The Evidence-Based Patient-Falls-Reduction Protocol

Introduction

The purpose of this study is to promote the use of an evidence-based patient-falls-reduction protocol. The proponent of the study will use the Re-Aim framework to determine evidence-based patient-falls-reduction protocol to reduce the incidence of patient-falls in hospitals. The proponent of the study is considering the use of hourly rounding strategies and combines those strategies with the efficient use of the call light system.

Literature Review

Numerous studies support the claim that patient-falls account for the majority of hospital accidents (Goldsack 25). It is also important to point out that 30% of patient-falls result in injury, and 4 percent to 6 percent of the said patient-falls result in serious injury (Olrich, Kalman, and Nigolian 23). It is imperative to look for a practical solution based on the Re-Aim framework (Virginia Tech 1).

A review of related literature reveals the importance of the call light system to reduce the incidence of patient falls (Lobiondo-Wood and Haber 91). The call light system enables the patients to call the attention of nurses when they need something beyond their reach or when they need to go to the bathroom. (Carter 15). The nurse rounding protocol also contributes to the significant reduction in the incidence of patient- falls (Mauk 71). The success of the call light system and the hourly rounding protocol in eliminating injuries as the result of patient-falls is well-documented (Chiappelli 56).

Work Plan

The work plan begins with a re-examination of the hourly rounding protocol and the call light system. First of all, the call light system strategy is prone to abuse. As a result, the frequent use of the call light system will lead to nursing staff burnout.

With regards to the hourly rounding protocol the strategy requires refinement in order to improve its efficiency. In other words, the mere existence of an hourly rounding protocol does not guarantee the significant reduction in the incidence rate of patient-falls. A review of related literature reveals the need to incorporate a custom-made checklist that will remind the nurse doing the rounds to perform the following tasks:

  1. assess patient’s pain level through the use of a pain-assessment scale;
  2. include the necessary medication needed into the nurse’s to-do-list in order to offer it to the patient when it is due;
  3. offer toileting assistance;
  4. assess patient’s position and ask the patient if there is a need to reposition him or her for comfort’s sake;
  5. make sure the call light system is within the patient’s reach;
  6. make sure the telephone is within the patient’s reach;
  7. make sure the TV remote and bed light switch is within the patient’s reach;
  8. make sure the bedside table is positioned next to the bed;
  9. make sure the Kleenex box is within the patient’s reach;
  10. make sure the garbage receptacle is within the patient’s reach;
  11. nurse should ask the patient if there is anything he or she can do before leaving the room;
  12. the nurse doing the rounds must remind the patient that another member of the nursing staff is scheduled to come back in an hour (Meade, Bursell, and Ketelsen 58).

The application of hourly rounding protocol reduced the need to use the call light system. At the same time, the use of an upgraded hourly rounding protocol will significantly reduce the incidence of patient-falls.

Discussion

The Re-Aim framework enables the proponent of the study to determine the following critical components of the research design: 1) the target population; 2) the effectiveness or efficacy of the proposed change; 3) adoption strategies for the nursing staff; 4) implementation strategies; and 5) the ability to determine the long-term effects of the proposed change.

In this particular case the target population is the nursing staff of a specific hospital. The effectiveness or the efficacy of the proposed change is made clear through the impact of reducing the incidence of patient falls. The adoption strategies includes the participation of influential leader and key stakeholders who will help change the culture of the hospital with regards to the call light system and the hourly rounding of the nurses. The maintenance component employs protocols that will enable hospital administrators to track down the changes made, and the impact of these changes to the reduction of the incidence of patient falls.

Conclusion

The evaluation strategy after the implementation phase includes interviews of the members of the nursing staff and the patients. The proponent of the study will design a questionnaire that will solicit feedback from the patients. It is also imperative to develop a feedback mechanism that enables researchers to record the number of times patients use the call light system. Every time a nurse performs the hourly rounding protocol, he or she will interview the patient in order to determine any incidence of patient-falls in the last hour. This data gathering scheme will continue six months after the implementation of new strategies on how to use the call light system and the application of the upgraded hourly rounding protocol.

Works Cited

Carter, Pamela. Lippincott’s Textbook for Nursing Assistants: A Humanistic Approach to Caregiving. San Francisco: Wolters Kluwer Health, 2005. Print.

Chiappelli, Francesco. Evidence-Based Practice: Toward Optimizing Clinical Outcomes. New York: Springer, 2010. Print.

Goldsack, Jennifer. Hourly Rounding and Patient Falls: What Factors Boost Success. San Francisco: Wolters Kluwer Health, 2015. Print.

Lobiondo-Wood, Geri and Judith Haber. Nursing Research: Methods and Critical Appraisal for Evidence-Based Practice. St. Louis, Missouri: Elsevier Mosby, 2014. Print.

Mauk, Kristen. Gerontological Nursing: Competencies for Care. Boston: Jones and Bartlett Publishers, 2006. Print.

Meade, Christine, Bursell, Amy, and Lyn Ketelsen. “Effects of Nursing Rounds on Patient’s Call Light Use, Satisfaction, and Safety.” American Journal of Nursing. 106.9 (2006): 58-70. Print.

Olrich, Todd, Kalman, Malanie and Cindy Nigolian. “Hourly Rounding: A Replication Study.” MedSurg Nursing 21.1 (2012): 23-36. Print.

VirginiaTech. “Re-Aim Framework. 2015. Web.