Topic: Patient Falls/Injuries Nursing Practice Issue: Inadequate staffing ratios to monitor patients effectively.
Rationale for Topic Selection: Patient falls and related injuries are a significant concern in my workplace, a substance abuse/mental health facility. Inadequate staffing ratios have exacerbated this issue, leading to increased workloads, burnout, and compromised patient care quality. The inability to provide 1:1 care for vulnerable patients, particularly those who are elderly or intoxicated, has made it challenging to ensure their safety. The scope of this problem highlights the urgent need for improved staffing practices to enhance patient monitoring and reduce fall-related incidents.
Star Point 2: Summary (Evidence to Support Need for a Change)
Practice Problem: Inadequate staffing ratios hinder the implementation of effective monitoring strategies, such as regular rounding, fall risk assessments, and surveillance of high-risk patients and areas. These limitations increase the likelihood of falls and related injuries.
PICOT Question: In substance abuse patients residing in substance abuse facilities or hospitals, how does the implementation of monitoring strategies, compared to standard care or single interventions, impact the rate of falls and fall-related injuries over a ten-month period?
Systematic Review (APA Reference): Colón-Emeric, C., Schenck, A., Gorospe, J., McArdle, J., Dobson, L., DePorter, C., & McConnell, E. (2006). Translating Evidence-Based Falls Prevention into Clinical Practice in Nursing Facilities: Results and Lessons from a Quality Improvement Collaborative. Journal of the American Geriatrics Society (JAGS), 54(9), 1414–1418. https://doi.org/10.1111/j.1532-5415.2006.00853.x
Other Sources (APA Format): Lira, R. P. C., & Rocha, E. M. (2019). PICOT: Imprescriptible items in a clinical research question. Arquivos Brasileiros de Oftalmologia, 82(2), 1–1. https://doi.org/10.5935/0004-2749.2019002
Summary of Main Findings: The systematic review emphasizes the effectiveness of addressing multiple risk factors in reducing fall rates and the likelihood of fractures. Interventions such as managing environmental hazards, maintaining adaptive equipment, minimizing the use of psychotropic drugs, encouraging physical activity, educating staff, and using hip protectors were identified as crucial in fall prevention.
Evidence-Based Solutions:
- Implement staff training to improve fall risk assessments upon patient admission, utilizing validated tools like the Morse Fall Scale or the Hendrich II Fall Risk Model.
- Conduct medication reviews and adjustments to minimize the use of psychotropic drugs or medications associated with fall risk.
Star Point 3: Translation (Action Plan)
Care Standards and Protocols: The Joint Commission establishes national patient safety goals annually, often including fall prevention. These goals provide specific recommendations and standards for fall risk assessment, prevention, and reporting.
Stakeholders and Roles:
- Director of Nursing: Participates in quality improvement efforts, analyzing fall data, identifying trends, and implementing targeted interventions to reduce fall rates.
- Assistant Director of Nursing: Implements protocols for post-fall assessment, documentation, and follow-up care.
- Supervisor: Provides ongoing education and training for nursing staff on fall prevention strategies.
- Charge Nurse: Ensures comprehensive and accurate assessments of patients' fall risk factors.
Nursing Role in the Change Process: As a supervisor, my role involves educating staff, patients, and caregivers on medication management, fall prevention strategies, safe mobility techniques, proper use of assistive devices, and recognition of fall hazards.
Cost Analysis: A cost-benefit analysis will compare the costs of implementing fall prevention interventions with the potential savings from reduced fall-related injuries and their associated healthcare costs. Involvement from healthcare administrators, clinical leaders, finance and accounting personnel, and quality improvement teams is necessary.
Star Point 4: Implementation
Permission and Planning Process:
- Research Question: Define the research objective and the potential benefits and outcomes of the trial.
- Research Protocol: Prepare a detailed research protocol outlining the study design.
- IRB Approval: Submit the research protocol to the Institutional Review Board (IRB) for approval.
- Regulatory Approvals: Obtain necessary regulatory approvals, if applicable.
- Secure Funding: Identify and secure funding sources.
- Engage Stakeholders: Collaborate with relevant stakeholders, including clinical leaders and quality improvement teams.
- Present Proposal to Leadership: Present the proposal to leadership bodies within the organization.
- Allocate Resources: Allocate the necessary resources for the trial.
- Implementation Plan: Develop a detailed plan outlining timelines, roles, recruitment strategies, and quality assurance measures.
Staff Education Plan: Hold staff meetings to introduce the change process trial, outlining the purpose, goals, and expected outcomes. Provide training sessions to equip staff with the knowledge and skills necessary for effective trial implementation.
Implementation Timeline:
- Prep Phase: Months 1-2 Develop the change process plan, identify stakeholders, and conduct initial training.
- Trial Implementation Phase: Months 3-6 Roll out the trial interventions, monitor progress, and provide ongoing support.
- Evaluation Phase: Months 7-9 Analyze trial data, identify successes, and make necessary adjustments.
- Sustainment Phase: Month 10 onwards Institutionalize successful interventions into standard practice.
Measurable Outcomes:
- Number of Falls per 30 Patient-Days: Measured during the intervention period.
- Number of Fall-Related Injuries: Documented and classified based on severity.
- Average Length of Hospital Stays: Compared between the intervention group and a comparison group.
Forms for Recording: Designated personnel will take notes and document meeting minutes throughout the trial.
Available Resources: Educational materials, training workshops, feedback mechanisms, and reference materials will be provided to support staff during the change pilot.
Stakeholder Meetings: Bi-monthly meetings will involve the Director of Nursing, Assistant Director of Nursing, Charge Nurses, Supervisors, QA, financial personnel, and administrators.
Star Point 5: Evaluation
Reporting Outcomes: Compile all relevant data, analyses, and findings into a comprehensive report documenting the trial process, methods, results, and conclusions.
Next Steps:
- Analyze trial outcomes and identify key insights and lessons learned.
- Review and revise existing policies and protocols based on trial findings.
- Implement changes in clinical practice and care delivery processes.
- Provide staff with training and resources to support the adoption of new practices.
- Track performance metrics and quality measures to monitor progress and ident
