Introduction
Falls are the most frequently reported in-hospital incidents today, and approximately a third of fall cases lead to injuries (Hill et al., 2015). The importance of this issue has been recognized by researchers and practitioners all over the world within recent years, and a large body of academic literature has been generated to estimate what can be done to prevent falls. One of the considerations in this area is the admission time of orthopedic adult patients, and efforts aimed at decreasing this indicator are a contribution to improving the fall situation. It is recommended under this project to employ an evidence-based practice model and introduce fall-prevention educational programs and the extended use of physical therapy devices for decreasing admission time.
Change Model Overview
The ACE Star Model of Knowledge Transformation is one of the evidence-based practice models that is designed as guidelines on transforming evidence and knowledge into practice. It incorporates five elements: first, the Discovery component indicates exploring and studying a given issue. Second, the Evidence Summary component is for synthesizing discovered knowledge into a manageable system, such as a systematic review. Third, the Translation component describes how clinical instructions can be designed based on the evidence. Fourth, the Integration component helps reflect on the evidence after applying it to practical issues. Finally, the Evaluation component is for revealing how the evidence-based approach affects the quality of care represented by such indicators as health outcomes and patient satisfaction. The Star Model can be used by nurses to facilitate change because it provides both theoretical and practical perspectives, thus strongly supporting recommendations for change.
Define the Scope of the EBP
The admission time for orthopedic adult patients has been observed to be averagely prolonged due to the fall rate trends. The issue may be connected to various patient-related as well as hospital-related circumstances. In this context, several measures can be proposed to address the issue and decrease admission time. Particularly, the effectiveness of postoperative fall education and physical therapy devices has been explored from the perspective of decreasing admission time for orthopedic adult patients. On a broader scale, the issue is important because falls constitute 20 to 30 percent of all incidents reported in hospitals today (Hill et al., 2015). The adult population is confirmed to have higher risks in this context. It is estimated that approximately a third of in-hospital falls result in injuries. Admission time is an important factor in the context of this issue, which is why it is suggested to measure its correlation to postoperative fall education and physical therapy devices.
Stakeholders
A team to implement the proposed change should include people whose positions are associated with different aspects of managing and operating a medical facility because implemented changes may require modifications on different levels throughout the organizational structure. For this project, four necessary positions are identified to be included in the team: the charge nurse, the nurse educator, a physician, and a hospital administrator.
Determine Responsibility of Team Members
First, the charge nurse should be included in the team, as the position implies managing various aspects of the nursing care system and knowing its processes from inside. A person who occupies the position is in charge of implementing procedural modification and is capable of gathering relevant feedback. Second, if there is no such position as the nurse educator currently, it might be considered to create it due to the potential benefits, as it is confirmed that nursing education incorporated into clinical practice contributes to the continuing improvement of a facility. Third, the team might also need a physician to overview the use of physical therapy devices. Finally, a hospital administrator should be included because the proposed change is related to administrative issues (admission time) and because the administrator will serve as a link between the change initiative team and the top management
Evidence
The evidence for the addressed issue is constituted by academic literature. Falls as a major clinical problem have been extensively explored within recent years, and many recommendations have been proposed to nursing care practitioners and medical facilities to contribute to falling prevention and related initiatives, such as decreasing admission time. Some of these recommendations are presented in the form of clinical practice guidelines, which may constitute additional evidence. However, what was primarily searched is the confirmation that particular measures (postoperative fall education and the use of physical therapy devices) are effective in decreasing the admission time for orthopedic adult patients.
Summarize the Evidence
Hill et al. (2015) examined the effectiveness of individualized fall-prevention education for patients. Education activities have been held as a ward-level program supported by training and feedback for healthcare providers. The intervention is a patient education program that is designed to provide information on patient goals, hospital environment feedback, and perceived barriers to engagement. The effects of the intervention were estimated based on three indicators: the number of falls, the number of injurious falls, and the number of fallers. The results definitively showed that the intervention group had lower rates under all three indicators. Combined with patient feedback on the education program, these findings can serve as evidence of the effectiveness of fall education, which is related to the addressed practice issue. Similar results were obtained by Hari and Rosenzweig (2012), as they state that nurses should try to fill in the knowledge gaps among patients because addressing “the areas of educational deficit at patient readmission could help nurses identify what they can do to minimize preventable complications” (p. 408). The importance of physical therapy devices for addressing the issue of interest has been confirmed by Karlsson, Magnusson, von Schewelov, and Rosengren (2013), as they concluded in their systematic review that such devices are beneficial in fall-prevention programs.
Develop Recommendations for Change Based on Evidence
Based on the research, the recommendation is to employ postoperative patient-oriented fall-prevention educational programs. Another recommendation is to enhance the use of physical therapy devices for the same category of patients. The nursing staff will need to be trained to conduct educational programs and enhanced physical therapy activities. The expected outcome is improving indicators associated with falls, including the admission time.
Translation
Action Plan
The primary action is training the nursing staff to enable its members to conduct educational programs and physical therapy activities. The help of the charge nurse and the nurse educator will be essential at this stage, as the nurses’ education needs to be organized in a way that will not disturb their work. The next step is to run a pilot program where nurses will educate orthopedic adult patients on fall-prevention and assist in the physical therapy for postoperative patients. Different performance indicators associated with fall-prevention need to be monitored during the entire pilot program to confirm the effectiveness of proposed measures.
Process, Outcomes Evaluation, and Reporting
The desired outcome is decreasing the admission time and, ultimately, decreasing the fall rate. Both outcomes can be measured quantitatively, thus facilitating the evaluation of effectiveness and the presentation of results. Also, it is planned to collect some qualitative data as well, such as the attitudes and expectations of nurses who will participate in the implementation. Patient feedback needs to be collected, too, for estimating the overall effectiveness of the proposed solutions for patient satisfaction.
Identify Next Steps
If the effectiveness of the proposed practice is confirmed in the pilot program, the next step will be continuing the practice and generating more evidence and feedback. After accumulating a considerable amount of data on the practice issue (challenges, complications, and solutions), the facility will be able to share it, thus contributing to the evidence available to other facilities.
Disseminate Findings
For effective communication of findings and results to both internal and external audiences, a dissemination strategy needs to be applied. The essential component of such a strategy is proposing certain practices to facilities along with presenting definitive primary evidence that confirms the effectiveness of these practices. Dissemination may occur in various forms, and there are many approaches to designing and targeting messages, but the central idea is that facilities do not need to be heavily persuaded because if the evidence of benefits is strong, the facilities will be willing to adopt the presented practices without much persuasion: let the evidence speak for itself.
Conclusion
To ensure the success of the proposed practices, i.e. their effectiveness in decreasing admission time and fall rates, the ACE Star Model of Knowledge Transformation has been applied. The proposed program includes all five elements: discovery, evidence summary, translation, integration, and evaluation. If the program is designed on the basis of existing evidence, properly implemented, and supported by feedback from nursing care providers and patients, it will allow creating new evidence, thus helping the beneficial practices spread to other facilities, which will be a positive contribution to the health outcomes of more patients.
References
Hari, M., & Rosenzweig, M. (2012). Incidence of preventable postoperative readmissions following pancreaticoduodenectomy: Implications for patient education. Oncology Nursing Forum. 39(4), 408-412.
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.
Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly: A review. Osteoporosis International, 24(3), 747-762.