Decision-Making on Procedure/Practice Modification

Full Answer Section

1. Gather Data: The team collected data on patient demographics, medications, mobility levels, cognitive status, and environmental factors that might contribute to falls. They also reviewed incident reports related to past falls.
2. Research Evidence-Based Practices: The team researched current literature and evidence-based guidelines on fall prevention in older adults. They consulted databases like PubMed, CINAHL, and the Cochrane Library.
3. Develop Potential Solutions: Based on the evidence, the team brainstormed several potential interventions, including:
   • Implementing a standardized fall risk assessment tool.
   • Increasing the frequency of nighttime checks on high-risk patients.
   • Providing patients with individualized exercise programs to improve balance and strength.
   • Modifying the environment to reduce hazards (e.g., improving lighting, removing clutter).
   • Educating staff and patients on fall prevention strategies.
4. Evaluate Solutions: The team evaluated the feasibility, cost-effectiveness, and potential impact of each proposed solution. They considered the resources available, the time required for implementation, and the potential benefits and drawbacks.
5. Select the Best Solution: The team decided to implement a multi-faceted approach, combining several interventions:
   • Use of the Hendrich II Fall Risk Model for all patients upon admission and after any change in condition.
   • Implementation of hourly rounding by nursing staff, including specific fall risk checks.
   • Development of individualized exercise programs by physical therapists.
   • Environmental safety assessment and modification.
   • Staff education on the new protocol and patient education materials.
6. Implement the Solution: The new fall prevention protocol was implemented in phases. Staff received training on the new assessment tool, hourly rounding procedures, and patient education strategies. Environmental modifications were made.
7. Evaluate the Outcome: After three months, the team reviewed the fall data again. They compared the fall rate before and after the implementation of the new protocol.

Evidence Considered:

The team considered various types of evidence, including:

• Research Studies: They reviewed randomized controlled trials (RCTs) and other studies evaluating the effectiveness of different fall prevention interventions.
• Clinical Practice Guidelines: They consulted guidelines from organizations like the American Geriatrics Society and the National Institute for Health and Care Excellence (NICE).
• Expert Opinion: They sought input from geriatric specialists and other healthcare professionals with expertise in fall prevention.
• Patient Data: They analyzed data from their own facility, including fall incident reports and patient characteristics.

Research Referenced:

The team likely referenced studies similar to these (examples):

• Hendrich, A., Nyhuis, A., Kipp, C., & Soja, M. E. (2003). Hospital falls: A framework for prevention. The American Journal of Nursing, 103(3), 44–48. (This type of research supports the use of a standardized fall risk assessment tool.)
• Oliver, D., Healey, F., & Ho, K. (2010). Post-fall management in hospital. Clinical geriatrics medicine, 26(1), 107–122. (This type of research supports comprehensive post-fall assessment and management.)

Sample Answer

Scenario: Reducing Fall Risk in a Skilled Nursing Facility

Practice Issue: A skilled nursing facility has seen a recent increase in patient falls, particularly at night. These falls result in injuries, increased healthcare costs, and decreased patient confidence and independence. The nursing staff wants to implement a new fall prevention protocol.  

Decision-Making Process:

1. Identify the Problem: The nursing staff identified the increased fall rate as a significant problem requiring intervention. They documented the frequency, time of day, and location of falls, as well as the severity of injuries sustained.
2. Form a Team: A multidisciplinary team was formed, including nurses, physical therapists, occupational therapists, physicians, and administrators. This team was tasked with investigating the issue and developing a solution.