Paper Example on Evidence Based Practice: Patient Fall

Patient fall is a significant and persistent health problem in health care and reducing patient's harm from fall is a top safety goal of any physician. Through eMR high-risk fall alert and eMR fall risk assessment tools, nurses can provide quality care and required assessments to patients risk of falls and take necessary interventions that patient's specific risk levels. Knowing the risk factors that may lead to preventable negative outcomes, the nurses is able to develop more effective interventions and implement system-wide changes. Despite the great potential for the Auto-FallRAS as an alert system to reduce patient falls, efficiency and quality of care would be ensured through staff training to give them the knowledge of the features of the system and how it works.

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Falls are associated with fall risk factors, most of which can be modified. The goal be to patient's fall risk, reduce injuries caused by fall risks, and ensure an ongoing follow up to ensure the quality of life. Thus, the monthly screening to identify patients with increased falling rate, comprehensive risk assessment, and the modification of the fall risk factors help reduce falls among high risk and low-risk patients. Since behavioral and environmental factors are the primary causes of falls, nurses help patients to understand the fall prevention strategies to help patients reduce the chances of falling or experience a functional decline in death or injury. The screening and assessment of fall risk using the Auto-FallRAS as a tool that analyzes information and shows results on fall risk assessment help in Medicare examination to stop accidents, injuries and deaths (Lee, Jin, Piao, & Lee, 2016). Such assessments help to measure safety outcomes and interventions and improve communication between nurses and parents to develop safety and prevent falls in an inpatient setting.

The implementation of Auto-FallRAS as an automated fall risk assessment system help healthcare providers to integrate falls assessment and management into their practice. This have a better predictive performance by automatically analyzing patient's information and demonstrate their fall assessment without the need of additional time for nurses (Lee, Jin, Piao, & Lee, 2016). This reduces the nurse's workload and narrow individual variation based on nurses understanding the use of Auto-FallRAS and enabling physicians to spend more time on fall prevention and taking care of patients. When the nurses accept the fall risk program or the HER tool, they report improvement in clinical outcomes resulting from the fall risk assessment reminders. Besides, the fall risk assessment reassess patients and recommend interventions that ensure routine follow-up visits that can help augment care. Thus, by evaluating every patient for fall risks and recent falls, nurses can provide proactive care, and prevent falls from occurring and recurring, which promote and improve safety and quality care of patients (Lee, Jin, Piao, & Lee, 2016). The nurses also appreciate to be part of the process and feel empowered with the EBT tool to improve patient care, which translates to decreasing falls in the emergency rooms.

The study also help the healthcare centers through the EMR application for quality improvement by reducing costs that would have been used to treat and care for patients who injure themselves through falling. The EMR system also help to identify patients with high risk of fall, facilitate documentation of fall risk assessments and develop fall prevention plans which lead to cost savings (Lee, Jin, Piao, & Lee, 2016). Thus, a culture of fall awareness which led to the reduction of fall among patients through tailored interventions help reduce the fall risk level.

The first changes or improvements to the nursing proactive when the EBP project is implemented involve the pediatric care improvement programs such as Nurses Improving Care for Health system (NICH). This is an example of how pediatric nurses can partner with frontline staff and nursing leadership to improve the care of patients with high risk of falling. The program can be integrated with EHR to provide clinical decision support and capture data in a coded format. This can ensure that those patients receive Evidence Based and personalized care.

The second change or improvement to the nursing proactive when the EBP project is implemented involve the use of an evidence-based assessment tools such as the learning health system (IOM) into the EHR to apply evidence-based data and provide personalized care to patients at high risk of falls. Such a structured HER tool with coded data helps to transform how the pediatric nurses apply and generate knowledge. Information and data recorded at individual patient level can be used to provide personalized care and simultaneously applied to prompt innovation for future care delivery.

Edwards Deming developed the Plan Do Study Act (PDSA) cycle in 1950 (Donnelly & Kirk, 2015). He defined the PDSA model as the model for change that aims to achieve top quality results and promote continuous improvement (Smith, 2014). The model is a great tool that can be applied in a falls reduction program to reduce the fall rate risk among inpatients.

The PDSA change model is best suited for implementation of a falls reduction program. It helps to predict the outcome of the proposed change and assess the effect of an intervention based on the outcome of processes being studied (Donnelly & Kirk, 2015). The PDSA model measure data and increase awareness that impact processes or outcomes and increase the impact of an intervention program (Donnelly & Kirk, 2015). Nurses can learn through the implementation of the intervention program for change purposes.

Steps of the PDSA Change Model

Once the problem has been introduced and communicated, which in this case is high risk fall rate, a design challenge is asked to facilitate brainstorming during the session. This requires more discipline and preparation. Examples of a design challenge question, which can be considered include: what items can be developed and implemented to reduce fall risk among inpatients? It may involve the invitation of a multi-disciplinary team with different perceptions and opinions to join the team, choosing a room that ensures interaction and movements, telling stories that may create new ideas and setting ground rules (Smith, 2014). The ideas are then collected, organized and prioritized and a plan is developed for implementation processes.

Phase Two: Do

The ideas developed and discussed in phase one are implemented into practice. Many activities and items are implemented by the pediatric nurses such as the use of baby monitors and bed alarms to reduce falls. This is the phase when the pediatric nurses are able to test the change (Smith, 2014).

Phase Three: Study

The phase involves reviewing the outcome of the model after changes have been implemented. For example, measures for falls may include severity of falls realized post or pre implementation or falls prevalence per 100 patients per day (Smith, 2014). The reports are then reviewed to evaluate whether the severity of injury or the prevalence of falls has reduced.

Phase Four: Act

Act is the final stage of the PDSA change model. Once the intervention of the program is complete, pediatric nurses ensure best possible outcomes are provided. The team would have learned if the change works appropriately and incorporate it into their daily pediatric practice (Smith, 2014). Once the cycle is complete, the change and new process are shared with sister agencies and hospice departments to ensure widespread improvement. Thus, continuous improvement be vital in reducing fall risk rate among newborn inpatients.

Applying PDSA successfully leads to a successful return on investment, but it requires buy in and sustained effort, methodological expertise and funding, which may be underestimated. Lack of financial support and human resources can make the program to fail and contribute to disillusionment and fatigue (Donnelly & Kirk, 2015). Thus it is important resource requirements are important for the successful application of a PDSA change model. An environment that supports EBP can be fostered in future practice setting through support and significant investment in resources, expertise and leadership. Thus, PDSA change model is a powerful approach that solves fall risk issues and shapes the culture of the health care institution.

The hope of the report is that it would be consistent with the studies on implementation of EMR fall risk alert systems to prevent patient falls. Thus, the implementation and effectiveness of the informatics systems would be based on the organizational context, timeliness of data and quality of data. Although most studies on nursing informatics systems fail despite the good intentions of the participants and the usefulness of the information, the failures may be as a result of specific organizational barriers. The primary significance of the study is that it would provide new guidance on the effective use of clinical informatics and technology in reducing patient falls, injuries and death by preventing patient falls.

The paper demonstrates the power of nursing informatics in helping the healthcare providers to integrate falls assessment and management into their practice using the Auto-FallRAS as an alert system in the patient's EMR. The Auto-FallRAS help the nurses to focus on efforts to avoid patient fall rates and errors in care planning and risk assessment. Knowing the risk factors that may lead to preventable negative outcomes, the nurses is able to develop more effective interventions and implement system-wide changes. Despite the great potential for the Auto-FallRAS as an alert system to reduce patient falls, efficiency and quality of care would be ensured through staff training to give them the knowledge of the features of the system and how it works. Thus, the monthly screening to identify patients with increased falling rate, comprehensive risk assessment, and the modification of the fall risk factors help reduce falls among high risk and low-risk patients. Since behavioral and environmental factors are the primary causes of falls, nurses help patients to understand the fall prevention strategies to help patients reduce the chances of falling or experience a functional decline in death or injury. The screening and assessment of fall risk using the Auto-FallRAS as a tool that analyzes information and shows results on fall risk assessment help in Medicare examination to stop accidents, injuries and deaths. Such assessments help to measure safety outcomes and interventions and improve communication between nurses and parents to develop safety and prevent falls in an inpatient setting.

References

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Lee, J. Y., Jin, Y., Piao, J., & Lee, S. M. (2016). Development and evaluation of an automated fall risk assessment system. International Journal for Quality in Health Care, 28(2), 175-182.

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