DPI Project Milestone 10 Strategic Points Project Proposal10 Strategic Points Project Proposal10 Str

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DPI Project Milestone 10 Strategic Points Project Proposal

10 Strategic Points Project Proposal

10 Strategic PointsComments/FeedbackBroad Topic AreaNew Fall Preventive Approach for Stroke Population in Rehabilitation FacilityLiterature Reviewa.      Background of the Problem/Gap:

·         Hospital falls are among the most commonly reported adverse hospital events with more than one million occurring annually (Leone & Adams, 2016).

·         Stroke patients were the largest diagnostic group accounting for all unassisted falls (Leone & Adams, 2016).

·         Most of these incidents were related to stroke patients attempting to toilet themselves when they fell.

·         There are some challenges for stroke patients to have awareness of their surroundings and ability effect by stroke.

b.      Theoretical Foundations (models and theories to be foundation for study):

·         The RE-AIM model (Reach, Efficacy, Adoption, Implementation, Maintenance) was used to identify strategies for an effective program (Day et al., 2011).

c.       Review of Literature Topics With Key Organizing Concepts or Topics for Each One

·         Research study found bladder training and prompted voiding share the two characteristics of cognitive behavioral modi?cation and active client participation (Roe, Milne, Ostaszkiewicz & Wallace, 2007).

·         Timed voiding program has proved successful in decreasing unassisted bathroom-related falls in the stroke population (Mehdi, Birms & Bhalla, 2013).

d.      Summary

• Gap/Problem: There is a need to implement evidence-based methods of improving hospital falls in stroke patients through preventive fall program.
• Prior studies: Prior studies show that timed voiding program has improved unassisted bathroom-related falls in the stroke population.
• Quantitative application: Sources of data provide a method of evaluating and analyzing a new intervention and its effectiveness.

e.       Significance:

·         Improving rate of hospital falls;

·.

Problem StatementWhile the literature indicates that it is important to develop new measures for fall prevention programs in stroke populations, it is unknown if the implementation of Bladder Training and Timed-voiding program would decrease unassisted bathroom-related falls in the stroke population.Clinical/PICO QuestionsCan a combination intervention (bladder training and timed-voiding) decrease unassisted bathroom related falls in post ischemic stroke patients within six weeks period on a rehabilitation unit at a local Rehabilitation Institute?Sample(L) – Local inpatient rehabilitation facility (Memorial Rehabilitation Institute in Hollywood, Florida).

(P) – Population: post ischemic stroke patients.

(I) – Intervention: Implementing a Bladder Training and Timed-voiding program to decrease unassisted bathroom-related falls in post ischemic stroke population.

(C) – Comparison: Use multiple data collection and analysis from EHR and FIM score to compare before and after the new fall prevention program.

(O) – Outcome: Decreased unassisted bathroom-related falls in post ischemic stroke population.

(T) – Time: Quasi-experimental review of electronic medical records for all stroke patients who fell in six months period prior to the program need to be conducted. Then compare with Fall debrief survey score for post program will be measure in 6 weeks period.

Define VariablesDefine Variables:

·         Independent Variable: Bladder training and timed-voiding program.

·         Dependent Variable: The effectiveness of decreasing unassisted bathroom-related falls post ischemic stroke population.

Methodology and DesignThis study will be using a quantitative methodology with quasi-experimental design.Purpose StatementThis quantitative quasi-experimental study is to explore and understand contributing factors of falls in the stroke population by using database from the electronic health record (EHR) at inpatient rehabilitation facility.  Based on targeted pre-intervention findings from falls database, design and implement an intervention specific to decrease unassisted bathroom related falls in stroke patients through a multidisciplinary timed voiding program. 

 

Data Collection ApproachQuasi-experimental review of electronic medical records for all stroke patients who fell in six months period prior to the program need to be conducted. Then collect the score from Fall debrief survey score for post program to be measure in 6 weeks period. Survey specific patient-related data focused on demographics (age and gender), medical condition (type of stroke, comorbidities), days since admission, neurological deficits (mental status, physical or visual impairment), and potential value of the functional independence measure (FIM) score for predicting falls.Data Analysis ApproachFall debrief data contained descriptive details of the falls and its circumstances which included the time of fall, day of week, location, call bell usage, activity being attempted, effect of medications that may impact falls.  EHR database provides valuable tools to help identify and assess risk factors for falls. These data also provide a method of evaluating and analyzing a new fall prevention program and pre and post program scores will be compared to determine its effectiveness.

References

• Day, L., Finch, C. F., Hill, K. D., Haines, T. P., Clemson, L., Thomas, M., & Thompson, C. (2011). A protocol for evidence-based targeting and evaluation of statewide strategies for preventing falls among community-dwelling older people in Victoria, Australia. Injury Prevention, 17(2), 3. doi: org/10.1136/ip.2010.030775
• Leone, R. M. & Adams, R. J. (2016). Safety standards: implementing fall prevention interventions and sustaining lower fall rates by promoting the culture of safety on an inpatient rehabilitation unit. Rehabilitation Nursing, 41, 26-32
• Mehdi, Z., Birms, J. & Bhalla, A. (2013). Post-stroke incontinence. International Journal clinical practice, 67(11), 1128-1137
• Roe, B., Milne, J., Ostaszkiewicz, J. & Wallace, S. (2007). Systematic reviews of bladder training and voiding programs in adults: a synopsis of ?ndings on theory and methods using metastudy techniques. Journal of Advanced Nursing, 57(1), 3–14. doi: 10.1111/j.1365-2648.2006.04098.x

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