NUR 550 Evidence-Based Practice Project Evaluation of Literature Table

NUR 550 Evidence-Based Practice Project Evaluation of Literature Table

NUR 550 Evidence-Based Practice Project Evaluation of Literature Table

Literature Evaluation 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)?

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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
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.