.
• Competency 3: Evaluate outcomes of evidence-based interventions.
o Develop a PICOT question for a chosen clinical problem.
o Propose outcome criteria for evaluating the evidence-based practice project and how the outcomes will be measured.
• Competency 4: Evaluate the value and relative weight of available evidence upon which to make a clinical decision.
o Evaluate the value and relevance of the evidence that supports the need for a practice change.
• Competency 5: Synthesize evidence-based practice and academic research to communicate effective solutions.
o Convey purpose of the poster presentation in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.

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Implementing Evidence-Based Practice Scoring Guide

CRITERIA	NON-PERFORMANCE	BASIC	PROFICIENT	DISTINGUISHED
Develop a PICOT question for a chosen clinical problem.	Does not create a PICOT question for a chosen clinical problem.	Creates a PICOT question for a chosen clinical problem, but the question is either not aligned to the problem, or does not follow the complete PICOT format.	Develops a PICOT question for a chosen clinical problem.	Develops a PICOT question for a chosen clinical problem. Provides background information on the chosen clinical problem.
Outline an action plan to implement the evidence-based practice project that includes the recommendations for practice change, a timeline, and tools or resources needed.	Does not describe an action plan to implement the evidence-based practice project.	Describes an action plan to implement the evidence-based practice project, but is missing one or more of recommendations for practice change, a timeline, and tools or resources needed.	Outlines an action plan to implement the evidence-based practice project that includes the recommendations for practice change, a timeline, and tools or resources needed.	Outlines an action plan to implement the evidence-based practice project that includes the recommendations for practice change, a timeline, and tools or resources needed. The items presented in the action plan are reasonable and realistic.
Identify the stakeholders and potential barriers to project implementation.	Does not identify stakeholders for the project.	Identifies stakeholders for the project. However, either does not address potential barriers to project implementation or the barriers identified are not relevant to the project.	Identifies the stakeholders and potential barriers to project implementation.	Identifies the stakeholders and potential barriers to project implementation. Calls out specific actions that could be taken to overcome barriers.
Propose outcome criteria for evaluating the evidence-based practice project and how the outcomes will be measured.	Does not identify outcome criteria for evaluating the evidence-based practice project.	Identifies outcome criteria for evaluating the evidence-based practice project. However, does not address how the outcomes will be measured or the method(s) for measuring outcomes is not appropriate.	Proposes outcome criteria for evaluating the evidence-based practice project and how the outcomes will be measured.	Proposes outcome criteria for evaluating the evidence-based practice project. Specifies how the outcome measures align to the Quadruple Aim.
Evaluate the value and relevance of the evidence that supports the need for a practice change.	Does not describe the evidence that supports the need for a practice change.	Describes the evidence that supports the need for a practice change. However, does not address the value and relevance of the evidence.	Evaluates the value and relevance of the evidence that supports the need for a practice change.	Evaluates the value and relevance of evidence used to support the need for a practice change. Provides a summary of findings from the evidence, as well as the search strategy and databases used.
Convey purpose of the poster presentation in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.	Does not convey purpose of the poster presentation in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and communication scholarly standards.	Conveys purpose of the poster presentation in an appropriate tone or style. Clear, effective communication is inhibited by insufficient supporting evidence and minimal adherence to applicable communication standards.	Conveys purpose of the poster presentation in an appropriate tone and style, incorporating supporting evidence and adhering to organizational, professional, and scholarly communication standards.	Conveys clear purpose of the poster presentation in a tone and style well-suited to the intended audience. Supports assertions, arguments, and conclusions with relevant, credible, and convincing evidence. Exhibits strict and nearly flawless adherence to organizational, professional, and scholarly communication standards, including APA style and formatting.