The EBP process is accomplished to the fullest when the recommendations and the evidence are utilized to cause a change within the organization. The EBP process is the interplay between research, education and practice and therefore forms a core for the implementation and adoption of change within an organization. It is the process that offers a viable plan to accomplish a change in respect to a particular research question or problem that has been identified within the setting (Dearholt & Dang, 2012). EBP is concerned about the specific interventions to a specific situation based on tangible evidence and data as opposed to generalizations and assumptions. Thus, before evidence is transferred to a specific situation, the researchers and those involved have to carefully examine the quality if research, the relevance of the findings within the clinical or practice setting as well as the benefits to the patients and whether they could in some way or another outweigh the adverse effects (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010).
Apparently, in every five cases of falls, one of them will result into a serious injury such as a head injury or a broken bone. Every year, up to 2.5 million elderly persons are treated within the emergency department on the basis of fall injuries with up to 700,000 being hospitalized. The directs costs of fall injuries to the healthcare sector is estimated to be around $34 billion on an annual basis with the hospitals accounting for two thirds of these costs and the rest being catered for as debt. These costs have a significant implication on the other services within the organization s a majority of human labor and resources which could have been saved are utilized in the management of falls. This renders the already strained system even more burdened subsequently affecting the aspects of patient safety and quality of care.
The ability and success of EBP within a facility is based on three major factors; on one hand the culture within the facility has to have a believe that EBP will achieve optimal patient outcomes; secondly the presence of a leadership that supports EBP through allocation of resources as necessary and required and thirdly the ability by each facility to develop clear expectations in regard to EBP by integration them in job descriptions and the standards of practice (Dearholt & Dang, 2012). This paper will seek to develop a change proposal formula for the implementation of EBP based on the earlier develop research question that focused on the determination of the viability of hourly rounding compared to a less frequent monitoring (two hour monitoring). This design will be accomplished in line with the 18 steps of the EBP process
Change plan; practice question
The EBP process begins at the point where the research or PICOT question has been develop to address a particular problem. In this case, the practice problem was the prevalence of falls and their frequency of occurrence in the group of hospitalized elderly patients. The stated PICOT question was as follows; “For hospitalized elderly patients how does hourly rounding compared to two hour monitoring help in reducing the occurrence of falls and their subsequent injuries?” The role of the nurse in the prevention of falls remains a pertinent issue that needs be addressed as they are at the actual point of care where they can interact with the patients and significantly influence their health status including the risk to falls. Nurses and the nurse managers will take the lead role in the accomplishment and designing of schedules to ensure appropriate staffing levels at all times (Deitrick, Baker, Paxton, Flores & Swavely, 2012).
On the other hand, the staff nurses will actualize the monitoring and ensure documentation within the wards to provide reliable data for evaluation in the future to determine how effective or otherwise the intervention resolves the existing problem. The nurse educators within the setting will schedule workshop sessions that will be used to train the nurse son their roles in the accomplishment of the intervention. The Management and administration within the facility will monitor the need for integration of nurse educators within the wards to guide the nurses while in practice and therefore make decision on increased hiring and recruitment (Dearholt & Dang, 2012). The informatics department will play a major role as they will be tasked with developing automated systems that will help collect all the desired evidence and data for future evaluation of the intervention. The Informatics department will also provide the nurses in the wards with support tools based on the identified areas of conflict or difficulty within the EBP implementation process (Dearholt & Dang, 2012).
Change plan; evidence
Deitrick, L. M., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly rounding: challenges with implementation of an evidence-based process. Journal of nursing care quality, 27(1), 13-19.
Deitrick et al., (2012) in their ethnographic study examined two inpatient units, neurological and surgical units; in which hourly rounding had not been utilized consistently. The units had similar patient demographic patterns, similar working environment and campus location. The staffing ratios were also within similar levels. The leaders of both units were approached to embrace the study and undertake the initiative of adopting hourly rounding in the units. The researchers utilized ethnographic methods to collect data from the people within these units in which they focused on patient satisfaction, number of falls and staffing levels. The results indicated that there were varying changes within the two units on occurrence of falls but there was significant reduction in number of falls as well as notable changes on patient satisfaction.
Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study. International Journal of Nursing Practice, 15(4), 287-293.
Garner et al. (2009) in their study sought to explore the efficacy of a proposed intervention in an acute care hospital that would increase patient safety and patient satisfaction as well as improve the nursing environment. Utilizing a quasi-experiment non-randomized group trial, the researchers tested the impact of hourly rounding and their apparent effect on the satisfaction of the patients as well as the perceptions of the nurses on the workplace. A Patient Satisfaction Survey tool was used to collect the data on the levels of patient satisfaction while a Practice Environment Scale of the Nursing Work Index was used to determine the nursing environment. A comparison was to be accomplished between the 1-hour rounding and the 2-hour rounding. The results indicated that in cases, there were significant changes on patient satisfaction as well as less use of the alarm or call bell. On the other hand, there were significant changes on the perceptions of nursing environment by the nurses and staff. The study also indicated that the 1-hour comfort rounds provided greater levels of comfort and satisfaction for the patients but had no significant changes on the climate within the nursing environment. The study supports the idea that hourly rousing can significantly be utilized or tailored for prevention of falls.
Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., & Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: prevalence and trends. Journal of patient safety, 9(1), 13.
Bouldin et al. (2013) in their study sought to establish normative data based on unit type as well as determine the trends in falls within the US hospitals. The study sought to also determine the impact on the reimbursement rule on the occurrence of falls. The results indicated that within the units of study, there were 315, 817 falls which translated to a rate of 3.56 falls per 1, 000 patient days in which 26.1% (0.93% per 1000 patient days) resulted to injuries. In this study sample, there was evidence that the incidences of falls varied by the unit type within the hospitals. However, within the 27- month period following the introduction and adoption of the reimbursement rule, there was a minimal but statistically significant decrease in the number of falls. The study supports the continued policy development in which the healthcare facilities are notified of the financial repercussions of increased falls as well as notified of their increased role in management and prevention of falls.
Mant, T., Dunning, T., & Hutchinson, A. (2012). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. The JBI Database of Systematic Reviews and Implementation Reports, 10(56 Suppl), 63-74.
Mant, T., Dunning, T., & Hutchinson, A. (2012) in their study sought to determine the efficacy of hourly rounding as compared to the other existing fall prevention strategies or in the absence of any interventions. The researchers based their study on a systematic review of literature in which they would determine the incidences of falls in elderly adults within inpatient care units. Noting that accidental falls are the most common type of falls, the researchers found a total of 16 studies that met the criteria for inclusion. 13 of these studies had an agreeable term that the hourly rounding formula is the best approach for the prevention of falls. The other three studies indicated that while hourly rounding is a prevention measure, regulatory measures and standards of practice are more reliable in prevention of falls. The study offers a diversified outlook on the prevention and management of falls within healthcare facilities.
Change plan; translation
This is the third phase in which the recommendations have already been developed and the focus is on the actual implementation. The first step here is to assess the feasibility of translating the recommendations into workable practice setting activities. This includes constant communication with the stakeholders especially those who are tasked with the distribution of resources. Once the support has been acquired and the feasibility has been determined, the next phase is to make changes that will accommodate the intended intervention. For instance, in this case, the policy on the designing of shift schedules for nurses will be based on the patient needs and the level of strain within a particular unit. Other policy changes such as the integration of nurse educators in wards will have to be acquired and recognized within the new policy. Aside from that, the feedback from the various groups that are affected by the change such as patients, staff nurses as well as the changes in the roles of the nurse supervisors will be assessed and used to evaluate the intervention in the future (Dearholt & Dang, 2012).
Once these measures have been put in place to safeguard the elements of the intervention, the team leaders will make verbal and written communication to the affected groups to notify them of the intended change and their new roles. The nurse educators in this case will have to be available at all times to answer the questions that the affected groups may have and therefore eliminate the fear that comes with an intended change. Once this has been done, the next process is to initiate a process for evaluation of outcomes which helps provide the basis for change/alteration/modification of the process (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010). This is based on the assessment to the short term outcomes as well as the response by the various stakeholders such as the patients and the staff nurses. The results of the assessment will then be communicated to the team members who will assess the frequent of falls, the magnitude of the injuries and the attached costs in each case. These results will then be used as the justification for the review of the EBP solution (Deitrick, Baker, Paxton, Flores & Swavely, 2012).
Summary
The success of the EBP is based on the level of collaboration and the presence of communication channels amongst the members of the team. The most important entity that helps the EBP process is the feedback; the team leaders have to provide a channel; for tracking and delivering messages to each of the members as appropriate. The feedback provides a basis for constant modification of the various components of the EBP since there is no single formula that can afford to accomplish EBP without regular reference to the previous steps or phases (Mant, Dunning & Hutchinson, 2012). The nurses have to be involved in this case as they are the actual point of interaction with the patients and have a clue as to the how falls manifest and therefore in a better position to analyze how well the intervention impacts the occurrence of falls and the satisfaction of the nurses and the patients (Mitchell, Fisher, Hastings, Silverman & Wallen, 2010).
References
Bouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., & Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: prevalence and trends. Journal of patient safety, 9(1), 13.
Dearholt, S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines (2nd-ed.). Indianapolis, IN: Sigma Theta Tau International.
Deitrick, L. M., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly rounding: challenges with implementation of an evidence-based process. Journal of nursing care quality, 27(1), 13-19.
Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study. International Journal of Nursing Practice, 15(4), 287-293.
Mant, T., Dunning, T., & Hutchinson, A. (2012). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. The JBI Database of Systematic Reviews and Implementation Reports, 10(56 Suppl), 63-74.
Mitchell, S. A., Fisher, C. A., Hastings, C. E., Silverman, L. B., & Wallen, G. R. (2010). A thematic analysis of theoretical models for translational science in nursing: Mapping the field. Nursing outlook, 58(6), 287-300.
