Question: An elderly patient who resides in a long-term care facility, will implementing a fall intervention be more effective compared to interventions that are patient-centered, reduce residents falls over a 30-day time frame from last month’s falls. P: Elderly patient in a long-term care facility.  Intervention: implanting fall is intervention vs Comparison: patient-centered fall interventions Outcome: reduce resident’s falls Time: 30-day time frame compared to last month’s falls.

My clinical issue of interest was related to falls in the elderly and in long-term care. Working in long-term care, resident falls have always been an issue due to debility, dementia, age, medications, and other health factors.  Falls in nursing homes happen all the time and in every nursing home in the United States. “There are 1.6 million residents in the U.S nursing facilities, with 1 in every 10 residents who fall have a serious related injury and 65,000 residents suffer a hip fracture each year” (Chapter 1. Introduction and Program Overview, n.d.). Injuries related to falls not only hinder the health of the elderly but impacts the nursing home too. Every injury-related fall has to be reported to the state or CMS (Centers for Medicare and Medicaid) and based on the severity of the injury, CMS could make a surprise visit and investigate further, which could lead to the nursing home being fined. Injuries can affect the resident’s health and alter their quality of life, epically if there was a need for surgery as most residents do not recover fully after surgery. There is also the concern for lawsuits after an injury-related fall as well. As you see, there are many issues that can occur just from one resident’s fall.

Working as a floor nurse and some in management I had the mindset of what the floor nurses thought the main issue on falls were and then from a management perspective, I can see the data from the incident reports through our EMR system. We had noticed that most of our falls were during dinner time, it appeared that there was minimum staff on the floor during this time as our nursing staff and CNA staff were in the dining room assisting with feeding residents, which left minimum staff on the floor to assist in answering call lights and resulting in residents trying to use the bathroom on their own leading to a fall. We also noticed that the interventions in place could be more of a problem. “assessing a resident risk for falls, implanting fall interventions can reduce the number of falls in the elderly in long-term care facilities” (RN, 2012). Yes, interventions are important, but we were finding that the nurses were quick to add a bed or chair alarm instead of an intervention for the resident’s needs as not every resident is the same. We started to question if our fall intervention in place was causing more harm than good.  For a PICOT question, it’s important to ask the right questions to get the most validated information. The PICOT process is based on a clinical question, “phased in a manner that will retrieve the most relevant information from research” (Melnyk & Fineout-Overholt, 2019, pg. 758).  The acronym stands for Patient/Population, Intervention, Comparison, outcome, and time frame.

Question: An elderly patient who resides in a long-term care facility, will implementing a fall intervention be more effective compared to interventions that are patient-centered, reduce residents falls over a 30-day time frame from last month’s falls.

P: Elderly patient in a long-term care facility. 

Intervention: implanting fall is intervention vs

Comparison: patient-centered fall interventions

Outcome: reduce resident’s falls

Time: 30-day time frame compared to last month’s falls.

I initially searched the Walden Library A-Z search and could not find any articles on falls in the elderly or falls in long-term care.  However, when searching the Boolean operators I was able to locate 1,193 peer review articles related to falls in long-term care or in the elderly. I then searched patient-centered interventions for falls through Boolean and found 10 peer-reviewed articles. Boolean was a better option as there were tabs to the side to select for peer review, this will be beneficial for the class to filter out the articles that are not peer-reviewed related. The Boolean will be the most effective database search for my PICOT question.

Reference:

Melnyk, B., & Fineout-Overholt, E. (2019). Evidence-based practice in nursing & healthcare: A guide to best practice (4th ed.). Wolters Kluwer.