D219 Task 1 Evidence-Based Practice: Fall Prevention in Hospitals

Student Name

Western Governors University

D218 Intrapersonal Leadership and Professional Growth

Prof. Name:

Date

Evidence-Based Practice and Applied Nursing Research: Hospital Fall Prevention

Clinical Practice Problem: Hospital Falls

Hospital falls represent a significant clinical concern that can lead to severe injuries, long-term disability, and even death. A fall within a healthcare setting not only compromises patient safety but also imposes substantial financial and operational burdens on hospitals. According to LeLaurin and Shorr (2019), nearly one million hospital falls occur annually in the United States, resulting in approximately 250,000 injuries and 11,000 deaths. These falls are considered the most common adverse events within hospital environments.

Furthermore, the Centers for Disease Control and Prevention (CDC, 2021) estimated that in 2015 alone, the total medical costs associated with fatal and nonfatal falls reached nearly $50 billion. These costs encompass direct medical expenses, extended hospital stays, and post-fall rehabilitation. The widespread prevalence of hospital falls underscores the urgent need for evidence-based interventions to mitigate risks and improve patient outcomes.

Identify the PICO Components

PICO Element	Description
P (Population/Problem)	Hospitalized patients at risk of falling
I (Intervention)	Implementation of comprehensive fall prevention education
C (Comparison)	Limited or no fall prevention education
O (Outcome)	Reduction or elimination of patient falls

Evidence-Based Practice (EBP) Question

In a population of hospitalized patients at risk for falls (P), how effective is implementing fall prevention education (I) compared to limited or no fall prevention education (C) in decreasing or eliminating the number of falls (O)?

Research Article

Citation
de Freitas Luzia, M., Vidor, I. D., da Silva, A. C. F. E., & de Fátima Lucena, A. (2020). Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC. Applied Nursing Research, 54. https://doi.org/10.1016/j.apnr.2020.151273

Background and Introduction

The study by de Freitas Luzia et al. (2020) sought to evaluate the effectiveness of nursing interventions and patient knowledge in preventing hospital falls among individuals identified as high-risk. The researchers explored how structured nursing outcomes, guided by the Nursing Outcomes Classification (NOC), could impact fall prevention efforts.

Methodology

This quantitative, cross-sectional study involved 68 adult patients aged 17 years or older who were classified as high risk for falls using the Morse Fall Scale (MFS). Participants were drawn from both clinical and surgical hospital units.

Methodological Aspect	Description
Design	Cross-sectional quantitative
Sample Size	68 patients
Inclusion Criteria	Age ≥ 17, high risk for falls
Assessment Tool	Morse Fall Scale (MFS)

According to the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) model, the level of evidence was classified as Level II (quasi-experimental), as researchers had some control over patient selection.

Data Analysis

Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS). Correlations between knowledge and fall prevention were measured using Pearson or Spearman correlation tests. The study also utilized t-tests to assess associations between categorical variables and nursing outcomes. NOC indicators were analyzed through mean score comparisons using Generalized Estimating Equations (GEE) and Post Hoc Least Significance Difference (LSD) tests to determine significant differences over time.

Ethical Considerations

The study was reviewed and approved by the institutional ethics committee. Informed consent was obtained from all participants, ensuring voluntary and ethical participation.

Quality Rating

The study received a Quality Rating of B, indicating good quality with minor limitations. One noted limitation was the exclusion of patients with cognitive impairment or communication barriers, which could potentially limit generalizability.

Analysis of the Results and Conclusions

Findings revealed that patients at high risk for falls often possess limited knowledge regarding prevention strategies. Educational interventions significantly improved patients’ awareness and behaviors associated with fall prevention. The study concluded that continuous education and nursing interventions were effective in reducing hospital fall rates.

Alignment to the EBP Question

This research aligns closely with the proposed EBP question, providing strong evidence that structured fall prevention education substantially reduces fall incidences among hospitalized patients.

Non-Research Article

Citation
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A.-M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

Background and Introduction

The scoping review by Heng et al. (2020) examined the impact of patient education interventions in preventing hospital falls. The study synthesized evidence from various inpatient programs, analyzing their design, effectiveness, and the educational tools used to engage patients in their own safety.

Type and Level of Evidence

Aspect	Details
Type of Study	Scoping Review
Level of Evidence	Level V
Quality Rating	B – Good quality

Author’s Recommendations

Heng et al. (2020) concluded that patient education significantly reduces the risk of hospital falls when programs are well-structured and grounded in behavioral change theories. They emphasized the importance of empowering patients with the knowledge and confidence to manage their own fall risks effectively.

Alignment to the EBP Question

This review supports the EBP question by reinforcing the idea that fall prevention education—particularly when designed around behavioral and educational principles—is crucial in reducing fall incidence.

Recommended Practice Change

The proposed practice change is to implement a comprehensive fall prevention education program for hospitalized patients identified as being at high risk. Both Luzia et al. (2020) and Heng et al. (2020) emphasized that patient-centered education not only enhances awareness but also fosters proactive behavior that prevents falls and associated injuries.

Key Stakeholders

Stakeholder Group	Role in Implementation
Hospital Leadership/Finance Team	Allocate budget and approve program resources
Education Department	Develop educational content and training modules
Bedside Nursing Staff	Deliver fall prevention education and monitor patient compliance

These groups are instrumental in ensuring that educational initiatives are properly designed, funded, and implemented within clinical settings.

Barriers to Implementation

Common barriers include limited financial resources, time constraints, and staff resistance to new initiatives. Nurses often experience “change fatigue,” making them hesitant to adopt new responsibilities without seeing immediate value.

Strategies to Overcome Barriers

Financial Strategies: Apply for state or federal grants and highlight the long-term cost savings from reduced fall rates.
Staff Engagement: Involve bedside nurses early in the EBP process to foster ownership and reduce resistance.
Quality Data Utilization: Collaborate with the quality improvement department to quantify the cost-benefit ratio of fall prevention interventions.

Indicator to Measure the Outcome

Outcome measurement will rely on comparing pre- and post-intervention fall rates. The hospital’s quality department can analyze recorded fall data to determine whether the educational program effectively reduced or eliminated falls among at-risk patients.

References

Centers for Disease Control and Prevention. (2021, August 6). Facts about falls. https://www.cdc.gov/falls/facts.html

de Freitas Luzia, M., Vidor, I. D., da Silva, A. C. F. E., & de Fátima Lucena, A. (2020). Fall prevention in hospitalized patients: Evaluation through the nursing outcomes classification/NOC. Applied Nursing Research, 54. https://doi.org/10.1016/j.apnr.2020.151273