An Evidence-Based Approach - Free Paper Example

Introduction

The Population, Intervention, Comparison, and Outcome (PICO) extended to PICO(T) (timeline), analysis is a widely applied framework for formulating answerable clinical or research questions. This formula aims to facilitate an accurate literature review (Eldawlatly et al., 2018). As a clinical research model, it focuses on questions like systematic reviews that involve coming up with evidence. Its focal elements (acronym) represent an evaluation of the participants (patients or target population), the intervention under interrogation, the control group or comparison intervention, and the clinical results (outcomes) to gauge the focal intervention’s effectiveness.

The extension (T) represents the Period (time frame) for outcome measurement. It is popular in evidence-based clinical research and therapy interrogations. It also suits research in diagnosis (diagnostic tests), determining etiology, and prognosis-prediction. However, not applicable to all medical issues as it may prove suboptimal and result in poor reporting(Abbade, Wang, Sriganesh, Mbuagbaw, & Thabane, 2016; Eriksen & Frandsen, 2018). The following analysis aims to come up with and answer the appropriate PICO(T) question to examine interventions for in-hospital falls in the geriatric population. The question will facilitate fitting the recommendations in a practical, evidence-based intervention approach to the issue.

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The Risk of Fall

Falling is the most reported threat to patient safety. It increases the mortality rate of hospitalized patients and negatively affects their quality of life by causing unintentional and avoidable injury and infirmity. It also results in adverse effects such as increased costs of treatment and a prolonged period of hospitalization. Falls happen in all clinical areas, and the geriatric population (above 65 years) is especially vulnerable to these falls, with more than 30% experiencing them once a year. Falls have severe implications and are frequent among the elderly due to their age, sequelae, sensory and mobility deficits, and other comorbidities. The risk increases with age (Crandall et al., 2016). Fall prevention interventions are crucial in healthcare and community setting, especially for the practice of nursing. Nurses often bear the responsibility to take care of these patients in hospitals, community homes, and other institutions. This analysis's primary concern is to gather evidence on what interventions best suit fall prevention among older adults in hospitals and the community. It compares two intervention categories, patient-centered interventions, and non-patient centered ones.

Fall Assessment Tools

There are numerous proposed and practiced interventions for patient fall prevention. Identifying a proper intervention may involve interrogating the medical (biological) conditions to identify their falling risk. This investigation involves using standard risk analysis tools (scales) such as the Schmidt, Stratify, and Morse scales. Fall and injury prevention may also focus on the presence or absence of environmental factors that can cause falls such as obstacles, bedside rails, furniture, and shoes, among others (Toren & Lipschuetz, 2017).

Each risk scale focuses on different factors contributing to falling risk. They use numeric values with a fixed cut-off to identify at-risk individuals. These scales inform fall prevention programs such as alarms, non-slip shoes, and bed-rails, among others, that account for both individual and environmental risk factors. However, they portray questionable validity, and each produces different results due to the different considerations. Moreover, this kind of risk detection is practitioner-centered. The patient is passive and allows the clinician or nurse to perform the assessment and decide without their input or participation (Toren & Lipschuetz, 2017). Studies show that this method is deficient because although they, to some extent, reduce fall risk, they do not account for patient-specific risk factors. This risk scale screening often results in a single component, nonspecific interventions such as exercise and usual care practices.

The individual risk assessment that involves the patients, on the other hand, result in multifactor patient-centered interventions. These evaluations consider various aspects of an individual’s risk of falling and tailor the interventions to their individual needs. Avanecean et al. (2017) conducted a systematic review of published and unpublished quantitative data from various studies to test the effectiveness of patient-centered intervention for falls among acute care patients. The review included five randomized control trials (RCTs). Three out of those RCTs showed a statistically significant reduction in patient falls rates compared to usual care practices. These three applied patient-centered care (patient involvement, education, and personalized care), thus indicating their possible contribution to reducing fall rate (Avanecean, Calliste, Contreras, Lim, & Fitzpatrick, 2017).

Effectiveness

A study by Hopewell et al. (2018) confirms the effectiveness of multifactorial (patient-centered) risk assessment and intervention among older adults in the community compared to usual care activities and single-component interventions such as exercise. The results show that the multifactorial strategy had the potential to decrease fall rates compared with control (single component). For instance, an assessment of 1000 in a year could result in 2317 falls with usual care, but 1784 falls with the multifactorial intervention (Hopewell et al., 2018).

An evidence-based practice project also evaluated a British and American Geriatrics Society endorsed multicomponent intervention. The project used this patient-engaging approach to assess fall frequency and fall-related injury. The method addressed the physical, functional, and psychological aspects of falling and came up with interventions customized to patients’ specific needs. This study established that the intervention caused a 25% reduction in falls, and there were no fall-related injuries (Wexler & D’Amico, 2015). Another study by Crandall et al. (2016) compared six different interventions and their effect on fall injury reduction among the elderly. The outcome for mixed or multifactorial strategies was that it helped minimize the injuries. However, the heterogeneity of the approach hampered its effectiveness (Crandall et al., 2016).

While fall scales are appropriate screening tools, they do not conduct a comprehensive assessment of an individual's risk of falling. A complete assessment involves diagnosing the patient's needs and conditions through an exhaustive synthesis and evaluation of patient analysis data. Patient information such as medical and family histories, mobility, physical and psychological (perception of fall) examination, environmental assessment, review of laboratory results and drugs used, and patient observation over time contributes to the diagnosis. Assessments are regular and repeated when appropriate, for instance, during transitions between different kinds of care after a fall. Patient-centered, multifactorial risk assessment facilitates a more robust, evidence-based approach towards fall prevention and enables custom interventions (Quigley, 2015). However, research evidence also identifies a weakness in multifactorial fall risk assessments. It is a non-standardized, heterogeneous method. These characteristics reduce its quality (WHO, 2017).

This analysis shows evidence of a difference between two categories of risk assessment tools and interventions. It presents a deficiency in patient-centricity in the fall risk screening tools and single component fall interventions. Patient-centered multifactorial risk assessment and interventions fill this gap. However, they have low quality due to their heterogeneity. Thus the data presented can help answer the following PICO(T) question and develop an evidence-based decision.

“Among the hospitalized geriatric population, how do patient-centered (multifactorial) risk of fall assessments compared to fall screening tools affect the number of falls within a three-month hospitalization period."

Conclusion

The evidence-based decision should influence the choice of risk evaluation tool and fall prevention strategy for the identified population’s issue. The above PICO question will require a comprehensive and possible standardized multifactorial fall assessment among the elderly in the hospital and compare its effect on fall prevention with a standard fall screening scale like the Stratify scale in the given (for instance, three-month) hospitalization period.

References

Abbade, L. P., Wang, M., Sriganesh, K., Mbuagbaw, L., & Thabane, L. (2016). Framing of research question using the PICOT format in randomized controlled. British Medical Journal (BMJ) Open, 1-5. doi:doi:10.1136/bmjopen-2016-013175

Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. The Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, 3006 - 3048. doi:DOI: 10.11124/JBISRIR-2016-003331

Crandall, M., Duncan, T., Mallat, A., Greene, W., Violano, P., Christmas, B., & Barraco, R. (2016). Prevention of fall-related injuries in the elderly: An Eastern Association for the Surgery of Trauma Practice Management Guideline. Trauma Acute Care Surgery, 81(1), 196-206. doi:DOI: 10.1097/TA.0000000000001025

Eldawlatly, A., Alshehri, H., Alqahtani, A., Ahmad, A., Al-Dammas, F., & Marzouk, A. (2018). The appearance of Population, Intervention, Comparison, and Outcome as a research question in the title of articles of three different anesthesia journals: A pilot study. Saudi Journal of Anaesthesia, 12(2), 283–286. doi:doi: 10.4103/sja.SJA_767_17

Eriksen, M. B., & Frandsen, T. (2018). The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. Journal of the Medical Library Association, 106(4), 420–431. doi:doi: 10.5195/jmla.2018.345

Hopewell, S., Adedire, O., Copsey, B. J., Boniface, G. J., Sherrington, C., Clemson, L., . . . Lamb, S. E. (2018). Multifactorial and multiple component interventions for preventing falls in older people living in the community (Review). Cochrane Database of Systematic Reviews(7), 1-307. doi:DOI: 10.1002/14651858.CD012221.pub2.

Quigley, P. A. (2015). Evidence Levels: Applied to Select Fall and Fall Injury Prevention Practices. Rehabilitation Nursing, 41, 5–15. Retrieved from
https://doi.org/10.1002/rnj.253

Toren, O., & Lipschuetz, M. (2017). Fall prevention in hospitals-the need for a new approach to an integrative article. Nursing & Care Open Access Journal, 2(3), 93-96. doi:DOI: 10.15406/ncoaj.2017.02.00040

Wexler, S. S., & D'Amico, C. (2015). Creating an environment of falls prevention: Evidence-based practice can reduce falls and fall-related injuries. American Nurse Today, 10(7), 34-35.

WHO. (2017). Integrated care for older people (ICOPE) guidelines. Evidence Profile: Risk of Falls. World Health Organization.