EBP project with Implementation Plan and Evaluation Plan Picot Question: Among the geriatric population (P), how effective are discrete nursing interventions (I) as against a complex fall prevention initiative (C) for reducing inpatient falls (O) over a one-year period (T)?

Falls among the elderly are one of the leading causes of incapacity and injury. For facilities which have a substantive amount of elderly patients, creating a plan to reduce falls is a critical component of protecting patients while still ensuring the maximum degree of autonomy.

Fall Prevention Program

Fall prevention begins with assessment. All patients must be assessed for their fall risk using an evidence-based testing scale. According to Phelan (et al. 2016), risks associated with falls include poor muscle strength, gait imbalances, poor vision, and medication regimes. After an initial assessment, all patients should be evaluated for a potential personal fall reduction strategy as well as integrated into the unit’s overall fall reduction strategy. For example, in one study of at-risk patients “only 21% of these had their prescription dose-reduced or discontinued or documentation of continued need for the medication after their fall,” despite the fact that an “intervention to decrease or stop the medication” decreased falls “in 49% of cases; another study that examined psychopharmacy found a [reduction] rate of 28% regarding the use of medication” (Phelan et al., 2016, par. 34). While reducing medications which contribute to falls through sedation may not be possible in the case of all patients, the possibility should be explored, given the risks of falls and also the risks of over-medication of elderly patients in general.

Muscle tone and balance can also be addressed through the use of physical and occupational therapy. While the responsiveness of the patient...

Finally, a redesign of the unit itself may facilitate protecting patients. Data analysis itself may be beneficial on a unit-by-unit basis “Control charts can be used to analyze fall rates overall; type of fall; repeat falls; fall injury and level of severity; number of days between preventable falls; and serious injury” (Quigley & White, 2013, par. 20). The use of bright colors to mark steps, guard rails, and specifically assigning staff members to high-risk patients to ensure that they carefully supervise yet encourage appropriate movement are all components of an effective fall prevention program.
Staff Meeting

As can be seen by the above-mentioned suggestions, getting staff members on board for a proposed change is critical. Nursing staff will provide the initial evaluation of patients and must also engage in ongoing evaluation of patients, to see if patients are improving or deteriorating and may need additional assistance. For example, if a patient must be prescribed a more sedating medication than usual, nursing staff must make a note that the patient may require additional supervision to prevent likely falls. Nursing staff must also be responsible for educational efforts of other staff members. Nurses should periodically review patients’ medications to ensure that patients are not being prescribed overly sedating substances and are being put at needless risk for a catastrophic fall.

Nursing assistants also have a vital role to play. They may be on the front lines of taking precautions in assisting the movements of high risk patients and ensuring that patients are not at risk for falls during the acts of daily life. Nursing assistants…