Essentials of Evidence Based Practice MAIN POST Introduction             It is estimated that patient falls in hospitals occur among 700,000 to 1,000,000 people in the United States. As well, approximately one third is preventable (Agency for Healthcare Research and Quality [AHRQ], 2013). Fall risk assessment tools, and alarm systems which alert staff when patients attempt to leave the bed or chair unassisted, are two methods among others utilized to reduce falls incidences. Evidence-based practice (EBP) in accordance with patient falls and the applicability to the author’s organization are the topics of this paper. Patient Care Experience Recently, an 83 year old male with dementia was hospitalized for pneumonia and under my care, on the night shift. As part of the routine admission process, all patients are evaluated for fall risk.  In this patient’s case, a fall risk evaluation tool was one EBP method used to predict and prevent such an incident. High risk status was concluded due to mobility issues, dementia, and incontinence, in accordance with the Hendrich Fall Risk Assessment tool in the electronic health record. Research by Hendrich, Bender, and Nyhuis, in 2003, as cited by Schmidt (2012, April 5) found that intrinsic factors such as “confusion, altered elimination needs and impaired gait and mobility” among others were predictors of falls (para 6). A second intervention used was a bed alarm. Evidence based research for this method showed mixed results. Ward-Smith, Barret, Rayson and Govro (2014) concluded that use of a bed alarm system did not prevent falls, with one reason being the frequency of false alarms caused ignorance by staff, over time. The authors also stated further research in evaluating which patients would be appropriate for the alarm use would be beneficial. Shorr, Chandler, Mion, Waters, Liu, Daniels, Kessler and Miller, (2012), cited a cluster randomized trial which supported a reduction in falls with alarms in use. Still, in searching CINAHL, no studies in the past 5 years were found in support of bed alarms as a fall reduction method.  I surmise the use of bed alarms in my facility came as a result of the elimination of the previous routine practice of waist and vest restraint application. Background and PICOT Questions             Since support of the use of alarm systems was either mixed or nonexistent, and given the previously mentioned in-hospital high incidence of patient fall statistics, more effective measures for reduction must be researched. In formulating an EBP research question, background definitions must be delineated and general knowledge questions answered. For example, in researching best practices for dementia patient fall reduction in acute care hospitals, I would answer the following questions · What constitutes a patient fall? · What is dementia? · What are some common signs and symptoms of dementia? · What factors place dementia patients at risk for falling? · What are the effects of hourly ...

1. Essentials of Evidence Based Practice
MAIN POST
Introduction
It is estimated that patient falls in hospitals occur
among 700,000 to 1,000,000 people in the United States. As
well, approximately one third is preventable (Agency for
Healthcare Research and Quality [AHRQ], 2013). Fall risk
assessment tools, and alarm systems which alert staff when
patients attempt to leave the bed or chair unassisted, are two
methods among others utilized to reduce falls incidences.
Evidence-based practice (EBP) in accordance with patient falls
and the applicability to the author’s organization are the topics
of this paper.
Patient Care Experience
Recently, an 83 year old male with dementia was hospitalized
for pneumonia and under my care, on the night shift. As part of
the routine admission process, all patients are evaluated for fall
risk. In this patient’s case, a fall risk evaluation tool was one
EBP method used to predict and prevent such an incident. High
risk status was concluded due to mobility issues, dementia, and
incontinence, in accordance with the Hendrich Fall Risk
Assessment tool in the electronic health record. Research by
Hendrich, Bender, and Nyhuis, in 2003, as cited by Schmidt
(2012, April 5) found that intrinsic factors such as “confusion,
altered elimination needs and impaired gait and mobility”
among others were predictors of falls (para 6). A second
intervention used was a bed alarm. Evidence based research for
this method showed mixed results. Ward-Smith, Barret, Rayson
and Govro (2014) concluded that use of a bed alarm system did
not prevent falls, with one reason being the frequency of false
alarms caused ignorance by staff, over time. The authors also
stated further research in evaluating which patients would be
appropriate for the alarm use would be beneficial. Shorr,

2. Chandler, Mion, Waters, Liu, Daniels, Kessler and Miller,
(2012), cited a cluster randomized trial which supported a
reduction in falls with alarms in use. Still, in searching
CINAHL, no studies in the past 5 years were found in support
of bed alarms as a fall reduction method. I surmise the use of
bed alarms in my facility came as a result of the elimination of
the previous routine practice of waist and vest restraint
application.
Background and PICOT Questions
Since support of the use of alarm systems was either
mixed or nonexistent, and given the previously mentioned in-
hospital high incidence of patient fall statistics, more effective
measures for reduction must be researched. In formulating an
EBP research question, background definitions must be
delineated and general knowledge questions answered. For
example, in researching best practices for dementia patient fall
reduction in acute care hospitals, I would answer the following
questions
· What constitutes a patient fall?
· What is dementia?
· What are some common signs and symptoms of dementia?
· What factors place dementia patients at risk for falling?
· What are the effects of hourly rounding on the incidence of
falls in dementia patients in acute care hospitals?
· How do patient sitters affect falls in dementia patients?
· What are the cost factors in an individual institution,
associated with patient safety?
Preparing a researchable question also involves a population or
patient (P), an intervention (I), a comparison (C), an outcome
(O) and when appropriate, a time frame (T) (Polit and Beck,
2017, p. 33) . For this issue of falls, I would ask the following
research question: What are the effects of hourly rounding
versus the presence of patient sitters in reducing the incidence
of falls in hospitalized dementia patients on the night shift? (P=
hospitalized dementia patients I=hourly rounding C=patient
sitters O= reduction of falls T= night shift). A study by Feil

3. and Wallace (2014) showed a statically significant reduction in
fall rates through the use of patient sitters, which included
dementia patients. A study by Morgan, Flynn, Robertson,
Robertson, New, Forde-Johnston, and McCulloch (2017) noted a
50% reduction in falls through intentional rounding on a
neuroscience ward which used a designated nurse for
implemented activity engagement, toileting or other patient
needs during the study period. The extra nurse was in addition
to regular staff.
Organizational Factors in EBP
At the present time, dementia patient falls are not
usually a problem on my unit. Occasionally, one to one care is
employed when such patients are unable to be kept safe by other
means. Since I work in a critical access hospital and patient
census is low, staff to patient ratio is not frequently a
significant issue either. However, depending on the EBP
measure, cost would be a barrier to implementation due to low
revenue and volume. I have worked in environments where
patient sitters were rarely used due to the cost, and instead, the
ward secretary sat at the patient’s bedside with a lap top
computer performing order entry and other usual tasks, while
simultaneously working to keep the dementia patient safe.
Culture might also play a role. Having read the research in
support of simulation for critical access hospital nursing
education, I approached the Director of Nursing regarding a
skills fair. I also offered to plan it and man a station by coming
in on a day off if necessary, and work without pay. I was met
with resistance and the instruction that I could create a scenario
such as a cardiac arrest, with a less experienced colleague, and
fulfill my desire that way. I could not help wondering why there
was no support for a unit wide educational endeavor. I
attempted to engage a colleague as instructed, but was
unsuccessful. As yet, the measure has not been implemented.
Since current financial issues are of concern hospital wide, the
understanding that there are “bigger fish to fry” may be at work,
but what could be more costly than a patient or staff member

4. injury due to a lack of knowledge or skill?
EBP Barrier and Conclusion
Shaheen, Foo, Luyt, Zhang, Theng, Chang, & Mokhtar,
(2011) cited a study in which nurses’ complaints of having
insufficient authority to implement changes in patient care
practices was a barrier to implementing EBP. After a great deal
of thought, I realized I might succeed if I asked the emergency
department (ED) director for support. Several days prior to this
writing, I did just that. Results were positive and specific
stations to be included were discussed, but since this manager
has an upcoming vacation, further planning will be delayed. In
the past, supervisors have spoken of implementing educational
offerings on the unit. As of yet, such events have not
materialized. My hope is the skills fair idea will not be another
statistic.
References
Agency for Healthcare Research and Quality.(2013). Preventing
falls in hospitals. Retrieved from
http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolki
t/index.ht
Feil, M., & Wallace, S. (2014). The use of patient sitters to
reduce falls: Best practices. Pennsylvania Patient Safety
Advisory, 11(1), 8-14. Retrieved from http://www.patientsafe
tyauthority.org/ADVISORIES/AdvisoryLibrary/2014/Mar;11(1)/
Pages/08.aspx
Morgan, L., Flynn, L., Robertson, E., New, S., Forde-Johnston,
C., & McCulloch, P. (2017). Intentional Rounding: a staff-led
quality improvement intervention in the prevention of patient
falls. Journal of Clinical Nursing, 26(1-2) 115–124.
doi:10.1111/jocn.13401
Polit, D. F., & Beck, C. T. (2017). Evidence-based nursing:
Translating research evidence into practice. In Nursing

5. research: Generating and assessing evidence for nursing
practice (pp. 25-45). (10th ed.). Philadelphia, PA: Wolters
Kluwer.
Schmidt, B. (2015, April 5). AHRQ: Evidence-based methods
and tools help reduce risk of falls in hospitals. Retrieved from
http://www.psqh.com/analysis/evidence-based-methods-and-
tools-help-reduce-risk-of-falls-in-
hospitals/#sthash.ztlE7JRV.dpuf
Shaheen, M., Foo, S., Luyt, B., Zhang, X., Theng, Y-L., Chang,
Y-K., & Mokhtar, I. A. (2011). Adopting evidence-based
practice in clinical decision making: Nurses’ perceptions,
knowledge, and barriers. Journal of the Medical Library
Association, 99(3), 229–236. doi: 10.3163/1536-5050.99.3.010
Shorr, R., Chandler, A., Mion, L., Waters, T., Liu, M., Daniels,
M., Kessler, L., & Miller, S. (2012). Effects of an intervention
to increase bed alarm use to prevent falls in hospitalized
patients. A cluster randomized trial. Annals Of Internal
Medicine, 157(10), 692-699. doi: 10.7326/0003-4819-157-10-
201211200-00005
Ward,-Smith, P., Barret, L., Rayson, K., and Govro, K.
(2015).Effectiveness of a bed alarm system to predict falls in an
acute care setting. Clinical Nursing Studies, 3(1).doi:
10.5430/cns.v3n1p1
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