1. Create an educational presentation for staff before the launch of your change project. This should inform the staff of the problem, your potential solution, and their role in change project. 2. The format for this proposal will be a PowerPoint presentation. 3. The length of the PowerPoint presentation should be 15-20 slides; excluding the title and reference slides. 4. Below are the topics for the slides: a. Title slide b. Description of the change model used c. PICO question—include the elements d. Scope of the problem—use statistics e. Your team/stakeholders f. Evidence to support your need for change—from research g. Action Plan h. Timeline for the plan i. The nurses role and responsibility in the pilot program j. Procedure k. Forms that will be used (if applicable) l. Resources available to the staff—including yourself m. Summary n. References 5. Citations and References must be included to support the information within each topic area. Refer to the APA manual, Chapter 7, for examples of proper reference format. Citations are to be noted for all information contained in your paper that is not your original idea or thought. Ask yourself, “How do I know this?” and then cite the source. Scholarly sources are expected, which means choose peer-reviewed journals and credible websites. This was my write up in milestone 1 and 2 which are continuous of the third milestone. Capstone Project Milestone #1: PICO and Evidence Appraisal Worksheets PICO WORKSHEET Your Name: IJEOMA ONYEJIJI Date: 1/13/15 Your Instructor’s Name: Tish Gembala Purpose: To identify a problem or concern that nursing can change and develop a PICO question to guide the change project. Directions: Use the form below to complete the PICO assignment in Milestone #1. This includes filling in the table with information about your research question and your PICO elements. Step 1: Identify the problem. What have you noticed in your work or school environment that isn’t achieving the desired patient or learning outcomes? What needs to change in nursing, what can you change with the support of evidence in the literature? Describe the problem or practice issue that you want to research. What is your practice area; clinical, education, or administration? (This is NOT where you will list your PICO question) Step 2: How was the practice issues identified? How did you come to know this was a problem in your clinical practice? Review the listed concerns and check all that apply. Step 3: What is the scope of the problem? Does this problem affect an individual, population, or an entire institution? Step 4: Select the key PICO terms for searching the evidence. Clearly define your PICO question. List each element P (problem, population, or problem), I (intervention), C (Comparison with other treatment/current practice), and O (Desired outcome). Is the potential solution something for which you (as nurse or student) can find a solution through evidence research? Look in your book for guidelines to developing your PICO question. Step 5: What evidence must be gathered? Everyone should have a literature search. However, what other sources of reliable information will be helpful for your particular question? Step 6: What terms will you use in order to make sure that your search is wide enough to obtain required information but narrow enough to keep it focused? How will you narrow your search if needed? What databases will you search? PICO Worksheet What is the practice issue/problem? : How to decrease fall episodes in healthcare settings? What is the practice area? _*__ Clinical ___ Education ___ Administration ___ Other How was the practice issue identified? (check all that apply) __*_ Safety/risk management concerns ___ Unsatisfactory patient outcomes ___ Wide variations in practice ___ Significant financial concerns ___ Difference between hospital and community practice __*_ Clinical practice issue is a concern ___ Procedure or process is a time waster ___ Clinical practice issue has no scientific base ___ Other: What is the scope of the problem? _*__ Individual ___ Population ___ Institution/system What is the PICO question?__ : Does holding nurse staff meeting regularly in the area of fall prevention contribute to decreased fall episodes in healthcare settings __________________________________________________________ Define each element of the question below: P- (Patient, population, or problem): Fall episodes in healthcare settings. I- (Intervention): Holding monthly staff meeting in relation to fall prevention C- (Comparison with other treatment/current practice): Not holding staff meetings. O- (Desired outcome): Decrease fall episodes in healthcare settings. What evidence must be gathered? (check all that apply) __*_ Literature search _*__ Guidelines ___ Expert Opinion ___ Patient Preferences __*_ Clinical Expertise ___ Financial Analysis _*__ Standards (Regulatory, professional, community) ___ Other List possible search terms, databases to search, and search strategies: CINAHL, Cochrane, Medline, ERIC. CINAHL (Cumulative Index to Nursing and Allied Health Literature) Plus with Full Text for Top Nursing and Allied Health Literature, Plus Additional Resources: The database has several peer reviewed article in the area of fall prevention. NICE (National Institute for Health and Care Excellence): The database has pertinent and precise information in the area of fall prevention in acute and long term care facilities. Nursing & Allied Health Source: The database has several peer reviewed article specific to area of fall related problems. EVIDENCE APPRAISAL WORKSHEET Your Name: IJEOMA ONYEJIJI Date: 1/13/15 Your Instructor’s Name: Tish Gembala Purpose: To find evidence to support an intervention that will change the outcomes. Directions: Type your search question below. Find AT LEAST FOUR sources to support the need for change and the potential intervention you have selected to solve the problem. At least three of your sources must be peer-reviewed articles. The forth source could be another peer-reviewed article or a reliable, credible source. Look in your text for ideas of other sources that can be used. Using the table below, insert and describe your four chosen resources. Step 1: APA Reference for the article. You will need to list the reference for the source in APA format. Be careful when using built-in APA formats and library citations. They may not be in APA format. Refer to Chapter 7 of your APA manual. Step 2: Type of Source. If your source is a research article, you will need to ensure that it is a peer review article. You need at least three peer-reviewed articles for your project. If your article is a non–research source, then you will need to list what type of source it is; systematic review, clinical practice guidelines, organizational experience, or individual expert opinion/case study/literature review. You may only use ONE non-research source. Step 3: Strength of Research. Refer to page 238-240 for research evidence and page 242-244 for non-research evidence. While you do not need to assign a level for each study, you will assign a quality of evidence (high, good, or low/major flaw) and should discuss the study using some of the elements that are discussed in the appraisal forms. For example, Research evidence: was the sample size adequate? Was there a controlled group? Was it a randomized study? Were results clearly stated? Was the conclusion based on the results? Were study limitations discussed? Not all of these elements need to be discussed, but you should discuss this information to determine if the strength of the evidence is HIGH, GOOD, or LOW/MAJOR FLAW. Step 4: Brief Description of the Research. In this section, you will summarize the source in your own words. How does this information apply to your project? What are the results of the source? What are their recommendations?   Evidence Appraisal Worksheet PICO Question: : Does holding nurse staff meeting regularly in the area of fall prevention contribute to decreased fall episodes in healthcare settings? APA Reference for Article Give the APA-formatted reference for the article. Type of Source *Research: Peer-reviewed article *Non-research systematic review, clinical practice guidelines, organizational experience, or expert opinion/case study/literature review Strength of Research Discuss the strength of the sources. Report if evidence is High, Good, or Low/Major Flaw. Use the tools on page 238-244 of your text and discuss the reasons why you have assigned a particular level of quality. Brief Description of Research Address the questions. *How does the information in the article apply to the project problem or proposed intervention? *Summarize in your own words. * Include results of the study and how these results are applicable to your project. * What is the recommendation of the source for clinical practice? 1 TzTzeng, H. M. (Dec 2011).Using multiple data sources to answer patient safety-related research questions in hospital inpatient settings: a discursive paper using inpatient falls as an example. Journal of Clinical Nursing, 2011 Dec; 20 (23/24): 3276-84. (journal article - research, tables/charts) ISSN: 0962-1067 PMID: 21585575 It is Peer Reviewed Journal by PsycINFO Possible data sources for answering patient fall-related research questions in hospital settings are as follows (1) using of hospital data, (2) surveys of patients/families/clinicians, (3) interviews and focus groups of patients/families/clinicians, (4) publicly available data sets and (5) published legal cases. The article discuss about patient safety and ways of fall reduction. It also answer explain common causes of inpatient fall episodes .24 solutions were identified by the nurses from interview transcriptions: 5 were related to inadequate caregiver communication, none was associated with the dimension of inadequate staff orientation and training, three were related to inadequate assessment and reassessment, 15 were associated with unsafe care environment, and one was related to inadequate care planning and provision. A safety-driven design with a goal to prevent inpatient fall-related injuries should be a hospital design principle. 2 Montero-Odasso M; Levinson P; Gore B; Epid D; Tremblay L; Bergman H. (June 2007).A flowchart system to improve fall data documentation in a long-term care institution Journal of the American Medical Directors Association, 2007 Jun; 8 (5): 300-6. (journal article - research) ISSN: 1525-8610 PMID: 17570308 National Center for Biotechnology Information. The National Center for Biotechnology Information is part of the United States National Library of Medicine, a branch of the National Institutes of Health. The evidence is of good quality because flowchart system with an ad hoc form was designed to advice on falls characteristics, post-fall risk factors identification, and appropriate referral. Educational sessions explaining the rationale for the flowchart system were given before the implementation of the system. An audit was conducted on incident report data in order to register the fall data documentation in the facility. The audit was repeated 2 times after implementation of the flowchart system. These articles elaborate the importance of documentation in fall episodes. To determine whether implementation of a flowchart system may improve fall data documentation especially in long term care is recommended. There were 107 incident reports audited before and after the implementation of the flowchart system. Average age of the participants with falls was 82.7 (SD: 3) and 53% of the participants had dementia. After the implementation new information not previously gathered, such as psychotropic medication, potential causes and contributors of the falls episodes were gathered. 3 Barker, Anna; Brand, Caroline; Haines, Terry; Hill, Keith; Brauer, Sandy; Jolley, Damien; Botti, Mari; Cumming, Robert; Livingston, Patricia M.; Sherrington, Cathie; et al. (Aug 2011).The 6-PACK program to decrease fall-related injuries in acute hospitals: protocol for a cluster randomized controlled trial. Injury Prevention, 2011 Aug; 17 (4): 1-6. (journal article - randomized controlled trial, research, tables/charts) ISSN: 1353-8047 PMID: 21653650 The BMJ is a weekly peer-reviewed medical journal. The research is of high quality because its aims are to determine the efficacy of the 6-PACK program for preventing fall-related injuries, and its generalizability to other acute care hospitals. This article explains guidelines to reduce fall episodes in an acute care facility. This will give guidance on how to manage fall episode in acute care facilities by following a strict guidelines.16, 000 patients were used with 24 acute medical and surgical wards from six to eight hospitals throughout Australia. The primary outcomes are fall and fall-related injury rates 12 months following 6-PACK implementation. 4 Sydenham, E. (Aug 2008). Systematic reviews on preventing fall-related injuries in older people. Injury Prevention, 2008 Aug; 14 (4): 274. (journal article) ISSN: 1353-8047 PMID: 18676789 The BMJ is a weekly peer-reviewed medical journal. This article provides complete fall information on geriatric patients in acute care settings. This article explains fall injury in relation to geriatric patients. It is recommended that population-level interventions can reduce the incidence of fall-related injuries in older populations. MILESTONE #2 Fall Prevention Ijeoma onyejiji Chamberlain College of Nursing NR451 RN Capstone Course 2/1/2015 Fall prevention. This paper discuss about efficient ways to prevent or decrease fall episode in acute care facilities. Fall is one of the most common problems in lengthening patients’ stay in hospital. It has a big effect especially on elderly patients. However it is possible to prevent or decrease fall episode by efficiently utilizing pertinent communication strategies. The writer of this paper attempts to explain the importance of holding nurse staff meeting on regular bases among nursing staffs in the area of fall prevention in order to decreased fall episodes. Change Model Overview The Rosswurm and Larrabee’s change model is an important pathway which enables nurses carry out research based changes in healthcare setting. It begins with assessing the need for change and identifying tangible problem. These steps of the model enable the nurse to put sustainable change in place. It is cost and time effective. Therefore this project utilizes the model to identify problems and implement solution to decreased fall episode at Community Hospital of Huntington Park. Practice Question Step 1: Identify an EBP question How to decrease fall episodes in healthcare settings? Fall episodes in healthcare settings by holding monthly staff meeting in relation to fall prevention. Not holding staff meetings might cause more harm. Decrease fall episodes in healthcare settings might be reduced by staff meetings every 6 months. Step 2: Scope of practice question Fall prevention interventions are vital in reducing health care cost. Centers for Disease Control and Prevention stated that “In 2000, falls among older adults cost the U.S. health care system over $19 billion, or $23.6 billion in 2005 dollars.” It also stated, “Total Lifetime Medical Costs of Unintentional Fatal Fall-Related Injuries in People 65 Years and Older by Sex and Age, United States, is $349 million.” Evidence also shows that improved communication among staff can decrease fall episodes effectively. Steps 3, 4, and 5: Team In this paper the participating bodies are nurse aide, registered nurses, charge nurses, nurse supervisor and manager of the Emergency unit and nurse from the rehabilitation unit and the manager. The pilot study allows CNAs and RNs who spend more time with patient to share experience why past fall prevention intervention were less effective. Evidence Steps 6 and 7: Internal and external search for evidence This project incorporates internal and external data that assert the importance of fall prevention. The main source of internal data is incident report. Fall incident reports filed in one year period are examined to find out what are the most common causes. The writer also assesses the effectiveness of various types of measures taken to curb fall episode in the past year following fall episodes. External data will be obtained by reviewing interventions used in other hospitals. Nurse Managers, supervisors and charge nurses will also take part to make additional input on identified problems. According to Rosswurn and Larrabbee’s model, in the first Step, practitioners collect internal data and compare it with external data. When data indicate a problem with an aspect of practice, practitioners can assemble. Steps 8 and 9: Summarize the evidence People under age 70 were more likely to be treated and released from fall than people aged 70+, and the likelihood of being hospitalized increased with age (CDC, 2005). Falls are an important cause of morbidity and mortality in older people (Montero-Odasso M and et al, 2007). Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Injuries from fall may result in disability, premature death, or a lower quality of life (Sydenham, ‎2008).Many people, who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling. Since the older adult is fragile and need more care, nurses need to identify goals that are important and meaningful during their care Sternbergh, Bill. (2001). Once those goals are identified, the important thing is to create goals that will help improve and carry out those values through actions. Step 10: Recommendations for change If the result is encouraging different strategies can be used to maintain fall free environment. One of the most effective strategies to maintain competency is to give staff incentives that motivate them. Translation Steps 11, 12, and 13: Action plan Charge nurses of each Emergency unit will report how far the staff is executing introduced changes every 6 months bases prior to the staff meeting. This allows nurse supervisors and manager to get ready to address it on every 6 months staff meeting. The staff will continue to review the strength and weakness of the change project based on fall rates on each Emergency unit. Based on noted weaknesses the staff meeting can be modified in different ways to strengthen its positive impact on fall reduction. These measures allows the staff to evaluate and maintenance changes on continues bases. Steps 14 and 15: Evaluating outcomes Presence and absence of fall will be monitored on monthly basis. The result will be compared to previous years of same month fall episode rate. The strength and weakness of the change project would be highlighted based on the result of comparisons of fall rates before and after the implementation of the project. Steps 16, 17, and 18: Implementation The pilot study will be implemented in two different units of hospitals. This allows evaluating the universal nature of the strategy when applied in different location. Rosswurn and Larrabbee’s model suggests implementation of the pilot study on two hospitals. Once the change is implemented incidents of fall will be evaluated on monthly bases. The result will be compared to previous years of same month fall episode rate. Conclusion Assessment is the first step in introducing change. Most important and useful changes fail to be practical due to staff resistance. Assessment allows to device ways of smooth implementation of the change. Once the design of change is set up in such matter there is also a greater task implementing the goal step by step. The paper also signifies the benefit of evaluation outcome. References Cost of Fall Injuries in Older Persons in the United States, 2005. Retrieved fromwww.cdc.gov/homeandrecreationalsafety/falls/data/cost-estimates.htm Dora, B., M. Beth, B., Sandra, K.C. & et.al, .Nursing professional development [electronic resource]: scope and standards of practice / National Nursing Staff Development Organization, American Nurses Association. Silver Spring, MD: Nursesbooks.org, 2010. Montero-Odasso M; Levinson P; Gore B; Epid D; Tremblay L; Bergman H. (June 2007). A flowchart system to improve fall data documentation in a long-term care institution Journal of the American Medical Directors Association, 2007 Jun; 8 (5): 300-6. (Journal article - research) ISSN: 1525-8610 PMID: 17570308 Sternbergh, Bill.(2001). Setting your development goals. Goal setting in personnel management. Greensboro, N.C.: Center for Creative Leadership. Devry University Library. HF5549.5.G6 S73 2001eb Sydenham, E. (Aug 2008). Systematic reviews on preventing fall-related injuries in older people. Injury Prevention, 2008 Aug; 14 (4): 274. (Journal article) ISSN: 1353-8047 PMID: 18676789 Thamar, J.B., (April 2009).Writing rehabilitation goals and achieving goal attainment scaling: a practical guide. Clinical Rehabilitation. vol. 23 no. 4 352-361. Retrieved from http://cre.sagepub.com/content/23/4/352.short