Expert answer:PICOT Statement
Expert answer:Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for your capstone project. A PICOT starts with a designated patient population in a particular clinical area and identifies clinical problems or issues that arise from clinical care. The intervention should be an independent, specified nursing change intervention. The intervention cannot require a provider prescription. Include a comparison to a patient population not currently receiving the intervention, and specify the timeframe needed to implement the change process. Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT statement will provide a framework for your capstone project. In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive patient outcome. Make sure to address the following on the PICOT statement: Evidence-Based Solution Nursing Intervention Patient Care Health Care Agency Nursing Practice Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required. This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
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Running head: HOSPITAL FALLS: AN ONGOING PROBLEM
Hospital Falls: An Ongoing Problem
Grand Canyon University – NRS 490
November 26, 2017
1
HOSPITAL FALLS: AN ONGOING PROBLEM
2
Hospital Falls: An Ongoing Problem
Inpatient hospital falls especially in elderly patients can impact not only the quality of
care provided but can have a substantial financial burden to the organization (Hoffman,
Neumann, Golgert, & Von Renteln-Kruse, 2015). Healthcare providers must be aggressive in
adhering utilizing tools and resources prevent falls and ensure patient safety.
The Medical Telemetry unit has an average of four days stay for patients are admitted for
multiple co-morbidities but all require cardiac monitoring (Hoffman et al., 2015). Examples
include congestive heart failure (CHF), dialysis, irregular heart rhythms, altered mental status,
and strokes to name a few. Many present with acute problems secondary to chronic conditions
such as CHF exacerbation, altered mental status due to drugs, toxins, or infections. The
population serves about 90% Caucasians and about 43% are age 60 and above (Office of
Statewide Health and Planning Development [OSHPD], 2015). Staffing ratio is 1:4 and a
multidisciplinary team approach is used in caring for patients.
Problem, Issue, Suggestion, Initiative, or Education Need
For every 1000 bed occupied, 3-20 falls will occur (Haines, Lee, O’Connell, McDermott,
& Hoffmann, 2012). Many factors contribute to patient falls particularly chronic conditions and
medications. For example, a patient on Lasix may try to jump out of bed to the bathroom, a
dialysis patient is confused due to elevated toxin levels, and stroke patients on heparin drips
are at higher risk for bleeds and falls if there are deficits from the stroke. A substantial
contributing factor to this is that elderly patients a weak bone structure as a result of age hence
their general weakness, often resulting to falling while in the hospital (Thomas & Mackintosh,
2016).
HOSPITAL FALLS: AN ONGOING PROBLEM
3
Many falls occur during shift change when nurses are pre-occupied with report. It is
recommended that fall risk is assessed at the beginning of every shift and interventions are
implemented immediately (call light at bedside, mobility aids within reach, beds locked and at
lowest position, and alarms on as necessary). Nurses should perform handoff at the bedside to
ensure that IV lines and meds are evaluated, patient is involved in their plan of care, and to
ensure that patient is safe and both staff member should sign off. Education should be
continuous to staff and to patients the importance of adhering to the plans discussed.
Impact on Work Environment, Quality of Care, and Patient Outcomes
The repercussions of patient falls not only affects patient outcomes, but the hospital work
environment and quality of care provided. Looking at the effects of falls on patient outcomes,
hospital falls have been an impeding factor to quick recovery of patients in hospitals. In this
regard, patients who are victims of falls often end up being injured contributing to their health
problems as well as their social and psychological well-being (Oliveira, Hammerschmidt,
Schoeller, Girandi, & de Paula, 2016).
This prolongs their recovery time hence elongating their stay in the hospital. Shifting
gears to quality of care, hospital falls are a subtracting factor to quality of care given to patients
in hospitals. Hospital falls are a pointer of lack of safety for inpatients. This significantly affects
the reputation of hospitals with high number of falls (Babine et al., 2016). The effects of hospital
falls on work environment are centered on the compromise of patient safety during their stay in
the hospital. A work environment is rendered unsafe for patients having in mind that there is a
high potential for patients to fall (Tzeng, Hu, & Yin, 2016).
HOSPITAL FALLS: AN ONGOING PROBLEM
4
Implications to Nursing
Poorly implemented programs, failure to follow recommendations, and quality of
delivery of fall risk programs can explain why falls continue to occur (Morello et al.,
2017). Studies show that fall programs are effective if carried out as it should. A study of the 6PACK falls program includes assessing patients daily using fall risk scales, placing a “Falls
Alert” sign outside the door, and at least one of the 6-PACK recommended strategy: a) assisting
patients to bathroom, b) bed at lowest level, c) mobility aids within reach, d) planned toileting,
and e) using bed/chair alarms (Morello et al., 2017).
Conclusion
Preventive measures that are based on evidence-based practice are implemented to ensure
the safety of patients during their stay. It is up to the organization as a whole to collaborate to
ensure that programs are adhered to. Nurses musts be consistent with shift assessments and
required interventions, handoff should be at the bedside, and management should provide
resources and support to ensure that interventions are not missed due to overwhelming
workload.
HOSPITAL FALLS: AN ONGOING PROBLEM
5
References
Araújo, J., Fernandes, A., Moura, L., Santos, M., Ferreira, M., & Vitor, A. (2017, May).
Validation of nursing outcome content fall prevention behavior in a hospital environment.
Revista da Rede de Enfermagem do Nordeste, 18(3), 337-344.
http://dx.doi.org/10.15253/2175-6783.2017000300008
Babine, R., Hyrkas, K., Bachand, D., Chapman, J., Fuller, V., Honess, C., & Wierman, H. (2016,
May/June). Falls in a tertiary care hospital – Association with delirium: A replication
study. The Academy of Psychosomatic Medicine, 57, 273-282. Retrieved from
http://eds.a.ebscohost.com.lopes.idm.oclc.org
Haines, T., Lee, D., O’Connell, B., McDermott, F., & Hoffmann, T. (2012). Why do hospitalized
older patients take risks that may lead to falls? Health Expectations, 18, 233-249.
Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org
Hoffman, V., Neumann, L., Golgert, S., & Von Renteln-Kruse, W. (2015, November 10). Proactive fall-risk management is mandatory to sustain in hospital-fall prevention in older
patients – Validation of the Lucas fall-risk screening in 2, 337 patients. Journal of
Nutrition Health and Aging, 19, 1012-1018. Retrieved from
http://eds.a.ebscohost.com.lopes.idm.oclc.org
Morello, R., Barker, A., Ayton, D., Landgren, F., Kamar, J., Hill, K., … Stoelwinder, J. (2017).
Implementation fidelity of a nurse-led falls prevention program in acute hospitals during
the 6-PACK trial. BMC Health Services Research, 17(383).
http://dx.doi.org/10.1186/s12913-017-2315-z
Office of Statewide Health and Planning Development. (2015). Hospital discharge summary
report. Retrieved from http://gis.oshpd.ca.gov/atlas/topics/use/inpatient#charts
HOSPITAL FALLS: AN ONGOING PROBLEM
Oliveira, D. M., Hammerschmidt, K. S., Schoeller, S. D., Girandi, J. B., & de Paula, N. F.
(2016). Assessment instrument for falls among the hospitalized elderly (Hospital AIFE):
Nurse analyzing vulnerability and mobility. Journal of Nursing, 4065-4074.
http://dx.doi.org/10.5205/reuol.9881-87554-1-EDSM1011201631
Thomas, S., & Mackintosh, S. (2016, June). Improvement of physical therapist assessment of
risk of falls in the hospital and discharge handover through an intervention to modify
clinical behavior. Physical Therapy, 96(6), 764-773. Retrieved from
http://eds.a.ebscohost.com.lopes.idm.oclc.org
Tzeng, H., Hu, H., & Yin, C. (2016, July-August). Understanding inpatient injurious fall rates
using Medicare’s hospital compare data. MedSurg Nursing, 25(4), 255-269. Retrieved
from http://eds.a.ebscohost.com.lopes.idm.oclc.org
MY PICOT STATEMENT
For the growing pool of hospital patients 65 and older (P), will the increased presence of nurses
at a patient’s bedside (I), compared to those receiving the current nurse attention (C),
experience less falls during their stay in the hospital in addition to a lesser degree of
severity in said falls (O), over a 6-month period (T)?
6
Review the Topic Materials and the work completed in NRS-433V to formulate a PICOT statement for
your capstone project.
A PICOT starts with a designated patient population in a particular clinical area and identifies clinical
problems or issues that arise from clinical care. The intervention should be an independent, specified
nursing change intervention. The intervention cannot require a provider prescription. Include a
comparison to a patient population not currently receiving the intervention, and specify the timeframe
needed to implement the change process.
Formulate a PICOT statement using the PICOT format provided in the assigned readings. The PICOT
statement will provide a framework for your capstone project.
In a paper of 500-750 words, clearly identify the clinical problem and how it can result in a positive
patient outcome.
Make sure to address the following on the PICOT statement:
1.
2.
3.
4.
5.
Evidence-Based Solution
Nursing Intervention
Patient Care
Health Care Agency
Nursing Practice
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the
Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become
familiar with the expectations for successful completion.
Welcome to WEEK 3!
Class, in week 3 we will begin the capstone project and this process, like research, always begins with
a burning question or questioning statement. So many students get nervous about this and my
challenge to you is not get nervous but rather take a deep breath and plunge in. Think about practice
problems or questions you have often asked yourself. This is the time to find best evidence supported
answers!! The PICO(T) is the question that guides a research study-it needs to be succinct and explicitwith just a little leeway .
P= Population. You will want this to be kind of vague or all the studies and articles you find will have to
be very tight. For example, if your population is ‘in children 5-10 years old’, then you will have to find
studies done on children between 5-10; however, if you say children, adolescents and teens your base
is larger. In addition, if the issue can be applied in general, such as Hospital Acquired Infections- you
will want to say, “In patients with central lines” or “In intubated and vent dependent
patients”….rather than in adults, children, elderly. Now you can find studies for ALL patients with
central lines or all patients that are tubed and vented.
I-Intervention. What it is you plan to do, or plan to research. This must be nursing focused and patient
driven. This can be an independent intervention or a bundle. For example, “In vented patients, what
does current literature suggest for best practice in the prevention of ventilator associated pneumonia?”
C-Comparison. Not all PICO(T)s have a comparison. For example, if you wonder if staffing is an issue
with medication errors, you may want to research the evidence supporting ‘best’ way to staff- is it by
numbers, acuity, team/primary mix, etc. There will not be a comparison. If you like the idea of
investigating hourly purposeful rounding, your comparison will be assumed. For example, ‘In the acute
care setting, will purposeful hourly rounding decrease patient falls?’ In this study, one would monitor
falls and compare to prior statistics. Here is the issue with using a ‘background foreground’ type
question (see Dearholt & Dang, pg.64) is that it does not lead to the change plan you want. You can
use a background foreground question as you seek best practice but once you start your change plan in
milestone 2, you will have to take the information you learned from this question and then develop
another PICO to build your change project.
O-Outcome. What it is you are trying to determine- often this is related to best practice… fewer falls,
less mortality, shorter hospital stays, higher patient/nurse satisfaction, decreased burnout, better
compliance, better outcomes, shorter hospital stays, etc.
Putting it all together!!
In the diabetic patient (P), implementation of (outpatient) telemedicine and support of a nurse
practitioner (I), will improve patient compliance and decrease long-term effects of diabetes (O).
In the diabetic patient (P), implementation of aggressive education program regarding disease process
and self-care (I) will lead to increased compliance through self-efficacy (O).
In school age children (P), education regarding diet and exercise (I) with parents/family present,
compared to school age child without parents/family present(C) in long term healthy health choices
and compliance.
Let’s practice! See if you can label the P-I-C-O in these statements/questions!
•
In patients with central lines, does the use of Curos Port Protectors, compared with no
protectors, decrease incidence of blood born infection?
•
In acute care, does including alcohol-based dispensers on the unit, compared with soap and
water only, increase staff compliance in hand washing?
•
In nursing population, what reasons are stated for poor hand hygiene compliance?
•
In patients with peripheral IV lines, does the implementation of Curos Port Protectors decrease
incidence of blood born infections?
•
In the diabetic population, integration of exercise programs with diet education, compared to
diet education alone, will decrease risk of long-term complications.
•
For the diabetic patient, which self-care strategies are most important in the control of the
disease and minimizing long term complications?
•
In the diabetic patient, formal education and support system, compared with no formal
education and follow up, will increase self-efficacy leading to better compliance reducing
complications to disease.
T-Time. Time is not always appropriate. Sometimes it is important to note that you will be researching
for a period of time. For example, if you were planning to collect data on handwashing, you may put
alcohol dispensers up and then collect data for a month. On the other hand, you may complete a
teaching project and you want to assess learning after a presentation. If you are doing a literature
search for studies on a particular topic, you may not want to limit your search to a specific period of
time.
Dearholt, S. & Dang, D. (2012). Johns Hopkins nursing evidence-based practice: Model and guidelines
(2nd.). Indianapolis, IN :Sigma Theta Tau International
PICOT Statement Paper
2
1
Less than
Unsatisfactory
Satisfactory
0.00%
75.00%
80.0 %Content
30.0
%Identification
of Clinical
Problem/Issue
30.0 %Clinical
Problem/Issue,
Including
Description,
Clinical
problem/issue
is not
identified, and
resolution is
not addressed.
Clinical
problem/issue
is identified
with little
discussion of
resolution or
patient
outcome.
3
Satisfactory
79.00%
4
Good
89.00%
Clinical
Clinical
problem/issue problem/issue
is identified but is identified
not supported based on
with clinical clinical
observations or observation
evidence. The experience or
identified
evidence in
problem/issue literature.
can be
Articles are
resolved, or a cited to
patient
support the
outcome shows need for
minimal
change in
improvement. nursing
practice. The
identified
problem/issue
can be
resolved, or a
patient
outcome can
be improved
using nursing
interventions.
5
Excellent
100.00%
Clinical
problem/issue
is identified
based on key
concepts that
define
evidencebased practice
or clinical
experience.
Articles are
cited to
support the
need for
change in
nursing
practice. The
identified
problem/issue
can be
resolved, or a
patient
outcome can
show a marked
improvement
through a
nursing
intervention.
Clinical
Clinical
Clinical
Clinical
Clinical
problem/issue problem/issue problem/issue problem/issue problem/issue
is not
description
description
description description
described with includes a
includes a
includes a
includes a
Evidence-Based clarity and the
Solution, Nursing corresponding
Intervention,
elements are
Patient Care,
not included.
Health Care
Agency, and
Nursing Practice
10.0 %PICOT
Statement
Focused on
Resolution,
Improvement,
Application, and
Intervention
PICOT
statement does
not focus on
resolution of a
problem/issue,
improvement
of patient care
basic
basic
thorough
developed and
understanding understanding understanding thorough
of the
of the
of the
explanation of
problem/issue problem/issue, problem/issue, the
and setting,
the setting, and the setting, the problem/issue,
with few of the the patient
patient
the setting, the
following
population.
population, patient
elements
The following and why it is a population,
explained:
elements are problem/issue. and the
evidence-based explained:
The following rationale for
solution,
evidence-based elements are why it is a
nursing
solution,
explained in problem/issue.
intervention, nursing
detail:
The identified
patient care, intervention, evidenceclinical
health care
patient care, based
problem/issue
agency, and health care
solution,
explains the
nursing
agency, and
nursing
following
practice.
nursing
intervention, elements with
practice.
and patient
detail and
Minimal
care
clarity:
rationale is
consistent
evidenceprovided to
with specific based solution,
support the
health care
nursing
resolution of agency and intervention,
the clinical
nursing
and improved
problem/issue. practice.
patient care
Sound
consistent with
rationale is
specific health
provided
care agency
supporting the resulting in
clinical
nursing
problem/issue practice
resolution.
change. Sound
rationale is
provided in
the discussion
of the clinical
problem/issue
resolution.
PICOT
PICOT
PICOT
PICOT
statement
statement
statement
statement
discusses a
focuses on the focuses on the clearly focuses
clinical
resolution of a resolution of a on the
problem/issue clinical
clinical
resolution of a
without a focus problem/issue problem/issue, clinical
on
that improves with
problem/issue
10.0 %PICOT
Statement
Including
Population,
Intervention,
Comparison,
Outcomes, and
Time
or application improvement patient care
discussion of
of a nursing
or intervention. through the
improving
intervention.
application of a patient care
nursing
through the
intervention. application of
an evidencedbased nursing
intervention.
Population,
Population,
Population,
Population,
Intervention, Intervention, Intervention, Intervention,
Comparison, Comparison, Comparison, Comparison,
Outcomes, and Outcomes, and Outcomes, and Outcomes,
Time are not Time are
Time are
and Time are
included.
present, but
present.
clearly
lack detail or
provided and
are incomplete.
well
developed.
15.0
%Organization
and Effectiveness
5.0
Paper lacks
Thesis is
Thesis is
%Presentation any discernible insufficiently apparent and
overall purpose developed or appropriate to
or organizing vague. Purpose purpose.
claim.
is not clear.
and aims at
improving
patient care
through the
application of
an evidencedbased nursing
intervention.
Population,
Intervention,
Comparison,
Outcomes, and
Time are
comprehensive
and
thoroughly
developed
with
supporting
details.
Thesis is clear Thesis is
and forecasts comprehensive
the
and contains
development the essence of
of the paper. the paper.
Thesis is
Thesis
descriptive
statement
and reflective makes the
of the
purpose of the
arguments and paper clear.
appropriate to
the purpose.
5.0 %Argument Statement of Sufficient
Argument is Argument
Clear and
Logic and
purpose is not justification of orderly, but
shows logical convincing
Construction
justified by the claims is
may have a few progressions. argument that
conclusion.
lacking.
inconsistencies. Techniques of presents a
The conclusion Argument
The argument argumentation persuasive
does not
lacks
presents
are evident. claim in a
support the
consistent
minimal
There is a
distinctive and
claim made. unity. There justification of smooth
compelling
Argument is are obvious
claims.
progression of manner. All
incoherent and flaws in the
Argument
claims from sources are
uses
…
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