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Prevention for Patient Falls

Prevention for Patient Falls

Prevention for Patient Falls

QUESTION
Use 4 systemic and/or peer review articles previously used ( it looks like only one was completed). its 3-4 chart pages and 1-2 pgs summary for critical analysis. Module 2-3 assignment uploaded.
Prevention for Patient Falls

ANSWER
Prevention for Patient Falls

Name
Institutional Affiliation
Course
Instructor’s Name
Date

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full APA formatted citation of selected article. Article #1 Article #2 Article #3 Article #4
Klinkenberg, W. D., & Potter, P. (2017). Validity of the Johns Hopkins Fall Risk Assessment Tool for predicting falls on inpatient medicine services. Journal of nursing care quality, 32(2), 108-113.

Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A. (2016). Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project. International Journal for Quality in Health Care, 28(1), 92-98.
van Schooten, K. S., Pijnappels, M., Rispens, S. M., Elders, P. J., Lips, P., & van Dieen, J. H. (2015). Ambulatory fall-risk assessment: amount and quality of daily-life gait predict falls in older adults. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 70(5), 608-615.
Walker, G. M., Armstrong, S., Gordon, A. L., Gladman, J., Robertson, K., Ward, M., … & Williams, W. (2016). The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes. Clinical rehabilitation, 30(10), 972-983.

Evidence Level *
(I, II, or III)
Level I Level II Level III Level II
Conceptual Framework

Describe the theoretical basis for the study (If there is not one mentioned in the article, say that here).**
No conceptual framework No conceptual framework No conceptual framework No conceptual framework
Design/Method

Describe the design and how the study was carried out (In detail, including inclusion/exclusion criteria). The study is a randomized controlled study, which is a quantitative approach. The study embarked on a process of assessing the predictive validity of the Johns Hopkins Fall Risk Assessment Tool to determine its efficiency in fall prevention. The study engages in a multi-site audit using eight evidence-based audit criteria. The audit process focused on evaluating the sustainability of practice change as a way of determining whether this would be a viable approach to preventing falls. The method use for this study was quantitative with the researchers using two-way analysis of variance (ANOVA) when comparing follow-up audits and fall rates.
This study uses an exploratory research considering that it is part of a larger study being conducted at the VU University Amsterdam. The study uses a mixed method approach, such as qualitative analysis of data and manipulation of descriptive characteristics presented from the questionnaires used for purposes of information gathering. This study uses a two-center, cluster feasibility randomized control trial, which evaluates the parameters associated with the interventions adopted to prevent patient falls. The study evaluates the feasibility of using a risk assessment and decision support tool.
Sample/Setting

The number and characteristics of
patients, attrition rate, etc. The study uses electronic data for 13574 patients admitted in a large tertiary academic medical center in Midwest in 2014. The study uses nine participants, who are clinical leaders selected from each of the nine acute care hospitals from Australia participating in this study. The participating hospitals included a mix of public and private facilities. The participants had training in evidence implementation to allow for efficiency in conducting audits. The study uses one week trunk accelerometry (DynaPort MoveMonitor) from a sample of 169 older
adults (mean age 75) patients. The study focuses on care home residents aged over 50 years, who had experienced a fall within the past year and were not bed-bound, hoist-dependent, or terminally ill.
Major Variables Studied

List and define dependent and independent variables – Predicting patient falls
– Hopkins Fall Risk Assessment Tool – Patient fall prevention
– Multi-site audit
– Best practice implementation project – Ambulatory fall-risk assessment
– Amount and quality of daily-life gait predict falls – Patient falls
– Prevention of falls
– Risk assessment and decision support tool
Measurement

Identify primary statistics used to answer clinical questions (You need to list the actual tests done). T-test
X2-test
SPSS tool Two-way analysis of variance (ANOVA) SPSS tool Central measures of tendency
Data Analysis Statistical or
Qualitative findings

(You need to enter the actual numbers determined by the statistical tests or qualitative data). The analysis is quantitative Quantitative findings Descriptive/qualitative findings Narrative findings
Findings and Recommendations

General findings and recommendations of the research The Johns Hopkins Fall Risk Assessment Tool presents considerable weaknesses. However, it is still being used in different clinical settings with the objective being to nurture a culture that supports fall prevention. The tool’s effectiveness can be seen from the fact that it helps in identification of possible instances when patients are most likely to fall. Clinical audit and feedback are an effective step to advancing quality improvement as part of minimizing risks associated with falls. The multi-component approach allows for an in-depth evaluation of barriers likely to prevent compliance with existing EBPs on fall prevention. Fall prevention relies on two main aspects, which are staff and patient education. Fall prevention can be achieved through good accuracy based on questionnaires and daily-life accelerometry. These define the quality and quantity of daily-life gait that contribute significantly to fall prevention. The study recommends the adoption of preventive approaches that would play a critical role in minimizing risk of falls among elderly patients. Utilizing case records is an important step in falls prevention because it helps in ascertaining the risk of falls among patients. Case records also present an easier approach through which to ensure caregivers are well equipped with knowledge and information to enhance their capacity and ability to deal with possible cases of fall among elderly patients
Appraisal and Study Quality

Describe the general worth of this research to practice.

What are the strengths and limitations of study?

What are the risks associated with implementation of the suggested practices or processes detailed in the research?

What is the feasibility of use in your practice? The study used an evidence-based approach, which maximizes its general worth and advance overall applicability of the information presented. The use of an evidence-based approach also serves as the study’s main strength. The main limitation is that the authors use a language that is rather difficult or challenging for readers, especially those without a background in medicine.
The findings are feasibility in my practice because they help me determine whether to use the Johns Hopkins Fall Risk Assessment Tool to predict patient falls. The study has a general worth to practice because the development of audit criteria was informed by an evidence review.
The key strength of the study is that it focuses on clinical leaders, who are given the mandate of conducting audits to determine some of the key areas to improve.
The study is feasible in my practice because it gives me an in-depth understanding of what I should expect as I deal with patients that face a high risk of falls. The study has defined its worth by enhancing overall use of evidence to support the importance of questionnaires to guide the processes in risk identification.
The main strength of the study is that it evaluates questionnaires and daily-life accelerometry from multiple perspectives with an aim of understanding how this would improve fall risk prevention.
The study is feasible in my practice because it supports the use of preventive approaches to deal with possible cases of risk prevention. The general worth of this study can be seen from the fact that it advances the importance of using care records, which would help ascertain the fall risks among patients.
The strength of this study can be justified from its ability to use an evidence-based approach to support the conclusions made.
The study is feasible in my practice because I deal with patients from different age groups, which creates a high risk of falls.
Prevention for Patient Falls

Key findings

The Johns Hopkins Fall Risk Assessment Tool is a viable tool that would be of value in predicting patient falls but presents considerable weaknesses. Conducting audits is an important step in enhancing overall efficiency while seeking to prevent patient falls, especially when dealing with older patients. Most risk indicates can be obtained using validated questions, trail making test, or grip strength. Hospitals must create relevant care records for their patients, which would help in identifying those that face the greatest risk of falls.

Outcomes

Using the Johns Hopkins Fall Risk Assessment Tool should be complemented by another fall prevention tool to ensure that it achieves the intended outcomes. Clinical leaders should come up with strategic approaches to conduct audits that would focus on establishing strategic measures through which to minimize patients’ risk of falls. Validated questions, trail making test, and grip strength are some of the key determinants of whether patients should be observed closely based on their fall risks. Hospital managers should come up with a strategy to ensure nurses gather as much data as possible, which will help determine whether patients are likely to experience falls while in care homes.
General Notes/Comments The analysis and the results of this study show that the JHFRAT has considerable weakness according to the results of predictive validity, mostly on assessing psychometric properties, but on the other hand, it is still being used in different clinical settings which nurture a culture of fall awareness thus reducing incidences of fall.

The study indicates that Clinical audit and feedback is an effective strategy to promote quality improvement in falls prevention practices in acute hospital settings. A multi-component approach to fall prevention is vital to targeting specific barriers that hinder compliance with EBPs. The relevance of patient fall prevention does also rely on staff and patient education. The study shows that prospective falls can be predicted with good accuracy based on questionnaires and daily-life accelerometry, to which parameters describing quality and quantity of daily-life gait contribute substantially. The study supports the use of preventive approaches to minimizing patient falls, especially in the elderly. The study informs on the importance of utilizing care records to ascertain falls. It is also easier to achieve the goals of minimizing patient falls if caregivers adhere to care guidelines as implemented in trial conditions in studies.

Summary for Critical Analysis
The studies above play a major role in providing information concerning the best practices that should be implemented to prevent falls among patients. Patient falls in healthcare is a major issue that results in devastating complications. The risk associated with patient falls may hinder the ability to heal from other medical conditions, thus worsening the health situation. Some of the main causes of hospital falls among the patients include nurse shortage, an aging population, and an environment that is not safe. The prevention of hospital falls requires the implementation of best practices that reduces the rate at which patients may fall in a hospital environment. The prevention process requires the efforts of nurses and other stakeholders in a healthcare organization to ensure that hospitals become a safe environment for the patients. Understanding the causes of patients falls may help in defining the best practices that may help in aiding the prevention.
The best practice that emerges from the research regarding prevention of patient’s fall is the use of a risk assessment and decision support tool. The research indicates that the tool has an integral role in enabling healthcare practitioners to deal with cases of patients falls in hospitals. The use of the risk assessment and decision support tool helps to prevent the frequency of patients fall in a healthcare organization. The first significant reason the tool is considered a best practice is the ability to predict falls among the patients, thus offering preventative measures. The occurrence of most cases associated with patient’s fall in a hospital results from the fact that it was difficult to predict the fall. The implementation of the best practice noted help to provide information that offers precaution against various aspects that may resulting in patients fall.
The second reason support the implementation of the mentioned best practice in prevention of falls among the patients is the calculation of risks associated with the fall of patients. The implementation of the best practice plays an integral role in calculating the risks factors that contribute to falls in a hospital environment. The strategy enables the health practitioners such as nurses to identify the risk factors that have the potential of causing falls among the patients. The assessment is important as helps to protect patient and improve on their wellbeing. The assessment tool act as a basis for providing guidelines that could be used to promote safety among the patients and ensure that the nurses and medical practitioners learn effective ways of handling patients.
Lastly, the assessment tool is considered a best practice considering that it helps in enhancing the decision-making process in an organization. When dealing with of prevention of falls in hospitals, decision making is an integral aspect that helps to promote the wellbeing of patients. The use of the best practice helps to ensure that nurses communicate to the patients regarding the safety measures that help to prevent falls. Patient education is considered an important aspect in healthcare as it helps to promote the overall wellbeing of patients. The implementation of the best practice helps in ensuring that hospitals create safe environment for the patients, which is a key factor that helps in preventing falls among the patients. Additionally, the best practice helps in supporting the nurses and other medical practitioners in the process of the handling patients to ensure that they are protected against different forms of harm in a hospital environment.

References
Klinkenberg, W. D., & Potter, P. (2017). Validity of the Johns Hopkins Fall Risk Assessment Tool for predicting falls on inpatient medicine services. Journal of nursing care quality, 32(2), 108-113.
Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A. (2016). Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project. International Journal for Quality in Health Care, 28(1), 92-98.
van Schooten, K. S., Pijnappels, M., Rispens, S. M., Elders, P. J., Lips, P., & van Dieen, J. H. (2015). Ambulatory fall-risk assessment: amount and quality of daily-life gait predict falls in older adults. Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences, 70(5), 608-615.
Walker, G. M., Armstrong, S., Gordon, A. L., Gladman, J., Robertson, K., Ward, M., … & Williams, W. (2016). The Falls In Care Home study: a feasibility randomized controlled trial of the use of a risk assessment and decision support tool to prevent falls in care homes. Clinical rehabilitation, 30(10), 972-983.

Prevention for Patient Falls

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