NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization

Name

Capella university

NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner

Prof. Name

Date

Problem Statement and Patient Safety Issue

Patient safety is a major concern in the healthcare setting. Improved patient safety is associated with better outcomes. In this context, patient fall prevention is a vital contributing factor. The patient safety issue of patient falls within Henry Ford Hospital (HFH) entails several challenges, including severe injuries of the head, bruises, and bone fractures among elderly patients admitted to acute care units.

Recent hospital safety grade data show 0.164 for every 1000 persons discharged in 2023 (Leapfrog, 2024) and a hip fracture rate of 0.09 due to inpatient falls. The data demand the urgent need to implement measures for reducing patient fall rates. Despite current fall prevention strategies, inpatient falls remain a crucial issue due to the risk of mortality, morbidity, and medical costs. 30-35% of falls cause injury, with a 6.3-day increase in hospitalization and a cost of $4,000 for each incident (Mikos et al., 2021).

PICOT Question

In an acute care unit, would a standard patient fall prevention bundle, in comparison to current prevention practices, lower elderly patients’ falls within 12 weeks?

Population (P): Hospitalized elderly patients in acute care unit of HFH

Intervention (I): standard patient fall prevention bundle including risk assessment, patient and staff education, environmental modifications, and assistive devices.

Comparison (C): Current fall prevention practices

Outcome (O): Mitigation of the occurrence of elderly patients falls

Timeframe (T): Within 12 weeks

Narrative of Search Strategy

The systematic search approach was used to answer the PICOT question on the efficiency of an extensive patient fall prevention bundle intervention in lowering fall rates among elderly hospitalized patients in HFH’s acute care units. The search process started with identifying and selecting appropriate keywords, like “patient fall,” “patient fall prevention intervention,” and “patient fall prevention bundle effectiveness.” These phrases were used to search credible resources from databases, including Cochrane Library, CINAHL, and PubMed, for publications published during the last five years.

Filters were employed to restrict the results to full-text research having open access available online. Pertinent MeSH (Medical Subject Heading) terms were used to expand the research scope (DeMars & Perruso, 2022). The inclusion criteria were publications that focused on the integration of fall prevention strategies in hospitals, which were published in the last five years. Exclusion criteria included non-English articles, wrong population irrelevant to the PICOT, or outdated articles, as shown in the PRISMA diagram in the Appendix (Shaffril et al., 2021). 

• Identify Databases Searched: Different databases, such as Cochrane Library, CINAHL, and PubMed, were searched for systematic reviews on inpatient falls among older adults.  
• Initial Search Results: The initial database searches identified 32 articles. Only those studies included were published in the past five years.
• Screening: Articles were screened through a screening process to remove duplicates, ineligible records through automation tools, or due to other reasons based on titles and abstracts for relevance. Through screening, four articles were removed. 
• Eligibility: 27 articles were assessed based on full-text review and reasons for exclusions to address the safety issue of patient falls through fall avoidance interventions.
• Excluded Studies: Five articles were omitted at the full-text analysis step for several reasons, such as language other than English, wrong population, or protocol studies.
• Included Studies: The systematic review included 16 studies or peer-reviewed articles, along with their characteristics, e.g., study design, intervention, and outcomes. It directly addresses the components of PICOT, including the problem question of patient falls among elderly patients and the intervention of fall prevention bundles.
• PRISMA Flow Diagram: The PRISMA diagram exhibited the steps from identification to study inclusion during the systematic review process. 

Appropriate Databases and Robust Keywords

 Databases like CINAHL, PubMed, and the Cochrane Library were used to conduct a thorough search for evidence on the patient fall prevention bundle in lowering fall rates among older hospitalized patients in the acute setting of HFH. Appropriate keywords, such as “patient fall,” “patient fall prevention intervention,” and “patient fall prevention bundle effectiveness,” were used with Boolean operators, which are OR and AND, to improve results from searches (Albasha et al., 2023). The databases include broad articles spanning the healthcare and nursing professions, offering a solid basis for evidence and research.

Inclusion/Exclusion Criteria for Articles

The standards or criteria for inclusion for the studies maintained the priority of research published during the previous five years, presented in English, and focusing on elderly people in medical settings similar to HFH’s acute care unit. Studies must analyze the implementation of a patient fall prevention bundle or intervention, which includes education, risk assessment, supportive tools, and environmental alterations, and present outcomes related to lowering fall rates among senior patients (Heng et al., 2020). Exclusion criteria included studies that are not relevant to the PICOT topic, such as those that focus primarily on non-hospital settings or wrong populations and those with no rigorous methods or protocol papers. After the search, 30-32 articles were selected for further examination.

The selected articles use several research designs, such as systemic reviews and Randomized Controlled Trials (RCT). These articles were chosen based on their primary relevance to the problem presented. They provide empirical data supporting the efficacy of extensive patient fall prevention bundle strategies to lower the fall rate among older adults admitted to the acute care unit, thus influencing decisions and practice at HFH.

References

Albasha, N., Ahern, L., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons, S. (2023). Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: A systematic review. BioMed Central Geriatrics, 23(1), 47. https://doi.org/10.1186/s12877-023-03738-z

DeMars, M. M., & Perruso, C. (2022). MeSH and text-word search strategies: Precision, recall, and their implications for library instruction. Journal of the Medical Library Association, 110(1). https://doi.org/10.5195/jmla.2022.1283

NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization

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

Leapfrog. (2024). Henry Ford Hospital- Hospital details table. Hospitalsafetygrade.org. https://www.hospitalsafetygrade.org/table-details/henry-ford-hospital

Mikos, M., Banas, T., Czerw, A., Banas, B., Strzępek, L., & Curyło, M. (2021). Hospital inpatient falls across clinical departments. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health, 18(15), 8167–8167. https://doi.org/10.3390/ijerph18158167

Shaffril, H. A., Samsuddin, S. F., & Abu Samah, A. (2021). The ABC of systematic literature review: The basic methodological guidance for beginners. Quality & Quantity, 55, 1319-1346. https://doi.org/10.1007/s11135-020-01059-6

NURS FPX 8030 Assessment 2 Evidenced-Based Literature Search and Organization