Evidence-Based Practice Project Proposal Presentation

Editor's Notes

• #2: Patient safety is one of the major considerations in healthcare because it influences outcomes, costs, satisfaction, and organizational reputation. Falls in older adults is one of the most common threats to patient safety in healthcare settings. It is important to investigate this issue to determine potential interventions that can help reduce the risk of falls. Therefore, this presentation provides an overview of a project proposal based on the following PICOT question: In older adults with fall risk in healthcare settings, does using the Fall TIPS program compared to Fall Risk wristbands and alarm pads lead to reduced falls over six months?
• #3: Many healthcare facilities are experiencing high incidence of patient falls, especially in older adult patients. Li et al. (2025) reported that the annual incidence of falls in the US is one million. The falls contribute to many moderate and severe injuries that undermine patient safety and increase healthcare costs. Other potential effects of the falls include morbidity, mortality, and prolonged hospitals stays. This project proposal considers the Fall TIPS Program, which is a nurse-led fall prevention initiative, as an effective solution that can potentially help address the issue of falls, especially in older adults. According to Tzeng et al. (2021), the program allows modification of interventions depending on daily assessment of the patients, leading to tailored or individualized approaches to reducing the risk of falls.
• #4: Six studies were included in the literature review to help understand the issue of patient falls and explore potential interventions to the problem. One of the outstanding studies was Montejano-Lozova et al.’s (2020) article, which reported that nurse-led fall risk assessments led to a significant reduction in the incidence of falls in the intervention group (0.3%) compared to the control group (2.2%). In another study, Knott et al. (2021) compared the efficacy of traditional physical therapy (TPT) with Otago-based exercise programs in reducing falls among older adults and found that both interventions lower falls and there was no significant difference between the two. Tzeng et al. (2021) implemented the Fall Tailoring Interventions for Patient Safety (TIPS) Program in nursing homes and noted a significant reduction in falls and related injuries.
• #5: Naseri et al. (2021) conducted a randomized controlled trial to evaluate whether tailored fall prevention education increases older adults' capability and motivation to prevent falls and found that the intervention significantly improved older adult patients’ motivation and knowledge to engage in fall prevention at discharge. Ximenes et al. (2024) assessed how an educational intervention influenced hospitalized patients' perceptions of fall risks and found that the intervention significantly improved patients’ understanding of fall risk. Finally, Ellmers et al. (2023) examined the impact of fear of falling on fall risk in older adults and developed a new scale for assessing perceived control over falling. According to their findings, low perceived control over falling significantly increases fall risk. Generally, the Fall TIPS program was chosen as the most appropriate and effective intervention based on the literature review.
• #6: Some of the features of the organizational culture of the target magnet hospital include open communication and transparency, patient-centered care, safety, teamwork, interprofessional collaboration, transformational leadership, and evidence-based practice. These are significant characteristics of a positive organizational culture according to Engle et al. (2021). The Organizational Change Management (OCM) tool was used to assess readiness for change and the results obtained indicated the facility has high readiness for change. Some organizational strengths that can support the project include transformation leadership and staff empowerment while strategies that can further enhance readiness for change include communicating the role of each staff member, regular meetings for stakeholder engagement, staff training, and hiring additional staff.
• #7: The implementation of this project will be guided by the knowledge translation framework (KTF). The model emphasizes addressing clinical problems using evidence-based interventions supported by credible knowledge from RCTs, systematic reviews, and practice guidelines. Applying the model will involve eight stages, starting with problem identification, which is high incidence of falls in older adults. This will be followed by identifying sources of knowledge and adapting the knowledge to the local context of the target setting. The next step will be identifying the determinants of knowledge use, such as resource availability, and selecting the most appropriate intervention based on knowledge obtained. Next will be implementing the chosen intervention, evaluating its impact, and sustaining it.
• #8: Implementing this project may take up to six months. The process will involve three phases, starting with preparation by developing educational materials, seeking IRB approval, and securing buy-in from stakeholders. The second phase will entail the actual implementation of the chosen intervention by training staff and initiating the solution. The last phase will be evaluating the impact of the intervention by comparing pre- and post-intervention incidence of falls. During the implementation stage, subjects will be selected using fall-risk assessment tools and quantitative methods will be used to collect pre- and post-intervention data for effective evaluation. The implementation will be monitored using a questionnaire to evaluate adherence to the proposed intervention, assess staff knowledge and perceptions, and identify challenges encountered during the process.
• #9: The project is expected to cost approximately $12,500. Specifically, the cost for personnel training, toolkit materials, data collection tools, and miscellaneous expenses will be approximately $5,000, $3,500, $3,000, and $1,000, respectively. The process of delivering the intervention will involve staff training, distributing the Fall TIPS materials, and the actual implementation of the Fall TIPS protocols. All staff members, including nurses, IT specialists, and patient care technicians will attend workshops and presentations to receive quality training involving hands-on and role-playing exercises to enable them master the Fall TIPS intervention to implement it effectively in practice. Stakeholders will include nurse leaders, case managers, staff nurses, a project coordinator, physicians, and hospital administrators.
• #10: The primary expected outcome of this project is a significant drop in the prevalence of falls, implying that the success of the proposed Falls TIPS protocol will be evaluated by considering the extent to which it prevents or lowers adverse events related to patient falls. This outcome will be evaluated by comparing pre- and post-intervention data to determine the trend in patient falls before and after implementing the intervention. The Electronic Health Records (EHRs) will be used as a data collection tool because it contains a record of all falls at the hospital, making it possible to determine the overall prevalence of falls at the facility at any given time. Statistical analysis will be performed using the paired t-test because it allows the comparison of two measurements taken from the same group, facility, or patient at two different times.
• #11: The data collection methods that will be applied to the chosen data collection tool are pre-intervention and post-intervention data collection. Pre-intervention data collection will help establish the baseline data at the hospital by reviewing the EHR for the cases of falls recorded in the previous three months. Strategies that will help manage negative or unexpected outcomes include increasing training and support for the staff and reviewing the entire Falls TIPS program to modify the intervention. Generally, the Fall TIPS program will be sustained if it results in the desired outcomes. It will be revised in case it results in unexpected or negative outcomes, and it will be discarded if it fails to produce desired outcomes even after revising it.
• #12: Resistance to change is one of the potential barriers to effective implementation of the proposed intervention, as Cheraghi et al. (2023) noted that many organizational changes fail due to lack of buy-in from stakeholders and the staff. One of the ways of addressing this barrier is emphasizing how the proposed intervention aligns with the organization’s mission and demonstrating how it can improve outcomes for both patients and staff members. Lack of sufficient resources can also undermine the project since it is important to mobilize both material, financial, and human resources for the intervention to succeed. Seeking external funding to support the project that can help avail more resources to address the barrier.
• #13: This project aims at implementing the Fall TIPS program to reduce the risk of falls in a magnet hospital. The program is a nurse-led fall prevention initiative that can potentially help address the issue of falls, especially in older adults. Most of the studies included in the literature review indicated that the intervention is highly reliable and effective in addressing the issue of falls. The target organization has a positive culture and high readiness for change that can support the implementation of the intervention. The knowledge translation framework (KTF) will inform the implementation of this project. The project will involve preparation, implementation, and evaluation. Evaluation will be performed by comparing pre- and post-intervention incidence of falls.