Evidence-Based Practice Proposal: Patient Fall Safety Problem

Introduction

Patient falls may be recognized as one of the gravest issues that lead to drastic outcomes causing traumas of different kinds. This paper focuses on the evidence-based solution to the fall safety problem. The PICOT question of this research is, “In the Acute Care/Inpatient population (P), how does Patient Bedside Shift Report (I) compare to Traditional shift reporting method (C), compare to Patient fall safety (O) in 8 weeks period (T)? Therefore, the proposed solution is a bedside shift report that ensures that nurses can be physically present in the patient’s room and see their patient face to face. The conducted research suggests that patient bedside shift reporting is a valuable tool that allows for keeping patients safe by means of reducing risk factors associated with falls.

The Proposed Solution

Although medical practitioners attempt mitigating the issue of patient falls in acute care units, the problem remains stable. Therefore, it validates the need for an effective preventive and safety increasing intervention. The statistics of recent years demonstrates that the amount of hospital fall rates shifts within a range from 2.2 to 4.1 per 1000 patient days with about 30% of falls causing injury disability or death (Choi & Boyle, 2013). Thus, there is a need for eliminating the issue in order to reduce patient fall risks in acute care and inpatient setting, which would increase the overall productivity of care and treatment. Among the causes of patient falls, scholars often name nursing factors such as poor nurse staffing, interventions, and RN experience (Choi & Boyle, 2013). However, one presumes that the change of nursing shift reports from traditional to patient bedside ones would allow managing the patient fall problem without the increase of nurse-per-patient ratio.

The solution is based on the change of quality of nursing shift reports in order to reveal risk factors that lead to patient falls and eliminate them. Thus, the proposed strategy is proactive. One of the benefits of the initiative is that it increases the quality of patient survey ensuring that handoffs are safe and effective. Thus, communication is used as a tool that allows bypassing specific patient safety risk. In this sense, experts assert that 70% of adverse effects are caused by breakdown in communication among nurses and patients (Agency for Healthcare Research and Quality, n. d. b). Moreover, the statistic approves that bedside shift reports are efficient in reducing patient falls “dropping from one to two patient falls per month to one patient fall in six months” (Agency for Healthcare Research and Quality, n. d. b). In contrast with the traditional patient handoff report, the strength of this method is that it gives emphasis to communication with a patient and includes an advanced checklist. The checklist allows considering such aspects as situation, background, assessment, and recommendation for the patient’s concerns (Agency for Healthcare Research and Quality, n.d. a). Moreover, nurses who participate in this initiative undergo special training, which allows them revealing additional factors that may trigger a patient fall situation. Therefore, a medical facility that intends to implement this initiative does not need additional financing but requires time for staff training. One expects that staff training initiative may take about 20 hours including lecturing, briefing, analysis of training cases and role playing the materials provided by Agency for Healthcare Research and Quality online (Agency for Healthcare Research and Quality, 2013). Consequently, the implementation of this strategy is realistic and does not require any substantial financial and time resources.

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The Organization Culture

In order to successfully implement the proposed strategy, it must match the safety as a component of the organizational culture of participating community. Scholars characterize it as “the subset of organizational culture, relating specifically to the attitudes, values, norms and beliefs towards patient safety” (Ausserhofer et al., 2013). The proposed patient bedside shift report initiative supports the safety culture of the facility because it is directed towards mitigating safety issue on the basis of communication and risk preventive actions.

The Expected Outcomes

The research suggests that the proposed initiative of patient bedside shift reporting would allow decreasing patient fall risks of the acute care/inpatient population within a medical facility that is participating in the initiative throughout 8 weeks period.

The Method to Achieve Outcomes

The outcomes would be achieved mostly by interviewing and revealing the risk factors that may provoke patient falls. After determining the risks, a nurse should take certain action in order to eliminate or reduce them. Due to the fact that the main source of information is verbal communication, specific barriers may evolve in case this mode is not supported by the patient. This problem may be bypassed by means of including the answers of the patient’s relatives regarding the possible problems associated with falling. In case it is impossible to validate this measure, a nurse is obliged to assess the safety situation manually.

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Conclusion: The Impact of the Outcome

Summarizing analyzed information, the proposed solution would allow reaching advanced patient safety outcomes because it bypasses the risks of patient falling that may lead to injuries or death. Thus, the intervention would improve the quality of care along with overall upgrade of the efficacy of patient handling. These changes would become possible due to update of a bedside shift report model that would include a list of critical factors that should be considered by a nurse. Moreover, the solution would increase the patient-centered quality care through the improvement of communication between nurses and patients. As a result, these changes would positively change the organizational environment and make it more patient-centered and safety-concerned. Thus, overall professional expertise of the staff that participates in this experiment would increase. Due to this reason, it is advised to implement the proposed solution in other medical institutions of the country.