PICO(T) Question: Use the PICOT question developed in Topic 3 Discussion Question 1 and refine it based on feedback received.
| PICO(T) Question Template | ||
| P | Population | Elderly hospitalized patients |
| I | Intervention | Purposeful hourly rounding |
| C | Comparison | Normal rounding by nurses |
| O | Outcome | Rate of falls |
| T | Timeline | Three months |
| PICOT Question | ||
| In elderly hospitalized patients (Population/problem), how does purposeful hourly rounding (Intervention) compared to normal rounding by nurses (Comparison) reduce the rate of falls by 40% (Outcome) within three months (Time, optional)? | ||
| Problem Statement | ||
| The problem statement is a scholarly statement that justifies or rationalizes that this is a problem. A problem statement must include literature for support and justification. In 150 words or less, provide a problem statement for your PICOT question.Falls among elderly people, including those hospitalized, are a safety and quality care issue because of the negative effects on patients. According to the Centers for Disease Control and Prevention (CDC) (2024), one in every four older persons falls at least once every year. However, less than half report such events to their healthcare providers. The Centers for Medicare and Medicaid Services (CMS) considers falls as “never events” since they are preventable. Consequently, the agency does not reimburse facilities and providers for costs associated with falls and their adverse effects. Over 1 million fall-associated hospitalizations occur among older adults due to their susceptibility to falls. As a growing issue, especially due to an aging population, falls are a patient concern because of their negative effects like injuries, increased cost of care, and increased stays in hospitals as well as comorbidities and even death. Therefore, nurses as patient care providers should implement evidence-based interventions to reduce and prevent the increasing prevalence of falls among hospitalized adults. | ||
| Population | ||
| The population target helps narrow the scope of the project. In 150 words or less, describe the population of interest including its functional and problem-solving capabilities.The population of interest is elderly patients who are susceptible to falls because of various reasons or problems. For instance, elderly people who are 65 years and above are susceptible to falls due to the fragility of their body status, aging that entails using more medications than normal due to age-related conditions like schizophrenia. Aging leads to cognitive impairment and conditions like diabetes or problems with the thyroid, nerves, feet, and blood vessels can impact balance leading to falling. Age-related loss of muscle mass (sarcopenia) and problems with balance and gait as well as blood pressure that drops too much increase the risk of falling. Therefore, this population faces increased risk factors for falling and requires effective interventions to reduce and prevent their susceptibility to falls, especially in inpatient settings. Reducing the risk of falling ensures that this population enjoys better health and improves their well-being since they are not susceptible to adverse events like head fractures and other devastating injuries to their body. | ||
| Nursing Intervention | ||
| A nursing intervention is used to address the problem. In 150 words or less, describe the nursing intervention.The proposed nursing intervention is purposeful hourly rounding where nurses ensure that the patient is closely monitored to prevent any chances of falling. Existing evidence shows that purposeful hourly rounding reduces and prevents falls among elderly patients. In their study, Gliner et al. (2022) demonstrate that nurse hourly rounding in acute settings can lead to better patient experience and outcomes, including reduced falls. The article notes that when nurses conduct hourly rounding, they will likely identify patients at increased risk for falls and rectify such situations. Again, hourly rounding ensures that nurses have sufficient data on patients and their progress, especially on activities of daily living like bathing and toileting. Additionally, the intervention ensures effective communication between nurses, patients, their families, and colleagues (Khawaja et al., 2023). As a nursing intervention, purposeful hourly rounding ensures that nurses closely monitor patients’ movements and their gait while in the facility to reduce the chances of falling. | ||
| Comparison | ||
| In 150 words or less, compare the nursing intervention to what is currently in place at your practicum site/selected setting.The comparison of the proposed intervention is normal rounding where nurses only make ward rounds based on the scheduled time and shifts. Normal rounding means that nurses only see patients when necessary, especially during shift handover, and when giving them medications or other prescribed measures by the physicians. Other than that, nurses do not go on hourly rounds to establish a patient’s current status unless alerted by the patient using the beside alarm system. As such, the increased prevalence of falls happens despite the current intervention of normal rounding. Therefore, the proposed intervention focuses on improving fall detection and reducing occurrence. The current practice is limited in its scope to detect or notice risk factors for falls and implementation of evidence-based approaches. | ||
| Outcome | ||
| An outcome is the result expected from the implemented action. In 150 words or less, describe the expected outcome for the selected intervention.The outcome or result expected from implementing purposeful hourly rounding is a positive patient experience and provider satisfaction emanating from reduced falls in the facility. The proposed intervention is effective in reducing and preventing falls in any settings, especially inpatient settings. According to the National Institute on Aging (2024), for older people, even a broken or fractured bone can be a source of more serious health issues that can degenerate and lead to long-term disability. Therefore, due to their nature and health status, older people require evidence-based practice (EBP) interventions to reduce susceptibility to falls and other adverse health events. Therefore, the intervention focuses on improving health outcomes by reducing and preventing the chances of falling among elderly patients. On their part, nurses and other providers want interventions that will lead to better patient outcomes and improve their level of satisfaction. The proposed intervention will have better outcomes for patients and their families and more provider satisfaction. | ||
| Time Frame | ||
| Every project should have a specified time frame. In 150 words or less, describe the time frame for implementing the proposed intervention and evaluating the outcome. (Note: The capstone project will not be implemented on the practicum site. This is only a proposal.)The time frame for the proposed project is three months or twelve weeks. The project team will implement all aspects of purposeful hourly rounding to ascertain its effects on patient falls, especially among those susceptible due to their fragile nature and health. Within the period (3 months) all components of the project based on the project life cycle will be implemented to gather sufficient data and evidence on the efficacy of the proposed intervention. The duration is relevant as making the proposed intervention part of the organizational processes based on their protocols and culture will require time and resources. The time frame will also ensure that evaluation of the project occurs to ascertain its positive effects on the target population and community. The implication is that sufficient time for implementing the proposed intervention will be critical to attain the expected outcomes. | ||
Centers for Disease Control and Prevention (CDC) (2024 May 6). Older Adult Fall Prevention:
Facts about Falls. https://www.cdc.gov/falls/data-research/facts-stats/index.html
Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2022). Patient falls, nurse communication, and nurse
hourly rounding in acute care: Linking patient experience and outcomes. Journal of public health management and practice, 28(2), E467-E470. DOI: 10.1097/PHH.0000000000001387.
Khawaja, I., Awan, S. A., Babar, M., Khan, T., & owais Khalil, M. (2023). Fall prevalence and associated risk factors in the
hospitalized adult population: a crucial step towards improved hospital care. Cureus, 15(8). DOI: 10.7759/cureus.46976
National Institute on Aging (2024). Falls and Fractures in Older Adults: Causes and Prevention.