Evidence-Based Practice QSEN PDF

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Running head: SELF-REFLECTIVE JOURNAL: Evidence-Based Practice

Self-Reflective Journal: Evidence-Based Practice Name Course Professor Date

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SELF-REFLECTIVE JOURNAL: Evidence-Based Practice

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Self-Reflective Journal: Evidence-Based Practice Pre-Planning Evidence-Based Practice integrates best current evidence with clinical expertise and patient or family likings and values for delivery of optimal health care (QSEN, 2020). As nurses, almost all of our decisions are based on evidence-based practice. We are able to deliver care with validated interventions that aide in pinpointing care strategies that best help our patients. This competency requires that nurses have skills including the ability to participate in data collection, the ability to read primary research journal articles, to base individual patient care on both clinical research and experience, and to consult with experts in the field before choosing to deviate from standardized patient care protocols. Introduction Evidence-Based Practice is implemented in all hospital settings to ensure more desirable outcomes and provision of care to patients in an inpatient setting. Falls in the acute care setting are a major issue in the current health care system and are a main topic of interest for students to address in order to demonstrate their competency in risk reduction, health promotion, and evidence-based practice. The adverse event of a patient fall, regardless of the outcome, has the potential to cause physical and emotional harm to patients, staff, and the organization. In-hospital patient falls are the leading cause of injuries among the older population and can lead to patient injuries, prolonged hospital stays, and higher cost to the institution of care (Dunne, Gaboury, & Ashe, 2014). This paper will focus on the measures that can be taken to reduce the risk of patient falls as well as how evidence-based practice is implemented to ensure prevention of these incidents. Background

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I previously encountered a 70 year old female patient who was admitted for severe obesity. She was 1 day post op from a gastric sleeve procedure and had been placed on fall precautions. She had a yellow fall risk ID band placed on her wrist as well as a sign outside of her door indicating that she was a fall risk patient. This patient had no history of falls and was strictly placed on precautions due to the surgical procedure. Based on this information, I was adamant in providing assistance with using the restroom, ambulating in the hallway, and assessing for any other signs and symptoms that could contribute to a fall. Noticing According to the CDC, screening all older adults for falls and identifying modifiable risk factors has been shown to significantly decrease the amount of falls occurring in hospitals. To reduce future fall risk, the Rees-Jones Trauma Center created an injury flowsheet within each patient’s electronic health record. This enabled staff to collect data on the patient’s fall. Data included items like the location of the fall, and the approximate height from which the patient fell. This information was then used to identify potential hazards, and prevent future falls. Some other risk factors that were taken into account included: evaluating a patient’s gait, strength , and balance; assessing and managing postural hypotension, or dizzy spells; and reviewing and managing medications (Keep Them STEADI: Preventing Older Adult Falls in Hospital-Based Settings | STEADI - Older Adult Fall Prevention | CDC Injury Center, 2021). Interpreting Using CDC’s STEADI program to prevent older adult falls in a hospital-based setting improved the quality of life for many patients. Data collected from the falls prevention program at the Rees-Jones Trauma Center showed a statistically-significant decreased length of stay in the hospital. During the two year study, 2,784 older adult patients were admitted to the level one

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trauma center. Among this group, 62% sustained injuries after a fall. Before implementing STEADI, the average length of stay at the hospital was 7.9 days with 46.8% of patients discharged home. After STEADI implementation, the average length of stay decreased to 6.5 days with 54.5% of patients discharged home. In addition, 1.5% of fall patients returned with another fall before STEADI, while only 0.6% returned with a second fall after implementation. Results of year two showed a continued decreased stay of five days at the hospital with 63.6% of patients discharged home. Using STEADI’s evidence-based approach in hospital-based settings can significantly improve injury prevention programs, improve patient outcomes, and prevent falls in older adults (Keep Them STEADI: Preventing Older Adult Falls in Hospital-Based Settings | STEADI - Older Adult Fall Prevention | CDC Injury Center, 2021). Responding Kaiser Permanente uses the Hester Davis Fall Score Assessment to determine the risks and likelihoods of patients experiencing a fall. Upon reviewing my patients chart, I found that her score was an 8, which is indicative of a low risk score. Upon further review, I obtained that my patient was also taking two blood pressure medications (Losartan and Metoprolol), which are both known for causing side effects that include dizziness as well as muscle weakness. Based on this data, I realized that given my patients age, it rendered her more susceptible to a fall. Following the administration of her blood pressure medication, I made sure to include patient teaching about the side effects that may occur in relation to falls. The patient responded well to the medications and didn’t experience any bouts of dizziness or muscle weakness after administration. The doctor put in orders to have the patient ambulate in the hallway if capable. Before having the patient ambulate, I made sure the environment was free of any clutter, ensuring it was safe for movement. Next, I assured that the patients IV pole was mobile and could be used during ambu-

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lation. Lastly, the patient and I established a goal of walking halfway down the hallway and back to her room, with an agreement that she would let me know if at any point she felt as if she may fall or couldn’t handle the duration of the walk. My patient successfully ambulated the entire distance without any complications and required minimal assistance from me during this process. Reflection-in-action When fall risks are identified, the appropriate precautions are initiated per hospital protocol. According to Kaiser Permante’s protocol in relation to falls, the prevention of falls is the responsibility of every staff member and fall precautions are initiated and maintained for all patients. I made certain I followed these protocols by providing education to my patient on specific safety measures to prevent falls, ensuring the call light was within reach at all times, routinely assisting my patient to the restroom, and aiding in the ambulation process to reduce any fall instances. Reflection-on-action and clinical learning This experience taught me the importance of analyzing and exploring perspectives regarding fall prevention in the healthcare setting. I was able to utilize this knowledge and expand my nursing skills by learning the importance of how to properly identify the level of patient mobility, determine and monitor patient’s elimination patterns, and discover if my patient had any previous history of falls. Furthermore, this experience taught me how to gather information regarding perspectives on the current fall prevention protocols. By properly implementing all fall protocols, I guaranteed the best possible outcome for my patient as well as prevented any falls that could have potentially caused further harm.

SELF-REFLECTIVE JOURNAL: Evidence-Based Practice

References

Cdc.gov. 2021. Keep Them STEADI: Preventing Older Adult Falls in Hospital-Based Settings | STEADI - Older Adult Fall Prevention | CDC Injury Center. [online] Available at: [Accessed 3 April 2021].

Dunne, T. J., Gaboury, I., & Ashe, M. C. (2014). Falls in hospital increase length of stay regardless of degree of harm. Journal of evaluation in clinical practice, 20(4), 396-400.

QSEN.org. (2020). Quality and Safety Education for Nurses [Video]. https://qsen.org/

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