Evidence-Based Practice Project: Literature Review Paper

Evidence-Based Practice Project: Literature Review Paper

Evidence-Based Practice Project: Literature Review Paper

Patient falls in the care environment are among the care setting events which put patient safety and care quality at risk. The problem has been shown to lead to various adverse care outcomes, which further threaten the patient’s well-being (Ang et al., 2020). The implication is that there is always a need to develop effective and affordable strategies to prevent and control such event such as patient falls. The fall events incidences vary from one patient setting to another, depending largely on the kind of patients in the unit. The medical and surgical units, in particular, usually experience higher incidences of falls putting the patient’s life in danger. In the previous weeks, the use of a Fall Tailored Interventions for Patient Safety (TIPS) Toolkit was proposed. Therefore, the purpose of this current write-up is to conduct a literature review and obtain the research articles that support the proposed intervention.

The PICOT Statement

A PICOT question was formulated to help in answering the project’s objectives. The statement was as follows: Among hospitalized adult patients in the medical-surgical ward (P), does the utilization of the Fall Tailored Interventions for Patient Safety (TIPS) Toolkit (I), as compared to routine fall prevention protocols (C) help reduce the incidences of falls and injuries (O) within 24 weeks (T)?

The Search Strategy Used

In efforts to obtain research articles relevant to the project, a database search was conducted to obtain appropriate peer-reviewed journal articles. Various websites and databases were used in retrieving the articles. The databases used include CINHAL, Dynamed, PubMed, Cochrane Library, and Trip database. In addition, google scholar was also employed in the literature search. Various keywords were used in querying the database, including patient falls, fall prevention, medical-surgical ward, and fall tailored intervention for patient safety. The search was then limited to articles published in the last five years.

Synthesis of Literature

Cuttler et al. (2017) conducted a study to examine the efficacy of a fall prevention program containing fall prevention visual signaling icons and education videos integrated with bed exit alarms in improving fall and injury rates among patients in medical-surgical inpatients. The study design took the form of a performance improvement study with historic control involving a total of four medical-surgical units. As part of the intervention, trained volunteers showed patients four-minute video icons containing the patient’s interventions and risk factors. In addition, the researchers also used patients’ beds fixed with sensitive exit alarms and used for patients at risk of falling. Upon the analysis of the collected data, the researchers noted that the rates of patient falls were reduced by 20%. Falls causing injuries were also reduced by 40%.  In addition, there was a reduction by 85% in falls that led to serious injuries. This article supports the proposed PICOT as it shows the efficacy of a fall-tailored intervention in reducing the rates of falls.

Another research was performed by Duckworth et al. (2019). The objective of the study was to evaluate the impact of a fall TIPS in engaging patients towards fall prevention and the efficacy of the fall prevention program. The research was based on a three-step fall prevention process where random audits were performed with the focus on measuring adherence which was represented by the presence of a poster detailing a fall TIPS. Analysis of the data indicated that a total of 1209 audits were performed for patient engagement, while 1401 were for the poster. Every unit attained an eighty percent adherence in both measures. Therefore, the program effectively facilitated a three-step fall prevention process making it suitable for evidence-based fall prevention. This also supports my PICOT as it showed the efficacy of the TIPS modality.

Dykes et al. (2020) performed a study on the efficacy of a fall-prevention tool kit that engages families and patients in reducing the rates of patient falls. This was a large nonrandomized controlled trial with a total of 37231 research subjects drawn from several medical units. The intervention used in this study was a fall-prevention program that links evidence-based interventions for preventing falls to patient-specific fall risk factors. The tool was integrated with a continuous engagement of the family and the patients. While the primary outcome was the patient fall rates, the secondary outcome was falls with injuries. The pre and post-intervention analysis showed a reduction in patient falls by 15% after implementing the intervention. In addition, upon the use of the fall prevention kit, there was a reduction in injurious falls by 34%. Therefore, the use of a fall-prevention kit led to a substantial reduction in the rates of falls and fall-related injuries. Therefore it also supports the proposed PICOT statement.

Johnston and Magnan (2019) also performed a study on patient falls to determine the impact of the application of a fall prevention checklist on the implementation of a fall prevention protocol and the rates of patient falls. A total of 37 nursing staff were involved in the study and, in total, completed ninety fall prevention checklists. The researchers used a fourteen-item checklist based on the hospital’s already approved fall prevention protocol to evaluate the nursing staff’s adherence to every intervention and the resultant fall rates. The researchers then tracked the patient’s falls on a daily basis. It was noted that the most frequently missed intervention was that of setting bed alarms which the staff incorrectly set nearly 20% of the time. The researchers also noted that there was no patient fall during the study indicating the efficacy of the protocol. Therefore, this paper also supports the PICOT as the fall prevention protocol was instrumental in reducing falls rates.

Dyke et al. (2017) conducted a study on a fall TIPS toolkit. The study’s objective was to use the fall TIPS tool kit in educating and engaging patients in three-step fall prevention. The implication is that the tool was also offering clinical decision support at the patient’s bedside. The program then links every patient’s fall risk assessment with possible interventions. The analysis of the data indicated that there was an average of eighty-two percent unit compliance with the Fall TIPS. In addition, the mean falls rate was also reduced from 3.28 to 2.80 per 1000 patient days. Again, the researchers observed a decrease in the number of falls leading to injury. Therefore, this source also supports the proposed project and the PICOT questions as it shows that an application of a fall TIPS positively impacts the incidences of falls among inpatients.

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Mayhoba and Amin (2022) conducted research with the aim of comparing routine fall prevention and a tailored fall prevention approach for preventing falls among the elderly. Using a quasi-experimental study design, the researchers recruited one hundred and eight patients to take part in the study, with fifty-four each recruited into the control and study group. The intervention group received a tailored intervention for patient safety which entailed putting forth an individualized fall prevention strategy for every patient and a poster that was placed in a visible place to act as a reminder of the fall prevention interventions and the risks. The control group received normal care. The data analysis indicated that the patients who received usual care were close to two times more likely to fall than those in the tailored approach. The paper, therefore, supports the PICOT as it shows that the use of TIPS is efficacious in preventing falls.

Tzeng et al. (2021) conducted a study that focused on evaluating the efficacy of a fall tailoring intervention for patient safety programs in the prevention of falls and related injuries among older individuals residing in nursing homes. The intervention used in this study is one that offers bedside clinical decision support to prevent patient falls. Upon the analysis of the collected data, the researchers noted that there was a significant decrease in the rates of patient falls, indicating that the fall TIPS intervention was important in controlling and preventing falls. Therefore, the sources also support the PICOT as it shows the importance of using a fall prevention protocol to control and prevent patient falls.

Avenecean et al. (2017) conducted a systematic review with the aim of evaluating the effectiveness of patient-centered interventions on falls applied in acute care settings. The data considered were on patients admitted to the surgical or medical units. The researchers reviewed only randomized controlled trials, and through a database search and refining, they obtained five relevant randomized controlled trials. While three studies showed a statistically significant reduction in the incidences of patient falls (p-value of less than 0.04), the other two showed no statistical difference. One notable conclusion is that the studies that had a significant reduction of falls employed patient-centered education and personalized care plans formulated based on the patient’s fall risks. Therefore, the interventions should be patient-centered for them to be more useful.

Comparison of Articles

A total of eight research articles have been reviewed, with seven of them being primary research articles while one being a systematic review. The major theme explored in the articles is patient fall prevention, even though in diverse patient settings. One major difference was observed in the study designs employed; while some of the articles employed controlled trials, others employed quasi-experimental designs to help achieve the goals. While there is no controversy reported, all the articles reported some limitations that need to be addressed, such as inadequate sample size and the possible lack of generalizability.

Suggestions for Future Research

From the literature analysis performed, various gaps could be identified. For example, few studies on the topic have used a randomized controlled trial design. Being that the design is a golden standard. More research on this area should use the design to obtain better evidence that can be translated. In addition, studies should be done using larger sample sizes as well as a multicentre approach to improving the results and generalizability.

Conclusion

Patient falls lead to adverse impacts in the clinical settings such as injuries, longer hospital stay, and prolonged hospital stay, hence a need to come up with better strategies for preventing falls. Therefore an intervention has been proposed, and a PICOT statement has been formulated to lead the project. Besides, a literature review has been conducted on various sources that support the PICOT statement

References

Ang, G. C., Low, S. L., & How, C. H. (2020). Approach to falls among the elderly in the community. Singapore medical journal, 61(3), 116.

Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3006–3048. https://doi.org/10.11124/jbisrir-2016-003331

Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons, and alarms. BMJ Open Quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119.

Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., Khasnabish, S., … & Dykes, P. C. (2019). 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. Journal of Medical Internet Research, 21(1), e10008.doi:10.2196/10008.

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. W. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. JAMA Network Open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889.

Dykes, P. C., Duckworth, M., Cunningham, S., Dubois, S., Driscoll, M., Feliciano, Z., … & Scanlan, M. (2017). Pilot testing fall TIPS (tailoring interventions for patient safety): a patient-centered fall prevention toolkit. The Joint Commission Journal on Quality and Patient Safety, 43(8), 403-413. DOI: 10.1016/j.jcjq.2017.05.002.

Johnston, M., & Magnan, M. A. (2019). Using a Fall Prevention Checklist to Reduce Hospital Falls. AJN, American Journal of Nursing, 119(3), 43–49. https://doi.org/10.1097/01.naj.0000554037.76120.6a.

Mayhob, M. M., & Amin, M. A. (2022). Fall Prevention Interventions: Tailored Approach versus Routine Interventions among Elderly Hospitalized Patients. American Journal of Nursing Research, 10(1), 26-33. DOI:10.12691/ajnr-10-1-4.

Tzeng, H. M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C. (2021). Adopting the fall Tailoring Interventions for Patient Safety (TIPS) program to engage older adults in fall prevention in a nursing home. Journal of nursing care quality, 36(4), 327-332. DOI: 10.1097/NCQ.0000000000000547

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Appendix

APA Checklist Summarized

Page numbering- flush right	Yes
Title of document appears at the top of the first page of text	Yes
The introductory paragraph or section should not be labeled	Yes
Double line spacing	Yes
Margins- 1 inch	Yes
Paragraph formatting- indented and left-aligned	Yes
Punctuations after quotations	None
Section headings- level 1 headings centered and in bold, and in title case	Yes
References- in a new page. The word references centered.	Yes

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Assessment Description
The purpose of this assignment is to write a review of the research articles you evaluated in your Topic 5 “Evidence-Based Practice Project: Evaluation of Literature” assignment. If you have been directed by your instructor to select different articles in order to meet the requirements for a literature review or to better support your evidence-based practice project proposal, complete this step prior to writing your review.
A literature review provides a concise comparison of the literature for the reader and explains how the research demonstrates support for your PICOT
In a paper of 1,250-1,500, select eight of the ten articles you evaluated that demonstrate clear support for your evidence-based practice and complete the following for each article:
1. Introduction – Describe the clinical issue or problem you are addressing. Present your PICOT statement.
2. Search methods – Describe your search strategy and the criteria that you used in choosing and searching for your articles.
3. Synthesis of the literature – For each article, write a paragraph discussing the main components (subjects, methods, key findings) and provide rationale for how the article supports your PICOT.
4. Comparison of articles – Compare the articles (similarities and differences, themes, methods, conclusions, limitations, controversies).
5. Suggestions for future research: Based on your analysis of the literature, discuss identified gaps and which areas require further research.
6. Conclusion – Provide a summary statement of what you found in the literature.
7. Complete the “APA Writing Checklist” to ensure that your paper adheres to APA style and formatting criteria and general guidelines for academic writing. Include the completed checklist as an appendix at the end of your paper.
Refer to the “Evidence-Based Practice Project Proposal – Assignment Overview” document for an overview of the evidence-based practice project proposal assignments.
You are required to cite eight peer-reviewed sources to complete this assignment. Sources must be published within the last 5 years and appropriate for the assignment criteria and nursing content.

These are the articles

Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3006–3048. https://doi.org/10.11124/jbisrir-2016-003331
Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons, and alarms. BMJ Open Quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119
Duckworth, M., Adelman, J., Belategui, K., Feliciano, Z., Jackson, E., Khasnabish, S., … & Dykes, P. C. (2019). 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. Journal of medical internet research, 21(1), e10008. doi:10.2196/10008
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. W. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries. JAMA Network Open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889
Dykes, P. C., Duckworth, M., Cunningham, S., Dubois, S., Driscoll, M., Feliciano, Z., … & Scanlan, M. (2017). Pilot testing fall TIPS (tailoring interventions for patient safety): a patient-centered fall prevention toolkit. The Joint Commission Journal on Quality and Patient Safety, 43(8), 403-413. DOI: 10.1016/j.jcjq.2017.05.002
Johnston, M., & Magnan, M. A. (2019). Using a Fall Prevention Checklist to Reduce Hospital Falls. AJN, American Journal of Nursing, 119(3), 43–49. https://doi.org/10.1097/01.naj.0000554037.76120.6a
Jong, L. D., Weselman, T., Kitchen, S., & Hill, A. (2019). Exploring hospital patient sitters’ fall prevention task readiness: A cross‐sectional survey. Journal of Evaluation in Clinical Practice, 26(1), 42–49. https://doi.org/10.1111/jep.13114
Mayhob, M. M., & Amin, M. A. (2022). Fall Prevention Interventions: Tailored Approach versus Routine Interventions among Elderly Hospitalized Patients. American Journal of Nursing Research, 10(1), 26-33. DOI:10.12691/ajnr-10-1-4
Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient’s perspective: a qualitative study. Applied Nursing Research, 43, 114-119. https://doi.org/10.1016/j.apnr.2018.08.001
Tzeng, H. M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C. (2021). Adopting the fall Tailoring Interventions for Patient Safety (TIPS) program to engage older adults in fall prevention in a nursing home. Journal of nursing care quality, 36(4), 327-332. DOI: 10.1097/NCQ.0000000000000547

PICOT Final

PICOT Question
P Population Hospitalized adult patients in the medical-surgical ward.
I Intervention Fall Tailored Interventions for Patient Safety (TIPS) Toolkit
C Comparison Routine fall prevention protocols
O Outcome Reduced incidences of falls and injuries
T Timeframe 24 weeks.
PICOT
Among hospitalized adult patients in the medical-surgical ward (P), does the utilization of the Fall Tailored Interventions for Patient Safety (TIPS) Toolkit (I), as compared to routine fall prevention protocols (C) help reduce the incidences of falls and injuries (O) within 24 weeks (T)?

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Problem Statement
Create a problem statement for your PICOT. You will use this problem statement throughout your final written paper.
Falls and associated injuries among hospitalized patients are widespread in most medical and surgical wards, posing a serios threat to the safety of the patient. Accidental falls account for most reported incidences in hospitals complicating roughly 2% of hospital stays. According to Dykes et al. (2020), the rate of falls among hospitalized patients in the United States ranges from approximately 3–5 per 1000 bed-days. The incidences of falls depend on the characteristic of the unit, with patients hospitalized in the medical-surgical unit being at high risk as compared to those in the intensive care unit (Lucero et al., 2019). Consequently, studies have also reported that approximately 25% of reported falls among hospitalized patients normally result in injury, whereas 2% causes fractures. Acute care patients normally display an increased risk of falls resulting from newly altered mobility, history of previous falls, medication side effects, or altered mental status among other factors (Cuttler et al., 2017). Despite the cause, the increasing incidences of falls are becoming very costly, with increased morbidity and mortality rates from fall-associated injuries and fractures. The lack of significant fall prevention intervention despite years of struggle has contributed to the frustrations among healthcare workers, researchers, and patients at risk. It is thus time to adapt nurse-led evidence-based interventions like the TIPS tool which have proven to be effective in the reduction of fall incidences among adults in the medical-surgical ward (Tzeng et al., 2021). The facility where I work utilizes the morse fall scale (a score of 25 or higher is considered high risk), a red rose is placed on the patient’s chart as well on their door, and a red risk band is applied.