NUR 630 What strategy would be best to approach this issue—quality improvement, evidence-based practice, or research?

NUR 630 What strategy would be best to approach this issue—quality improvement, evidence-based practice, or research?

NUR 630 What strategy would be best to approach this issue—quality improvement, evidence-based practice, or research?

According to Silva & Hain (2017), falls are caused by a variety of reasons and each patient should be evaluated individually. The best strategy for preventing falls is quality improvement initiatives. Quality improvement is most effective at preventing avoidable harm and has proven effectiveness in reducing falls with injury. However, quality improvement initiatives are best supported by evidence-based practice and research which provides a standardized approach to care (Tricco et al., 2019).

Quality improvement strategies focus on identifying and implementing interventions which significantly impact problem areas, such as falls. It’s necessary to obtain data regarding the problem and investigate the root cause. After the cause is identified, further direction will be provided to obtain the appropriate research and intervention. Once the appropriate supporting evidence and best practices are identified the implementation of the quality improvement process can begin. Although, quality improvement is an ongoing process of identifying innovative strategies for further development (Silva & Hain, 2017).

 

References

Silva, K. B. & Hain, P. (2017). Fall prevention: Breaking apart the cookie cutter approach. MEDSURG Nursing26(3), 198–213.

Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., Khan, P. A., Sibley, K. M., Robson, R., MacDonald, H., Riva, J. J., Thavorn, K., Wilson, C., Holroyd-Leduc, J., Kerr, G. D., Feldman, F., Majumdar, S. R., Jaglal, S. B., Hui, W., & Straus, S. E. (2019). Quality improvement strategies to prevent falls in older adults: A systematic review and network meta-analysis. Age & Ageing48(3), 337–346. https://doi.org/10.1093/ageing/afy219

 

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Crystal it is true that various reasons can cause falls. Therefore, evaluation becomes an important step towards

NUR 630 What strategy would be best to approach this issue—quality improvement, evidence-based practice, or research
NUR 630 What strategy would be best to approach this issue—quality improvement, evidence-based practice, or research

avoiding more falls to be witnessed in the facility. However, quality improvement programs are the more suitable strategy for avoiding falls (Parker et al., 2020). Quality improvement initiatives may be reliable when the programs are supported by evidence-based practice and research. Some improvement programs may fail to achieve the purpose due to incorrect strategies deployed in the process (Keuseman & Miller, 2020). As a result, factual information obtained from research and EBP is significant.  Continuous falls may cause accidents in the facility (Stoeckle et al., 2019). Therefore, the intervention process should identify the cause of falls and the best strategies to prevent more falls. Research provides data that can be used in developing a reliable intervention mechanism.

 

References

Keuseman, R., & Miller, D. (2020). A hospitalist’s role in preventing patient falls. Hospital Practice48(sup1), 63-67. https://doi.org/10.1080/21548331.2020.1724473

Parker, C., Kellaway, J., & Stockton, K. (2020). Analysis of falls within pediatric hospital and community healthcare settings. Journal of pediatric nursing50, 31-36. https://doi.org/10.1016/j.pedn.2019.09.026

Stoeckle, A., Iseler, J. I., Havey, R., & Aebersold, C. (2019). Catching quality before it falls: preventing falls and injuries in the adult emergency department. Journal of emergency nursing45(3), 257-264. https://doi.org/10.1016/j.jen.2018.08.001

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Patient falls are one of the most common events that occur in healthcare organizations every year costing an estimate of $14,000 on each fall (Quigley, 2019).  As a leader in healthcare, one must be aware of clinical and financial complications falls have on an organization can utilize programs to minimize and prevent falls.  Researching the best current quality or evidence-based processes is the first step to reduction of falls and improving outcomes.

Evidence based practice it the proof of a process that has been tried and produces improving results based on a practice and is a clinical decision-making tool based on the latest evidence in clinical areas.

Quality improvement strategies are systematic action of process and steps that lead to a measurable outcome (Fowler, 2021)

Research is a diligent investigation of studies, and literature to gain knew knowledge on the process (Fowler, 2021).

The chosen path of how to reduce falls depends on the question you are trying to answer, in the situation of reducing falls in a specific area such as rehabilitation, choosing Evidence Based Practice would be the path I would choose in this situation (Quigley, 2019). Health care is slow to adopt EBP practices, yet much can be gained by implementing a practice based on the current research in fall prevention. EPB has clinical evidence by the clinical experts in the field, yet it has quality metrics and measure tied to it for improvement of outcomes. EBP has the ability to be specific on clinical driven findings yet gives a broad base of knowledge to help reduce falls. EPB also has a variety of models based on the start of a question enabling one to specifically tailor the process to a specific area compared to a quality improvement metric that has more rigidity to the process.

EPB, quality improvement, or research can all be useful in the process, yet it is helpful to choose a process that best fits the question and solution to be desired.

 

Fowler, S. B. (2021). Quality improvement, evidence-based practice, and research. Home Healthcare Now39(3), 178–178. https://doi.org/10.1097/nhh.0000000000000941

 

Quigley, P. A. (2019). Building clinical capacity and competency: fall and fall injury prevention [White Paper]. https://doi.org/file:///C:/Users/deann/Downloads/10_White_Paper_Pat_Quigley_Jun19.pdf

It is estimated that between 30% and 50% of falls that occur in a hospital setting result in injuries according to Pati et al. (2019). This presents a serious dilemma for healthcare facilities since the Centers for Medicare and Medicaid Services (CMS) instituted a policy in 2008 that requires hospitals to cover costs associated with hospital-acquired conditions, including the treatment of injuries as a result of falls (as cited in Chu, 2017). Although problematic for hospitals, patients deserve and expect to receive quality care in a safe environment.

The best strategy to reduce patient falls is to implement a robust quality improvement (QI) fall prevention program. Quality improvement involves the structured utilization of various methods and tools with the goal of continuously improving measurable patient outcomes and experiences (Fowler, 2021). Chu (2017) suggested the implementation of the following interventions that have all been proven with valid evidence to reduce falls, hourly rounding, communication with family, patients, and staff regarding various aspects of fall prevention, medication review, and education. Tricco et al. (2019) noted that QI strategies guided by data are effective in reducing falls.

 

References

 

Chu, R. Z. (2017). Preventing in-patient falls, Nursing, 47(3), 24-30. https://doi.org/10.1097/01.nurse.0000513367.11311.50

 

Fowler, S. B. (2021). Quality improvement, evidence-based practice, and research. Home Healthcare Now, 39(3), 178-178. https://doi.org/10.1097/nhh.0000000000000941

 

Pati, D., Valipoor, S., Lorusso, L., Mihandoust, S., Jamshidi, S., Rane, A., & Kazem-Zadeh, M. (2019). The impact of the built environment on patient falls in hospital rooms: An integrative review. Journal of Patient Safety, 17(4), 273-281. https://doi.org/10.1097/pts.0000000000000613

 

Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., Khan, P. A., Sibley, K. M., Robson, R., MacDonald, H., Riva, J. J., Thavorn, K., Wilson, C., Holroyd-Leduc, J., Kerr, G. D., Feldman, F., Majumdar, S. R., Jaglal, S. B., Hui, W., … Straus, S. E. (2019). Quality improvement strategies to prevent falls in older adults: A systematic review and network meta-analysis. Age and Ageing, 48(3), 337-346. https://doi.org/10.1093/ageing/afy219

Patient falls impact not only the patient but also the staff caring for the patient and can impact the financial and reputation aspects of the organization. Patient Safety Network (2019) states that injuries in hospitals occur in more than one-third of patient falls and are as frequent as 3-5 falls per 1000 bed-days. When the incidents of falls begin rising on any particular unit it is the responsibility of the facility to thoroughly investigate and determine the root cause of the falls to ensure the safety of future patients.

Utilizing a quality improvement (QI) approach to the increased falls on the rehabilitation floor would be the best strategy. Carlisle & Blanchard (2016) describe QI as a means to identify the care that was provided, the expected care, and the deficiencies between the two. A QI approach would require the quality team to determine the question to be answered and then follow a specific process to improve patient outcomes. Plan, Do, Study, Act (PDSA) sequential methodology would be the QI approach of choice. Carlisle & Blanchard (2016) discuss the benefit of utilizing this method due to the effectiveness of addressing one specific process at a time and repeating the cycle multiple times to uncover all problems that need to be addressed to improve outcomes. Planning sets the question that needs to be answered and outlines the course for each member of the team; doing tests the proposed changes on the rehabilitation unit and documents barriers; studying includes collecting data before and after interventions and evaluating the results; and acting involves the team members determining the next steps based on the study results (Carlisle & Blanchard, 2016). The sequence of steps in the PDSA cycle provides a clear QI approach to addressing the falls concern on the rehabilitation unit.

A QI approach does not occur in isolation. There are elements of research and evidence-based practice that cross into the QI realm and vice versa. Having a strong understanding of all three and how they work together to improve patient outcomes will lead to the most effective, safety-driven results.

References

Carlisle, A. & Blanchard, M. (2016). The Washington Manual of Patient Safety and Quality Improvement (E. Fondahn, M. Lane, & A. Vannucci Eds.). Wolters Kluwer.

 

Patient Safety Network. (2019). Falls. Agency for Healthcare Research and Quality. https://psnet.ahrq.gov/primer/falls