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Evidence-Based Practice Project: Evaluation of Literature Table

Literature Evaluation Table

Learner Name:

PICOT: In African American females aged 55 years and above with osteoarthritis, does the use of structured intervention including breathing exercises, postures and meditation for six months improve pain and sleep problem as compared to usual care?

 


Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article

 

Article Title and Year Published

 

Research Questions/ Hypothesis, and Purpose/Aim of Study

 

Design (Quantitative, Qualitative, or other)

 

Setting/Sample

 

Methods: Intervention/ Instruments

 

Analysis/Data Collection

 

Outcomes/Key Findings

 

Recommendations

 

Explanation of How the Article Supports Your Proposed EBP Practice Project Proposal
Bennell, K. L., Schwartz, S., Teo, P. L., Hawkins, S., Mackenzie, D., McManus, F., Lamb, K. E., Kimp, A. J., Metcalf, B., Hunter, D. J., & Hinman, R. S. Annals of Internal Medicine, https://doi.org/10.7326/M22-1761 Effectiveness of an Unsupervised Online Yoga Program on Pain and Function in People With Knee Osteoarthritis. 2022

 

What is the effectiveness of unsupervised online yoga program in patients with knee osteoarthritis? Quantitative, randomized clinical trial 212 adults with symptomatic knee osteoarthritis Patients in both control and intervention groups received online osteoarthritis information. The yoga group accessed an unsupervised online yoga program for 12 weeks, 1 video per week and each session performed 3 times per week. Quantitative methods of data analysis on outcome measures such as changes in knee pain while walking and physical function was analyzed. The other sets of data obtained for analysis included anxiety, overall knee pain, stiffness, depression, global change, stress, self-efficacy, fear of movement, and quality of life. Yoga improved function but not knee pain during walking. More of the yoga participants achieved clinically significant in primary and secondary outcomes. At 12 weeks, there were improvements in quality of life, knee stiffness, and self-efficacy in the yoga group as compared to intervention group. Unsupervised yoga programs should be incorporated into osteoarthritis treatment to improve outcomes. Future studies to focus on the impact on larger sample sizes. The article shows that yoga improves outcomes such as pain, anxiety, depression, and quality of life among patients with osteoarthritis. The improvements also led to better quality sleep for these patients.
de Orleans Casagrande, P., Coimbra, D. R., de Souza, L. C., & Andrade, A. PM & R: The Journal of Injury, Function, and Rehabilitation. https://doi.org/10.1002/pmrj.12867 Effects of yoga on depressive symptoms, anxiety, sleep quality, and mood in patients with rheumatic diseases: Systematic review and meta-analysis. 2022 What are the effects of yoga on depressive symptoms, sleep, anxiety, and mood of patients with rheumatic diseases? Quantitative, systematic review and meta-analysis 27 studies were used for qualitative analysis and 18 studies for meta-analysis. Searches for relevant studies were performed in databases that included Web of Science, Scopus, SportDiscus, EBSCO, PubMed, and Cochrane. Data was extracted from the articles using PICOS (participants, intervention, comparison, outcome, and study strategy). The meta-analysis showed that yoga decreased depressive symptoms and improved sleep quality. There was also improvement in anxiety symptoms among the participants. Further studies on the effectiveness of yoga are needed due to the studies in this topic having high risk of bias The article supports the effectiveness of yoga in inflammatory diseases such as osteoarthritis and rheumatic diseases. It shows that it improves anxiety, depressive symptoms, and sleep quality, hence supporting the project focus.
Deepeshwar, S., Tanwar, M., Kavuri, V., & Budhi, R. B. Frontiers in Psychiatry, 9. https://www.frontiersin.org/articles/10.3389/fpsyt.2018.00180 Effect of Yoga Based Lifestyle Intervention on Patients With Knee Osteoarthritis: A Randomized Controlled Trial. 2018 What is the effect of integrated approach of yoga therapy intervention on individuals with knee osteoarthritis? Quantitative, randomized controlled trial 66 individuals pre-diagnosed with knee osteoarthritis aged between 30 and 75 years. Participants were randomized into either control or intervention group. The control group received integrated approach of yoga therapy for 1 week at yoga center while the control group maintained their normal lifestyles. Data on outcome measures such as falls and self-efficacy were obtained on first and seventh day. The tools utilized included the Falls Efficacy Scale, Timed Up and Go Test, Handgrip Strength Test, Sit-to-Stand test, and right and left flexion and extension tests. Data analysis was done using SPSS version 20.00. Repeated measures of Analysis of Variance were used for outcome measures with two factors. Yoga led to significant reductions in Timed Up and Go Test, Right and Left Flexion, and considerable improvements in Left Hand Grip Strength among the intervention group as compared to intervention group. Yoga may be an effective intervention to be adopted in improving outcomes in patients with osteoarthritis. The article supports my proposed project by showing the benefits of yoga for patients with osteoarthritis. It shows that it improves functional status, which can result in minimal depressive symptoms such as pain and altered sleep processes.
Gautam, S., Tolahunase, M., Kumar, U., & Dada, R. Restorative Neurology and Neuroscience, 37(1), 41–59. https://doi.org/10.3233/RNN-180875 Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active Rheumatoid arthritis patients: A randomized controlled trial. 2019 What is the effect of yoga based mind body intervention on disease specific inflammatory markers and depression severity in patients with rheumatoid arthritis on routine disease modifying anti-rheumatic drugs therapy? Quantitative, randomized controlled trial 72 patients with rheumatoid arthritis The participants were randomized into control and intervention groups. Blood samples were obtained before and after the study. Data analysis was performed using IBM statistics for Macintosh, Version 25.0. A p value of<0.05 was considered statistically significant. Chi-square test and Fisher’s exact tests were used to compare categorical characteristics at baseline. Wilcoxon rank-sum test was used to compare normally distributed continuous variables and nonparametric continuous data. T-tests were used to determine the different within groups. The yoga-based mind body intervention group demonstrated significant decrease in severity of rheumatoid arthritis as compared to the control group. There were reduction in various systemic inflammatory markers and disease activity score 28 erythrocyte sedimentation rate. Yoga may be adopted as adjunct or complementary therapy in patients with inflammatory arthritis. This study supports my project by demonstrating the effectiveness of yoga in inflammatory processes involved in osteoarthritis. The research also demonstrates the efficacy and feasibility of yoga use in osteoarthritis.
Kuntz, A. B., Chopp-Hurley, J. N., Brenneman, E. C., Karampatos, S., Wiebenga, E. G., Adachi, J. D., Noseworthy, M. D., & Maly, M. R. PLOS ONE, 13(4), e0195653. https://doi.org/10.1371/journal.pone.0195653 Efficacy of a biomechanically-based yoga exercise program in knee osteoarthritis: A randomized controlled trial. 2018 The aim of this study was to compare the effectiveness of a biomechanically-based yoga exercise program with traditional exercise and no-exercise attention equivalent control in patients with knee osteoarthritis. Quantitative, randomized controlled trial It was conducted in a community in Southwestern Ontario, Canada. The participants were 31 women with symptomatic knee osteoarthritis Participants were allocated either into one of the three supervised interventions. They included biomedically-based yoga exercises, traditional exercises, and no intervention. Descriptive statistics were calculated. ANOVA was calculated to detect differences in BMI, age, and LEFS scores between groups at baseline. An ANCOVA was used to detect between-group differences for the outcomes. Sidak adjustments were done to account for multiple comparisons between groups. Shapiro-Wilk tests were used to assess data distribution visually. The participants in the biomedically-based yoga group demonstrated greater improvements in pain scores, self-reported physical function as compared to the other groups. Future research should investigate the effectiveness of the intervention using a larger sample. The article supports my project by demonstrating the effectiveness of yoga interventions on osteoarthritis. It shows that yoga interventions improve pain scores and functioning among the affected patients.
Lauche, R., Hunter, D. J., Adams, J., & Cramer, H. Current Rheumatology Reports, 21(9), 47. https://doi.org/10.1007/s11926-019-0846-5 Yoga for Osteoarthritis: A Systematic Review and Meta-analysis. 2019 The aim of this study was to systematically review and summarize evidence on the safety and efficacy of yoga for osteoarthritis. Quantitative: systematic review and meta-analysis Nine trials that used 640 participants with lower extremity osteoarthritis aged between 50 and 80 years. A literature search was performed in databases that included Medline, Cochrane, and Scopus. The primary outcomes of focus included function, pain intensity, and quality of life. Secondary outcomes included mental health and safety. Cochrane tool was used to assess risk of bias. Data was extracted from the studies with a focus on aspects such as yoga style, frequency, duration, and outcomes. Two authors reviewed the risk for bias in the selected articles independently. Statistical heterogeneity between studies was analyzed using I2 statistics. Chi-test was used to assess compatibility in differences in results due to chance alone. Subgroup sensitivity analyses were performed according to the type of osteoarthritis. Yoga demonstrated some effectiveness in improving pain, stiffness, and function in individuals with knee osteoarthritis. The benefits cannot be compared with those seen in interventions such as exercises and no intervention approach to management. More studies required to support the importance of using Yoga to improve knee function. The study supports my project by showing the potentials of yoga interventions in improving symptoms of osteoarthritis. It shows its efficacy over other interventions such as exercise and non-exercise.
Mahr, J. PCOM Physician Assistant Studies Student Scholarship. https://digitalcommons.pcom.edu/pa_systematic_reviews/491 Can Yoga Therapy Help to Decrease Osteoarthritis-related Pain in Adults with Knee Osteoarthritis? 2019 The objective of this study was to determine whether or not yoga therapy can help decrease osteoarthritis-related pain in adult patients with knee osteoarthritis Quantitative: review of two randomized control trials and one randomized control trial pilot study Two randomized controlled trials and one randomized control trial pilot study A literature search on PubMEd was performed. Authors performed data extraction on aspects such as patient demographics, yoga, type of yoga, and duration and linking them with outcomes. Data analysis mainly focused on outcome measures in this study. The outcome measures included pain reported by patients with osteoarthritis. The results showed that yoga interventions led to a significant decrease in pain levels of patients with knee osteoarthritis. The outcomes were enhanced as compared to those seen in patients enrolled in other therapeutic programs. Yoga programs could be considered as part of the alternative treatments for osteoarthritis. This study supports my project focus by showing the effectiveness and efficacy of yoga in improving pain symptoms among osteoarthritis patients.
Seguin-Fowler, R., Graham, M., Ward, J., Eldridge, G., Sriram, U., & Fine, D. BMC Geriatrics, 20(1), 400. https://doi.org/10.1186/s12877-020-01818-y Feasibility of a yoga intervention to decrease pain in older women: A randomized controlled pilot study. 2020 The objective of this pilot randomized study was to evaluate the feasibility of a flow-restorative yoga intervention on pain and related outcomes in elderly women experiencing chronic pain. Quantitative 38 participants Participants were randomized into either control or intervention groups. Those in the intervention group attended yoga classes for 12 weeks and supplemental materials for at home practice. Those assigned to the control group maintained their normal daily routines IBM SPSS Statistics for Macintosh version 25.0 was used for quantitative data analysis. Means for continuous variables and frequencies for categorical variables were summarized for feasibility measures and baseline characteristics. T-tests and Mann-Whitney U tests were used to compare differences in baseline between the groups. Open ended questions were coded qualitatively using Microsoft Excel 2014. Codes were then categorized into themes that represented outcomes of the study. Participants experienced significant reductions in pain interference and improvements in social functioning and energy. Future studies on the topic should focus on strategies to recruit a more diverse study population at a risk of functional decline and disability. The study supports my proposed project by showing the effectiveness of yoga in improving social functioning, energy, and pain that women with chronic conditions such as osteoarthritis experience. It also demonstrates its feasibility in practice.
Wang, Y., Lu, S., Wang, R., Jiang, P., Rao, F., Wang, B., Zhu, Y., Hu, Y., & Zhu, J. Medicine, 97(31), e11742. https://doi.org/10.1097/MD.0000000000011742 Integrative effect of yoga practice in patients with knee arthritis. 2018 The aim of this study was to quantify the efficiency of yoga exercise for patients pain reduction, general wellbeing, and functional recovery. Quantitative 13 clinical trials that involved 1557 patients with knee osteoarthritis and rheumatoid arthritis A literature search of relevant studies was performed on Embase and PubMed databases. The outcome measures of focus included stiffness, pain, and physical function. Two independent authors extracted data from the selected articles. The quality of citations was assessed using Jadad score. The meta-analysis program of the Cochrane Collaboration was used for data collection and quantitative analysis. Standard mean difference was used to calculate measures of continuous parameters. Mantel-Haenzel method was used to synthesize combined results using random or fixed effect models. Begg’s funnel plot and Egger’s regression plot were used to assess potential publication bias. The results showed that regular yoga training is effective in reducing knee osteoarthritis symptoms, general wellbeing, and physical function of the patients. Research is needed to evaluate yoga as an effective treatment for managing osteoarthritis and improving function among the affected populations. Studies on the most appropriate yoga prescription are also needed. It supports the project since it shows the effectiveness of yoga in managing osteoarthritis.
Dhrubaprasad, B. D. MOJ Yoga & Physical Therapy, 3(3). https://doi.org/10.15406/mojypt.2018.03.00044

 

Effectiveness of yoga asanas over conventional physiotherapy treatment on functional outcomes in patients with knee osteoarthritis. 2018 The purpose of this study was to check the effectiveness of 2 weeks of yoga asana exercises on patients with osteoarthritis in comparison with physiotherapy interventions Quantitative 58 subjects diagnosed with osteoarthritis aged 40-55 years Participants were randomly allocated to two groups. Group A received yoga program for 4 weeks while Group B received conventional physiotherapy for four weeks. The outcomes were assessed in terms of knee range of motion, WOMAC 30second Chair Stand, and Visual Analog Scale. Shapiro-Wilk test was used to check normality of data. Data was presented as mean and standard deviation for outcome measures. Friedman ANOVA test was used for within group comparison. Between group comparison was done using Mann Whitney U test. The analysis was performed using SPSS version 20.0. The findings from this study showed that there were statistically significant improvements in outcomes in both groups. There were no significant clinical differences in between-group comparisons at the end of week 2 and 4. Both yoga and conventional physiotherapy can be combined for improved outcomes in patients with osteoarthritis. This study supports my proposed project by showing the enhanced effectiveness of yoga interventions in improving symptoms of osteoarthritis. It also supports its use with other interventions such as conventional physiotherapy for optimum outcomes.

NUR-550 Evidence-Based Practice Project: Evaluation of Literature Table

The need for patient safety and improved quality of care implores organizations and providers to leverage evidence-based practice (EBP) interventions to address any issues that can lead to occurrence of adverse events in healthcare settings and impact patient outcomes. Falls and incidences of falling among adult patients in medical-surgical settings remain a healthcare safety challenge that requires effective interventions. Falls are considered sentinel and never events by the Centers for Medicare and Medicaid Services (CMS) because they are preventable through institution of different measures aimed at addressing their adverse effects (Cerilo et al.,2022). Falls lead to increased cost of care and stay, poor patient outcomes and in some cases, serious head injuries and fractures that can cause death (Khasnabish et al., 2020). The purpose of this literature evaluation table is to present different research articles on falls and assess their application in medical-surgical settings. The use of TIPS toolkit is considered as one of the ways to reduce and prevent the occurrence of falls in different healthcare settings.

PICOT:

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls (O) within 6 months (T)?

 


Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article 
Article Title and Year Published

 

Research Questions/ Hypothesis, and Purpose/Aim of Study

 

Design (Quantitative, Qualitative, or other)

 

Setting/Sample

 

Methods: Intervention/ Instruments

 

Analysis/Data Collection

 

Outcomes/Key Findings

 

Recommendations

 

Explanation of How the Article Supports Your Proposed EBP Practice Project Proposal
Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D.

JAMA Network Open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889

Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries.

2020

 

The purpose of this study was to evaluate if a fall-prevention toolkit which engages patients and families in fall-prevention process during hospitalization leads to a reduction in falls and injurious falls. The researchers used a nonrandomized controlled trials based in the stepped wedge design. The setting comprised of 14 medical units in academic centers in Boston and New York. The participants were all hospitalized patents in the participating settings; the patients were 37 231. The instrument was a nurse-based fall-prevention tool kit that links evidence-based measures to patient-focused risk factors. The method incorporated continuous patient and family engagement preventing occurrence of falls. The study collected data based on the rate of patient falls and injurious falls in every 1000 patient-days on the units. The study analyzed the data using Poisson regression to estimate the frequency of falls in the facility. The outcome of the study shows a positive correlation between the intervention and a reduction in falls. The article also found that the nurse-driven intervention reduced injurious falls by enabling the families to have sufficient information on different ways to prevent and reduce falls. The study recommends the use of a nurse-led and patient-centered fall-prevention tool kit to reduce the rates of falls and injurious falls. The authors assert that providers can have different modalities to implement and integrate the intervention to reduce falls in medical-surgical units. The article supports the EBP as it shows that the proposed intervention is based on evidence and is effective in reducing the rate of falls and injurious falls among hospitalized patients. The article will offer more information about the effectiveness and efficacy of fall prevention interventions tailored to the needs of a patient.
Tzeng, H.-M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C.

Journal of Nursing Care Quality, https://doi.org/10.1097/ncq.0000000000000547

Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home

2021

The focus of the study was to evaluate the impact of fall (TIPS) program on prevention of falls and fall-associated injuries among older adults in nursing home. The study used mixed method comprising of qualitative and quantitative approaches at various levels of the research gathered findings. The study occurred in a 15-bed subacute nursing care unit. The instrument entailed using fall TIPS initiative customized to setting The approach comprised of providing clinical decision support to prevent falls. The article collected both qualitative and quantitative data based on the respective tools used. These included recording of monthly fall rates among patients within certain period for effective analysis. The findings after the implementation of the Fall TIPS show that the rate of falls and injurious falls reduced with clinical significance. The researchers attribute the reduction in falls to awareness among patients, information offered to patients on the TIPS poster and other interventions like self-transfer. The article recommends the implementation of Fall TIPS initiative in healthcare settings to lower falls and injurious fall incidents among older adult residents in nursing homes and other areas of care delivery. The article also recommends the need for larger studies in different healthcare settings to assess the overall effectiveness of such interventions. The article supports the proposed EBP practice project proposal by demonstrating that the intervention is sound and based on evidence. The proposed EBP project focuses on reducing falls in medical-surgical unit and this study is categorical that such revelations are important to illustrate the efficacy of the Fall TIPS framework.
Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I.

Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077

Interventions to reduce falls in hospitals: a systematic review and meta-analysis.

2022

The aim of the study was to enquire the effects of falls prevention interventions on fall rates and the risk of falling in healthcare facilities The study is mixed as it uses a systematic review and meta-analysis. The participants in the study were hospitalized adults The intervention entailed staff and patient education, modification of the environment, use of assistive devices, development of policies and systems, medication management and rehabilitation as well as management of cognitive impairment The researchers collected data from 43 studies that satisfied the inclusion criteria and 23 were included in the meta-analyses. The findings show that the use of tailored interventions leads to a reduction in rates of falls and injurious falls. The outcomes also suggest that the use of multi-factorial interventions led to a positive impact on patient care. The study recommends the use of patient and staff education as approaches that can have positive effects on hospital falls. The use of chair alarms, bed alarms, and wearable sensors and scored risk assessment tools did not reduce falls. The study will be used in the EBP project proposal to demonstrate the need to use TIPS toolkit for both patients and staff with the aim of reducing and preventing the occurrence of falls and injurious falls in medical-surgical settings.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E.

BMC geriatrics, 20, 1-12. DOI: https://doi.org/10.1186/s12877-020-01515-w

Hospital falls prevention with patient education: a scoping review.

2020

The aim of the scoping review was to examine the content, design, and outcomes concerning patient education approaches to prevent hospital falls. The paper evaluates the significance of patient education to prevent falls and suggests for hospitals to implement in their clinical settings. The study uses a methodological model developed by Arksey and O’Mallet and refined by Joanna Briggs Institute. The researchers evaluated 43 articles in their analysis based on different interventions on patient education like face-to-face and educational tools. The interventions included direct face-to-face education, educational tools, patient-focused consumer materials and hospital systems, policies and procedures The researchers collected and analyzed data from existing studies. These included studies on falls or education associated outcomes before and after patient fall prevention education. The findings from the article illustrate the effectiveness of the interventions that use patient education to reduce falls related to injuries like bruises, lacerations and fractures.

 

The study recommends the implementation of patient-centered prevention education as part of the TIPS approach to reducing falls in healthcare settings. The study observes that well-designed education initiatives can enhance knowledge and self-perception of risk and empower patients to lower their risk of falling while in hospitals. The study is essential to the EBP project proposal since it illustrates the significance of having a patient-centered toolkit or intervention to reduce and prevent the occurrence of falls among hospitalized patients. The article will offer more information on the efficacy of the TIPS model to reduce and prevent falls.
LeLaurin, J. H., & Shorr, R. I.

Clinics in geriatric medicine, 35(2), 273-283. DOI: 10.1016/j.cger.2019.01.007

Preventing falls in hospitalized patients: state of the science.

2019

The aim of this study was to familiarize the audience with the strengths and the cons of different types of research used in testing fall prevention approaches or interventions. The article uses a review of existing literature or systematic review to highlight different studies on fall prevention in healthcare settings. The researchers evaluate different articles based on their approaches to reducing falls in healthcare settings. These include quality improvement studies, randomized studies, and non-randomized studies a well as single fall prevention interventions and multifactorial one among others. The interventions include focusing on single approaches as well as use multifactorial interventions. The researchers collected and analyzed data from the different types of studies that they evaluated. The researchers focused on both single and multifactorial interventions to reduce and prevent patient falls. The findings show that different interventions are effective based on a host of factors. Again, the study notes that single interventions are more practical compared to multifactorial interventions in prevention of falls. The study recommends the implementation of all interventions, especially those emanating from research and are effective based on the healthcare setting. The study notes that the implementation of any of the interventions is the most essential for any patient safety initiative. The article is essential to the EBP project proposal as it offers sufficient research evidence on the efficacy of the different interventions to prevent and reduce falls in healthcare settings.
Dykes, P. C., Adelman, J. S., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., … & Spivack, L.

B.

Nurse Leader, 17(4), 365-370. https://doi.org/10.1016/j.mnl.2018.11.006

The fall TIPS (tailoring interventions for patient safety) program: A collaboration to end the persistent problem of patient Falls

2019

The aim of the article was to offer information to nurse leaders concerning evidence about the efficacy and effectiveness of the Fall TIPS program and how they can create collaborative teams as well as access resources to support implementation at their facilities. The article uses a qualitative approach to the issue and proposes the integration of different teams to enhance the implementation of the intervention. The researchers assess and appraise different articles since the development of the Fall TIPS in Boston and how organizations are leveraging it to offer care. The main intervention is the implementation of the Fall TIPS initiatives in different settings to reduce and prevent the occurrence of falls. The researchers evaluate data from the existing studies for analysis. They do not collect any data since they only review existing studies’ findings. The findings show that implementing a fall TIPS program can reduce and prevent the occurrence of falls in different care settings. The researchers are categorical that since its implementation, it has led to a significant reduction and prevention of falls. The researchers recommend the use of TIPS in healthcare settings to reduce the occurrence of falls, especially in critical care settings with hospitalized adult patients The resource is essential as it highlights the use of TIPS as an effective intervention in mitigating risks that may lead to falls. The resource will be used in the EBP project to demonstrate the need for TIPS as a way to reduce and prevent the occurrence of patient falls.
Cuttler, S. J., Barr-Walker, J., & Cuttler, L.

BMJ open quality, 6(2), e000119.

DOI: 10.1136/bmjoq-2017-000119

Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms

2018

The focus of this article was to determine the effectiveness of patient education videos and visual signs with bed exit alarms to reduce falls among hospitalized medical-surgical inpatients. The study used a performance improvement model based on historic control The participants were adults in medical-surgical units. The main intervention was a four-minute video for patients’ viewing by trained volunteers. The second intervention was having icons of risk factors and interventions on the patients’ bedsides. The third intervention was having a bed alarm for those confused patients at risk of falling. The researchers collected and analyzed data based on the incidences in every 1000 patient days for patient falls, and falls with an injury and those with serious injuries The findings show that these interventions reduced all different types of falls in every 1000 patient days. However, icons were not fully implemented. The study recommends more studies, especially multicenter randomized controlled trials to confirm the effectiveness of icons and video interventions o reduce falls. The article is critical to the EBP proposed project as it demonstrates that the use of TIPS toolkit is effective but requires increased involvement and integration of all stakeholders.
Bargmann, A. L., & Brundrett, S. M.

Military medicine, 185(Supplement_2), 28-34.

https://doi.org/10.1093/milmed/usz411

Implementation of a multicomponent fall prevention program: Contracting with patients for fall safety

2020

The study aimed at the implementation of a multicomponent fall prevention program to enhance patient safety from falls and associated risks The researchers developed a multicomponent approach to fall prevention that comprised of literature and use of a patient fall safety agreement in the facility. The setting for the research was a 26-bed medical-surgical telemetry unit in a 352-bed level 1 trauma center. The center caters to both civilian and military beneficiaries. The interventions include a patient fall safety agreement among the providers and EBP fall prevention bundle. The researchers collected and analyzed data after four months to assess the rate of falls in the unit. They also collected data from an incentive program aimed at increasing adherence to patient safety approaches. The findings from the study show that the agreements facilitated dialogue among nurses and other providers as well as patients. The findings show that these interventions lead to a reduction in patient falls within the facility The study recommends the implementation of this intervention since it creates a collaborative environment for nurses and other professionals to carry out safe and quality patient care. The article is essential to the EBP project because it shows the use of these interventions leads to a decrease in the number of falls in the unit. It also demonstrates the efficacy of using multiple components to reduce and prevent falls in acute care settings.
Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., Khasnabish, S., … & Dykes, P. C.

Journal of medical internet research, 21(1), e10008.

DOI: 10.2196/10008

Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study

2019

The focus of the research was to determine the efficacy of fall TIPS tool in engaging patients through three-step fall prevention interventions The researchers used random audits through a questionnaire. They also used the audits to measure adherence. They also used a case-control approach to understand the prevalence of patients using Fall TIPS to experience falls The researchers utilized a randomized control trial with a sample size of over 10,000 subjects. The intervention entailed conducting fall risk assessments, developing a tailored fall prevention plan, and implementing the plan consistently along other well accepted standards and precautions The researchers collected data from the feedback offered by the participants in the site of the study. They analyzed the data using different fall modalities to assess the effectiveness of the intervention. The findings show that each Fall TIPS modality led to the engagement of patients in the fall prevention process. The researchers assert that Fall TIPS modalities can enhance effective control of falls ad ensure that patients do not suffer from them. The researchers recommend the use of the three modalities by healthcare organizations in different settings based on their abilities and one that aligns with the organizational culture. The article is important to the EBP proposed project as it illustrates that importance of using the TIPS model as an intervention to reduce and prevent the occurrence of falls in medical-surgical units. The intervention is important since it demonstrates the need for better patient outcomes.
Carter, E. J., Khasnabish, S., Adelman, J., Bogaisky, M., Lindros, M. E., Alfieri, L., … & Dykes, P.

OBM Geriatrics, 4(2), 1-21.

DOI:10.21926/obm.geriatr.2002119.

Adoption of a Patient-Tailored Fall Prevention Program in Academic Health Systems: A Qualitative Study of Barriers and Facilitators.

2020

The aim of this study was to evaluate the facilitators and barriers to the adoption of Fall TIPS in healthcare settings. The researchers used a multisite qualitative design. The setting comprised of 11 hospitals that represented three academic health systems that had implemented Fall TIPS. The researchers identified 50 patients and 71 staff for the focus groups. The interventions included interviews and focus groups where 71 nurses were analyzed. The researchers collected data from these two cohorts and analyzed them using a conventional content analysis approach. The findings show that the use of Fall TIPS led to increased levels of partnerships between nurses and patients. The fall prevention interventions were tailored to meet patient needs leading to better clinical decisions. The facilitators include motivation, use of residual fall prevention approaches and willfulness. The researchers recommend the implementation of Fall TIPS to improve patient safety and prevent the occurrence of falls. The article is essential as it shows the need for providers to integrate Fall TIPS where it works and leads to better patient safety measures.

 

Conclusion

The evaluation table is categorical that healthcare facilities and providers can mitigate falls through a raft of evidence-based practice (EBP) interventions like the Fall TIPS model. Existing literature is emphatic that these interventions are important in reducing falls and preventing their occurrence. The articles evaluated agree that while organizational challenges can arise in the implementation process, it is critical to evaluate all the aspects of the interventions to enhance adherence to the toolkit. The articles are important as they suggest implementation of the Fall TIPS framework across all areas of patient safety.

 

References

Cerilo, P. C., & Siegmund, L. A. (2022). Pilot testing of nurse led multimodal intervention for falls prevention. Geriatric Nursing, 43, 242-248. DOI: 10.1016/j.gerinurse.2021.12.002

Khasnabish, S., Burns, Z., Couch, M., Mullin, M., Newmark, R., & Dykes, P. C. (2020). Best practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. Journal of the

American Medical Informatics Association, 27(2), 308-314. DOI: 10.1093/jamia/ocz190.

Hello! Nursing shortages continues to be an ongoing problem, and our patients are affected greatly when we continue to work short. Our patients are growing sicker and are requiring more time and care. Our nursing workload is increasing and the time that we are able to spend with our patients is decreased. When we have such as heavy workload, our time being spent collaborating with our patients and with the physician, decreases. This is where medical errors can happen and can lead to a poor communication amongst the interdisciplinary team, including our patients. Our patient’s quality of care decreases as well. Our patients are at a great risk for infection and poor outcomes when we are not able to spend time understanding and caring for their needs. Our nurses are having to take on such a great deal of workload that we are seeing an increase in our nurse burnout.

Our nurses are being burned out by limited resources and shortages; our nurse satisfaction rates are going down. When nurses are feeling unsatisfied with their jobs, our patients care is also affected. Our nurses are not able to practice at the highest level that they can when they are feeling burned out, and unsatisfied with their positions. This is leading to an increase in workload and an increase in errors as well.  We are not able to spend our time and knowledge in using our critical thinking skills. We may not be able to notice with the decrease in time spend on patient care when something may be going on with our patients.

Learner Name:

PICOT:

In individuals from low socioeconomic status and poor educational levels suffering from alcohol use disorder (AUD) (P), does offering behavioral treatments and coordinated care with other providers (I) compared to non-interventions (C) lead to improvement in handling of alcohol withdrawal systems and treatment of alcohol use disorder (O) within 12 months (T)?

 

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Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article 
Article Title and Year Published

 

Research Questions/ Hypothesis, and Purpose/Aim of Study

 

Design (Quantitative, Qualitative, or other)

 

Setting/Sample

 

Methods: Intervention/ Instruments

 

Analysis/Data Collection

 

Outcomes/Key Findings

 

Recommendations

 

Explanation of How the Article Supports Your Proposed EBP Practice Project Proposal
Ray, L. A., Grodin, E. N., Leggio, L., Bechtholt, A. J., Becker, H., Feldstein Ewing, S. W., … & Koob, G. F.

Addiction biology, 26(2), e12903.

doi:10.1111/adb.12903.

The future of translational research on alcohol use disorder

2021

 

The purpose of this review was to discuss ways that stakeholders can implement to speed up the translation of neurobiological insights in advancing the treatment of alcohol use disorder (AUD). The review also identifies the present landscape in AUD treatment, development efforts in AUD treatment from a translational perspective, and barriers to treatment development. The study method deployed is qualitative since the authors use existing literature to review the topic of treatment interventions for AUD and the current development. The article’s setting is a conference or scientific meeting where participants make discussions on the way to use translational research in development of AUD treatment models. The intervention is that scientists and practitioners should develop and deploy models of translational science in public health, especially in clinical care and population health for AUD. The should bolster application of their research findings to fasten the translation of knowledge into patient care. The study does not involve collection of data but analyzes existing translational research models for effective application in a host of settings. The study finds that transitional research models can help stakeholders develop new AUD treatment interventions and translate the knowledge to patient care. The study recommends that all stakeholders should consider the importance of translational research in development of treatment interventions for AUD. The article supports the EBP practice project proposal by showing the significance of translational research in development of treatment interventions. The article is also important as it shows how translation of knowledge to patient care will help practitioners have better outcomes.
Cheng, H. Y., McGuinness, L. A., Elbers, R. G., MacArthur, G. J., Taylor, A., McAleenan, A., … & Kessler, D

BMJ, 371

doi: https://doi.org/10.1136/bmj.m3934

 

Treatment interventions to maintain abstinence from alcohol in primary care: systematic review and network meta-analysis

2020

Determine the most effective ways in recently detoxified, alcohol dependent patients to implement in primary care. Systematic review and meta-analysis The authors collected existing literature and data from databases and journals like Medline, PsycINFO, Cochrane CENTRAL and WHO. The study selection was use of randomized control trials where two or more interventions can be used in primary care. The population for the study comprised of individuals with alcohol dependency diagnosed using standardized clinical models and became detoxified in four weeks’ time. Data was collected from the participants for at least 12 weeks after the beginning of the intervention. The authors assert that no evidence was collected to demonstrate the efficacy of the interventions in primary care for individuals with alcohol dependency, especially from alcohol abstinence. The authors recommend need for more evidence from high quality randomized control studies to demonstrate the efficacy of combining interventions like drug interventions and psychosocial approaches to enhance treatment of alcohol dependency. The article is essential in helping understand the barriers that practitioners face in treatment of individuals with alcohol use disorder (AUD). The article demonstrates that existing interventions have no evidence of their benefits despite being considered as effective in treating the affected individuals.
Hass-Koffler, C. L & Schank, J. R.

Neurotherapeutics, 17 (1-3).

DOI: https://doi.org/10.1007/s13311-020-00833-6

Translational Research in the Neurobiological Mechanisms of Alcohol and Substance Use Disorders

(2020)

The purpose of the study was to evaluate the present translational research into neurobiological targets in alcohol and substance use disorder treatment. The study is a qualitative research where the scholars integrate preclinical and clinical neuroscience research to reduce knowledge gap, identify and describe new treatment models and enhance translational efforts in advancing downstream recovery pathways for those suffering from AUD. The authors do not have a setting but review original articles in different settings to develop knowledge and information on the use of translational research to enhance treatment options for individuals with AUD and substance use disorder The intervention is the use of literature review of scientific literature in the specific areas of research on the issue. The authors analyze data from the existing sources based on identified themes about the problem like potential targets in development of effective treatment for AUD. The authors’ main findings include the need to develop more personalized treatment approaches, increased research on effective interventions for alcohol and substance use disorder treatment. The authors recommend the need for experts and stakeholders to have effective knowledge to fill the current gaps in information and use of effective models to help individuals with the AUD. The article will be used to support the EBP project proposal as it shows the need for stakeholders to work together and apply translational science findings to developing better interventions. I will the article to enhance the literature part of the project as a way of showing previous scientific literature’s position on the issue.
Louise, E., Barrett, E. L., Baillie, A., Haber, P., & Morley, K. C.

BMC Systematic Reviews, 9(25).

DOI: https://doi.org/10.1186/s13643-020-1285-0

Implementation of evidence-based practice for alcohol and substance use disorders: protocol for systematic review

2020

The study synthesizes and evaluates the effectiveness of implementing programs in the treatment of individuals with drug and alcohol problem using the Consolidated Framework for Implementation Research (CFIR) approach. The study is a systematic review implying that it evaluates the current existing evidence from previous study articles on the issue of alcohol use disorder (AUD). The setting for the study was the need to integrate evidence-based practice interventions or therapies as part of the existing literature on the issue of alcohol use disorder. The study’s method entails searching different journal databases that include MEDLINE/PubMed, CINAHL, and Cochrane Library for clinical trial and observation studies to evaluate strategies used in implementing evidence-based psychosocial treatments for individuals with alcohol and substance use disorders. The study used two researchers to screen all citations, full-text articles and abstract data The findings from the study shows the need for specific effective strategies in the use of interventions, the settings and involvement of individuals and the implementation process. The findings also show the need to study the knowledge gaps that exist in getting effective information The authors recommend the need to have more insightful understanding of the effective interventions in helping individuals with AUD. The authors recommend filling the knowledge gaps through more research and use of EBP approaches. The article sheds more light on barriers that practitioners face even when using EBP interventions in treating individuals with AUD in their clinical settings. I will use the article to shed more light on these barriers and offer divergent perspective on what practitioners can do to enhance efficacy of the existing integrated models.
Heilig, M., Augier, E., Pfarr, S. & Sommer, W. H.

Translational Psychiatry, 9 (255).

DOI: https://doi.org/10.1038/s41398-019-0591-6

Developing neuroscience-based treatments for alcohol addiction: A matter of choice?

2019

The authors hypothesize that few medications exist to treat alcohol addiction making the problem a medical condition. The authors review the current situation, discuss challenges and lesson learned and chances to redesign drug development to provide effective remedies. The article is a systematic review of existing literature on the issues identified in its themes for discussion. The study’s setting entails a host of settings where individuals with alcohol addiction seek treatment. The primary method in by the study is the use of neuroscience studies on alcohol addiction. The authors are keen on development of neuroscience interventions to help treat these individuals. The article analyzes data from multiple sources to identify the most effective approaches to development of neuroscience-based treatment to alcohol addiction. Key outcomes include the identification of different approaches that clinicians can deploy to treat the condition. The authors demonstrate how these interventions also need more studies to validate their efficacy based on individual characteristics. The authors recommend the need to have better understanding of the different aspects that impact care delivery and use of neuroscience-based treatment options. The authors recommend better understanding of the functioning of the brain for each patient for increased efficacy of the interventions. I will use the article to show the various approaches/interventions that clinicians can deploy to ensure that they understand how to tackle the current problem. Through the article, I will bolster the literature review of the proposed project and offer more information on different mechanisms to improve care delivery.
De Beaurepaire, R., Sinclair, J., Heydtmann, M., Addolorato, G., Aubin, H. J., Beraha, E. M., … & Agabio, R.

Frontiers in Psychiatry 9(708)

https://doi.org/10.3389/fpsyt.2018.00708

The Use of Baclofen as a Treatment for Alcohol Use Disorder: A Clinical Practice Perspective

2019

The purpose of this study was to show the use of Baclofen as a treatment intervention for alcohol use disorder (AUD). The authors assert that Baclofen is used widely but requires keen medical monitoring because of safety reasons. The article is qualitative as it reviews existing information and integrates it to show the efficacy of Baclofen and potential side effects. The authors conduct meta-analyses to attain different settings for the trials and use of the drug in treating individuals with AUD. They also offer reasons for the inconsistency in research findings about the use of Baclofen. The primary method or intervention identified by the researchers is the use of Baclofen in treatment of AUD. Using different studies like laboratory studies, dosage variations and observations, the authors show that baclofen at certain quantities on a daily basis can help individuals with AUD symptoms The authors analyze data from different settings where baclofen has been used among patients with the condition. The authors leverage this data to make informed findings and recommendations. The key findings include the acceptable use f Baclofen, the ensuing side effects of the drug for individuals suffering from AUD and the need for more research on its efficacy among certain patients with AUD. The authors recommend cautious use of Baclofen in treating AUD because of its safety reasons. They recommend the need for patients to understand the current use of the drug and others approved for the condition. The article offers an insightful analysis of one of the treatment interventions for the issue of AUD and I will use it in the project to enhance knowledge and reduce the existing gap in practice settings for the drug and other medications.
Wood, K., Giannopoulos, V., Louie, E., Baillie, A., Uribe, G., Lee, K. S., Haber, P. S., Morley, K. C.

Implementation Research and Practice.

https://doi.org/10.1177/2633489520959072

The role of clinical champions in facilitating the use of evidence-based practice in drug and alcohol and mental health settings: A systematic review

2020

The purpose of the article was to examine the role and efficacy of clinical champions in drug and alcohol and mental health practices. The authors carried out a systematic literature search beginning from 1980 to the today. As a systematic review, the authors majored on different settings based on the need to get information on the role and efficacy of clinical champions in mental health settings. The instruments or methods used included a review of different databases which comprised of PubMed and PsycINFO. They also conducted more studies using reference searches of relevant reviews. The authors included data from 13 different studies on the topic and their selection criteria. Key findings show that clinical champions did not emerge but rather selected; including those engaged in professional clinical roles. The findings also show that clinical champions are essential in facilitating practice changes and facilitate overcoming system barriers and improved staff engagement and motivation The authors recommend the need for additional studies to offer specific details concerning attributes and training and examination of relevant combination of personal features and training to offer effective implementation of EBP in such settings. The article is relevant and highlights the need for stakeholders to understand the role and efficacy of clinical champions in treatment of different mental health challenges associated with alcohol use disorder (AUD). I will use the article to enhance the information and interventions that should be deployed to improve care delivery and use of the clinical champions to address barriers in clinical practice.
Slade, E., Dowskin, L. P., Zhang, G. Q., Talbert, J. C., Chen, J., Freeman, P. R., Kantak, K.M, Hankosky, E. R., Fouladvand, S., Meadows, A. L. & Bush, H. M.

The Journal of Clinical and Translational Science, 5(1), e29.

DOI: https://doi.org/10.1017/cts.2020.521

Integrating data science into the translational science research spectrum: A substance use disorder case study The purpose of the article is to show how effective team science in translational research studies can overcome challenges and ensure success in successfully bridging T0 to T4 research in substance use disorder situations. The article uses a case study approach to demonstrate how preclinical data and evidence from studies can be use transitioned to help health populations with substance use disorder problems. The setting entails getting highlights of critical roles that data science expertise and effective team science play in translating preclinical research into public health effect. The intervention is the use of hypotheses generated from the preclinical rodent studies to prove their efficacy in clinical settings and if they have public health impact. The authors collected data using databases that could offer big data for effective analysis on the translational research studies that can impact population health. The main outcomes from the study is that clinicians and other stakeholders can leverage big data to make critical decisions and translate findings from preclinical studies to have effects in public health situations. The article recommends that need to increase the use of translational research types’ findings into public health situations to help individuals with substance use disorders like AUD. I will use the article to demonstrate the importance of different translational research studies into public health settings in addressing the underlying issue. The article is essential in underscoring the importance of different types of translational research in knowing AUD treatment barriers.
Thompson, A., Ashcrof, D. M., Owens, L., Van Staa, T. P & Pirmohamed, M.

PLOS ONE

https://doi.org/10.1371/journal.pone.0173272

Drug therapy for alcohol dependence in primary care in the UK: A Clinical Practice Research Datalink study

2017

The purpose of the paper was to evaluate drug therapy for alcohol dependence in 12 months after initial diagnosis in primary care settings. The study was a quantitative model with open cohort under the selected setting. The setting entailed general practices that contribute data to the Clinical Practice Research Database in the UK. The intervention was the use of pharmacotherapy in promoting abstinence from alcohol use and reducing drinking to safety level in the first 12 months after diagnosis of alcohol dependence. The authors collected data from 39,980 participants with incidence diagnosis of alcohol dependence for 13 years. The individuals were aged 16 and above. The findings based on data analysis shows that treatment for alcohol dependence is haphazard. There is no demonstrated efficacy of the different approaches using drugs on alcohol dependence. The authors recommend the need to explore more strategies and approaches among stakeholders to enhance clinical management of the patient population diagnosed with alcohol dependence condition. The article is important and shed more insight into the barriers that many individuals with alcohol dependence face in their efforts to get better clinical management of their condition. I will use the article to highlight these barriers and how practitioners can overcome them in the long term.
Tshchorn, M. & Lorenz, R. C.

Translational Psychiatry, 11 (157).  https://doi.org/10.1038/s41398-021-01260-7

Differential predictors for alcohol use in adolescents as a function of familial risk

2021

The purpose of the study is to identify different predictors that lead to alcohol use in adolescents as a function of familial risk. The study is quantitative and deploys analysis based on an identified cohort of adolescents in community settings. The setting comprises of adolescents in familial environment with a family history of drug abuse. The authors use a host of methods or interventions to identify alcohol use disorder based on the AUDIT tool that they applied. The authors used the IMAGEN cohort which was a longitudinal community-based cohort as the baseline. Findings show that individual differences including personality, cognition, life events, drinking behavior and brain function contribute differently to the prediction of alcohol misuse in the future The authors assert that the findings are essential in development of customized preventive approaches based on individual cases as opposed to one common approach. The article is critical and I will use it to demonstrate the different factors that can lead to alcohol use disorders at an early age among adolescents and young adults in community settings. I will also use the article to show the need for individualized approach to providing treatment interventions for individuals with AUD.

The need for patient safety and improved quality of care implores organizations and providers to leverage evidence-based practice (EBP) interventions to address any issues that can lead to occurrence of adverse events in healthcare settings and impact patient outcomes. Falls and incidences of falling among adult patients in medical-surgical settings remain a healthcare safety challenge that requires effective interventions. Falls are considered sentinel and never events by the Centers for Medicare and Medicaid Services (CMS) because they are preventable through institution of different measures aimed at addressing their adverse effects (Cerilo et al.,2022). Falls lead to increased cost of care and stay, poor patient outcomes and in some cases, serious head injuries and fractures that can cause death (Khasnabish et al., 2020). The purpose of this literature evaluation table is to present different research articles on falls and assess their application in medical-surgical settings. The use of TIPS toolkit is considered as one of the ways to reduce and prevent the occurrence of falls in different healthcare settings.

PICOT:

Among hospitalized adult patients in medical-surgical units (P) does the use of TIPS toolkit as a bundled care approach (I) compared to normal falls prevention approach (C) reduce the prevalence of falls (O) within 6 months (T)?

 


Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article 
Article Title and Year Published

 

Research Questions/ Hypothesis, and Purpose/Aim of Study

 

Design (Quantitative, Qualitative, or other)

 

Setting/Sample

 

Methods: Intervention/ Instruments

 

Analysis/Data Collection

 

Outcomes/Key Findings

 

Recommendations

 

Explanation of How the Article Supports Your Proposed EBP Practice Project Proposal
Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D.

JAMA Network Open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889

Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries.

2020

 

The purpose of this study was to evaluate if a fall-prevention toolkit which engages patients and families in fall-prevention process during hospitalization leads to a reduction in falls and injurious falls. The researchers used a nonrandomized controlled trials based in the stepped wedge design. The setting comprised of 14 medical units in academic centers in Boston and New York. The participants were all hospitalized patents in the participating settings; the patients were 37 231. The instrument was a nurse-based fall-prevention tool kit that links evidence-based measures to patient-focused risk factors. The method incorporated continuous patient and family engagement preventing occurrence of falls. The study collected data based on the rate of patient falls and injurious falls in every 1000 patient-days on the units. The study analyzed the data using Poisson regression to estimate the frequency of falls in the facility. The outcome of the study shows a positive correlation between the intervention and a reduction in falls. The article also found that the nurse-driven intervention reduced injurious falls by enabling the families to have sufficient information on different ways to prevent and reduce falls. The study recommends the use of a nurse-led and patient-centered fall-prevention tool kit to reduce the rates of falls and injurious falls. The authors assert that providers can have different modalities to implement and integrate the intervention to reduce falls in medical-surgical units. The article supports the EBP as it shows that the proposed intervention is based on evidence and is effective in reducing the rate of falls and injurious falls among hospitalized patients. The article will offer more information about the effectiveness and efficacy of fall prevention interventions tailored to the needs of a patient.
Tzeng, H.-M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C.

Journal of Nursing Care Quality, https://doi.org/10.1097/ncq.0000000000000547

Adopting the Fall Tailoring Interventions for Patient Safety (TIPS) Program to Engage Older Adults in Fall Prevention in a Nursing Home

2021

The focus of the study was to evaluate the impact of fall (TIPS) program on prevention of falls and fall-associated injuries among older adults in nursing home. The study used mixed method comprising of qualitative and quantitative approaches at various levels of the research gathered findings. The study occurred in a 15-bed subacute nursing care unit. The instrument entailed using fall TIPS initiative customized to setting The approach comprised of providing clinical decision support to prevent falls. The article collected both qualitative and quantitative data based on the respective tools used. These included recording of monthly fall rates among patients within certain period for effective analysis. The findings after the implementation of the Fall TIPS show that the rate of falls and injurious falls reduced with clinical significance. The researchers attribute the reduction in falls to awareness among patients, information offered to patients on the TIPS poster and other interventions like self-transfer. The article recommends the implementation of Fall TIPS initiative in healthcare settings to lower falls and injurious fall incidents among older adult residents in nursing homes and other areas of care delivery. The article also recommends the need for larger studies in different healthcare settings to assess the overall effectiveness of such interventions. The article supports the proposed EBP practice project proposal by demonstrating that the intervention is sound and based on evidence. The proposed EBP project focuses on reducing falls in medical-surgical unit and this study is categorical that such revelations are important to illustrate the efficacy of the Fall TIPS framework.
Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I.

Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077

Interventions to reduce falls in hospitals: a systematic review and meta-analysis.

2022

The aim of the study was to enquire the effects of falls prevention interventions on fall rates and the risk of falling in healthcare facilities The study is mixed as it uses a systematic review and meta-analysis. The participants in the study were hospitalized adults The intervention entailed staff and patient education, modification of the environment, use of assistive devices, development of policies and systems, medication management and rehabilitation as well as management of cognitive impairment The researchers collected data from 43 studies that satisfied the inclusion criteria and 23 were included in the meta-analyses. The findings show that the use of tailored interventions leads to a reduction in rates of falls and injurious falls. The outcomes also suggest that the use of multi-factorial interventions led to a positive impact on patient care. The study recommends the use of patient and staff education as approaches that can have positive effects on hospital falls. The use of chair alarms, bed alarms, and wearable sensors and scored risk assessment tools did not reduce falls. The study will be used in the EBP project proposal to demonstrate the need to use TIPS toolkit for both patients and staff with the aim of reducing and preventing the occurrence of falls and injurious falls in medical-surgical settings.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E.

BMC geriatrics, 20, 1-12. DOI: https://doi.org/10.1186/s12877-020-01515-w

Hospital falls prevention with patient education: a scoping review.

2020

The aim of the scoping review was to examine the content, design, and outcomes concerning patient education approaches to prevent hospital falls. The paper evaluates the significance of patient education to prevent falls and suggests for hospitals to implement in their clinical settings. The study uses a methodological model developed by Arksey and O’Mallet and refined by Joanna Briggs Institute. The researchers evaluated 43 articles in their analysis based on different interventions on patient education like face-to-face and educational tools. The interventions included direct face-to-face education, educational tools, patient-focused consumer materials and hospital systems, policies and procedures The researchers collected and analyzed data from existing studies. These included studies on falls or education associated outcomes before and after patient fall prevention education. The findings from the article illustrate the effectiveness of the interventions that use patient education to reduce falls related to injuries like bruises, lacerations and fractures.

 

The study recommends the implementation of patient-centered prevention education as part of the TIPS approach to reducing falls in healthcare settings. The study observes that well-designed education initiatives can enhance knowledge and self-perception of risk and empower patients to lower their risk of falling while in hospitals. The study is essential to the EBP project proposal since it illustrates the significance of having a patient-centered toolkit or intervention to reduce and prevent the occurrence of falls among hospitalized patients. The article will offer more information on the efficacy of the TIPS model to reduce and prevent falls.
LeLaurin, J. H., & Shorr, R. I.

Clinics in geriatric medicine, 35(2), 273-283. DOI: 10.1016/j.cger.2019.01.007

Preventing falls in hospitalized patients: state of the science.

2019

The aim of this study was to familiarize the audience with the strengths and the cons of different types of research used in testing fall prevention approaches or interventions. The article uses a review of existing literature or systematic review to highlight different studies on fall prevention in healthcare settings. The researchers evaluate different articles based on their approaches to reducing falls in healthcare settings. These include quality improvement studies, randomized studies, and non-randomized studies a well as single fall prevention interventions and multifactorial one among others. The interventions include focusing on single approaches as well as use multifactorial interventions. The researchers collected and analyzed data from the different types of studies that they evaluated. The researchers focused on both single and multifactorial interventions to reduce and prevent patient falls. The findings show that different interventions are effective based on a host of factors. Again, the study notes that single interventions are more practical compared to multifactorial interventions in prevention of falls. The study recommends the implementation of all interventions, especially those emanating from research and are effective based on the healthcare setting. The study notes that the implementation of any of the interventions is the most essential for any patient safety initiative. The article is essential to the EBP project proposal as it offers sufficient research evidence on the efficacy of the different interventions to prevent and reduce falls in healthcare settings.
Dykes, P. C., Adelman, J. S., Alfieri, L., Bogaisky, M., Carroll, D., Carter, E., … & Spivack, L.

B.

Nurse Leader, 17(4), 365-370. https://doi.org/10.1016/j.mnl.2018.11.006

The fall TIPS (tailoring interventions for patient safety) program: A collaboration to end the persistent problem of patient Falls

2019

The aim of the article was to offer information to nurse leaders concerning evidence about the efficacy and effectiveness of the Fall TIPS program and how they can create collaborative teams as well as access resources to support implementation at their facilities. The article uses a qualitative approach to the issue and proposes the integration of different teams to enhance the implementation of the intervention. The researchers assess and appraise different articles since the development of the Fall TIPS in Boston and how organizations are leveraging it to offer care. The main intervention is the implementation of the Fall TIPS initiatives in different settings to reduce and prevent the occurrence of falls. The researchers evaluate data from the existing studies for analysis. They do not collect any data since they only review existing studies’ findings. The findings show that implementing a fall TIPS program can reduce and prevent the occurrence of falls in different care settings. The researchers are categorical that since its implementation, it has led to a significant reduction and prevention of falls. The researchers recommend the use of TIPS in healthcare settings to reduce the occurrence of falls, especially in critical care settings with hospitalized adult patients The resource is essential as it highlights the use of TIPS as an effective intervention in mitigating risks that may lead to falls. The resource will be used in the EBP project to demonstrate the need for TIPS as a way to reduce and prevent the occurrence of patient falls.
Cuttler, S. J., Barr-Walker, J., & Cuttler, L.

BMJ open quality, 6(2), e000119.

DOI: 10.1136/bmjoq-2017-000119

Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms

2018

The focus of this article was to determine the effectiveness of patient education videos and visual signs with bed exit alarms to reduce falls among hospitalized medical-surgical inpatients. The study used a performance improvement model based on historic control The participants were adults in medical-surgical units. The main intervention was a four-minute video for patients’ viewing by trained volunteers. The second intervention was having icons of risk factors and interventions on the patients’ bedsides. The third intervention was having a bed alarm for those confused patients at risk of falling. The researchers collected and analyzed data based on the incidences in every 1000 patient days for patient falls, and falls with an injury and those with serious injuries The findings show that these interventions reduced all different types of falls in every 1000 patient days. However, icons were not fully implemented. The study recommends more studies, especially multicenter randomized controlled trials to confirm the effectiveness of icons and video interventions o reduce falls. The article is critical to the EBP proposed project as it demonstrates that the use of TIPS toolkit is effective but requires increased involvement and integration of all stakeholders.
Bargmann, A. L., & Brundrett, S. M.

Military medicine, 185(Supplement_2), 28-34.

https://doi.org/10.1093/milmed/usz411

Implementation of a multicomponent fall prevention program: Contracting with patients for fall safety

2020

The study aimed at the implementation of a multicomponent fall prevention program to enhance patient safety from falls and associated risks The researchers developed a multicomponent approach to fall prevention that comprised of literature and use of a patient fall safety agreement in the facility. The setting for the research was a 26-bed medical-surgical telemetry unit in a 352-bed level 1 trauma center. The center caters to both civilian and military beneficiaries. The interventions include a patient fall safety agreement among the providers and EBP fall prevention bundle. The researchers collected and analyzed data after four months to assess the rate of falls in the unit. They also collected data from an incentive program aimed at increasing adherence to patient safety approaches. The findings from the study show that the agreements facilitated dialogue among nurses and other providers as well as patients. The findings show that these interventions lead to a reduction in patient falls within the facility The study recommends the implementation of this intervention since it creates a collaborative environment for nurses and other professionals to carry out safe and quality patient care. The article is essential to the EBP project because it shows the use of these interventions leads to a decrease in the number of falls in the unit. It also demonstrates the efficacy of using multiple components to reduce and prevent falls in acute care settings.
Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., Khasnabish, S., … & Dykes, P. C.

Journal of medical internet research, 21(1), e10008.

DOI: 10.2196/10008

Assessing the Effectiveness of Engaging Patients and Their Families in the Three-Step Fall Prevention Process Across Modalities of an Evidence-Based Fall Prevention Toolkit: An Implementation Science Study

2019

The focus of the research was to determine the efficacy of fall TIPS tool in engaging patients through three-step fall prevention interventions The researchers used random audits through a questionnaire. They also used the audits to measure adherence. They also used a case-control approach to understand the prevalence of patients using Fall TIPS to experience falls The researchers utilized a randomized control trial with a sample size of over 10,000 subjects. The intervention entailed conducting fall risk assessments, developing a tailored fall prevention plan, and implementing the plan consistently along other well accepted standards and precautions The researchers collected data from the feedback offered by the participants in the site of the study. They analyzed the data using different fall modalities to assess the effectiveness of the intervention. The findings show that each Fall TIPS modality led to the engagement of patients in the fall prevention process. The researchers assert that Fall TIPS modalities can enhance effective control of falls ad ensure that patients do not suffer from them. The researchers recommend the use of the three modalities by healthcare organizations in different settings based on their abilities and one that aligns with the organizational culture. The article is important to the EBP proposed project as it illustrates that importance of using the TIPS model as an intervention to reduce and prevent the occurrence of falls in medical-surgical units. The intervention is important since it demonstrates the need for better patient outcomes.
Carter, E. J., Khasnabish, S., Adelman, J., Bogaisky, M., Lindros, M. E., Alfieri, L., … & Dykes, P.

OBM Geriatrics, 4(2), 1-21.

DOI:10.21926/obm.geriatr.2002119.

Adoption of a Patient-Tailored Fall Prevention Program in Academic Health Systems: A Qualitative Study of Barriers and Facilitators.

2020

The aim of this study was to evaluate the facilitators and barriers to the adoption of Fall TIPS in healthcare settings. The researchers used a multisite qualitative design. The setting comprised of 11 hospitals that represented three academic health systems that had implemented Fall TIPS. The researchers identified 50 patients and 71 staff for the focus groups. The interventions included interviews and focus groups where 71 nurses were analyzed. The researchers collected data from these two cohorts and analyzed them using a conventional content analysis approach. The findings show that the use of Fall TIPS led to increased levels of partnerships between nurses and patients. The fall prevention interventions were tailored to meet patient needs leading to better clinical decisions. The facilitators include motivation, use of residual fall prevention approaches and willfulness. The researchers recommend the implementation of Fall TIPS to improve patient safety and prevent the occurrence of falls. The article is essential as it shows the need for providers to integrate Fall TIPS where it works and leads to better patient safety measures.

 

Conclusion

The evaluation table is categorical that healthcare facilities and providers can mitigate falls through a raft of evidence-based practice (EBP) interventions like the Fall TIPS model. Existing literature is emphatic that these interventions are important in reducing falls and preventing their occurrence. The articles evaluated agree that while organizational challenges can arise in the implementation process, it is critical to evaluate all the aspects of the interventions to enhance adherence to the toolkit. The articles are important as they suggest implementation of the Fall TIPS framework across all areas of patient safety.

 

References

Cerilo, P. C., & Siegmund, L. A. (2022). Pilot testing of nurse led multimodal intervention for falls prevention. Geriatric Nursing, 43, 242-248. DOI: 10.1016/j.gerinurse.2021.12.002

Khasnabish, S., Burns, Z., Couch, M., Mullin, M., Newmark, R., & Dykes, P. C. (2020). Best practices for data visualization: creating and evaluating a report for an evidence-based fall prevention program. Journal of the

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