Capstone Project Change Proposal Final Paper

In this assignment, students will pull together the capstone project change proposal components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. For this project, the student will apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.

Develop a 1,250-1,500 written project that includes the following information as it applies to the problem, issue, suggestion, initiative, or educational need profiled in the capstone change proposal:

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Background

Clinical problem statement.

Purpose of the change proposal in relation to providing patient care in the changing health care system.
PICOT question.
Literature search strategy employed.
Evaluation of the literature.
Applicable change or nursing theory utilized.
Proposed implementation plan with outcome measures.
Discussion of how evidence-based practice was used in creating the intervention plan.
Plan for evaluating the proposed nursing intervention.
Identification of potential barriers to plan implementation, and a discussion of how these could be overcome.
Appendix section, if tables, graphs, surveys, educational materials, etc. are created.
Review the feedback from your instructor on the Topic 3 assignment, PICOT Question Paper, and Topic 6 assignment, Literature Review. Use this feedback to make appropriate revisions to these before submitting.

PICOT Question: In an adult inpatient healthcare system setting (P), does hourly rounding (I) compared to no rounding (C) reduce patients’ falls (O) within two months of implementation?

PICOT is a commonly used acronym in research protocols, defined as “Patient, Intervention, Comparison, Outcome and Time.” We will compare an intervention of hourly rounding with an intervention of not having hourly rounding. The comparison group will be patients in adult inpatient healthcare systems who are not receiving hourly rounding like the control group. It would take about two months for staff to be trained on implementing this new practice and then another month to begin implementing it with patients.

Problem

Patient falls are a typical occurrence in all medical facilities. In addition, the number of patients receiving care in hospitals is increasing. The clinical problem is the high number of patients falling into the adult inpatient healthcare system. This can result in death, hospitalization, and a decreased quality of life for patients and their families.

Evidence-Based Solution

The nurses could provide short one-on-one training sessions on safely transferring patients. Alternatively, they could implement a system that would allow staff members to check in with each other throughout their shift to ensure that all residents are safe and comfortable (Little 2022). In addition, nurses can use evidence-based practice to improve the health of patients with dementia in long-term care settings by offering those activities that stimulate the senses, such as music therapy or aromatherapy. It was evident that the patients monitored closely on an hourly basis were in a better state to recover fast, and the rate of falls was reduced.

Nursing Intervention:

The nurses could assign one nurse to each resident at night to help them safely get out of bed and into a wheelchair when they need assistance getting up. In addition, implementing the practice of hourly rounding would require a change process. These change processes may include educating nurses on how to round efficiently, developing protocols for transferring task responsibilities, and establishing accountability for completing rounds. Moreover, an hourly rounding schedule ensures that a healthcare professional checks on each fall-risk patient every hour, reducing the likelihood that a fall will go unnoticed without intervention (Cunha et al., 2019 Capstone Project Change Proposal Final Paper). By implementing this system, nurses can better manage patient flow to ensure that all patients receive timely attention without compromising safety or quality of care.

Patient Care:

Hourly rounding allows for more direct contact with the patients and strengthens their relationships with nurses. This increases rapport, which leads to better communication between the staff and patients and makes them feel more comfortable coming forward if they require help. This can greatly reduce patient falls by alerting medical staff early on of any problems, such as difficulty breathing or confusion (Thayer et al., 2018). It also allows for quicker response times should a situation arise that requires urgent attention. Furthermore, hourly intervention would improve the safety and quality of patient care and ensure that all staff members are aware of any changes in their condition to respond accordingly.

Health Care Agency

Implementing hourly rounding would require changing policies and educating staff on implementing new policies. However, many hospitals have not achieved full EHR implementation as they face challenges with technological capabilities, staff training, cultural barriers, and financial barriers. Poor workflow can result when a facility lacks standardization across departments. One department may use paper-based processes while another relies on voice recognition software, leading to errors affecting patient safety.

As patient diagnoses are varied with increasing complexity due to shifting demographics and new technologies available, it is important for staff to communicate effectively to ensure proper care delivery. Additionally, with the ever-increasing number of older adults entering long-term care facilities and the following discharged from acute care settings, preventing falls and reducing injuries in these populations is critical to improving outcomes. When the policies are followed closely, there will be a significant change in reducing the number of falls in a hospital setting.

Nursing practice

The nursing practice of hourly rounding allows nurses to document patient needs and address concerns. In a hospital setting, hourly rounding also allows nurses to provide family support and promote family participation in care. According to Elnitsky et al. (2014), hourly rounding is significant because families can greatly impact the health of their loved ones, especially for patients who tend to be isolated from friends and loved ones during their hospital stay. Nurses play an important role in preventing patient falls by paying attention to any changes in their condition that may indicate danger, such as dizziness or confusion.

Conclusion

Fall prevention is an important goal of nursing care for hospitalized patients. In addition, patient falls can result in death, hospitalization, and decreases in quality of life for patients and their families. Intervention in an hourly rounding prevents falls in patients, thereby saving lives in hospitals. PICOT statement helps collect information about the survey; thereby, the reader can standardize their finding. Moreover, hourly rounding by nursing staff has been recommended as a preventive measure against falls. It has been proven that hourly checkups reduce falls without notice and improve patient-nurse relations.

Capstone Project Change Proposal Final Paper References

Cunha, L. F. C. D., Baixinho, C. L., & Henriques, M. A. (2019). Preventing falls in hospitalized elderly: design and validation of a team intervention. Revista da Escola de Enfermagem da USP, 53. DOI: 10.1590/S1980-220X2018031803479

Little, K. K. (2022). Developing a Standardized Process for an Effective, Evidence-Based Fall Management Program to Reduce Falls in a Nursing Home Setting. https://doi.org/10.1093/ageing/afac077

Elnitsky, C. A., Lind, J. D., Rugs, D., & Powell-Cope, G. (2014). Implications for patient safety in the use of safe patient handling equipment: A national survey. International Journal of Nursing Studies, 51(12), 1624-1633. https://doi.org/10.1016/j.ijnurstu.2014.04.015

Thayer, M. K., Kleweno, C. P., Lyons, V. H., & Taitsman, L. A. (2018). Concomitant upper extremity fracture worsens outcomes in elderly patients with hip fracture. Geriatric orthopaedic surgery & rehabilitation, 9, 2151459318776101. https://doi.org/10.1177/2151459318776101