The following PICOT question is proposed for consideration: in patients aged 65 and older, who run a risk of falls and live either with a caregiver or alone (P), does an education effort directed at caregivers and patients (I) compared to a group of similar patients undergoing only standard fall prevention interventions (C) help to reduce falls (O) over four or six weeks. Each element of the PICOT can be considered in detail and justified.
Older patients are especially likely to experience falls which tend to result in significant health consequences (Center for Disease Control and Prevention [CDC], 2017; Tricco et al., 2017). CDC (2017) reports that 3 million older adults are injured in a fall badly enough to require treatment in an emergency department every year in the US. The primary investigator is also interested in the population because the described project can be considered a practice improvement effort. It will assist Dr. Rheinchard Reyes’ practice which has a large percentage of older adults who are falls-prone. Depending on their health condition, older patients might be considered vulnerable (Polit & Beck, 2017). Various factors that make the population vulnerable will be treated as exclusion criteria in the project.
The choice of intervention is explained by recent research. Educational efforts that are aimed at patients and their caregivers have been tested for some time (Meyer, Dow, Hill, Tinney, & Hill, 2016; Tricco et al., 2017). They can result in fall reductions (Hill et al., 2015; Meyer et al., 2016; Tricco et al., 2017). The plan developed by the University of Michigan Health System (2015) is proposed for the project: it is regularly updated, non-commercial, and can be adapted.
The introduction of a comparison group will help to improve the quality of the evidence produced by the project. This way, it will be able to use an experimental or quasi-experimental design (Polit & Beck, 2017). The proposed PICOT suggests comparing the outcomes (fall rates) of the intervention group to a similar group that is composed of fall-prone older patients. The project site does employ particular methods of preventing falls in all at-risk populations. However, the intervention group will receive supplementary training (the educational intervention) in addition to the standard procedures, and the comparison group will only be subjected to standard procedures. This way, the project will be able to determine the effects of the intervention.
The outcome that was chosen is measurable and relatively easy to track. It is also commonly used in studies on the topic (Hill et al., 2015; Tricco et al., 2017). Office records, which are an established tool, will be used as the primary source of data. Additionally, the participants and their caregivers will be asked to track falls and their consequences (for example, injuries). By combining two methods of data collection, the project will decrease the likelihood of inaccurate or incomplete data, which is a common concern in research (Polit & Beck, 2017).
Finally, the time of the project is predominantly limited by the restrictions of the project, but it is acknowledged that a greater timeline will offer more data for analysis (Polit & Beck, 2017). As a result, depending on the progress of the project, it may take up between four and six weeks.
In conclusion, the significance of the topic should be mentioned. The statistics provided by the CDC (2017) demonstrate that the problem of falls is massive. Furthermore, CDC (2017) highlights the negative outcomes of falls, pointing it out that traumatic brain injuries, as well as the absolute majority of hip fractures, are often related to falls. While costly, prevalent, and very traumatic, falls are also often preventable, and educational efforts can assist with the problem (Hill et al., 2015; Tricco et al., 2017). The chosen topic will become a direct practice improvement effort, and it is in line with PICOT guidelines since it is not too costly, does not have to involve a vulnerable population, and can be carried out within an appropriate timeframe.
Center for Disease Control and Prevention. (2017). Important facts about falls. Web.
Hill, A. M., McPhail, S. M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L.,… Haines, T. P. (2015). Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: A pragmatic, stepped-wedge, cluster-randomised controlled trial. The Lancet, 385(9987), 2592-2599. Web.
Meyer, C., Dow, B., Hill, K., Tinney, J., & Hill, S. (2016). “The right way at the right time”: Insights on the uptake of falls prevention strategies from people with dementia and their caregivers. Frontiers in Public Health, 4, 1-10. Web.
Polit, D.F., & Beck, C.T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L.,… Riva, J. J. (2017). Comparisons of interventions for preventing falls in older adults. JAMA, 318(17), 1687-1699. Web.
University of Michigan Health System. (2015). How to prevent falls: Tips for patients and caregivers. Web.