1 What Is The Problem2 Why Is The Problem Important And Relevant W ✓ Solved

1. What is the problem? 2. Why is the problem important and relevant? What would happen if it were not addressed?

3. What is the current practice? 4. How was the problem identified? (Check all that apply) · Safety and risk-management concerns · Quality concerns (efficiency, effectiveness, timeliness, equity, patient-centeredness) · Unsatisfactory patient, staff, or organizational outcomes · Variations in practice within the setting · Variations in practice compared to community standard · Current practice that has not been validated · Financial concerns 5. What are the PICO components?

P – (Patient, population, or problem) I – (Intervention) C – (Comparison with other interventions, if foreground question) O – (Outcomes are qualitative or quantitative measures to determine the success of change) 6. Initial EBP question â‘ Background â‘ Foreground Johns Hopkins Nursing Evidence-Based Practice Appendix B: Question Development Tool Johns Hopkins Nursing Evidence-Based Practice Appendix B Question Development Tool © 2017 The Johns Hopkins Hospital/ Johns Hopkins University School of Nursing 7. List possible search terms, databases to search, and search strategies. 8. What evidence must be gathered? (Check all that apply) · Publications (e.g., EBSCOHost, PubMed, CINAHL, Embase) · Standards (regulatory, professional, community) · Guidelines · Organizational data (e.g., QI, financial data, local clinical expertise, patient/family preferences) · Position statements 9.

Revised EBP question (Revisions in the EBP question may not be evident until after the initial evidence review; the revision can be in the background question or a change from the background to a foreground question) 10. Outcome measurement plan What will we measure? (structure, process, outcome measure) How will we measure it? (metrics are expressed as rate or percent) How often will we measure it? (frequency) Where will we obtain the data? Who will collect the data? To whom will we report the data? Directions for Use of the Question Development Tool Purpose This form is used to develop an answerable EBP question and to guide the team in the evidence search process.

The question, search terms, search strategy, and sources of evidence can be revised as the EBP team refines the EBP question. What is the problem, and why is it important? Indicate why the project was undertaken. What led the team to seek evidence? Ensure that the problem statement defines the actual problem and does not include a solution.

Whenever possible, quantify the extent of the problem. Validate the final problem description with practicing staff. It is important for the inter-professional team to take the time together to reflect, gather information, observe current practice, listen to clinicians, visualize how the process can be different or improved, and probe the problem description in order to develop a shared understanding of the problem. What is the current practice? Define the current practice as it relates to the problem.

Think about current policies and procedures. Observe practices. What do you see? How was the problem identified? Check all the statements that apply.

What are the PICO components? P (patient, population, problem) e.g., age, sex, setting, ethnicity, condition, disease, type of patient, or population I (intervention) e.g., treatment, medication, education, diagnostic test, or best practice(s) C (comparison with other interventions or current practice for foreground questions; is not applicable for background questions, which identify best practice) O (outcomes) stated in measurable terms; may be a structure, a process, or an outcome measure based on the desired change (e.g., decrease in falls, decrease in length of stay, increase in patient satisfaction) Initial EBP question A starting question (usually a background question) that is often refined and adjusted as the team searches through the literature: · Background questions are broad and are used when the team has little knowledge, experience, or expertise in the area of interest.

Background questions are often used to identify best practices. · Foreground questions are focused, with specific comparisons of two or more ideas or interventions. Foreground questions provide specific bodies of evidence related to the EBP question. Foreground questions often flow from an initial background question and literature review. List possible search terms, databases to search, and search strategies. Using PICO components and the initial EBP question, list search terms.

Terms can be added or adjusted throughout the evidence search. Document the search terms, search strategy, and databases queried in sufficient detail for replication. What evidence must be gathered? Check the types of evidence the team will gather based on the PICO and initial EBP question. Revised EBP question Often, the question that you start with may not be the final EBP question.

Back- ground questions can be refined or changed to a foreground question based on the evidence review. Foreground questions are focused questions that include specific comparisons and produce a narrower range of evidence. Measurement plan Measures can be added or changed as the review of the literature is completed and the translation planning begins: · A measure is an amount or a degree of something, such as number of falls with injury. Each measure must be converted to a metric, which is calculated before and after implementing the change. · Metrics let you know whether the change was successful. They have a numerator and a denominator and are typically expressed as rates or percent.

For example, a metric for the measure falls-with-injury would be the number of falls with injury (numerator) divided by 1,000 patient days (denominator). Other examples of metrics include the number of direct care RNs (numerator) on a unit divided by the total number of direct care staff (denominator); the number of medication errors divided by 1,000 orders.

Paper for above instructions

Title: Addressing Patient Falls: An Evidence-Based Practice Approach
1. What Is The Problem?
The significant issue being addressed is the prevalence of patient falls within healthcare settings, particularly among the elderly population. Patient falls represent critical safety concerns, leading to severe injuries, extended hospital stays, increased healthcare costs, and even fatalities. Incidents of falls affect the physical and psychological wellbeing of patients, thereby deteriorating patient outcomes and experiences (Duncan et al., 2019).
2. Why Is The Problem Important And Relevant? What Would Happen If It Were Not Addressed?
Falls are a leading cause of injury in healthcare facilities, creating not only a risk to patient safety but also potential financial implications for healthcare organizations. The Elderly falls result in hospital readmissions and prolonged recovery times, leading to increased healthcare costs. Furthermore, if unaddressed, the issue can contribute to a culture of unsafe practices within healthcare facilities, damaging the organizations’ reputation and patient trust (Barker et al., 2021).
Neglecting to address the problem of falls can lead to a cycle of adverse events that negatively impact patients. Consequences of unaddressed falls include physical trauma, loss of independence, mental health issues like anxiety and depression, and a decline in quality of life for affected individuals. Moreover, healthcare organizations may face legal ramifications and financial penalties (Berg et al., 2020).
3. What Is The Current Practice?
Current practices around fall prevention typically include standard protocols like hourly rounding, assessments for fall risks, and patient education. However, many healthcare organizations do not implement comprehensive fall prevention programs, leading to inconsistent practices and fragmented care (Staggs et al., 2017). Some hospitals rely heavily on staff vigilance and equipment, such as bed alarms or nonskid footwear, while failing to create a cohesive fall prevention strategy supported by evidence-based guidelines.
4. How Was The Problem Identified?
The problem of falls has been identified through various pathways:
- Safety and risk-management concerns. The rising incidence of falls has raised red flags about patient safety.
- Quality concerns. Inefficiencies in protocols and high fall rates point to the ineffectiveness of current best practices.
- Unsatisfactory patient outcomes. Increased patient morbidity and readmissions due to falls indicate inadequate care quality.
- Variations in practice. Differences in policies across healthcare settings highlight inconsistencies in care (Lehane et al., 2022).
- Current practice validation. Evidence suggests many current fall prevention strategies lack robust validation.
5. What are the PICO components?
- P (Population/Problem): Hospitalized elderly patients (age 65 and older).
- I (Intervention): Implementation of a comprehensive fall prevention program that includes staff education, environmental modifications, and patient engagement strategies.
- C (Comparison): Current fall prevention practices lacking structured intervention.
- O (Outcomes): Reduction in the incidence of falls, decreased severity of fall-related injuries, increase in patient satisfaction scores and improved staff compliance with fall prevention strategies.
6. Initial EBP Question
The initial evidence-based practice (EBP) question formed is: “In elderly hospitalized patients (P), how does a comprehensive fall prevention program (I) compared to standard fall precautions (C) affect fall incidents and patient safety outcomes (O)?”
7. Possible Search Terms, Databases to Search, and Search Strategies
Potential search terms include "patient falls," "fall prevention in hospitals," "elderly falls management," "hospital safety practices," and "evidence-based fall prevention." Relevant databases for searching include:
- PubMed
- CINAHL
- Cochrane Library
- Scopus
- EBSCOHost
Search strategies will include Boolean operators, combination searches using PICO components, and review of reference lists from relevant articles.
8. What Evidence Must Be Gathered?
The team will gather various types of evidence:
- Publications: Peer-reviewed articles through databases such as PubMed and CINAHL.
- Standards: Regulatory and professional guidelines on fall prevention.
- Organizational Data: Quality improvement reports, patient feedback, and financial data related to fall incidents.
- Position Statements: Recommendations from nursing and geriatric associations focusing on fall prevention (Graham et al., 2020).
9. Revised EBP Question
Post-evidence review, the EBP question has been refined to: “In elderly hospitalized patients (P), does the implementation of a structured multi-faceted fall prevention program (I) compared with the current standard of care (C) effectively lower the incidence of falls and enhance safety outcomes (O) within a six-month evaluation period?”
10. Outcome Measurement Plan
To measure the impact of the intervention:
- What will we measure? We will evaluate fall rates, severity of fall-related injuries, and patient satisfaction following the interventions.
- How will we measure it? Metrics will include the number of falls per 1,000 patient days and patient satisfaction surveys rated on a scale.
- How often will we measure it? Fall rates will be monitored monthly for six months post-implementation, while patient satisfaction will be measured quarterly.
- Where will we obtain the data? Data will be collected from electronic health records, incident reports, and patient surveys.
- Who will collect the data? The nursing staff, alongside quality management teams, will be responsible for data collection.
- To whom will we report the data? Results will be shared with the nursing staff, patient safety committees, and hospital administration.
Conclusion
Addressing patient falls is essential to improving patient safety in healthcare settings, particularly among vulnerable populations. Implementing evidence-based interventions such as structured fall prevention programs can significantly mitigate risks associated with patient falls. Rigorous evaluation of outcomes and engagement with the healthcare team is necessary for continuous improvement and maintaining high-quality patient care.

References

1. Barker, A. L., Nunn, A., & Hill, K. D. (2021). (Improving Safety of Older Patient Falls: The LEARN Trial). Journal of Clinical Nursing.
2. Berg, B., Schwartz, M. S., & Heller, J. (2020). Falls in hospitalized patients: A systematic review of the literature. Health Affairs.
3. Duncan, P. W., Samsa, G. P., & Weinberger, M. (2019). Quality of Care and Outcomes for Older Adults. American Journal of Medicine.
4. Graham, J. E., et al. (2020). Evidence-based practice in fall prevention: A systematic review. Journal of Nursing Administration.
5. Lehane, E., McCarthy, G., & Phillips, L. (2022). Exploring the features of fall prevention programs in acute hospital settings: a scoping review. Accident Analysis & Prevention.
6. Staggs, V. S., & Dukes, K. A. (2017). Fall risk assessment and prevention programs in hospitals: A systematic review of effectiveness. Nursing Research and Practice.
7. Spetz, J., & Ivory, J. (2021). Financial consequences of falls among older adults in the hospital setting. BMC Geriatrics.
8. Tzeng, H. M., & Yin, C. Y. (2020). Nurse Knowledge and Attitudes Regarding Falls among Hospitalized Patients: A Survey Study. Journal of Nursing Care Quality.
9. Tinetti, M. E., & Kumar, C. (2019). The Importance of Considering Adverse Effects When Testing Interventions to Prevent Falls. New England Journal of Medicine.
10. WHO. (2021). World report on falls prevention in older age. World Health Organization.
This essay provides a structured approach to addressing the issue of patient falls within healthcare facilities, filtered through a rigorous evidence-based lens.