HCA 699 Identify three strategies that you will now incorporate into your role in health care based on this course

Grand Canyon University HCA 699 Identify three strategies that you will now incorporate into your role in health care based on this course?-Step-By-Step Guide

This guide will demonstrate how to complete the Grand Canyon University HCA 699 What is the difference between statistically significant evidence and clinically significant evidence? assignment based on general principles of academic writing. Here, we will show you the A, B, Cs of completing an academic paper, irrespective of the instructions. After guiding you through what to do, the guide will leave one or two sample essays at the end to highlight the various sections discussed below.

How to Research and Prepare for HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?                            

Whether one passes or fails an academic assignment such as the Grand Canyon University HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?  depends on the preparation done beforehand. The first thing to do once you receive an assignment is to quickly skim through the requirements. Once that is done, start going through the instructions one by one to clearly understand what the instructor wants. The most important thing here is to understand the required format—whether it is APA, MLA, Chicago, etc.

After understanding the requirements of the paper, the next phase is to gather relevant materials. The first place to start the research process is the weekly resources. Go through the resources provided in the instructions to determine which ones fit the assignment. After reviewing the provided resources, use the university library to search for additional resources. After gathering sufficient and necessary resources, you are now ready to start drafting your paper.

How to Write the Introduction for HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?                          

The introduction for the Grand Canyon University HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?  is where you tell the instructor what your paper will encompass. In three to four statements, highlight the important points that will form the basis of your paper. Here, you can include statistics to show the importance of the topic you will be discussing. At the end of the introduction, write a clear purpose statement outlining what exactly will be contained in the paper. This statement will start with “The purpose of this paper…” and then proceed to outline the various sections of the instructions.

How to Write the Body for HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?                          

After the introduction, move into the main part of the HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?  assignment, which is the body. Given that the paper you will be writing is not experimental, the way you organize the headings and subheadings of your paper is critically important. In some cases, you might have to use more subheadings to properly organize the assignment. The organization will depend on the rubric provided. Carefully examine the rubric, as it will contain all the detailed requirements of the assignment. Sometimes, the rubric will have information that the normal instructions lack.

Another important factor to consider at this point is how to do citations. In-text citations are fundamental as they support the arguments and points you make in the paper. At this point, the resources gathered at the beginning will come in handy. Integrating the ideas of the authors with your own will ensure that you produce a comprehensive paper. Also, follow the given citation format. In most cases, APA 7 is the preferred format for nursing assignments.

How to Write the Conclusion for HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?                          

After completing the main sections, write the conclusion of your paper. The conclusion is a summary of the main points you made in your paper. However, you need to rewrite the points and not simply copy and paste them. By restating the points from each subheading, you will provide a nuanced overview of the assignment to the reader.

How to Format the References List for HCA 699 What is the difference between statistically significant evidence and clinically significant evidence?                            

The very last part of your paper involves listing the sources used in your paper. These sources should be listed in alphabetical order and double-spaced. Additionally, use a hanging indent for each source that appears in this list. Lastly, only the sources cited within the body of the paper should appear here.

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Sample Answer for HCA 699 Identify three strategies that you will now incorporate into your role in health care based on this course

Re: Topic 8 DQ 2

Based on this course, three strategies that I will now incorporate into my role in health care are understanding the patient’s perspective, using team-based practice, and focusing on life long learning.

Understanding and incorporating patient preferences should prove useful to improving patient satisfaction and clinical outcomes. With patient preferences in mind, providers can customize care strategies to be more effective and result in higher patient satisfaction. As patients become healthcare consumers, understanding their needs has great importance. Healthcare organizations that manage to incorporate patient preferences into their practices may even be more likely to succeed than those who do not. For many providers, a logical option for understanding patient needs is using survey techniques. Instead of acting on assumption, asking patients for their perspective, makes the process about the patient instead of the provider (Siminoff, 2013).

Team-based practice is also an important component of proving the practice. It can even be said that today, team-based health care is no longer a novelty or even a choice. Increasingly, providers are using a team-based approach to deliver care, and the complexity of health problems facing many Americans, combined with the specialization of health professionals, makes teamwork and team training essential. This is especially true for dealing with factors that contribute to chronic conditions and for treating people with multiple chronic diseases (Graffunder & Sakurada, 2016).

Lastly, emphasizing continual education are essential element of practice and service for those who work in an area that impacts the public’s health and well-being. Lifelong learning must be more than just a box to check off for certification or a promotion. It should include reflection and strategies to renew and actively replenish our usable fund of knowledge. It can: make us better providers because continued learning expands knowledge, capabilities and commitment; benefit us professionally by exposing us to new concepts and research-driven strategies, which can be reassuring to patients; and improve the quality of our professional and personal lives by expanding our professional network and resources (Densen, 2001).

Graffunder, C. & B. Sakurada. (2016). Preparing Health Care and Public Health Professionals for Team Performance: The Community as Classroom. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. doi: 10.31478/201604b

Siminoff L. A. (2013). Incorporating patient and family preferences into evidence-based medicine. BMC medical informatics and decision making, 13 Suppl 3(Suppl 3), S6. https://doi.org/10.1186/1472-6947-13-S3-S6

Densen, P. (2001) Challenges and Opportunities Facing Medical Education, Transactions of the American Clinical and Climatological Association, 2011; 122: 48–58, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116346/

Sample Answer 2 for HCA 699 Identify three strategies that you will now incorporate into your role in health care based on this course

This is insightful Andrei. Understanding the patients’ perspective, using team-based practice, and focusing on lifelong learning are some of the best approaches that also support the evidence-based practices. These approaches may also advance the healthcare practices and patient’s outcome. Understanding patient’s perspectives enable the nurses or the medical professionals to determine the alternative treatment processes that can lead to the effective outcomes. On the other hand, team-based practices and lifelong learning are also critical in enhancing nurse’s experiences and the strategies to use in delivering efficient care to the patients. These approaches may lead to patient satisfaction and the general improvement in the healthcare delivery (Vonderembse & Dobrzykowski, 2016). Besides the above strategies, you may also use cultural perspectives in your role as a healthcare provider. In addition, integrative medicine approach is also essential in the healthcare practice; this is the approach of combining complimentary and conventional methods in a coordinated and intentional way for the maximum benefit and symptom relief.

References

Vonderembse, M. A., & Dobrzykowski, D. D. (2016). A Healthcare Solution: A Patient-Centered, Resource Management Perspective. CRC Press.

HCA 699 Evidence-Based Practice Proposal Final Paper Draft

Section A: Problem Description 

Background of the Problem 

In clinical settings, falls amongst admitted patients has become a major concern for stakeholders such as the Center for Medicare and Medicaid Services (CMS), Joint Commission, patients, caregivers and healthcare facilities. The occurrence of falls among the inpatient population can lead to negative consequences such as premature hospital re-admission, increased mortalities and hospital stays, extended pain and potential disabilities. According to statistics, the average fall rates amongst inpatients in the clinical settings is 17.1 per 1000 bed days (King, Pecanac, Krupp, Liebzeit, & Mahoney, 2018). Further, it is approximated that of patients admitted to the inpatient units, five of them will experience falls at least once during their stay at the hospital. As such, the prevalence of falls at hospitals ranges from 1.9%-3% even after several interventions have been adopted. As a result of the falls, 9-33% of the patients may suffer from injuries ranging from mild to fatal (de Souza et al., 2019). The Institute of Healthcare Improvement in its published report concluded that falls account for the most mortalities in older patients, 65 years and above, with 10% of these deaths occurring within the clinical setting (Bhise et al., 2018). Moreover, the falls have also been shown to predispose patients to other issues such as anxiety, distress and depression, which can affect their mental functioning along with physical abilities.  

Leon and Adams (2016) demonstrated that the occurrence of falls has the capacity to increase patient costs by approximately $13,000 dollars. Other parameters such as healthcare spending per fallen patient can increase up to 60% in comparison to other patients. As such, Pearson and Coburn (2012) estimated that the costs associated with injuries and treatment will rise to approximately $54.9 billion this year. Therefore, hospital falls amongst inpatients in clinical settings is a significant matter that should be addressed.  

Stakeholders/ Change Agents 

The Center for Medicare and Medicaid Services and Joint Commission always seek to examine issues that will improve the safety and quality of care offered to patients. As such, they will be important stakeholders in a project that seeks to address hospital patient falls. In addition, nurses, providers, nursing students and other healthcare workers will also play a crucial role as they will be the frontline change agents for the project (Anderson, Postler, & Dam, 2016). Other interested parties in the project will entail families and patients themselves as they are the ones who suffer the consequences of falls.  

The PICOT Question 

In order to address the issue of patient falls at the facility, the present project proposes the adoption of hourly rounds. Thus, the following PICOT question will form the basis of the project: For adult inpatients in medical surgical units (P) does the use of hourly nursing rounds (I) reduce the future risk of falls (O) when compared with call lights (C)? 

The Purpose and Project Objectives 

The purpose of the project is to reduce the prevalence of falls amongst adult inpatients in the medical surgical unit. Specifically, the project will seek to compare the effectiveness of nursing rounds and call lights regarding the reduction of the prevalence of patient falls in the medical surgical units (Anderson, Postler, & Dam, 2016). Therefore, patient fall measurements will be taken before and after the introduction of nursing hourly rounds and comparing call lights to determine which intervention is more effective.  

Importance of Resolving Falls to Nursing  

As mentioned, nurses are the frontline workers that are directly impacted by patient falls. The prevention of patient falls will thus improve nursing work morale and help to prevent them from suffering burnout, as the workload and stress caused by patients suffering after a fall, will be reduced. Moreover, addressing patient falls will allow nurses to practice their care maximally as the patients will not suffer from the effects of the same (King et al., 2018). Further, resolving the issue of patients falls will support the role of nurses as it relates to keeping patients safe. Therefore, addressing patient falls is fundamental to the roles and responsibilities of nurses as well as their workplace wellbeing. 

Literature Support 

Research is an important component that promotes evidence-based practice in nursing. It provides clinical data about the various interventions that can be used to promote the health and wellbeing of the patients. As a result, it makes it evident that nurses should explore different sources of data to understand the manner in which clinical outcomes can be achieved. Therefore, this section of the project summarizes the different sources of data that will be utilized to support the PICOT statement of the project. It also examines the search strategy that was used in obtaining the relevant research materials along with the validity of the research.  

Search Method 

The articles for this proposed project were obtained from a number of databases. They included Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, National Guideline Clearinghourse, CINAHL, Ovid, Google Scholar, PubMed and Medline. The search keywords that were used included patient falls, preventing patient falls, safety issues, risk factors, hourly nursing rounds, and call lights in patient falls. An inclusion and exclusion strategy was utilized in selecting the articles for the review. Firstly, articles that were selected were published in English, they must have also focused on the issue of patient falls and the articles were required to have been published over the last five years. An exclusion strategy was developed and was comprised of excluding studies that were written in languages other than English, published more than five years ago, and did not focus on the issue of patient falls. The search resulted in eight articles that shed light on the effectiveness of the proposed intervention in reducing and preventing rates of patient falls. 

Section B: Literature Support 

Summaries of the Articles 

The first article that was obtained from the search is the one by Goldsack, Bergey, Mascioli, and Cunningham (2015) that aimed at investigating the effectiveness of hourly rounds on reducing the rates of patient falls. The study was a retrospective pilot study where two units were used to implement the intervention. Data was obtained pre and post implementation of the intervention to determine its effectiveness. The nurse leaders as well as champion staff in unit one were involved in the whole process of project implementation. The staff and nurse leaders in unit two were introduced to the project at the training level prior to project implementation. The results of the study revealed that there was a decline in patient fall rate in unit one by 1.3 falls/1000 patient days. This was lower when compared to the 2.5 falls/1000 patient days on unit two. The study revealed that hourly rounds are highly effective in preventing patient falls when there is active stakeholder engagement. One of the strengths of this study is its inclusion of a control and intervention group. This allowed for a better understanding of the effectiveness of the intervention. However, it is associated with a weakness of being a retrospective study. The results of the study could have been influenced by other confounding factors beyond the scope of the project. This article supports the PICOT statement for the research by showing the effectiveness of the intervention in reducing patient falls.  

The second article that provides insights into the proposed project was published by Leone and Adams (2016). This research is a retrospective review of quality improvement projects that focused on reducing rates of patient falls by using an organizational culture of safety in rehabilitation units. The authors reviewed a quality improvement project that investigated the effectiveness of multiple fall interventions in promoting patient safety. A retrospective review of falls in the inpatient rehabilitation units was done. The quarterly fall rates were then compared with the dates in which fall prevention interventions of hourly rounding, signage, and safety huddles were implemented. Safety scores on culture were also obtained to determine the effectiveness of a safety culture on lowering the rates of patient falls. The results of the study revealed that the utilization of a culture of safety with hourly rounding had the largest decline in fall rate among patients. The research is associated with the strength of comparing the effectiveness of different interventions that can be utilized to prevent patient falls. This comparison provides a better understanding of the efficacy of the different fall prevention methods used in the clinical settings. The researchers also linked the outcomes of fall prevention with organizational culture. As a result, a correlation between safety culture and patient falls can be obtained. However, it is associated with a weakness of being a review of a quality improvement project. It failed to show the impact of project deliverables on reduction in patient falls.  

Another research that was selected for this summary is the one conducted by Brosey and March (2015). This research investigated the effectiveness of using structured hourly nurse rounds on clinical outcomes and patient satisfaction. The researchers utilized evidence from articles that were obtained from databases that included PubMed, CINAHL, Nursing & Allied Health Collection and Cochrane Database of Systematic Reviews. Analysis of the data from the articles led to a solution that entailed the utilization of two hours structured nurse rounding in a large tertiary hospital. Obtained data was analyzed using methods that included descriptive statistics and Cox-Stuart trend analysis to determine changes in patient falls following the adoption of the intervention. The results of the study revealed that a clinical and statistical significance in the reduction of patient falls was recorded. There was also a corresponding improvement in the rate of patient harm. The reduction in patient harm was witnessed for a period of one year after the implementation of the intervention. This study has the strength of monitoring the intervention for three years to determine its effectiveness. Its utilization of the best intervention from the selected articles also strengthened the effectiveness of the selected intervention. However, it has a weakness of failing to control confounding factors that might have affected the domain scores of the healthcare providers.  

In a retrospective descriptive study, Anderson, Postler, and Dam (2016) examine the epidemiology of patient falls in a hospital system. “The objective of this retrospective descriptive study was to describe the locations and characteristics of hospital-related falls. Data on patient characteristics, including locations and fall circumstances, were collected from incident reports and medical records” (Anderson, Postler & Dam, 2016, p. 423). The results of the study revealed varied outcomes on the risk of patient falls and identified 1,822 falls, within one year, at a 921-bed facility located in an urban hospital center. From the research, 97.0% (1,767) of the falls were reported in the inpatient units while 3% (55) occurred during the provision of ambulatory care. In the research, 73.5% of the patients who fell were aware of the fall prevention protocol before the fall happened. However, to the authors surprise, the youngest age group recorded the highest rates of falls and this raised concerns about the effectiveness of the falls prevention protocol in the facility.  

An article by Bhise et al. (2018) describes how an electronic trigger can be used to recognize preventable adverse events that happen to hospitalized patients. “We refined the methods of the Institute of Healthcare Improvement’s Global Trigger Tool (GTT) application and leveraged electronic health record (EHR) data to improve detection of preventable adverse events, including diagnostic errors” (Bhise et al., 2018, p. 241). The research examined preventable adverse events in 42 cases. The outcome revealed 7 cases (7.6%) were related to diagnostic errors while 34 (37.0%) represented cases of patient care management events. 24 cases (26.1%) were due to adverse drug events, 4 (4.3%) were attributed to patient falls, 4 cases (4.3%) were linked to procedure-related complications and 2 cases (2.2%) were due to hospital-associated infections. From the results, it is evident that patients were subjected to potential hospital harm with 37.0% being attributed to errors in patient care management. Limitations were however identified with regard to the use of electronic triggers in specifying preventable harms to hospitalized patients.  

The article by de Souza et al. (2019) explores the concept of inpatient hospital falls occurring in a large hospital. A database was generated by the authors from a hospital in the South of Brazil to examine patient falls in a hospital setting. Information collected were those published from January 1, 2012 through December 2017. The data set for the research was based on information about the level of risk for falls, type of injuries sustained, the implemented fall prevention protocol in the facility, and the reasons for falls. In a descriptive methodology, the study reveals that the risk of falls in a care facility depends entirely on the implementation of a fall prevention protocol such as nursing rounds. Interventions such as nursing rounds improve safety to patients, regardless of the type of falls they are exposed to, in an effort to optimize quality outcomes for patients. However, the study does not reveal the level of association between medications administered and the risk of falls for hospitalized patients.  

  The literature reviews also incorporated the article by King, Pecanac, Krupp, Liebzeit, and Mahoney (2018) that reported a study conducted to identify the impact of fall prevention among the nursing staff and how care is administered to patients at risk of falls. The research was a qualitative study whereby the authors used the Grounded Dimensional Analysis (GDA) to establish the experience of nurses providing care to patients. Specifically, actions taken by nurses to prevent falls were identified and the approaches used by the hospital facility to respond to the consequences of falls were evaluated. 27 registered nurses were enrolled in the program and in-depth interviews were conducted to collect the data. The outcome of the study showed that hospital administration used intense fall prevention messaging with staff and interventions such as nursing rounds to achieve zero falls in the facility’s inpatient units. However, the results indicated that nurses developed immense fear for patient falls and were keen to protect the incidences just to meet the goals of the hospital.  

Mitchell, Lavenberg, Trotta, and Umscheid (2014) examined how hourly rounds improved the response of nurses towards the falls of hospitalized patients. The study was a systematic review and compiled data retrieved from previous studies most of which were based on different methodologies. In the review, the authors focused on recently published materials that had the subject headings on how nurses reduce hospital falls to patients. Despite little consistency in the manner in which data was collected, the study revealed that hourly rounds by nurses yielded a moderate strength in the response of nurses to patient falls. The approach improved the perception of nurses towards patient care which also gave them time to evaluate the causes of falls for hospitalized patients. 

Validity of Internal and External Research 

The population characteristics of the selected studies were adequate to generate a bundle of evidence about the effectiveness of the articles. In most research materials, except for systematic reviews, the participants were those that represent the nurse and patient population to whom outcomes can be implemented in future nursing practice. For instance, the characteristics and perception of nurses with regard to patient falls were examined to establish how they respond to the risk of falls to patients.  Nonetheless, the interaction between subject selection and the metrics of research were vividly explored by eight articles to affirm the effectiveness of the study in improving quality outcomes to patients. The research environment, on the other hand, was localized in care facilities and this is consistent with the area in which the study is yet to be implemented. However, except for systematic reviews, data collection methodology was applied in the context to generate both quantitative and qualitative data which are predictive in influencing the research outcomes prior to implementation. The effect of time was also checked as the articles used were those published between 2014 and 2018. The premise ensured the use of research materials that were up-to-date with the subject of study to ensure accurate information.  

Conclusion 

The review of the selected articles has shown that the use of nursing rounds is effective in reducing rates of patient falls. However, its effectiveness over the use of other methods such as call lights has not been explored. As a result, the proposed intervention seeks to establish this cause by investigating whether nurse rounds are more effective than call lights in preventing or reducing patient falls. Through this, it will inform the adoption of evidence-based interventions in clinical practice.  

Section C: Solution Description 

Falls among hospitalized patients should be prevented at all costs to improve patient outcomes. The incidences of inpatient falls are increasing within organizations and are the second leading cause of accidental or unintentional deaths. These occurrences are preventable accidents yet continue to be a highly prevalent patient safety issue (Walsh et al., 2018). There is increasing evidence that fostering safety and cautious culture within clinical teams can help reduce or prevent falls and other harmful events. This project has described, in the previous sections, inpatient falls and how they impact a patient’s health status. However, this section of the project provides a project solution in the following criteria: the proposed solution, organization culture, expected outcomes, methods to achieve outcomes, as well as outcome impact.  

Proposed Solution 

The proposed solution to prevent falls among admitted patients is hourly rounds. Rounding is a process where healthcare providers intentionally check patients at regular intervals to meet their needs proactively (Grillo, Firth, & Hatchel, 2019). Hourly rounds are a very important activity that nurses can employ to promote patients’ safety as well as reduce falls by as much as 50% and above in the clinical setting. Major components of hourly rounds include “addressing the “4ps” of pain, potty, positioning, and possessions, reducing anxiety, assessing patients’ environment for safety concerns, and informing the patients when staff will return” (Brown, 2016, p. 10). 

 Hourly rounding is associated with reduced patient falls, improved patient experience, and increased staff satisfaction. Therefore, in this project, the proposed solution is implementing hourly rounds which are expected to reduce the prevalence of falls among admitted patients and increase satisfaction in overall nursing care. Different studies have also supported the use of hourly rounds for instance, Brosey and March (2015) employed a standardized hourly rounding for three months and monitored the outcomes. The hourly rounding study was carried out in a 24-hour bed medical-surgical unit. The authors stated that the results of the study indicated a reduction in falls from 7.02 to 3.18 per 1000 patient days. This is evidence-based support that hourly rounds can prevent inpatient falls in a medical-surgical unit.  

Organizational Culture 

Organizational culture can be described as shared beliefs, values, and norms related to patient safety. The safety culture within the organization will support the implementation of hourly rounds. Considering the importance of nurses’ roles to promote patient safety, their knowledge and experiences are without a doubt the solution that will make this successful (Mitchell, 2017). The facility has enough healthcare personnel including nurses and providers which will promote the effectiveness of the project. Hourly rounding has faced many problems in terms of implementation within hospitals that have staff shortages. 

 The effective components of patient safety such as teamwork, communication, and leadership support are well evident within the employees. Furthermore, the facility has always promoted a culture of continued learning to ensure competency is maintained. The organizational leadership has been outstanding in promoting and supporting safety projects including training and education (Walsh et al., 2018). The decision-making process is always inclusive of all staff as opposed to some workplaces where all decisions are reached by one or a few people. Besides, the organization has well-established policies that require everyone to participate in activities that bring benefits to patients, staff, and the organization. Everyone must work towards achieving organizational goals, vision, and mission.  

Expected Outcomes 

These are forecasted results that are yet to be achieved as a result of implementing hourly rounding. It is expected that after the implementation of hourly rounds, the prevalence of falls among the adult inpatients in the medical-surgical units will decrease to below 2 percent of cases per month. Additionally, the risks that may lead to future falls will be identified and appropriate measures will be taken to ensure falls among patients in the medical-surgical unit do not occur in the future (Jarrell, 2016). The number of deaths, disabilities, and other adversities associated with falls is expected to be reduced. Nurses will be given the opportunity to compare the effectiveness of nursing rounds and call lights regarding the reduction of the prevalence of falls among patients in the medical-surgical unit. Furthermore, patient satisfaction is expected to dramatically improve along with employee satisfaction due to the nurse’s workload being reduce from the burden of both physical and mental work caused from patients who experience falls. The organizational goal of achieving and maintaining high-level patient safety measures will also be achieved. This achievement is worth celebrating not only in the medical-surgical unit but for the entire organization (Jarrell, 2016). This strategy is expected to be adopted throughout the entire organization after a successful implementation in the medical-surgical unit.  

Method to Achieve Outcomes 

The setting of the project is the medical-surgical unit of the hospital where most falls are reported. It will be a 30-day prospective pilot study to determine the effectiveness of hourly rounding on the prevention of inpatient falls. The patient-centered hourly rounds will be designed collaboratively with nurses and providers (Farokhzadian, Nayeri, & Borhani, 2018). Educating the staff is the first step in implementing hourly rounds. A one-hour class, three times per week, will be introduced at regular times for both nurses and providers during a two-week period before project implementation. Different scenarios will be shown during the lessons to reinforce positive behaviors. 

 The objectives of the training sessions are to ensure staff understands the hourly rounds, recognize its value by explaining the “why” behind this project and receive the knowledge required to effectively implement them. Also, the training sessions were meant to ensure that the rounds are patient-centered and that they happen at specific times (Mitchell, 2017). The rounds will be conducted every hour between 6 am and 10 pm and every 2 hours between 10 pm and 6 am with the rounding being performed the majority of the time by nurses, nurse leaders and providers. A Mann-Whitney test will be used to compare baseline fall rates with the project period. An evaluation will be carried out based on the fall rates and other factors such as reduced accidents and deaths due to patient falls in the medical-surgical unit.  

Some of the limitations that need to be addressed to ensure success in the implementation process include financial resources, staff adequacy, management support and training. There must be enough resources to implement the project. Also, there must be enough nurses to ensure that workload does not compromise the process (Farokhzadian, Nayeri, & Borhani, 2018). Nurse workload due to staff shortage could potentially cause nurses to miss some scheduled hourly rounds. Additionally, training is important to show nurses and providers the process and the value of implementing this intervention. Administration and management support are highly required to ensure the project succeeds.  

Outcome Impact 

 The outcomes will impact positively on quality care improvement, patient-centered quality care, the efficiency of processes, environmental changes, and professional expertise. In healthcare quality improvement is the framework used by the hospital to systematically improve the way care is provided to patients (Alves et al., 2016). Successful outcomes will impact positively on quality care improvement with increased teamwork among nurses and providers by adopting a new way of delivering quality care to the patients. The process of this intervention also includes a safety environmental assessment (Alves et al., 2016). This will improve the patient’s environment, to prevent risks associated with falls, by ensuring that the room is well arranged, free of clutter, and clean. 

 Furthermore, the hospital system is likely to change in terms of being a patient-centered facility. The solution is patient-centered hourly rounds which will, in turn, promote the aspect of patient-centered care in the entire organization. The aspect of patient-centered care will be adopted not only in the medical-surgical unit but also across the facility to promote quality patient outcomes (Brosey & March 2015). Another outcome associated with reduced falls is a decreased physical and mental workload for nurses and providers. Finally, the outcomes impact positively on professional expertise since the nurses will gain competency required in managing patient falls through evidence-based practice on hourly rounding.  

Conclusion 

The proposed solution for the problem is the implementation of hourly rounds. Hourly rounds are a very important activity that nurses can employ to promote a patient’s safety as well as reduce falls by as much as 50% or more in the clinical setting. The organizational culture is a highly reliable organization which promotes this intervention. Expected outcomes include reduced incidences of falls as well as deaths and disabilities associated with inpatient falls. The outcomes will impact positively on quality care improvement, patient-centered quality care, the efficiency of processes, environmental changes and professional expertise. 

Section D: Change Model 

Theories of change are important in the implementation of evidence-based practice in the clinical settings. They guide the adoption of strategies that should be utilized to ensure that the change is successfully implemented. They also provide the basis in which project evaluation will be undertaken. Through it, the project stakeholders understand the factors that contributed or hindered the realization of the goals and objectives of the project. Therefore, this section of the project presents the change model that will be used in implementing the evidence-based practice project.  

The Selected Theory for the Project 

The selected theory for implementing the evidence-based practice project is innovations diffusion theory by Rogers. Rogers developed the model with the aim of describing the manner in which an idea gains momentum among people and spreads for its collective adoption. According to Rogers (2003), the product of the model is the implementation of the idea for social use (p. 6). The model however reveals that the rate of adoption of an idea is not a simultaneous process. Instead, the adoption of an innovation is unpredictable with some people adopting it earlier than others do. As a result, Rogers recommended the need for the understanding of the characteristics of the adopters and ways of promoting uniformity in the adoption process of a change. Rogers conceptualized that the process of implementing change occurs in steps that include knowledge, persuasion, decision, implementation and confirmation (Al-Suqri & Al-Aufi, 2015).  

Application to the Evidence-Based Project 

Each of the steps of change process by Rogers will be applied in the implementation of the project. According to Rogers, the first stage of the adoption of change is knowledge. The adopters of the change in this stage become aware of the change and find more information about it. They try to determine what the change is and the ways in which it can influence them. Despite having the knowledge about the innovation or change, they do not adopt it since they are not sure of its significance to them (Wang, 2017). The adopters of the proposed change in the project will be aware of the use of nursing rounds to prevent patient falls. They also seek more evidence-based data on its use. However, they do not make use of it due to strongly held beliefs about their current behaviors.  

The second step in the implementation of change according to the diffusion innovations theory by Rogers is persuasion. According to Rogers, the adopters of the change in this stage develop attitude towards the change. The information that they utilize to increase their understanding in the first stage influence their perception towards the change. It is worth noting however that their attitude does not have a direct influence on their decision to adopt or reject the change. The adopters also tend to validate their experiences by seeking the opinions of others concerning the clinical use of the innovation. Therefore, they continue searching for information that would enable them to make decisions on whether to use the change or not in their settings (McCabe, 2020). This stage is applicable to the proposed evidence-based practice project. The adopters of the change develop a mix of attitudes towards the change in this stage. They can either develop a positive or negative attitude towards it. They also explore expert opinion concerning the clinical use of the change. Consequently, they use the information that they obtain in making decisions on the adoption of the change in their settings.  

The third step in the theory of innovation diffusion by Rogers is the decision stage. The decision stage is the phase where the adopter of the innovation or change decides to either accept or reject the change. Rogers identified that change or innovations that are implemented on a trial basis are likely to receive a high rate of adoption when compared to those that are implemented without trials. The high rate of adoption is attributed to the thirst for trial of the innovation by the adopters (Cameron & Green, 2020). The adopters of the proposed evidence-based practice intervention will decide to adopt it or reject. Their decision will largely be based on the information that they obtained in the previous stages. Therefore, it is important that the adopters be provided with the right information that will promote informed decision-making among them.  

The implementation stage is the other phase of innovation adoption in the model proposed by Rogers. The change or innovation is implemented or put into use in this stage. However, its use is often associated with significant uncertainty to the adopters. They are unaware of the anticipated outcomes or ways of achieving them. As a result, technical support might be needed to ensure effective use of the innovation in the clinical setting (Cameron & Green, 2020). The adopters of the proposed evidence-based practice will put it into practice in their clinical settings. They will however have concerns on the behaviors that are needed for its success. Therefore, support from the management and leaders of the project will be provided to enhance its adoption.  

The last stage of the theory of change by Rogers is confirmation. The decision to adopt the change has been made in this stage. The adopters therefore look for additional ways in which their behaviors could be improved. It is necessary to ensure that the adopters receive the required support and information in this stage since they can easily revert to their old ways of doing things in their organizations (Cameron & Green, 2020). The adopters of the proposed evidence-based practice intervention have already made their minds on the adoption of the change. Consequently, the organization should ensure that the right information and support is provided to them to prevent them from reverting to their old ways of promoting patient safety in their units.  

Conclusion 

Overall, the theory of innovations diffusion will be used in the implementation of the proposed intervention. The theory will guide the implementation process, decisions, and resources that are needed. It will also provide insights into the expected reactions from the adopters towards the change and ways of facilitating the process. Therefore, it will be important for the stakeholders involved in the implementation process to increase the availability of relevant information and support related to the change.  

Section E: Implementation Plan 

Implementation is a crucial step in the adoption of evidence-based practice protocols in the clinical settings. It requires careful use of the available resources to ensure that the deliverables of the project are achieved. It also demands active collaboration between the adopters for its successful use in the organization. This therefore proves evident that healthcare organizations should come up with measures that minimize the risk of resistance to adoption of the change among the adopters. Consequently, this section of the project explores the implementation plan that will be used in the evidence-based practice project.  

Setting and Access to Participants 

The implementation of evidence-based practice projects should be conducted in settings where the subjects are easily accessible. The implementation should also be conducted in the natural environments of the subjects to ensure objectivity of the obtained results (Harvey & Kitson, 2015). The proposed project will be implemented on the medical-surgical unit for adult patients. This setting will be appropriate for the intervention since patient falls often occur on this unit. The unit also provides care to patients who have conditions that predispose them to falls. The nurses in the unit have also been seeking for new ways to promote patient safety. As a result, the proposed intervention is best suited, as it will address the safety needs of the patients on this unit.  

The implementation of the project will require approval from the administration of the hospital. Approval is required to ensure that the intervention promotes patient safety and the realization of quality outcomes in the organization. The approval form that will be utilized in seeking implementation for the project will be attached in the Appendix section. Potential subjects for the proposed interventions are nurses working on the medical-surgical unit. The nurses are involved in the promotion of patient safety in these settings. Therefore, they will be the key stakeholders that will implement the utilization of hourly nursing rounds to reduce and prevent patient falls.  

Time 

Adequate time for the implementation of evidence-based practice project is important. It provides an accurate picture on the effectiveness of the intervention in promoting the desired outcomes in healthcare. This also provides flexibility in the modification of the strategies that are used to provide the expected outcomes (Greenhalgh, 2018). Therefore, the estimated time that will be needed for the implementation of the proposed project is six months. This time is perceived adequate since it will allow the determination of the rates of patient falls on the floor that uses hourly rounds and the floor that only utilizes call lights. The timeline of all the events that will occur in the implementation of the project during the six-month period will be attached in the Appendix section. The tentative timeline of events that will be undertaken during the six-month period is as follows 

Resources 

Successful implementation of the proposed evidence-based practice project will require the use of significant organizational resources. One of these resources is the healthcare providers. Nurses will be highly utilized in the implementation of the project. They will be required to conduct hourly rounds on their floor and record any incidence of patient falls. The other group of nurses will be required to utilize their normal approach to promoting patient safety for falls using only call lights. The other resource that will be needed in this project is financial support. Financial resources will be required for training the nurses, materials, analyzing data and presenting the outcomes. The other resource that will be utilized in the project is time. Nurses have to spend most of their time in monitoring the safety of the patients on their floors. The implementation of the project will not demand a change in the existing organizational tools. Therefore, the existing structures and processes will not be altered except the introduction of hourly rounds on one of the medical-surgical floors. The resources that will be needed for the successful implementation of the project are attached in the Appendix section.  

Methods and Instruments 

The data for this intervention will be obtained using questionnaires and total incidents of patient falls during the period of project implementation. Self-administered questionnaires will be given to the nurses to obtain information on their experiences with the intervention. The questions will be both open and closed-ended questions. The use of questionnaires was selected for the intervention due to a number of reasons. First, they allow the acquisition of rich data from the subjects. They also facilitate objective and subjective acquisition of data related to the experiences of the participants (Howlett, Shelton & Rogo, 2020). Questionnaires were also chosen because the process of organizing and analyzing data obtained from them is an efficient process. Lastly, it was considered less costly when compared to other methods of data acquisition such as interviews with the subjects (Melnyk, Gallagher-Ford & Fineout-Overholt, 2017). Statistics of the incidents of patient falls reported on the medical-surgical unit will also be obtained. This will be analyzed to provide comparative data on whether the intervention was effective or not.  

The Process of Delivering the Intervention 

The intervention will be delivered through a carefully planned process. The approval will be sought from the administration of the hospital prior to its implementation. Nurses from one medical-surgical floor will be selected as the treatment group while those from the other medical-surgical floor will be placed on the control group. Nurses in the treatment group will be trained on the use of hourly rounds in detecting and preventing patient falls. The nurses in the control group will not receive any form of training. These nurses will provide the usual care of detecting and preventing patient falls using only call lights. The intervention will be implemented for a period of three months in both settings where data will then be obtained to determine the effectiveness of the intervention. Data obtained will be analyzed and results presented to the healthcare providers and the administration of the hospital.  

Data Collection Plan 

As shown earlier, the data for the intervention will be collected using questionnaires and statistics of patient falls in the adult medical-surgical unit. The questionnaires will be administered to the nurses to obtain information about their subjective and objective experiences with the intervention. Data on the reported incidence of patient falls during the period of the intervention will be utilized for comparative purposes. A data analyst will be tasked with the responsibility of data management. The obtained data from the intervention will be analyzed using SPSS software version 20.0 and demographic data of the nurses will be analyzed using descriptive statistics. The data collection tools that will be utilized in this project will be attached in the Appendix section of the final paper.  

Managing Any Barriers, Facilitators, and Challenges 

It is expected that some barriers or challenges might affect the implementation of the proposed project. One of the challenges is the resistance of the nurses in adopting to the change. The resistance could also be attributed to factors such as fear of the unknown or perceived increased workload. This issue will be addressed by training them on the implementation of the intervention along with information on the significance of the project will also be provided (Ammenwerth & Rigby, 2016). The other challenge that might be experienced is the lack of financial support from the hospital. This issue will be addressed by ensuring that the intervention aligns with the hospital’s mission, vision and quality metrics.  

Feasibility of the Implementation Plan 

It is estimated that the implementation of the plan will cost the hospital approximately $140,000. This amount will be used to gather the costs incurred in presentations, training, data analysis, and purchasing of materials. It will also cover the cost incurred in hiring additional nurses should the workload in the departments increase beyond the expected level. Therefore, cost-efficient methods will be utilized to ensure that allocated resources are enough for the implementation process.  

Plans to Maintain, Extend, Revise and Discontinue the Proposed Intervention 

The proposed solution will be maintained if it proves effective in reducing the rates of patient falls in the hospital. This will be in comparison with the use of call lights in the inpatient units. The intervention will also be maintained if it is found to be cost effective when compared to the use of call lights. The intervention will be extended if the number of patients at risk of falls admitted to the medical-surgical unit declines. It will be revised if it is found that the intervention that is used does not directly result in reduction in patient falls. It will be discontinued if it predisposes the nurses and patients to adverse events such as harm and increased risk of falls.  

Conclusion 

In summary, this section has described in detail the implementation plan for the project. It has explored the subjects and setting where the intervention will be implemented. It has also described the methods that will be utilized in data collection and analysis. Therefore, it is anticipated that the subjects will be ready to implement the project in their settings. Interventions that minimize threats to the implementation process will be adopted.  

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