NUR 550 Benchmark – Evidence-Based Practice Project PICOT Paper

Sample Answer

Falls and fall-related injuries in elderly patients in long-term care facilities are a patient safety concern in nursing and healthcare that requires an evidence-based practice (EBP) approach to address. Falls are prevalent among elderly patients and lead to adverse effects like fractures, head injuries, and permanent disabilities.

Hourly rounding protocols are evidence-based practice (EBP) interventions combined with structured fall prevention education for healthcare providers and patients can lower and prevent the prevalence of falls and enhance care outcomes (Anu, 2021). The purpose of this paper is to develop and elaborate on key parts of the PICOT as proposed in the EBP project.

Population Demographics and Health Concerns

The population targeted by the proposed EBP project entails elderly patients comprising individuals who are 65 years and above in long-term care facilities. In their study, Shao et al. (2023) posit that elderly patients are at a heightened risk for falls because of various factors that include age and frailty, poor gait and balance, and failing eye-sight that may affect vision.

Falls are a patient safety concern and increase the risk of injuries, including permanent disability. Complications associated with falling include fractures, head injuries, and increased possibility of hospitalization leading to higher cost of care. Reducing falls can lower the utilization of emergency department and hospital services while enhancing the quality of life of elderly patients (Albasha et al., 2023).

As a nursing practice issue and health concern, addressing falls and the risks associated with falls enables nurses to prevent adverse events and improve the quality of care delivered.

Proposed Evidence-Based Intervention

The proposed evidence-based intervention is implementing hourly rounding protocols combined with structured fall prevention education for both healthcare workers and patients. In her study, Anu (2021) found that hourly rounding and fall prevention protocols among elderly patients in long-term care can lead to safety changes and enhance the quality of life.

By implementing hourly rounding and patient education, facilities like long-term care entities, can reduce and prevent falls and associated risk factors. Another study by Albasha demonstrated that healthcare workers should have sufficient knowledge of falls and fall prevention strategies, including implementing evidence-based interventions like hourly rounding.

Additionally, Heng et al. (2020) agreed that patient education plays a critical role in fall prevention. The study recommended that facilities, including long-term care facilities (LTCFs), should implement such protocols because of their overall outcomes or effects on fall prevention.

The proposed intervention integrates health policies and goals that support health equity for elderly patients. For instance, the Healthy People 2030 policy focuses on improving the quality of life and patient safety for vulnerable populations like the elderly.

Furthermore, providing education on falls to healthcare workers and patients aligns with the value-based care model where the Centers for Medicare and Medicaid Services (CMS) reimburses healthcare facilities based on the quality of care offered and not quantity. Falls are considered as never events since they are preventable through sufficient safety measures like hourly rounding and education (Albasha et al., 2023). As such, the proposed intervention aligns with these policies and supports equity for elderly patients to attain quality outcomes in the LTCFs.

Comparison of Intervention to Current Research

Existing studies and literature evidence demonstrate that hospitals and residential settings for elderly patients and individuals use various fall prevention interventions. For instance, in their study, Schoberer et al. (2022) conducted a systematic review of the literature to identify clinical guidelines on fall prevention among elderly patients.

The study recommended various interventions like professionally supported exercise, and education and counseling strategies. A systematic review by Albasha et al. (2023) recommended the use of education and training as well as the development of stakeholder inter-relationships to prevent patient falls.

Meulenbroeks et al. (2024) focused on exercise as an effective fall prevention intervention in residential aged care and community settings. Through their review, the authors demonstrate that facilities can roll out exercises as an intervention to reduce and prevent falls among the chosen population. As such, these interventions are highly used in healthcare facilities.

However, limited studies focus on hourly rounding and structured education for both healthcare workers and patients in LTCFs to reduce and prevent falls among elderly patients. Therefore, while the studies by Schoberer et al. (2022) and Albsaha et al. (2023) focus on education, they do not specify its type and how it can be integrated with hourly rounding. Consequently, the proposed intervention differs in some aspects from the current studies, making it important for implementation.

Expected Outcomes for the Intervention

The implementation of the proposed intervention aims at various positive outcomes for patients and long-term care facilities. Based on the formulated PICOT question, the core outcome entails reducing falls and fall-related injuries and adverse events by 40% within three months.

The second outcome is to improve the quality of life and patient safety by ensuring that elderly patients have better protocols and measures in various areas of care in the selected facilities. As demonstrated by existing literature, hourly rounding protocols combined with structured education for patients and nurses will help attain the expected goals for the proposed EBP project.

Time Estimated for Implementing Intervention and Evaluating Outcome
The implementation of the suggested intervention will take three months based on the duration of the course and being in the practicum site. The implementation will involve developing all aspects of the proposed EBP project and engaging relevant stakeholders within and outside the organization.

Using the allocated time, the project will evaluate the outcomes in the final month of the implementation. As mentioned, the core outcome of the proposed intervention is to reduce the prevalence of falls among the elderly, especially by enhancing knowledge and understanding among the targeted population and healthcare workers. Outcome evaluation will involve determining the rate of fall reduction within the implementation period.

Support for Population Health Management for Selected Population

Nursing science, social determinants of health, and epidemiologic, genomic, and genetic data are used or synthesized to support the management of the population health for elderly patients susceptible to falls in various ways. Nursing science is critical in managing the population health of elderly patients vulnerable to falls as it entails using evidence-based practices, and health promotion interventions like hourly rounding and education.

Social determinants of health and their understanding assist healthcare providers in developing appropriate and targeted interventions to lower susceptibility to falls (CDC, 2024). Epidemiologics offer data on prevalence helping nurses to identify risk factors and monitor trends on falls while evaluating the effects of current interventions to manage these incidences.

Genomic and genetic data offer insight into genetic issues that contribute to reduced gait and other causes of frailty among elderly patients (Dordunoo et al., 2023). As such, this information supports the management of the selected population as it helps develop effective mechanisms for long-term safety outcomes.

Conclusion

Falls and fall-related injuries are major patient safety and quality care concerns for elderly patients in long-term care facilities. As such, the proposed EBP project intervention aims to reduce the rate of falls and their associated adverse effects and cost of care.

Existing evidence, nursing science, social determinants for health and epidemiological, genetic, and genomic data support the implementation of the proposed intervention to reduce and prevent falls and associated injuries in long-term care facilities for elderly individuals or residents.

References

• Albasha, N., Curtin, C., McCullagh, R., Cornally, N., & Timmons, S. (2023). Staff’s insights
  into fall prevention solutions in long-term care facilities a cross-sectional study. BMC Geriatrics, 23(1) 738. DOI https //doi.org/10.1186/s12877-023-04435-7
  
• Albasha, N., Ahern, L., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons,
  S. (2023). Implementation strategies to support fall prevention interventions in long-term care facilities for older persons a systematic review. BMC Geriatrics, 23(1) 47. DOI 10.1186/s12877-023-03738-z.
  
• Anu, J. A. (2021). Hourly Rounding and fall prevention among the elderly in long-term care a
  change process. Journal of Geriatric Medicine, 3(1) 1-5. DOI 10.30564/jgm.v3i1.2614
  
• Centers for Disease Control and Prevention (CDC) (2024 January 14). Social Determinants of
  Health (SDOH). https //www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html
  Dordunoo, D., Limoges, J., Chiu, P., Puddester, R., Carlsson, L., & Pike, A. (2023). Genomics-
  informed nursing strategies and health equity A scoping review protocol. Plos One, 18(12), e0295914. DOI 10.1371/journal.pone.0295914
  
• Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital
  falls prevention with patient education A scoping review. BMC Geriatrics, 20(1), 1–12. https //doi.org/10.1186/s12877-020-01515-w
  
• Meulenbroeks, I., Mercado, C., Gates, P., Nguyen, A., Seaman, K., Wabe, N., … & Westbrook, J.
  (2024). Effectiveness of fall prevention interventions in residential aged care and community settings an umbrella review. BMC Geriatrics, 24(1) 75.
  DOI https //doi.org/10.1186/s12877-023-04624-4
  
• Shao, L., Shi, Y., Xie, X. Y., Wang, Z., Wang, Z. A., & Zhang, J. E. (2023). Incidence and risk
  factors of falls among older people in nursing homes systematic review and meta-analysis. Journal of the American Medical Directors Association, 24(11) 1708-1717. DOI 10.1016/j.jamda.2023.06.002.
  
• Schoberer, D., Breimaier, H. E., Zuschnegg, J., Findling, T., Schaffer, S., & Archan, T. (2022).
  Fall prevention in hospitals and nursing homes Clinical practice guideline. Worldviews on Evidence‐Based Nursing, 19(2) 86-93. DOI 10.1111/wvn.12571