Introduction
The Doctor of Nursing Practice (DNP) is a responsible role that has a direct impact on people who need help in hospitals and require continuous support from the hospital’s employees. The practice and knowledge that the Doctor of Nursing Practice has influence people’s lives and may change their state and health for better. The purpose of this paper is to evaluate the proposed DNP project and the problem that persists in the organization to get an in-depth understanding of systems that can handle various issues.
The aim of the proposed DNP project is to tackle the issue of the highest number of falls on the stroke floor of the hospital that adversely affects the medical organization and patients. The paper will include a comprehensive overview of the problem, its significance, project implementation and evaluation plan, and resources needed to reduce the number of patients falls in the hospital. The paper will help to prepare for real-life projects that may arise in the work of DNP.
Problem Statement and Significance of the Practice Problem
The central problem is the highest number of falls of patients on the stroke floor in the hospital. The issue disrupts the view of the organization as an excellent healthcare provider with a focus on compassion towards people (“Mission & Values”, n.d.). The quality department of the medical institution monitors the number of patients falls and looking for prevention measures. Falls may lead to the worsening of patients’ health with unforeseen results.
Looking into details of the situation with patients’ falls on a global level, several essential facts can be identified. The World Health Organization (2018, para. 2) highlights that “falls are the second leading cause of accidental or unintentional deaths in the world”. It was also discovered that a rate of falls in hospitals for older adults might vary from 1.3 to 16.9 per 1000 patient days (Tehewy et al., 2015). It was found that falls cause an associated rise in mortality rates, costs per patient, and length of stay in a medical organization.
Considering the issue and its significance on a national level, it can be said that falls are a persistent problem in the US. As it was mentioned previously by the Agency for Healthcare Research and Quality (AHRQ, 2018), up to 1 million patients fall annually in hospitals across the USA. Analysts report that in-hospital fall rates in the US vary from 3.3 to 11.5 per 1000 patient-days (Schubert, 2020). One-third of all falls in the US results in injuries, including serious ones (AHRQ, 2019). Moreover, falls, when not causing an injury, may result in patients’ anxiety and stress (AHRQ, 2019).
Within the hospital, the issue of falls is found to be alarming as the rates vary from one floor to another but do not remain at a zero or close to zero levels. The data reported from January 2019 to March 2020 showed that there occurred 330 falls of patients in the hospital. The number varied from one month to another from 16 to 28 cases on all floors. The problem of falls within the practicum site that strives to provide excellence in patient-centered care adversely influences the hospital, and the quality of services it offers.
As falls are unpredictable, it is impossible to control them fully; still, some systems help to reduce the number of falls. Currently, there is no specific practice in the hospital that oversees the problem of falls to avoid possible cases. There is a Falls Report that shows the data on falls and documents the necessity to address the issue as the number of falls does not decrease over time at the practicum site. The primary decision-makers may also be interested in tackling the problem as Falls Reports are also submitted to regulatory authorities and discussed by the public.
PICOT Question
The PICOT question based on the needs of the hospital is the following: “For patients 65 years and older (P), how does meaningful hourly rounding (I) compared to the absence of rounding (C) influence the risk of falls (O) over three months period (T)?” The hospital’s data suggests that patients aged 65 and older are more likely to fall and have serious consequences; at the same time, the hourly rounding program was proven to have successful results in reducing patient falls. The two months period was identified based on the requirements of the DNP project.
Project Implementation and Evaluation Plan
The evidence for the DNP project shows that the rounding program may positively affect the reduction in the in-hospital falls. This was proved by researchers that conducted the rounding program based on the help from nurses and leadership of front-line staff members of the medical institution (Goldsack et al., 2015). Another study showed that older people experience several related states that can influence their possibility to fall, such as dementia and elopement (Mitchell, 2017). The research highlighted that the development and implementation of a tailored rounding program could help to avoid future falls of patients (Mitchell, 2017). Overall, the evidence related to the PICOT question suggests that the DNP project should be created with medical executives.
The rationale behind the decision to use the hourly rounding program as an intervention method was based on several facts. First, the Locator System that is used for the hourly rounding program is already installed in the hospital. It will help managers monitor patients and medical employees’ compliance with the rounding program. Second, the practicum site needs to support the brand image and the quality of care that it provides to patients that the rounding system can address unobtrusively. Finally, based on previous studies, the hourly rounding program boosts other beneficial areas, such as patient satisfaction level and reduction in errors, which are also crucial points.
The participants will be patients aged 65 and older that reside on the stroke floor in the hospital. As the program is aimed to protect them from accidental falls, they will naturally get additional care and attention. The private data will be used solely for the research process, which corresponds to the information that medical employees usually track, such as comfort needs, pain, and toileting. Therefore, the facility will not require the Institutional Review Board (IRB) approval.
The primary and expected goal is a significant reduction of patient falls on the hospital’s stroke floor. An additional outcome is the dissemination of the project to other floors of the hospital and its implementation to decrease the overall number of falls in the medical organization and improve the quality of healthcare. The Falls Report created in the institution will assess the achievement of goals; the project team may also track the indirect outcomes that can be reported by employees and patients.
The project requires substantial attention, workload from employees, and resources. It is suggested to implement the project in the hospital in 8-10 weeks. If all resources are gathered and steps appropriately conducted, the project can be accomplished in the given period. However, better feasibility can be achieved if the system is used for 12 weeks to monitor the rounding program’s performance and get more reliable results. Among the barriers that can be named are a disruption in the locator system’s technology and compliance of the workers who may not be accountable for hourly check-ups of patients.
The best plan to collect data is to observe changes during the project implementation and interview the employees and patients about the outcomes. It is noted that observations are possible in natural settings to collect information (Kabir, 2016). The primary utilized instrument will be a Locator System installed in each room of the organization that monitors patients’ state. The data from the Locator System will give insights about the staff and patients’ actions and interactions during the hourly rounding program. The reliability and validity of the instrument will be evaluated based on the collected data. The reliability analysis will be assessed based on the internal consistency indicator (Price et al., 2019). The validity statistics will be evaluated at the face validity, which helps to facilitate analysis by presenting substantial data (Price et al., 2019).
The data will be researched using statistics software, such as SPSS or R. The data about falls will be measured before and after the intervention. After all the information is gathered, chi-square analysis will be performed to assess if the intervention had a statistically significant effect on the number of falls on the stoke floor. Moreover, the data will help identify what happened before the fall of the patient to determine if the situation could be prevented.
Each week of the eight weeks of the implementation phase of the DNP project will help to maintain and facilitate processes and collaboration in the hospital.
- During the first week, blueprints and guidelines will be distributed among employees. The executives will give a presentation to staff members with the value of necessary adjustments and will inform patients.
- The second week will be dedicated to medical employees’ training so they can record their check-ups and progress.
- The third week will be used to evaluate the initial data, compliance, and feedback to propose changes.
- During the fourth week, the adjustments will be introduced based on patients’ and staff’s comments.
- The fifth and sixth week will be dedicated to encouraging employees to be accountable and track the system further with regular meetings.
- During the seventh week, specific issues with the rounding program will be gathered and assessed to propose relevant solutions.
- The last week will be dedicated to collect the data and analyzed comments, feedback, and fix problems, if necessary.
Resources Including Financial Budget
The project requires significant resources that are going to be used in the implementation phase; they will be indicated in the attached budget plan. First are financial resources that should be spent on one nurse, quality team member/statistician, project manager, and a nurse educator. As discussed previously, these people will help launch the rounding program and analyze data on the project implementation and a level of successful application.
These people will get a salary and will be paid to help employees to be compliant for hourly checks of patients through the locator system. Second, human resources will be needed to encourage medical professionals to be responsible. To address this, the time of the management team and executives should be used to educate people. Finally, other materials and places, such as conference rooms, paper, printers, laptops, and projectors, will be needed to create a presentation and guidelines and show it to the hospital’s employees to communicate changes.
The sources of finance will be initially found internally through institutional budget support that is expected to provide the most significant investments. Among other sources, grants can be found to help with the launch of the project in the hospital. The hospital executives can present a project implementation plan to targeted scholarship and funding organizations and get additional support. The project is non-profit, and benefits are not expected to be monetary. Instead, they should increase the quality of healthcare services of the hospital.
Nevertheless, the indirect positive financial impact of the implemented project is expected. Researchers discovered that in-hospital falls lead to an increase in costs spent on a patient (Tehewy, Amin, & Nassar, 2015). The project will likely lead to a decrease in the number of falls on the stroke floor and in the hospital in general. Therefore, the reduced number of falls may result in a decline in expenditures associated with patients who have fallen in the hospital and required additional help from medical employees.
Conclusion
To conclude, it can be stated that the hourly rounding program proposed to tackle the issue of the high number of patients’ falls may help the hospital to manage the quality of services better and address the cost-related matters. Needs-based assessment of the medical organization included in the DNP degree helped to train the necessary skills and execute the project effectively and bring value for the organization. The areas that were discussed in the paper, including resources, evidence research, project planning, and implementation, will contribute to the successful execution of the rounding program.
References
Agency for Healthcare Research and Quality. (2018). Preventing falls in hospitals. Ahrq. Web.
Agency for Healthcare Research and Quality. (2019). Falls. Ahrq. Web.
Goldsack, J., Bergey, M., Mascioli, S. & Cunningham, J. (2015). Hourly rounding and patient falls: What factors boost success? Nursing, 45, 25-30. Web.
Kabir, S.M. (2016). Basic guidelines for research: An introductory approach for all disciplines. Book Zone Publication.
Mission & Values. (n.d.). UMiamiHealth. Web.
Mitchell, R. (2017). Hourly rounding: A fall prevention strategy in long-term care. [The Doctoral Study, Walden University]. Web.
Price, P., Jhangiani, R., & Chiang, I. (2019). Research methods in psychology. (4th ed.). Kwantlen Polytechnic University.
Schubert, C. (2020). The challenge of reducing patient falls in hospitals. Annals of Internal Medicine, 172(5), 356-357. Web.
Tehewy, M., Amin, G., & Nassar, N. (2015). A study of rate and predictors of fall among elderly patients in a university hospital. Journal of Patient Safety, 11(4), 210–214. Web.
The World Health Organization. (2018). Falls. WHO.int. Web.