Hudson County Community College Nursing Program Nursing 110

Hudson County Community College Nursing Programnursing 110 Fall 2024

Cleaned assignment instructions: Develop an evidence-based practice (EBP) paper discussing a specific nursing procedure or clinical protocol, including its importance, practice status, barriers, challenges, and suggestions for change based on EBP. The paper should include an introduction, detailed discussion of key issues, barriers and challenges, a summary with recommendations, and follow APA style, with proper citation and referencing. The paper must meet a two-page minimum length, include a bibliography, and be free of spelling/grammar errors.

Paper For Above instruction

Evidence-based practice (EBP) has become a cornerstone of modern nursing, emphasizing the integration of the best current evidence, clinical expertise, and patient preferences to deliver high-quality care. Developing an EBP paper involves critically examining a specific nursing procedure or protocol, highlighting its significance, evaluating current practice adherence, identifying barriers and challenges, and proposing improvements based on available evidence. This comprehensive approach ensures continuous quality improvement and enhances patient safety and outcomes.

In this paper, I will focus on the adult fall risk assessment and management protocol within a hospital setting, illustrating its importance, current practice status, prevalent barriers, and potential strategies for enhancement based on evidence-based guidelines.

Introduction and Procedure Overview

The adult fall risk assessment and management protocol, particularly in inpatient, observation, and emergency departments, is designed to identify patients at risk of falling and implement tailored interventions to prevent falls and related injuries. Falls in hospitals remain a significant concern, as they lead to increased morbidity, extended hospital stays, and additional healthcare costs (Oliver et al., 2010). The protocol involves systematic assessment using validated tools, ongoing reassessment, patient education, and environmental modifications.

The protocol outlined by Atlantic Health System emphasizes comprehensive risk assessment upon admission, with frequent reassessments during hospitalization and after any change in patient condition. Interventions include environmental adjustments, patient supervision, assistive device use, educational activities, and communication of fall risks across the care team (AHS, 2023). Proper documentation and continuous monitoring are essential components to ensure adherence and evaluate effectiveness.

Significance of the Protocol and Key Issues

Falls among hospitalized adults pose a notable risk to patient safety, leading to injuries such as fractures, head trauma, and even death in severe cases (Reddy et al., 2016). The protocol's importance lies in its capacity to systematically identify at-risk individuals and mitigate fall risks through preventive measures. Despite recognizing its importance, many healthcare institutions face challenges in consistent implementation and adherence.

Key issues related to the protocol include variability in risk assessment accuracy, staff compliance, environmental hazards, and patient-specific factors such as cognitive impairment or mobility limitations. A significant concern is underassessment or inconsistent reassessment, which can lead to missed opportunities for fall prevention (Miake-Lye et al., 2013). Additionally, staff workload, inadequate training, and resource limitations serve as barriers to optimal protocol adherence.

Barriers and Challenges to Implementation

Implementing an effective fall prevention protocol encounters numerous barriers. Staff resistance due to workload or perceived complexity can hinder adherence. Inadequate training and inconsistent use of assessment tools compromise the accuracy of risk identification. Environmental factors, such as cluttered hallways, inadequate lighting, or uneven flooring, contribute to fall risk and are sometimes overlooked due to resource constraints (Oliver et al., 2010).

Patient-related barriers include cognitive impairments or refusal to participate in preventive strategies. Organizational challenges, including lack of leadership support or inadequate staffing ratios, further impede protocol adherence. Moreover, a culture that does not prioritize fall prevention may result in underreporting or insufficient follow-through on interventions (Miake-Lye et al., 2013).

Recommendations for Practice Improvement Based on Evidence

Enhanced education and training programs for staff are vital to improve assessment accuracy and intervention consistency. Utilizing validated tools like the Johns Hopkins Fall Risk Assessment Tool can standardize assessments and reduce variability (Oliver et al., 2010). Incorporating technology, such as bed and chair alarms and real-time location systems, can further mitigate fall risks, especially in high-risk populations.

Environmental modifications, including proper lighting, clutter reduction, and accessible call systems, play a crucial role in prevention. Engaging patients and families through education about fall risks and involving them in safety planning fosters a culture of safety. Organizational leadership must prioritize fall prevention through continuous monitoring, staff accountability, and fostering a safety-centric environment (Reddy et al., 2016).

Implementing multidisciplinary approaches, including physical therapy consultations for mobility-impaired patients, can reduce functional decline and fall likelihood. Regular audits, feedback, and a system for reporting and analyzing fall incidents support ongoing quality improvement efforts (Miake-Lye et al., 2013). Such comprehensive strategies grounded in evidence can significantly lower fall rates and improve patient safety outcomes.

Conclusion

The adult fall risk assessment and management protocol is a critical component in promoting patient safety within hospital settings. While evidence underscores its importance, barriers such as resource limitations, environmental hazards, and staff compliance issues challenge effective implementation. Addressing these challenges through targeted education, environmental modifications, technological support, and organizational commitment can enhance protocol adherence and reduce fall incidents. Continuous evaluation and adaptation based on emerging evidence are essential to sustain and improve fall prevention practices in healthcare environments.

References

• Oliver, D., Daly, F., Martin, F. C., & McMurdo, M. E. (2010). Risk factors and risk assessment tools for falls in hospital in-patients: A systematic review. Age and Ageing, 39(2), 230-241.
• Reddy, M. K., Seeley, M. E., & Mylotte, J. M. (2016). Fall prevention in hospitalized older adults: A systematic review. Journal of the American Geriatrics Society, 64(4), 764-771.
• Miake-Lye, I. M., Hempel, S., Shanman, R., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient safety strategy: A systematic review. Annals of Internal Medicine, 158(5 Pt 2), 390-396.
• Agency for Healthcare Research and Quality (AHRQ). (2017). Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
• Joint Commission. (2023). Hospital Accreditation Standards – Provision of Care – PC.01.02.08 EP 1 & 2. The Joint Commission.
• National Database for Nursing Quality Indicators (NDNQI). (2017). Fall & Injury Prevention Data. American Nurses Association.
• Centers for Medicare & Medicaid Services (CMS). (2016). Resident Assessment Instrument - MDS 3.0 Manual. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsandRegulations/Downloads/MDS30RAIManual.pdf
• Gates, S., et al. (2017). Effectiveness of acupressure and acustimulation in reducing falls: A systematic review. Clinical Rehabilitation, 31(8), 979-987.
• Shumway-Cook, A., et al. (2017). Fall prevention in community and clinical settings. Physical Therapy, 97(4), 361-369.
• Rubenstein, L. Z. (2013). Falls in older people: Epidemiology, risk factors and strategies for prevention. Age and Ageing, 42(1), 7-11.