EBP Unit 6 Assignment.edited

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Nov 24, 2024

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1 Critique of Chosen Article for Evidence Netsanet Darihun Herzing University NSG324-8: Evidence-Based Practice in Nursing April 15, 2023

2 Critique of Chosen Article for Evidence Introduction The concept of purposeful hourly rounding includes regular check-ins with patients every hour during the day and every two hours at night in order to proactively address their needs. This technique is structured to address factors such as pain, personal needs, and patient positioning (Brown, 2016). Patient falls are a common issue in medical facilities, particularly in acute care settings, and can be caused by a range of factors such as muscle weakness, poor balance, and memory loss (Weil, 2015). Hospitals need to implement patient safety measures, including preventative measures, to ensure patients are safe while receiving medical care. The article being discussed in this critique is entitled Implementation of Purposeful Hourly Rounds in Addition to a Fall Bundle to Prevent Inpatient Falls on a Medical-Surgical Acute Hospital Unit by Dorothy M. Grillo, Karen H. Firth, and Kimberly Hatchel. Problem/Purpose Although it may seem like keeping patients confined to their beds would prevent falls, doing so would be unethical and not a proper form of intervention (Gliner et al., 2021). When patients are confined to their beds, they can experience serious complications like pressure ulcers or aspiration, which can prolong their hospital stay and compromise their recovery. Patient falls are a significant issue during hospitalization and can cause injury, morbidity, and distress, ultimately indicating low-quality care (Gliner et al., 2021). Patients depend on nurses to respond to their requests effectively and judge the efficacy of their therapy based on their interactions with nurses. To make sure that purposeful hourly rounding is not perceived as an additional burden, nurses must concentrate solely on improving patient outcomes. The objective of this

3 initiative was to reduce patient falls by half through the implementation of purposeful hourly rounds as part of an existing fall prevention procedure. Review of the Literature Numerous studies have demonstrated that hourly nurse rounding has several benefits, including reducing call light usage, improving patient's perception of nursing care, and improving patient health and treatment outcomes. Additionally, purposeful hourly rounds can help alleviate patients' fears of falling, even if they have not yet experienced a fall during their hospital stay. These rounds are designed to address the four Ps - pain, personal needs, position, and placement - and are primarily used to reduce anxiety (Brown, 2016). Research Question/Hypothesis Research Question: In the acute care setting, does implementing a nurse-led rounding program compared to a no rounding program decrease patient falls? Hypothesis: Implementing a nurse-led rounding program compared to a no rounding program reduces patient falls in the acute care setting. Sample The location of the research was a well-established medical facility within a larger hospital group situated in the southwestern region of the United States. The particular unit being studied consists of 26 beds and has constant video surveillance throughout the day and night. The patients who are admitted to this unit are typically individuals who are legally or medically protected or those who have a high risk of falling due to conditions such as dementia, mental disorders, confusion, and/or a lack of ability to care for themselves (Grillo et al., 2019). Research Design

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4 The research design used by this paper is the CQI model: Plan, Do, Study, and Act (PDSA) approach. Threats to External/Internal Validity Evidence-based practice (EBP) alone is not adequate to initiate or govern clinical practice. There is a need for reforms that can validate and sustain medical interventions pegged on scientific and clinical evidence. According to Sims et al. (2020), EBP is a comprehensive approach to making clinical decisions in treatment that draws on the most reliable and up-to-date evidence from various experts, such as clinical management and performance data. Also, it considers the concerns and preferences of individual patients. Many patients at risk of falling are more susceptible to falls, which can decrease activity, flexibility, and overall fitness levels. Methodology In collaboration with the nursing staff and Falls Committee members, the Director of Nursing initiated a quality improvement program that aimed to reduce patient falls by implementing a nurse-driven protocol based on evidence. The program included providing targeted fall prevention technique and education to clients and their families using a teaching technique with increased frequency. To examine the impact of the program, historical data for a 31-day period in January 2018, prior to the implementation of hourly rounds, were compared with data for another 31-day period in March 2018, following the implementation of hourly rounds (Grillo et al., 2019). As a result of fewer falls, increased Press Ganey scores, and more efficient call response times, the patient safety committee of the medical facility recommended extending this quality improvement initiative to other units, including surgical, medical, and intensive care departments. Instruments

5 The researchers reviewed patient falls and medical documents based on particular criteria. This included reviewing records and reports of patient falls that occurred during the 31- day comparison period and the 31-day program period for all patients aged 18 years and above who were tasked to the program units. Patients exhibiting behavioral collapse were excluded from the analysis. In addition, the researchers collected patient satisfaction statistics from the Press Ganey survey. Legal/Ethical Issues Training programs that offer open communication customized to a client's language and reading abilities can aid improve their understanding of the risks of falling, but it cannot replace proper training. Patients, along with their families and friends, should be made aware of the risks of not following the prevention plan and be presented with alternatives and potential consequences. Patients have the right to decline care as described in their treatment plan, and healthcare professionals must provide and document alternative approaches and the client's response and comprehension of all alternatives provided. This alternative intervention should be considered in healthcare settings and included in the treatment plan. Establishing relevant rules and procedures is the most crucial step in preventing such incidents in healthcare facilities. Proper training and focus on professional ethics can also help individuals better understand and trust the ethical principles of patient safety. Data Analysis The data analysis involved the use of statistical techniques such as the chi-square test of independence and independent samples t-test. The number of calls made before and after the program was also compared. The Press Ganey results and top box score were adopted to examine the data further (Grillo et al., 2019).

6 Implications for EBP The nurse-led strategy aims to decrease patient falls by incorporating purposeful hourly rounds into existing fall prevention protocols, which may lead to reduced falls, better response times to patient requests, and enhanced patient outcomes. This program was developed using evidence-based practices and includes training and testing staff for competency. Effective training and involvement of key stakeholders are essential for successful implementation, and the project can be replicated in other units and hospitals to gain comparable outcomes. Although purposeful hourly rounding needs significant effort from nurses, the benefits of patient care should be emphasized to medical staff to gain their acceptance. The nurse manager can initiate purposeful hourly rounding to maximize efficiency and take advantage of the potential benefits of decreasing patient falls. Conclusion The research found that although intentional hourly rounds in conjunction with existing fall prevention strategies did not produce a statistically significant difference in fall rates, there was a lower incidence of falls compared to the national average. The decrease in patient falls was a significant clinical outcome, and the diminishing trend continued for two months following the implementation period. The use of overhead lighting after construction activities impacted implementation, and nurses encouraged clients to use telephone lights. A crucial clinical outcome was a notable decrease in call light response time. Furthermore, nursing outcomes increased when staff fully implemented fall prevention protocols, including purposeful hourly rounds.

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7 References Brown, C. H. (2016). The effect of purposeful hourly rounding on the incidence of patient falls . Gardner-Webb University. Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2021). Patient Falls, Nurse Communication, and Nurse Hourly Rounding in Acute Care: Linking Patient Experience and Outcomes. Journal of public health management and practice: JPHMP Grillo, D. M., Firth, K. H., & Hatchel, K. (2019). Implementation of purposeful hourly rounds in addition to a fall bundle to prevent inpatient falls on a medical-surgical acute hospital unit. Medsurg Nursing , 28 (4), 243-250. Sims, S., Leamy, M., Levingston, R., Brearley, S., Ross, F., & Harris, R. (2020). The delivery of compassionate nursing care in a tick-box culture: qualitative perspectives from a realist evaluation of intentional rounding. International Journal of Nursing Studies, 107, 103580. Weil, T. P. (2015). Patient falls in hospitals: an increasing problem. Geriatric Nursing , 36 (5), 342-347.

EBP Unit 6 Assignment.edited

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