Evidence-Based Project, Part 5: Recommending An Evidence-Based Practice Change profile

Evidence-Based Project, Part 5: Recommending An Evidence-Based Practice Change profile. To Prepare:

  • Reflect on the four peer-reviewed articles you critically appraised in Module 4.
  • Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Evidence-Based Project, Part 5: Recommending An Evidence-Based Practice Change profile
Create an 8- to 9-slide PowerPoint presentation in which you do the following:

  • Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
  • Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
  • Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
  • Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
  • Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
  • Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.

Evidence-Based Project, Part 5: Recommending An Evidence-Based Practice Change profile

  • Add a lessons learned section that includes the following:
    • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
    • An explanation about what you learned from completing the evaluation table (1 slide)
    • An explanation about what you learned from completing the levels of evidence table (1 slide)
    • An explanation about what you learned from completing the outcomes synthesis table (1 slide)Synthesis of literature for an Evidence Based ProjectEvaluation TableUse this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research
      Full citation of selected article Article #1 Article #2 Article #3 Article #4
      Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494.

       

      		 DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Meta‐analysis: multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of hospital medicine, 7(6), 497-503. Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clinical Rehabilitation, 21(8), 742-753. Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for Preventing Falls in Acute Care Hospitals.
      Conceptual Framework

      Describe the theoretical basis for the study

       

      		 None

       

      		 multidisciplinary fall prevention interventions in acute care hospital None Inclusion of prospective controlled-design studies reporting the effectiveness of fall prevention programs in hospitals.
      Design/Method Describe the design

      and how the study

      was carried out

       

      		 Systematic review using a qualitative method Used qualitative method where the bibliographies of all systematic reviews and meta-analyses were hand searched a meta-analysis reviews Randomized controlled trial, subgroup analysis. Cluster randomized study
      Sample/Setting

      The number and

      characteristics of

      patients,

      attrition rate, etc.

      		 U.S. acute care hospitals

       

       

      		 Acute care settings 5038 total participants. 1958 Male and 3080 Female. Patients of a metropolitan sub-acute/aged rehabilitation hospital Acute Care Settings
      Major Variables Studied

      List and define dependent and independent variables

      		 Participants Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before-after studies). The belt, older people, Dependent – Falls, independent – exercise, Dependent- the relative risk of a fall per occupied bed day (RR(fall)) and independent – the relative risk of being a faller (RR(faller))
      Measurement

      Identify primary statistics used to answer clinical questions

      		 Incidence rate ratios (IRR, ratio of fall rate post intervention or treatment group to the fall rate pre-intervention or control group) and ratings of study details. Electronic fall prevention tool kit which triggered automatic ordered interventions. multifactorial interventions including exercise to prevent inpatient falls in older adults The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries.
      Data Analysis

      Statistical or

      qualitative

      findings

      		 Meta-regressions analysis Effect sizes (odds ratios) and 95% confidence intervals were derived for individual studies and then combined across research reports using a random-effects meta-analysis. Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident. Hospitalization further increases risk of falls
      Findings and Recommendations

      General findings and recommendations of the research

      		 Study shows better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls. Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Additional randomized trials are needed to examine the possible benefits of multidisciplinary fall prevention strategies in the acute inpatient setting. This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting. The authors found that precautionary care including a falls safety champion reduced the occurrence of injurious falls by 58.3% (n=36).
      Appraisal

      Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?

      		 Adherence methodologies are of specific significance for long haul changes A broad eligibility criterion was incorporated in the study and questions were clearly reviewed and addressed. Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge. The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.
      General Notes/Comments N/A

       

      		 N/A N/A N/A

      Levels of Evidence Table

      Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

      Author and year of selected article Article #1 Article #2 Article #3 Article #4
      Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017

       

      		 DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Spiva, L., & Hart, P. (2014).
      Study Design

      Theoretical basis for the study

       

      		 Systematic review using a qualitative method

       

      		 systematic reviews and meta-analyses Randomized controlled trial, subgroup analysis. Cluster randomized study
      Sample/Setting

      The number and

      characteristics of

      patients

      		 U.S. acute care hospitals.

      Information on number of fallers, number of falls, fall rate (per 1,000 patient days), and number eligible to fall.

      		 Sample sizes were not reported but the number of 1,000-patient days in treatment groups ranged from 4.3 to 160.3. 5038 total participants. 1958 Male and 3080 Female. Comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients).
      Evidence Level *

      (I, II, or III)

       

       

      		 Level V Level VII Level 1 Level 1
      Outcomes

       

      		 A critical analysis of the qualitative studies surrounding the use of interventions placed to reduce the number of elderly falls in the hospital. Fall prevention strategies had a statistically significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Provides a meta-analysis

      from randomized controlled

      trials involving exercise

      		 The review addressed a clear question and used broad eligibility criteria.
      General Notes/Comments N/A

       

      		 N/A N/A N/A

      * Evidence Levels:

      · Level I

      Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

      · Level II

      Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

      · Level III

      Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

      · Level IV

      Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

      · Level V

      Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

      Outcomes Synthesis Table

      Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

      Author and year of selected article Article #1 Article #2 Article #3 Article #4
      Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017

       

      		 DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Spiva, L., & Hart, P. (2014).
      Sample/Setting

      The number and

      characteristics of

      patients

      		 Same as above Same as above Same as above Same as above
      Outcomes

       

       

      		 Studies had to report on the outcome of inpatient falls. Fall prevention help should be considered along patient’s cultural differences. Properly implemented fall prevention strategies and interventions are important for older adults Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age.
      Key Findings

       

      		 Meta-regressions showed some evidence of the importance of adherence levels to reduce falls Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions.

       

      		 This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting The analysis of this study show that fall prevention strategies according to risk category and insufficient to prevent falls, especially low risk patients.
      Appraisal and Study Quality

       

      		 Population control study Random control study Cohort review study True experiment evidence from the RCT
      General Notes/Comments Feasibility of the entire study through examination of recruitment, Eligibility,

      Protocol, adherence and

      missing data

       

      		 Comprehensively reviews literature thus efficient in

      boosting the knowledge of

      clinical experts on about the

      Clinical issue. Generally

      ineffective unless supported by other sources

      		 Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue. Being a level one evidence with favourable outcomes, it

      helps to solve the clinical question and provides a

      comprehensive answer to the study question

      Critical Appraisal Tools Worksheet Template

       

       

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