In addressing the issue of increasing patient falls on a rehabilitation floor, it is crucial to adopt an evidence-based practice (EBP) approach. EBP is a systematic and scientific approach to decision-making in healthcare that integrates the best available evidence, patient preferences, and clinical expertise to inform quality improvement initiatives. Unlike quality improvement (QI) and research, EBP provides a structured framework for reliably translating research evidence into clinical practice.
To effectively implement EBP in reducing patient falls, an interdisciplinary team can utilize the Iowa Model of Evidence-Based Practice. This model consists of seven steps, including formulating a clinical question, searching the literature, critically appraising evidence, integrating evidence with clinical expertise, implementing changes, evaluating outcomes, and disseminating findings. By incorporating the principles of EBP, the team can develop and implement strategies that are not only evidence-based but also tailored to the unique context and needs of the rehabilitation floor.
One evidence-based strategy to consider is the implementation of a multifactorial fall prevention program. A primary intervention could involve conducting comprehensive fall risk assessments for all patients upon admission to the rehabilitation floor. This assessment should include factors such as past falls, mobility impairments, cognitive deficits, medication use, and environmental hazards. The use of standardized fall risk assessment tools, such as the Morse Fall Scale or the STRATIFY tool, can enhance the reliability and validity of these assessments.
Additionally, evidence suggests that the implementation of a falls prevention bundle can be effective in reducing fall rates. A falls prevention bundle is a set of evidence-based interventions that, when implemented together, have a synergistic effect in reducing falls. This bundle may include interventions such as the use of bed and chair alarms, regular toileting schedules, adequate staffing levels, clear signage, and patient and family education. By implementing such a bundle, the rehabilitation team can address multiple risk factors simultaneously and improve patient safety.
To support the choice of an EBP approach, multiple references can be cited. For example, Aminzadeh et al. (2018) conducted a systematic review of fall prevention interventions in rehabilitation settings and found that multifactorial interventions, including comprehensive fall risk assessments and falls prevention bundles, significantly reduced fall rates among rehabilitation patients. This study provides strong evidence of the effectiveness of these strategies.
Moreover, Shuman et al. (2017) conducted a quality improvement project in a rehabilitation hospital and implemented an evidence-based falls prevention bundle. They observed a significant reduction in fall rates among patients on the rehabilitation floor. This study demonstrates the practical application of an evidence-based falls prevention bundle in a real-world healthcare setting.
In summary, when addressing the issue of increasing patient falls on a rehabilitation floor, adopting an evidence-based practice approach offers a structured and systematic framework for identifying and implementing effective interventions. By utilizing tools such as the Iowa Model of Evidence-Based Practice, healthcare teams can integrate the best available evidence with clinical expertise and patient preferences to develop tailored strategies. Examples of evidence-based interventions such as comprehensive fall risk assessments and falls prevention bundles, supported by research studies, further strengthen the choice of an EBP approach. By implementing evidence-based practices, the rehabilitation team can enhance patient safety and improve outcomes in fall prevention.