Making the Case for Evidence-Based Practice

Introduction

At the current moment, the issue of patients’ falls in hospitals becomes rather significant, because it constitutes an apparent life-threatening event. The current work provides the description of this issue and identification of all concerned parties. The considerable part of the paper presents initiatives directed on the addressing of this problem. This work provides the understanding of the issue of patients’ falls for giving the effective solutions.

The Issue and the Concerned Parties

Patients’ falls represent one of the biggest problems of hospitals. This problem deserves attention because a number of patients’ falls (which cause injuries and the significant financial losses of hospitals and patients) increases every year. The relevant statistical information will be provided below. Unfortunately, the first case of patients’ falls cannot be identified.

Patients’ fall relates to all hospitals’ workers: doctors, nursing staff, etc. However, the major change agents are nurses. This statement is based on the work of Currie (2008) who noted that the improvement of nurse-to-patient relations and the amount of nursing staff can lead to the reduction of this issue.

The additional attention should be paid to the fact that patients’ falls lead to the necessity of further treatment of a patient, i.e. the additional expenses of hospitals: “the average hospital cost for a fall injury is $35,000” (Centers for Disease Control and Prevention, 2015). That means that health care providing organizations (like hospitals) are interested in the elimination of this issue for minimization of additional expenses and assurance of safety of patients’ life. It is obvious that patients are also interested in reduction of this issue because they want to protect their lives and health. The issue can be addressed with the help of the Agency for Healthcare Research and Quality that develops falls management programs directed on the improvement of the quality of nursing facilities and raising the effectiveness of nursing staff work (Agency for Healthcare Research and Quality, 2015). Moreover, the special Joint Commission performs examination of contributing factors to patients’ falls and makes relevant proposals and suggests effective solutions to hospitals for minimization of this problem (Zhani, 2015).

PICOT Question

The PICOT question of the current work will provide the information concerning patients’ problems, plan of intervention, possible outcomes, time frame and make a comparison to already existing initiatives (Riva et al., 2012). The type of the current PICOT initiative is preventive because it has the aim to prevent patients’ fall rates. This proposal will refer to the treatment of patients of all races and sexes older than 65 years old since they suffer from the discussed issue in a greater extent than patients of other ages (Currie, 2008).

The proposed plan of intervention contains several initiatives. Health care providers are proposed to perform additional “cardiovascular and neuroautonomic assessment” (Ungar et al., 2013). This recommendation is made because a number of patients’ falls older than 70 years with cardiovascular syncope is on 20% higher than the amount of patients’ fall who does not suffer from this disease (Ungar et al., 2013). Moreover, it is proposed to make special plan-of-care document that will contain the description of day-to-day care with the depiction of patients’ risks and associated interventions (Zuyev et al., 2011). This plan should be accessible to care team, family members, and patients. It is necessary for providing accurate information concerning patients’ treatment, elimination of any mistakes, and falls risk minimization. The last recommendation concerns the implementation of multi-component interventions which combine the following initiatives: effective risk assessment of patients, education of nursing staff, as well as scheduled and supervised toileting (Miake-Lye et al., 2013).

The alternative plan is reflected in the increase in the number of nurses and licensed nursing staff. This initiative is more time consuming and costly because it requires additional expenses on permanent hiring of new employees into hospitals.

The proposed initiative can be implemented within two months. As per personal understanding, this time will be enough for the organization of cardiovascular performance and neuroautonomic assessment, development of plan-of-care documents, and implementation of above stated multi-component interventions. The expected outcome is reduction in fall rates for patients.

The Purpose of the Project

The major purpose of the project is reduction of rate of falls on at least 10% in one particular health care providing institution within one year after the commencement of the implementation of above-mentioned initiatives. The measurement of patients’ fall rates will be performed before and after the implementation of the discussed recommendations. This is necessary for identification of the concrete reduction of fall rates.

The Evidence of Relevance of the Problem

The discussed problem is relevant because of several factors. The first factor is that it is more likely to happen with patients of older ages (older than 65 years old) (Currie, 2008). The second factor is that these falls are more likely to cause serious injuries (like wrist fractures and fractures of femur) (EMIS Group, n.d.) and even death. According to the official statistics, there are “approximately 41 fall-related deaths per 100,000 people per year” (Currie, 2008). And the last factor is that the amount of fall rates increased in recent years: between 1999 and 2004, it raised from 29% to 41% per 100,000 people (Currie, 2008). Consequently, this problem threatens the life of more patients. As it was mentioned above, this issue can be resolved only through the changes in the work of nursing staff.

Analysis Summary

The current work discusses the issue of patients’ falls in hospitals. This topic is considered to be rather relevant because it threatens the life of patients and causes additional expenses for hospitals and patients.

Patients, care givers, and hospitals are interested in addressing the described problem. They are interested in the assurance of safety of human lives and saving funds. The solutions can be found with the help of the Agency for Healthcare Research and Quality and Special Joint Commission.

The issue can be addressed by implementation of some changes in patients care: performance of additional assessment of patients’ health condition, making plans-of-care and realization of multi-component interventions. The researches show significantly high effectiveness of interventions and additional assessments of patients’ condition. For example, the application of multi-component approach can lead to lowering of patients’ fall rate on about 30% (Miake-Lye et al, 2013).

Readiness level of the organization is rather high because it has enough funds and personnel for the integration of described initiatives. However, there can be some barriers. Routinization is connected with the fact that each patient has a specific risk profile that should be thoroughly analyzed. Moreover, there is no guarantee that any initiative can lead to the total elimination of patients’ falls because all situations cannot be predicted.  The effectiveness of discussed initiatives depends greatly from cooperation of staff inside a hospital.

The integration of clinical inquiry will be reflected in the positioning of questions concerning the adequacy and the sufficiency of the existing precautions of patients’ falls by the assessment of the care providing for the identification and timely addressing of weak areas. This can be performed by surveys, interviews with patients and care givers, analysis of data concerning fall rates.

Conclusion

The current work provides the short description of patients’ falls in hospitals. This issue is considered to be rather relevant because it threatens people’s lives and leads to considerable financial losses. Patients’ falls concern patients, hospitals, and care providers. The solutions to this issue are developed in cooperation with the Joint Commission and Agency for Healthcare Research and Quality. The proposed solutions contain the establishment of special plans of care, a performance of assessment of patients’ conditions and application of a multi-component approach. These strategies can be implemented within one year in one health care institution and reduce patients’ falls rate at least 10%.

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