NRS 465 Benchmark Capstone Change Project Implementation Plan

Sample Answer

Patient falls, especially among the geriatric population, are a critical patient safety concern that requires facilities and providers to address because of their adverse effects on patients and the healthcare system.

The Centers for Disease Control and Prevention (2024) asserts that one in every four older persons falls at least once every year with less than half reporting the incidents to their healthcare providers.

Hourly purposeful rounding is an evidence-based practice (EBP) intervention that can reduce patient falls among the geriatric population if implemented in healthcare settings dealing with the population. The purpose of this paper is to discuss the implementation plan based on the formulated PICOT question to address the identified issue of patient falls in elderly patients.

Summary of the Problem or Issue

The identified issue involves patient falls among the geriatric population with over 1 million fall-related hospitalizations happening every year and leading to adverse effects. Falls are a patient safety concern as they lead to injuries like head fractures, increased cost of care, and longer stays in hospitals with patients susceptible to comorbidities (Roberts et al., 2020).

As such, nurses need to implement evidence-based interventions to reduce and prevent the increasing prevalence of falls among elderly adults in their practice settings.

Proposed Solution

The proposed solution entails implementing hourly purposeful rounding in the facility to reduce and prevent the occurrence of falls. The assessment of the practicum site and the evaluation of existing literature support the implementation of purposeful rounding because of its benefits to patients and healthcare providers.

The selected intervention will involve a consideration of sociocultural and linguistic aspects through effective communication to enhance the safety of the target population. Elderly individuals are susceptible to falls because of the fragility of their bodies and the use of medications due to age-associated conditions like dementia and schizophrenia.

In their study, Gliner et al. (2022) note that hourly rounding by nurses in acute settings leads to better patient experience and outcomes since nurses can notice patients struggling to move; which increases their susceptibility to falls.

Khawaja et al. (2023) observe that hourly rounding ensures that healthcare providers like nurses have sufficient data on patient progress and closely monitor every patient to reduce the possibility of falling. Again, Anu (2021) shows that rounding improves patient safety by reducing falls within the facility.

Studies by Leamy et al. (2023) Roberts et al. (2020) and Allari et al. (2020) demonstrate the effectiveness of the proposed intervention as it helps reduce falls and improve overall patient safety. Further, the studies are categorical that effective rounding ensures providers work in collaborative teams to attain quality outcomes.

Di Massimo et al. (2022), Ryan et al. (2022), Sims et al. (2020), and Rasmussen et al. (2022) all agree that intentional hourly rounding by nurses plays a significant role in reducing falls and improving patient care outcomes. Therefore, the proposed solution will lead to a better patient experience and a lower rate of falls by 40% within three months.

Implementation Steps and Impact on Nursing Practice

Implementing the proposed solution in the practicum site will entail certain steps to achieve the intended objectives.

Assessment, identification, and development of the program

The initial step will be to assess and identify the magnitude of the problem through using data from the organization. For instance, the current data shows that ten falls occur each week at the practicum site.

Secondly, the practicum site lacks an EBP intervention to curb these falls apart from normal rounding by nurses and other providers. The facility will develop the program using existing evidence and create a team to plan, implement, and evaluate.

Planning and Training

The selected team comprising nurse managers and leaders in the senior department will plan by gathering all requirements, communicating the need for change, engaging all stakeholders, and seeking resources and approval from the organizational management. The plan will also entail training nurses on the proposed intervention, its benefits, and strategies to implement it.

Implementation

Upon training and availing of sufficient resources, the practicum site will implement the intervention in one ward to evaluate its effects. The pilot implementation will take a week as providers gather data on the number of falls and tailor strategies for each patient.

The facility has an average of 20 elderly patients at any time in the geriatric unit with at least five reporting falls each week. Based on the outcomes of the pilot implementation, the facility will roll out the project as part of its routine patient safety procedures and care provision.

Monitoring and Evaluation

Continuous monitoring of the implementation of the intervention and evaluation of its effects on the population will entail daily reports and documentation of the number of falls (Melnyk & Fineout-Overholt, 2022). The evaluation will involve quantitative measures like gathering data on the number of falls before and after the implementation to ascertain the effects of the intervention.

Impact of Nursing Practice

The implementation of purposeful hourly rounding will have a significant impact on nursing practice. It will improve care coordination and job satisfaction as nurses will work together and communicate effectively leading to better approaches to work and patient issues. The intervention will lower falls in the facility and improve patient outcomes. These will enhance the interactions and quality care provision for patients.

Objectives of the Proposed Solution/Intervention

The objectives of the proposed intervention include;

• Reducing patient falls in the unit to improve patient outcomes
  
• Enhancing patient care experience and interactions with providers
  
• Improving fall management and quality of care for better reimbursement
  
• Improving inter-professional collaboration and multidisciplinary approach to patient issues
  

Measurable Outcomes

Positive outcomes are essential to ascertain the effectiveness of a proposed change project in reducing and preventing patient falls (Di Massimo et al., 2022). The outcomes of the proposed intervention include reducing the prevalence of falls in the target population by 40% within three months, increasing job satisfaction by nurses in the facility, and improving quality care for effective reimbursement through a value-based care approach. These outcomes will enhance care delivery and better results for patients and the facility.

Rationale and Respect for Autonomy

The rationale for the proposed intervention is to reduce and prevent patient falls among elderly individuals getting care from the facility. The proposed intervention respects the autonomy of individuals and diverse populations by ensuring dignity in their treatment and considering the impact of falls on their safety and quality of life.

Through the intervention, patients will make better decisions and choices while in the facility to avoid poor outcomes (Melnyk et al., 2022). The four objectives focus on ensuring elderly patients have better outcomes and do not suffer from comorbidities emanating from preventable falls (Roberts et al., 2020).

The rationale, objectives, and outcomes of the proposed intervention show respect for autonomy for the elderly patients as they will get tailored approaches based on their situation and health status.

Conclusion

The proposed change project is essential in reducing and preventing the ever-rising falls in geriatric facilities. Implementing the proposed project will result in better outcomes and quality of care for geriatric patients, including empowered decision-making. The proposed solution and its implementation are critical to improving the quality of care and life for the target population.

References

• Allari, R. S., & Hamdan, K. (2023). Caring Behavior and Hourly Rounding Nurses’ Perception.
  The open nursing journal, 17(1). http //dx.doi.org/10.2174/18744346-v17-e230210-2022-118
  
• 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 https //doi.org/10.30564/jgm.v3i1.2614
  
• Centers for Disease Control and Prevention (CDC) (2024 May 6). Older Adult Fall Prevention
  Facts about Falls. https //www.cdc.gov/falls/data-research/facts-stats/index.html
  Di Massimo, D. S., Catania, G., Crespi, A., Fontanella, A., Manfellotto, D., La Regina, M., … &
  INTENTO Study Group. (2022). Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards Results from a Cluster-Randomised Nation-Based Study. Journal of clinical medicine, 11(14) 3976.
  DOI 10.3390/jcm11143976
  
• Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2022). Patient
  falls, nurse communication, and nurse hourly rounding in acute care Linking patient experience and outcomes. Journal of public health management and practice, 28(2), E467-E470. DOI 10.1097/PHH.0000000000001387.
  
• Khawaja, I., Awan, S. A., Babar, M., Khan, T., & owais Khalil, M. (2023). Fall prevalence and
  associated risk factors in the hospitalized adult population a crucial step towards improved hospital care. Cureus, 15(8). DOI 10.7759/cureus.46976
  Leamy, M., Sims, S., Levenson, R., Davies, N., Brearley, S., Gourlay, S., … & Harris, R. (2023).
  Intentional rounding a realist evaluation using case studies in acute and care of older people hospital wards. BMC health services research, 23(1) 1341. DOI https //doi.org/10.1186/s12913-023-10358-1
  
• Melnyk, B. M., & Fineout-Overholt, E. (2022). Evidence-based practice in nursing &
  healthcare A guide to best practice. Lippincott Williams & Wilkins.
  Rasmussen, T. R. (2022). An Enhanced Purposeful Hourly Rounding Program Impact of
  Proactive Toileting on Rates of Falls and Injurious Falls. Georgetown University. https //www.proquest.com/openview/32c90604dba320472434dd55cfdd467c/1?pq-origsite=gscholar&cbl=18750&diss=y
  Roberts, B., Holloway-Kew, K., Pretorius, T., Hosking, S., Kennedy, A., & Armstrong, K.
  (2020). Does 20-min rounding reduce falls in an aged-care setting? A pilot intervention study. Geriatric nursing, 41(5) 579-584. DOI 10.1016/j.gerinurse.2020.03.003.
  
• Ryan, L., Jackson, D., East, L., Woods, C., & Usher, K. (2022). Mixed Methods Study
  Integration Nursing student experiences and opinions of intentional rounding. Journal of advanced nursing, 78(6) 1787-1797. https //doi.org/10.1111/jan.15197
  
• Sims, S., Leamy, M., Levenson, R., Brearley, S., Ross, F., & Harris, R. (2020). The delivery of
  compassionate nursing care in a tick-box culture qualitative perspectives from a realist evaluation of intentional rounding. International journal of nursing studies, 107, 103580. https //doi.org/10.1016/j.ijnurstu.2020.103580