Assignment: Part 5: Recommending an Evidence-Based Practice Change

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The Assignment: (Evidence-Based Project)
Part 5: Recommending an Evidence-Based Practice Change
Create an 8- to 9-slide PowerPoint presentation in which you do the following:
• Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
• Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
• Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
• Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
• Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
• Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
• Add a lessons learned section that includes the following:
o A summary of the critical appraisal of the peer-reviewed articles you previously submitted
o An explanation about what you learned from completing the evaluation table (1 slide)
o An explanation about what you learned from completing the levels of evidence table (1 slide)
o An explanation about what you learned from completing the outcomes synthesis table (1 slide)
Notes
Best Practices
Though just as identified in the appraisal, there are many interventions in heightening patient safety and preventing patient falls. However, I believe that the best practices involve the input of both the governance and the senior leadership. The input of both the senior leadership and governance can be reinforced with the utilization of an organizational structure that facilitates the identification and addressing of safety issues as well as technology adoption (Alexander et al. 2019).
Jähne-Raden (2019), notes that for patient safety measures to be needed, the basic idea is that there are areas of weaknesses in an organization’s safety precautions, which makes a change necessary in the organization. Change, on the other hand, though being an imperative aspect of any organizational development, is a daunting venture to succeed in. Change, irrespective of the segment it is supposed to be attained, is mostly not welcomed due to many reasons including a fear of the future and lack of insight on what the change is supposed to look like. Change resistance may lower employee morale, reduce efficiency, and disrupt the working environment (Austin et al., 2017). The part of making changes that foster the advancement of safety precautions requires the input of senior leadership. The individuals in the senior organizational level act as change agents who advocate for the change (Zhan, 2016). They lobby the entire organization towards a mentality of transitions that foster patient safety.
For an organization to transcend from a position of lower patient safety to a higher level there is a need for a well-planned strategy. The change itself is a process that is attained in multistep. Therefore, strategizing and having good governance may be imperative in ensuring that the desired patient safety practices are attained. In addition to having good governance, senior leadership, and good organizational structure, it is essential that the most advanced technologies for the detection and prevention of patient falls are implemented. Technology heightens efficiency and effectiveness, reduce cost, and heighten patient privacy just as identified by (Alexander et al. 2019)

References

Austin, J. M., Demski, R., Callender, T., Lee, K. K., Hoffman, A., Allen, L., … Peterson, R. R. (2017). From board to bedside: how the application of financial structures to safety and quality can drive accountability in a large health care system. The Joint Commission Journal on Quality and Patient Safety, 43(4), 166–175
Alexander, L., Swinton, P., Kirkpatrick, P., Stephen, A., Mitchelhill, F., Simpson, S., & Cooper, K. (2019). Health technologies for falls prevention and detection in adult hospital in-patients: a scoping review protocol. JBI Database Of Systematic Reviews And Implementation Reports, 17(5), 667–674. https://doi-org.ezp.waldenulibrary.org/10.11124/JBISRIR-2017-003844
Jähne-Raden, N., Kulau, U., Marschollek, M., & Wolf, K.-H. (2019). INBED: A Highly Specialized System for Bed-Exit-Detection and Fall Prevention on a Geriatric Ward. Sensors, 19(5), 1017.
Zhan, C. (2016). Health Services Information: Patient Safety Research Using Administrative Data. Data and Measures in Health Services Research, 1–24.

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 citation of the selected article
Article #1 Article #2 Article #3 Article #4

 Austin, J. M., Demski, R., Callender, T., Lee, K. K., Hoffman, A., Allen, L., … Peterson, R. R. (2017). From board to bedside: how the application of financial structures to safety and quality can drive accountability in a large health care system. The Joint Commission Journal on Quality and Patient Safety, 43(4), 166–175

 Alexander, L., Swinton, P., Kirkpatrick, P., Stephen, A., Mitchelhill, F., Simpson, S., & Cooper, K. (2019). Health technologies for falls prevention and detection in adult hospital in-patients: a scoping review protocol. JBI Database Of Systematic Reviews And Implementation Reports, 17(5), 667–674. https://doi-org.ezp.waldenulibrary.org/10.11124/JBISRIR-2017-003844
 Jähne-Raden, N., Kulau, U., Marschollek, M., & Wolf, K.-H. (2019). INBED: A Highly Specialized System for Bed-Exit-Detection and Fall Prevention on a Geriatric Ward. Sensors, 19(5), 1017.
 Zhan, C. (2016). Health Services Information: Patient Safety Research Using Administrative Data. Data and Measures in Health Services Research, 1–24.

Conceptual Framework
Describe the theoretical basis for the study

Safety improvement in healthcare organizations requires the input of both the governance and the senior leadership. Positive input from both the senior leadership and management is imperative in the imposition of changes that are crucial in safety improvement. Safety improvement also requires an organizational structure that facilitates the identification and addressing of safety issues (Austin et al., 2017).

Alexander et al. (2019) notes that falls are a major public health concern. Though no one is immune to falls, fatal falls are most prominent in older people. Falls have a detrimental impact both to the individual and to a country. At an individual level, falls can result in loss of independence, disability, and pain. At the country level, falls result in an increased cost of care provision. The rates of falls are predicted to increase with the predicted increase in the number of people aged 65 years and above. Due to the detrimental impact of falls and the expected increase the number of those most prone to falls, it is imperative to deduce interventions that can be utilized in fall prevention. One of the most utilized resources in fall prevention is technology. Technology is utilized both in the detection and the prevention of falls. There is a host of literature that affirms the vitality of fall prevention and detection technologies, which makes it difficult for policymakers to recommend the most effective technology in fall detection and prevention. Alexander et al. (2019) performed a scoping review to map the evidence related to falls prevention and detection in the in-patient setting. Risk of patient fall is high in geriatric institutions. The falls result in femoral neck and fractures, which may result in a heightened cost of care provision and serious consequences. Due to the current number of elderly people, there is a need for the invention of a smart solution for the prevention of falls in a patient’s daily life as well as in the clinical setting (Jähne-Raden et al., 2019).
Administrative data are a crucial source of information that can be used in heightening patient safety. The information available in the administrative data could be used in the development of technology and other resources that are crucial in elevating patient safety. The main challenge with the administrative data is with the method used in obtaining data. The lack of a well-established channel of data retrieval makes the utilization of the administrative data a challenge. Due to this challenge posed on other researchers who would like to utilize administrative data, it is important to highlight some of the methods that can be used in the retrieval of information from the administrative data (Zhan, 2016).

Design/Method Describe the design
and how the study
was carried out
A reporting and oversight framework was used with the application of four different principles: internal audits to ensure accuracy and reliability of quality and safety data, a consolidated quality performance statement to ensure transparency around priorities and goals, governance from shared accountability between clinical leadership and the board, and the hospital board’s dedicated patient safety and quality committee (Austin et al., 2017).

The researchers performed a scoping review to map the evidence related to fall prevention and detection in the in-patient setting. A search of Epistemonikos, EPPI (DoPHER), PEDro, Cochrane Library (reviews; protocols), JBI Database of Systematic Reviews and Implementation Reports, CINAHL, and MEDLINE were used in the identification of systematic reviews on specific aspects of fall detection and fall prevention technologies, in specific settings and in specific populations, mostly in relation to community-dwelling older adults (Alexander et al., 2019) The researchers used the Inexpensive Node for bed-exit Detection (INBED) and prevention of falls. The researchers gathered information on the stringent requirements for the Inexpensive Node for bed-exit Detection (INBED) (Jähne-Raden et al., 2019).
The researcher presents findings of a literature review on the methods of information retrieval from administrative data (Zhan, 2016).
Sample/Setting
The number and
characteristics of
patients,
the attrition rate, etc. The research was conducted at Johns Hopkins Medicine (Austin et al., 2017).

The review considered literature that included in-patient adults aged 18 years and over. The participants considered in the literature review were defined as being admitted to a setting for patient care activity taking place in hospital settings. The settings included long-stay rehabilitation units, secondary care, and day-care (community hospital care settings, elective and non-elective (accident and emergency/emergency admission) (Alexander et al., 2019). The researchers used patients in geriatric wards. The number of patients used is not specific, but the patients incorporated in the research had a functional motoric deficit and a high-risk of fall (Jähne-Raden et al., 2019). There is no specific sampling method indicated.
Major Variables Studied
List and define dependent and independent variables The dependent variables included value, safety, and quality while the independent variables are the four principles used in the reporting and oversight framework (Austin et al., 2017).

The main dependent variable in the research is patient falls. Patient fall is the act of a sick individual inadvertently coming to rest on the floor, the ground, or other lower levels.

The independent variables, on the other hand, are technologies used in fall prevention and detection like the bed alarm (Alexander et al., 2019). The dependent variable is patient fall during bed exit while the independent variable is the requirements of the Inexpensive Node for bed-exit Detection (INBED) in fall detection and prevention (Jähne-Raden et al., 2019). The dependent variable is patient safety, while the independent variable is the research methods used in obtaining information from administrative data (Zhan, 2016).

Measurement
Identify primary statistics used to answer clinical questions The information on patient safety and prevention is used in indicating how the framework works at Johns Hopkins Medicine (Austin et al., 2017).
Some of the measurements taken include expert opinions, reports, systematic reviews, and quantitative data from different sects, including quasi-experimental, observational, and experimental quantitative data. Government report data were also considered as a measurement for the number of falls with the utilization of different fall detection and prevention technologies (Alexander et al., 2019).
The system measures patient’s attempt to get up and notifies the nurses (Jähne-Raden et al., 2019).
there is no specific measurement
Data Analysis
Statistical or
qualitative
findings The information is analyzed statistically with the provision of statistical reduction in the incidences of fall and hospital acquired infection (Austin et al., 2017).
After data retrieval, a scoping review was to be conducted based on the Joanna Briggs Institute (JBI) methodology for scoping reviews (Alexander et al., 2019).
The research avails statistical data on the effectiveness of the Inexpensive Node for bed-exit Detection (INBED) on patient fall detection and prevention (Jähne-Raden et al., 2019). There is no insight into how the author came to their conclusions.

Findings and Recommendations
General findings and recommendations of the research The four principles are effective in heightening value, safety, and quality(Austin et al., 2017).
The article presents information on a research that is to be conducted. However, the findings will be crucial in informing policy makers on the best technology to incorporate at different levels in detecting and preventing falls (Alexander et al., 2019).
The research result led to the development of a multi-component system, effective patient movement, and fall detection. The researchers, therefore, recommend its implementation in the prevention of patient fall in geriatric institutions.
The authors recommend several strategies that can be adopted when administrative data is used in patient safety

Appraisal
Describe the general worth of this research to practice. What are the strengths and limitations of the study? What are the risks associated with the implementation of the suggested practices or processes detailed in the research? What is the feasibility of
use in your practice? The main strength of the study is that it is an experimental study which avails first-hand data on the outcomes. However, the research is not coupled with any method of countering the errors that may emanate from the study. It is difficult to ascertain whether the findings are due to the factors indicated or as a result of an external variable.
The study is crucial in informing policymakers on the best technology to implement in preventing and detecting patient falls. The main strength of the research is the utilization of data from a wide scope of secondary sources, which helps in ensuring that the research is credible. One of the most prominent limitations of the research is the utilization of secondary data. It is difficult to ascertain the level of truth in secondary data as compared to primary data. The research does not also include a method of ensuring research validity and trustworthiness. The research does not have results for a recommended technology to adopt in fall detection and prevention. The possible results of the study could be incorporated into clinical practice to prevent and detect patient falls. The research does not contain a control experiment making it difficult to ascertain whether it is the most effective method of patient fall detection and prevention. The intervention does not prevent all patient falls, and this still poses a high level of danger which the research intended to eliminate in initially. The main advantage of the intervention is that it heightens a patient’s privacy compared to the other fall detection and prevention interventions. The data retrieved from the experiment could be used in the implementation of INBED in geriatric centers to prevent patient falls. However, the data is not transferable to the entire population.
The insight from the article is not credible, dependable, conformable, or even valid.

General Notes/Comments

the result offers data that can be used in other care settings in heightening patient safety.

The study seems to utilize a method that could be effective in the detection and prevention of patient falls. The research still leaves a gap and does not offer the maximal benefit expected. There is no channel of information retrieval in the article, which makes it a poor source of information on the best methods of heightening patient safety.

Levels of Evidence Table

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

Author and year of the selected article
Article #1 Article #2 Article #3 Article #4

Study Design
The theoretical basis for the study

Safety improvement in healthcare organizations requires the input of both the governance and the senior leadership. Positive input from both the senior leadership and governance is imperative in the imposition of changes that are crucial in safety improvement. Safety improvement also requires an organizational structure that facilitates the identification and addressing of safety issues.

Patient fall is an issue of concern to public health. Despite the existence of numerous technologies in fall detection and prevention, there exist insufficient data to recommend a specific technology as the most effective in detecting and preventing patient falls. The researchers, therefore, perform a scoping review to map the evidence relating to the evaluation and reporting of health technologies for the detection and prevention of patient falls.
Risk of patient fall is high in geriatric institutions. The falls result in femoral neck and fractures, which may result in a heightened cost of care provision and serious consequences. Due to the current number of elderly people, there is a need for the invention of a smart solution for the prevention of falls in a patient’s daily life as well as in the clinical setting.
Administrative data are a crucial source of information that can be used in heightening patient safety. The information available in the administrative data could be used in the development of technology and other resources that are crucial in heightening patient safety. The main challenge with the administrative data is with the method used in obtaining data. The lack of a well-established channel of data retrieval makes the utilization of the administrative data a challenge. Due to this challenge possed on other researchers who would like to utilize administrative data, it is important to highlight some of the methods that can be used in the retrieval of information from the administrative data.

Sample/Setting
The number and
characteristics of
patients
the research was conducted at Johns Hopkins Medicine

The review considered literature that included in-patient adults aged 18 years an over. The participants considered in the literature review were defined as being admitted to a setting for patient care activity taking place in hospital settings. The settings included long-stay rehabilitation units, secondary care, and day-care (community hospital care settings, elective and non-elective (accident and emergency/emergency admission.)
The researchers used patients in geriatric wards. The number of patients used is not specific, but the patients incorporated in the research had a functional motoric deficit and a high-risk of fall
there is no specific sampling method indicated.
Evidence Level *
(I, II, or III)

I III I v
Outcomes

the research results are valid, credible, and transferable.

The research results are useful in the detection and prevention of patient falls. The research results are not satisfying as the evidence cannot be applied in all care settings. Additionally, the intervention does not prevent all patient falls, which makes it an ineffective method of fall prevention and detection.
The results are provided without indication of any channel used in data retrieval, which makes the information invalid.

* Evidence Levels:

• Level I
Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

• Level II
Quasi-experimental studies, a systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

• Level III
Nonexperimental, a systematic review of RCTs, quasi-experimental with/without meta-analysis, a qualitative, qualitative systematic review with/without meta-synthesis
• Level IV
Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence
• Level V
Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

Outcomes Synthesis Table

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

Author and year of the selected article
Article #1 Article #2 Article #3 Article #4

Sample/Setting
The number and
characteristics of
patients the research was conducted at Johns Hopkins Medicine
The researchers utilized research that used participants aged 18 years and above. The patients were situated in either long-stay rehabilitation units, secondary care, and day-care (community hospital care settings, elective and non-elective (accident and emergency/emergency admission.)
The researchers used patients in geriatric wards. The number of patients used is not specific, but the patients incorporated in the research had a functional motoric deficit and a high-risk of fall
there is no specific sampling method indicated.
Outcomes

the four principles (internal audits to ensure accuracy and reliability of quality and safety data, a consolidated quality performance statement to ensure transparency around priorities and goals, governance from shared accountability between clinical leadership and the board, and the hospital board’s dedicated patient safety and quality committee) are effective in heightening safety, value, and quality The possible outcomes of the study are information that maps the evidence relating to the evaluation and reporting of health technologies for the detection and prevention of falls in adult hospital in-patients. The research led to the development of a multi-component system with a core wearable device used in movement detection. Occurring events are forwarded to the nursing staff who come to assist the patient.
The authors present different methods of retrieving information from administrative data
Key Findings
It is important to engage individuals at all organizational levels in a heightening the quality, safety, and value of care. The possible findings are the best technologies in fall detection and prevention and the gap in the available studies.
The main finding is that the intervention helps in heightening a patient’s privacy and personal freedom of movement while relieving the nursing staff significantly. The authors identify the Advantages and Challenges in Administrative
Data-Based Patient Safety Research.
Appraisal and Study Quality
The results from the research are credible, transferable, and valid. The study is to be performed in a stepwise manner with all the steps identified. The information retrieved will be credible, dependable, and transferable. The study result is credible, dependable, and conformable. However, the result is not transferable to all care settings.
The insight from the article is not credible, dependable, conformable, or even valid.

General Notes/Comments The research offers insight into an intervention that can be adopted in heightening patient safety.

The research will avail crucial insight that will be useful in fall detection and prevention. The study does not wholly resolve the challenge of patient fall as the tool is not effective in preventing all types of falls. The result cannot be used in any clinical setting due to the absence of a clear channel used in obtaining the information.

References

Sample Solutions

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Assignment: Part 5: Recommending an Evidence-Based Practice Change

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