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Benchmark Capstone Project Change Proposal

Students will develop a 1,250-1,500 word paper that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

Background
Problem statement
Purpose of the change proposal
PICOT
Literature search strategy employed
Evaluation of the literature
Applicable change or nursing theory utilized
Proposed implementation plan with outcome measures
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome
Appendix section, if tables, graphs, surveys, educational materials, etc. are created

Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

This assignment uses a rubric. Please USE THE RUBRIC FOR PROPER COMPLETION OF THIS ASSIGNMENT.

Literature Evaluation Table

Student Name: Yavaunee Jackson

Change Topic (2-3 sentences):

Falls is a national issue, with many interventions in place the statics related to falls has not indefinitely decreased. Through research and fall prevention efforts and studies on present efforts and potential interventions; I plan to understand how to implement changes in the hospital setting and to better equip and educate nursing staff on assessment of fall prevention.

Criteria	Article 1	Article 2	Article 3	Article 4
Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article	Radecki, Bethany Reynolds, Staci Kara, Areeba APPLIED NURSING RESEARCH ; OCT 2018, 43 p114-p119, 6p. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=edswss&AN=000445974000019&site=eds-live&scope=site	Huey-Ming Tzeng1 Huey-Ming Tzeng1 https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=126865180&site=eds-live&scope=site	Votruba, Lisbeth1,2 (NURSE) Graham, Bridget3 (NURSE) Wisinski, Jeana4 (NURSE) Syed, Ayesha5 (NURSE) Nursing Economic$. Jul/Aug2016, Vol. 34 Issue 4, p185-189. 5p. 1 Chart. https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=117536394&site=eds-live&scope=site	Cangany, Martha Clinical Educator, Post-Surgical Unit, Orthopedic/Neuroscience Unit, and Liaison, Carmel Inpatient Unit, Franciscan Health, Indianapolis, IN Source: MEDSURG Nursing (MEDSURG NURS), Nov/Dec2018; 27(6): 379-382. (4p https://lopes.idm.oclc.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=133645964&site=eds-live&scope=site
Article Title and Year Published	Inpatient fall prevention from the patient’s perspective: A qualitative study(2018)*	A Multihospital Survey on Effective Interventions to Prevent Hospital Falls in Adults. (Dec 2017)	Video Monitoring to Reduce Falls And Patient Companion Costs For Adult Inpatients. (Jul/Aug 2019)	Preventing Falls: Is No Toileting Alone the Answer? (NOV/DEC 2018
Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study	Falls are one of the most common adverse events in hospitals and can lead to preventable patient harm, increased length of stay, and increased healthcare costs. There is a need to understand fall risk and prevention from the patients’ perspectives; however, research in this area is limited. Aim: The aim of this study was to describe the patient’s perspective of fall prevention in an acute care setting to aid in the design of patient centered strategies	A multihospital, cross-sectional design explored the underlying grouping structure of the nurse perceived effectiveness items of preventive interventions in acute hospital settings. Twenty-one highly effective interventions to prevent fall injuries were identified.	The specific aim of this study was to evaluate the effectiveness of remote video monitoring with a dedicated tele sitter in order to reduce falls, as well as to reduce patient companion usage in the inpatient adult population	What affects do integrating a “fall bundle” have on patient safety and does utilizing a “no bathroom alone” policy help to decrease the amount of falls?
Design (Type of Quantitative, or Type of Qualitative)	A qualitative study was designed to describe the patient’s perspective of their own fall risk and of the fall prevention interventions implemented by nursing staff. The study was reviewed and approved by the local Institutional Review Board (protocol #1407636143).		All adult patients admitted to one of the three study units during the intervention stage were eligible to be selected for video monitoring with NURSING ECONOMIC$/July-August 2016/Vol. 34/No. 4 187 the exception of those meeting exclusion criteria. Patients with behavioral restraints and those at risk for harm to self or others were excluded from the stud	This study was compromised of taking a nursing unit with a high fall risk and slowly over 3 years integrating a fall bundle into the fall prevention program. Using these methods to assess if there would be a decrease in fall related to specific interventions. Nurses on the unit where educated comprehensively on new interventions.
Setting/Sample	The study was conducted in a large, urban, tertiary care, academic health center in the Midwest. The facility has been designated as a Magnet Hospital for excellence in nursing services and high-quality clinical outcomes for patients. Participants were selected from non-intensive care inpatient units. The facility screens all inpatients for fall risk on admission and every shift. In addition to universal fall risk prevention measures, additional interventions are matched to patient specific etiology to mitigate fall risk. Interviews took place over a period of seven weeks starting October 2014. Data collection was interrupted for a period of five months due to personal leave and was completed in March 2016.	Design. An exploratory, cross-sectional study was conducted at five nonprofit health systems located in the Midwest region of the United States from July 2011 through February 2012. It included 68 critical care, step-down, and noncritical acute care units for adult inpatients. Unit types included medical, surgical, combined medical-surgical, telemetry, oncology, orthopedics, cardiac, behavioral, women’s health/delivery, rehabilitation, and geriatric units (Tzeng & Yin, 2013). This study was approved by each health system’s institutional review board (IRB). Each IRB waived documentation of consent.	This research study took place in a 350-bed urban, not for-profit, Magnet ®-designated hospital. The intervention took place in three inpatient, adult units including a critical care/intermediate unit, a neuroscience unit, and a senior adult unit. Approval was obtained from the institutional review board to conduct the research with a waiver of consent. Consent for video monitoring was included in the organization’s general consent for treatment.	43-bed post-surgical unit in a not-for-profit healthcare setting in the midwestern United States
Methods: Intervention/Instruments	. Interviews were audiotaped and conducted in the patient’s private room using a standardized open-ended interview approach (Turner, 2010). The interview guide was developed by the investigators with input from local and national experts in fall prevention. The guide was designed to elicit patient awareness/perceptions of fall risk and prevention interventions. Interviews were transcribed verbatim and checked for accuracy – Benchmark Capstone Project Change Proposal	The survey tool used in this study, The Injurious Fall Risk Factors and Fall Prevention Interventions Survey, was developed by the authors (Tzeng & Yin, 2013). Its development was based on previous studies and guidelines related to fall prevention (American Geriatrics Society and British Geriatrics Society Panel on Prevention of Falls in Older Persons, 2011; Currie, 2008; GrayMiceli, 2008; Shever et al., 2011; Titler, Shever, Kanak, Picone, & Qin, 2011; Tzeng & Yin, 2008a, 2008b). Authors sought input from 11 clinical or content area experts on the initial version of the survey tool	The intervention phase of this prospective, descriptive study took place over a 9-month period. During the intervention phase, a dedicated tele sitter was added to the central monitoring unit (CMU) 24/7 to observe up to 12 patients at high risk for falls in three adult inpatient units as an alternative to using a patient companion. The tele sitter workstation was located in the CMU, at a workstation adjacent to the hospital’s two current cardiac monitor technicians (CMTs). During previous construct	The initial intervention was the use of a fall bundle (yellow blanket, yellow socks, yellow armband, yellow magnet to be placed outside the door) for all patients scoring 51 or greater on the MFS. This fall bundle included visual cues to identify a patient as high risk for falling, and to increase awareness and communication among caregivers who interact with patients
Analysis	Transcript analysis was guided by constant comparative methods (Kolb, 2012). During open coding, the team, which consisted of a CNS and a physician, read all transcripts repeatedly to gain a general understanding of the data. The team individually analyzed the transcripts for emerging themes. Together, the team iteratively refined the themes to reflect meanings in the data. Benchmark Capstone Project Change Proposal	Data were processed using SPSS 19.0 statistical software for Windows (SPSS Inc., Chicago, IL). Data from completed or partially completed surveys were included in the analysis; missing values in the partially completed surveys were kept as missing. Authors conceptualized information collected in the “Effectiveness” column captured nurses’ levels of agreement between their prior knowledge and their perceptions of the effectiveness of specific interventions. Agreement between prior knowledge and perceptions could be established through observation and clinical experience. Because nurses’ agreement precedes their know-how (e.g., knowing how to implement fall prevention interventions), exploratory factor analysis was completed on the items in the “Effectiveness” column. The skewness and kurtosis values of effectiveness intervention items on a 5-point scale were acceptable; absolute skewness values for all items were less than 2.00 and absolute kurtosis values were less than 2.42. Therefore, these items were treated as continuous variables	. Baseline data were collected in the 9 months prior to the intervention phase of this study on the three study units. The baseline data included falls per discharge and the number of 1:1 patient companion hours per month. A fall was defined as an unplanned descent to the floor with or without injury. During the 9 months of the intervention phase while video monitoring was in progress, data on falls per discharge and 1:1 patient companion hours continued to be collected. In addition, the tele sitters kept paper logs recording the patients monitored, admission date, time to video monitoring, discharge date, and reason(s) the patient was monitored. They also logged their interventions, which included verbal redirections via microphone to the patients and calls to care providers on their personal communication dev	Throughout this multi-year project as interventions were added gradually to nurses’ toolkit for fall prevention and safety, a steady decline in the number of falls occurred. Within 3 years, the unit consistently met and exceeded the National Database for Nursing Quality Indicators (NDNQI) benchmark for similar units (see Figure 1). Falls declined from 4.45 to 1.53 falls per 1,000 patient days (approximately 70% decrease). Falls with serious injury declined as well; for the year ending this inquiry, they remained at zero. The most drastic reduction in falls occurred after implementation of a no toileting alone program in 2013 for patients in the first 24 hours after a surgical procedure. This intervention was followed by implementation of the same program for all patients who were at high risk for falling
Key Findings	previous investigations focusing on patients’ perceptions of their own fall risk have found that patients do not perceive their risk accurately (Shuman et al., 2016; Sonnad, Mascioli, Cunningham, & Goldsack, 2014). Twibell, Siela, Sproat, and Coers (2015) found more than half of the patients who were considered at risk of falling as assessed by nursing did not believe that they were likely to fall. Contradictory to this, in our sample, most patients were aware that they were identified as a fall risk. Despite a lack of evidence supporting the effectiveness of bed and chair alarms to prevent falls, they are often used in fall prevention programs (Hempel et al., 2013; Sahota et al., 2014). Our patients identified the alarms as part of the fall prevention plan, but most viewed the alarm as a useful alert for nurses when a patient was out of bed rather than a reminder to wait for help	Twenty-one highly effective interventions to prevent fall injuries were identified. Ten were related to improving patients’ surrounding environment, and four of these environment modification-related interventions focused on patient pathways. Eleven were related to increasing RN staff vigilance, and four of these vigilance-related interventions focused on providing assistive devices or appropriate footwear. The 21 highly effective preventive interventions were not ranked as having the most frequently used interventions in practice. This difference suggests the need to address priorities of resource allocation as related to making effective interventions to prevent fall injuries feasible and available to nursing staff (e.g., timely housekeeping in patient rooms, storing sufficient and free-assistive devices in the units for patient use).	The number of falls decreased significantly from 85 to 53 (p< 0.0001, 95% CI) comparing 9 months of baseline data to 9 months of intervention data on the three units. Table 1 demonstrates the overall decrease of patient falls including all adult inpatients on the three study units; those who were video monitored and those who were not. This represented a 35% decrease in falls. Of the 828 patients selected for video monitoring, 13 (1.6%) experienced a fall. During the same time period there were 40 falls (1.7%) among the 4,213 adult patients admitted who were not selected for video monitoring. Patient companion hours decreased 10% from an average of 1,930 hours per month to an average of 1,735 hours per month during the study period. The average length of time for	Throughout this multi-year project as interventions were added gradually to nurses’ toolkit for fall prevention and safety, a steady decline in the number of falls occurred. Within 3 years, the unit consistently met and exceeded the National Database for Nursing Quality Indicators (NDNQI) benchmark for similar units (see Figure 1). Falls declined from 4.45 to 1.53 falls per 1,000 patient days (approximately 70% decrease). Falls with serious injury declined as well; for the year ending this inquiry, they remained at zero. The most drastic reduction in falls occurred after implementation of a no toileting alone program in 2013 for patients in the first 24 hours after a surgical procedure. This intervention was followed by implementation of the same program for all patients who were at high risk for falling
Recommendations	More research is needed to develop and validate an inpatient self-assessment tool that may help the patient recognize both their overt and covert risk factors and become a more active and accepting participant in the plan.	For future research, additional data collection and analysis (e.g., one-way ANOVA, multiple regression analyses with binary predictors) is needed to explore differences in RN staff perspectives on effectiveness and frequency of use of fall injury preventive interventions across, but not limited to, rural and urban areas, health systems and hospitals, and specialties and acuity levels of units (e.g., long-term care and skilled nursing home facilities). Differences in perspectives across nursing staff and nurse managers/executives, and nursing providers and other types of providers (e.g., physicians, physical therapists, occupational therapists, nutritionists, pharmacists) also warrant investigation. Findings of these additional analyses may help nurse executives and researchers identify essential interventions relevant to characteristics of settings beyond ones included in universal fall precautions. Universal fall precautions are meant to keep the patient environment safe regardless of fall risks and hospital areas. For example, maintaining a call light within reach is one of the keys (Agency for Healthcare Re	This study suggests the use of remote video monitoring is a safe tool for fall prevention. While there was a decrease in 1:1 sitter usage, there was no corollary increase in falls. In fact, falls decreased 35%. . An area for further study is accurate criteria for selecting the most appropriate patients for video monitoring. Implications for further study could also include investigating the most appropriate length of shift for a tele sitter and the most effective telesitter-topatient ratio.	Results of this project affirmed the need to assure patient safety during toileting. Nursing staff should acknowledge the importance of patient safety related to toileting when patients are of high risk for falling and remain with these patients while toileting. They also should discuss the rationale for this strategy with patients
Explanation of How the Article Supports EBP/Capstone Project	This article takes into account the patient’s perspective on falls and risk they identify in themselves and how even with education from staff patients still have little understand on the proper use of bed alarms, and things out in place as fall precautions. It also takes into account patient thoughts on what makes them not adhere to fall precautions and how they view interventions placed by staff and how useful they think they are.	This article based off a study of nurses and current fall prevention methods and their effectiveness is essential because it uses the perspective of healthcare workers that are on the frontlines of patient care. I also scrutinizing current practices and allows for new ideas to be formulated about old practices and opening doors for new interventions.	Video Monitoring is a fairly new intervention In the prevention of patient falls. I think it is relevant as it looks into the implications and differing risk associated with patient fall, the implementation of video monitoring on some units could help with cost needing to pull less staff for 1:1 sitters for patient safety thus increasing the amount of staff available on shift to properly assist patients. Also have one person watch multiple individuals on constant and recorded video allows for education and quicker response times.	This study focused on nursing staff lead interventions and assessment of fall risk patients. With the implementation of a “fall bundle”, technology and the no bathroom alone policy supports the finding that toileting Is a high risk activity for patients.

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Discussion Questions (DQ)

Initial responses to the DQ should address all components of the questions asked, including a minimum of one scholarly source, and be at least 250 words. Successful responses are substantive (i.e., add something new to the discussion, engage others in the discussion, well-developed idea) and include at least one scholarly source. One or two-sentence responses, simple statements of agreement or “good post,” and responses that are off-topic will not count as substantive. Substantive responses should be at least 150 words. I encourage you to incorporate the readings from the week (as applicable) into your responses. Benchmark Capstone Project Change Proposal

Weekly Participation

Your initial responses to the mandatory DQ do not count toward participation and are graded separately. In addition to the DQ responses, you must post at least one reply to peers (or me) on three separate days, for a total of three replies. Participation posts do not require a scholarly source/citation (unless you cite someone else’s work). Part of your weekly participation includes viewing the weekly announcement and attesting to watching it in the comments. These announcements are made to ensure you understand everything that is due during the week.

APA Format and Writing Quality

Familiarize yourself with the APA format and practice using it correctly. It is used for most writing assignments for your degree. Visit the Writing Center in the Student Success Center, under the Resources tab in Loud-cloud for APA paper templates, citation examples, tips, etc. Points will be deducted for poor use of APA format or absence of APA format (if required). Cite all sources of information! When in doubt, cite the source. Paraphrasing also requires a citation. I highly recommend using the APA Publication Manual, 6th edition.

Use of Direct Quotes

I discourage over-utilization of direct quotes in DQs and assignments at the Master’s level and deduct points accordingly. As Masters’ level students, it is important that you be able to critically analyze and interpret information from journal articles and other resources. Simply restating someone else’s words does not demonstrate an understanding of the content or critical analysis of the content. It is best to paraphrase content and cite your source. Benchmark Capstone Project Change Proposal

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Late Policy

The university’s policy on late assignments is a 10% penalty PER DAY LATE. This also applies to late DQ replies. Please communicate with me if you anticipate having to submit an assignment late. I am happy to be flexible, with advance notice. We may be able to work out an extension based on extenuating circumstances. If you do not communicate with me before submitting an assignment late, the GCU late policy will be in effect. I do not accept assignments that are two or more weeks late unless we have worked out an extension. As per policy, no assignments are accepted after the last day of class. Any assignment submitted after midnight on the last day of class will not be accepted for grading.

Communication

Communication is so very important. There are multiple ways to communicate with me: Questions to Instructor Forum: This is a great place to ask course content or assignment questions. If you have a question, there is a good chance one of your peers does as well. This is a public forum for the class. Individual Forum: This is a private forum to ask me questions or send me messages. This will be checked at least once every 24 hours. Benchmark Capstone Project Change Proposal

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