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Implementation of Evidence Based Guidelines to Reduce Fall Risk in a Patient Population Vulnerable to Falling Susan E

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Implementation of Evidence Based Guidelines to Reduce Fall Risk in a Patient Population Vulnerable to Falling Susan E Regis University ePublications at Regis University All Regis University Theses Fall 2016 Implementation of Evidence Based Guidelines to Reduce Fall Risk in a Patient Population Vulnerable to Falling Susan E. Jacquez Follow this and additional works at: https://epublications.regis.edu/theses Recommended Citation Jacquez, Susan E., "Implementation of Evidence Based Guidelines to Reduce Fall Risk in a Patient Population Vulnerable to Falling" (2016). All Regis University Theses. 804. https://epublications.regis.edu/theses/804 This Thesis - Open Access is brought to you for free and open access by ePublications at Regis University. It has been accepted for inclusion in All Regis University Theses by an authorized administrator of ePublications at Regis University. For more information, please contact [email protected]. Regis University Rueckert-Hartman College for Health Professions Capstone/Thesis Disclaimer Use of the materials available in the Regis University Capstone/Thesis Collection (“Collection”) is limited and restricted to those users who agree to comply with the following terms of use. Regis University reserves the right to deny access to the Collection to any person who violates these terms of use or who seeks to or does alter, avoid or supersede the functional conditions, restrictions and limitations of the Collection. The site may be used only for lawful purposes. The user is solely responsible for knowing and adhering to any and all applicable laws, rules, and regulations relating or pertaining to use of the Collection. All content in this Collection is owned by and subject to the exclusive control of Regis University and the authors of the materials. It is available only for research purposes and may not be used in violation of copyright laws or for unlawful purposes. The materials may not be downloaded in whole or in part without permission of the copyright holder or as otherwise authorized in the “fair use” standards of the U.S. copyright laws and regulations. Implementation of Evidence Based Guidelines to Reduce Fall Risk Implementation of Evidence Based Guidelines to Reduce Fall Risk in a Patient Population Vulnerable to Falling Susan E Jacquez Submitted in Fulfillment for the Doctor of Nursing Practice Degree Regis University November 17, 2016 i Implementation of Evidence Based Guidelines to Reduce Fall Risk I. Preliminary Pages ii Implementation of Evidence Based Guidelines to Reduce Fall Risk A. Copyright Copyright © 2016 Susan E Jacquez. All right reserved. No part of this work may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the author’s prior written permission. iii Implementation of Evidence Based Guidelines to Reduce Fall Risk B. Executive Summary In long-term care, older adults with cognitive and physical impairment are at high risk for falling and fall related injuries resulting in social isolation, poor quality of life, increase risk for repeat fall, and an increase in health care costs. According to the Centers for Disease Control & Prevention (2015), 1.4 million persons’ age 65 years and older reside in nursing homes or 18% of older adults in this age group (para.1). An estimated 50-75% of nursing home patients fall each year and often fall more than once (CDC, 2012, para.2). Ten to 20% of nursing home falls cause serious injuries with 2% to 6% resulting in fractures and an average hospital cost of $35,000 per fall per resident (CDC, 2015, para.1). “Each year a typical nursing home with 100 beds reports 100-200 falls among patients who cannot walk or have impaired mobility” (CDC, 2012, para.2). The Agency for Healthcare Research and Quality (2012) offers clinicians fall prevention protocols and evidence based guidelines to positively influence fall prevention programs in long-term care (p.1). The AHRQ proposes strategies to gain organizational support and educate nurses to participate in fall prevention programs dedicated to enhanced communication, collaboration, and teamwork to improve safety for the older adult, a population vulnerable to falling (p.2). Over a three-month period, nurses (N=49) in a for-profit long term care facility serving high fall risk older adults participated in completing a pre-education survey, an educational module (borrowed with permission from the AHRQ), and a post education survey to successfully implement the AHRQ fall prevention guidelines into long term care. iv Implementation of Evidence Based Guidelines to Reduce Fall Risk This Doctor of Nursing Practice (DNP) Project examined the effect of evidence on fall reduction in long term care and aimed to reduce the number of resident falls by a minimum of 20% and exceeded this goal. v Implementation of Evidence Based Guidelines to Reduce Fall Risk C. Acknowledgements Special thanks to American Baptist Homes of the Midwest for agreeing to participate in this DNP Project, as well as, the executive leaders, nurse care coordinators, and nursing staff of Mountain Vista Retirement Community for their dedication to resident safety and service to protect older adults from falling. Special thanks to Robert Priester, RN MBA, Staff Development Coordinator for his commitment to collaborative practice and quality improvement efforts in long-term care. vi Implementation of Evidence Based Guidelines to Reduce Fall Risk Table of Contents I. Preliminary Pages……..…………………………………………….…….........i A. Copyright Page……………………………………….…………….……...ii B. Executive Summary……………………………………….…………........iv C. Acknowledgements………….………………………………….………....vi D. Table of Contents……………………….…………………………….......vii E. List of Figures……………………………………………………………..ix F. List of Appendices……………………………………………………........x II. Problem Recognition and Definition……………………..………….…….......1 A. PICO…………………………………………………………….………....1 B. Abstract……………………………………………..………………...........1 C. Significance of the Problem………………………………………………..1 D. Literature Review………………………………..……………..…..……...4 i. Nursing Confidence and Competency...……………………...........8 ii. Nursing Challenges in Long Term Care…………………...............9 iii. Nursing Educational Modalities……………...…………..............10 iv. Theoretical Foundation…………………………….……...…….....10 III. Market Risk Analysis…………………………………………….…...…….....11 A. Strengths, Weaknesses, Opportunities and Threats…….…………....12 B. Needs, Resources, and Sustainability……………………….….........13 C. Stakeholders and Project Team………………………………...........16 D. Cost Benefit Analysis…………………………………………..........16 vii Implementation of Evidence Based Guidelines to Reduce Fall Risk IV. Project Objective…………………………………………………..…………19 A. Mission and Vision……………………………………………….........19 B. Goals……………………………………………………………….......20 C. Outcomes Objectives……………………………………….…….........20 V. Evaluation Plan…………………………………………..…………..............20 A. Logic Model……………………………………………...…….............20 B. Population and Sample Parameters……………………………….........21 C. Setting…………………………………………………………….........21 D. Methodology and Measurement……………………………....….........22 a. Human Subjects Protection……………………………….…......23 b. Instrument Reliability and Validity………………………...........23 VI. Project Findings and Results……………………………………..……...........24 A. Description of the Sample………………………………………….…....24 a. Objective One………………………………..…………..............24 b. Objective Two………………………...……………………........25 c. Objective Three………………………..………………………...25 d. Limitations………………………………………………….........25 e. Recommendations…………………………………..…................26 f. Implications for Nursing Practice………………………..…........28 VII. Summary………………..……………………………………………............28 VIII. References……………………………………………………………............30 IX. Appendixes…………………….………………………………….………….33 viii Implementation of Evidence Based Guidelines to Reduce Fall Risk List Appendices A. Morse Scale & Morse Score…………………………………………..................33 B. Fall Prevention Guidelines……………………………………………….……...34 C. Exemplar of Literature Review………………………………………….…........49 D. Logic Model………………………..………………………………….…...........51 E. Conceptual Diagram………………..………………………………..…..............52 F. Measurement Tool/Instrument…..…………..…….……………….….…...........53 G. Timeframe…………………………………..…………………………...............55 H. Budget and Resources…………………………..……………………...…..........55 I. IRB Approval Letters……………………………..………………………..........57 J. CITI Training Certificate………………………………………………………..59 ix Implementation of Evidence Based Guidelines to Reduce Fall Risk List of Figures I. Differences in Means Test Scores in the Pre- and Post- Intervention.…......63 II. Confidence Items Demonstrating Statistically Significance………….…....63 III. Participant Preferences for Specific Learning Modalities………….............64 x Implementation of Evidence Based Guidelines to Reduce Fall Risk II. Problem Recognition and Definition Problem-Intervention-Comparison-Outcome (PICO) Population: Nurses who care for older adults in a specific long term care facility and assess for fall risk Intervention: Implementation of the Agency for Healthcare Research and Quality Fall Prevention Guidelines for Long Term Care Comparison: Standard fall precautions at the site Outcome: Successful implementation of the AHRQ fall prevention guidelines in a specific long term care setting with a 20% reduction in fall events Abstract Purpose: This Doctor of Nursing Practice (DNP) Project explored implementation of the Agency for Healthcare Research & Quality (AHRQ) Fall Prevention Guidelines for Long Term Care in clinical practice to examine the
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