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To Prepare:

  • Reflect on the four peer-reviewed articles you critically appraised in Module 4.
  • Reflect on your current healthcare organization and think about potential opportunities for evidence-based change.

The Assignment: (Evidence-Based Project)

Part 5: Recommending an Evidence-Based Practice Change

Create an 8- to 9-slide PowerPoint presentation in which you do the following:

  • Briefly describe your healthcare organization, including its culture and readiness for change. (You may opt to keep various elements of this anonymous, such as your company name.)
  • Describe the current problem or opportunity for change. Include in this description the circumstances surrounding the need for change, the scope of the issue, the stakeholders involved, and the risks associated with change implementation in general.
  • Propose an evidence-based idea for a change in practice using an EBP approach to decision making. Note that you may find further research needs to be conducted if sufficient evidence is not discovered.
  • Describe your plan for knowledge transfer of this change, including knowledge creation, dissemination, and organizational adoption and implementation.
  • Describe the measurable outcomes you hope to achieve with the implementation of this evidence-based change.
  • Be sure to provide APA citations of the supporting evidence-based peer reviewed articles you selected to support your thinking.
  • Add a lessons learned section that includes the following:
    • A summary of the critical appraisal of the peer-reviewed articles you previously submitted
    • An explanation about what you learned from completing the evaluation table (1 slide)
    • An explanation about what you learned from completing the levels of evidence table (1 slide)
    • An explanation about what you learned from completing the outcomes synthesis table (1 slide)

Evaluation Table

Use this document to complete the evaluation table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Full citation of selected article

Article #1

Article #2

Article #3

Article #4

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society61(4), 483-494.

DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Meta‐analysis: multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of hospital medicine7(6), 497-503.

Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clinical Rehabilitation21(8), 742-753.

Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for Preventing Falls in Acute Care Hospitals.

Conceptual Framework

Describe the theoretical basis for the study

None

multidisciplinary fall prevention interventions in acute care hospital 

None

Inclusion of prospective controlled-design studies reporting the effectiveness of fall prevention programs in hospitals.

Design/Method Describe the design

and how the study

was carried out

Systematic review using a qualitative method

Used qualitative method where the bibliographies of all systematic reviews and meta-analyses were hand searched a meta-analysis reviews

Randomized controlled trial, subgroup analysis.

Cluster randomized study

Sample/Setting

The number and

characteristics of

patients,

attrition rate, etc.

U.S. acute care hospitals

Acute care settings

5038 total participants. 1958 Male and 3080 Female. Patients of a metropolitan sub-acute/aged rehabilitation hospital

Acute Care Settings

Major Variables Studied

List and define dependent and independent variables

Participants Studies reporting in-hospital falls for intervention groups and concurrent (e.g., controlled trials) or historic comparators (e.g., before-after studies).

The belt, older people,

Dependent – Falls, independent – exercise,

Dependent- the relative risk of a fall per occupied bed day (RR(fall)) and independent – the relative risk of being a faller (RR(faller))

Measurement

Identify primary statistics used to answer clinical questions

Incidence rate ratios (IRR, ratio of fall rate post intervention or treatment group to the fall rate pre-intervention or control group) and ratings of study details.

Electronic fall prevention tool kit which triggered automatic ordered interventions.

multifactorial interventions including exercise to prevent inpatient falls in older adults 

The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries.

Data Analysis

Statistical or

qualitative

findings

Meta-regressions analysis

Effect sizes (odds ratios) and 95% confidence intervals were derived for individual studies and then combined across research reports using a random-effects meta-analysis.

Intervention group participants in this subgroup analysis had a significantly lower incidence of falls than their control group counterparts (control: 16.0 falls/1000 participant-days, intervention: 8.2 falls/1000 participant-days, log-rank test: P = 0.007). However few differences in secondary balance, strength and mobility outcomes were evident.

Hospitalization further increases risk of falls

Findings and Recommendations

General findings and recommendations of the research

Study shows better reporting of outcomes, implementation, adherence, intervention components, and comparison group information is necessary to establish evidence on how hospitals can successfully prevent falls.

Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions. Additional randomized trials are needed to examine the possible benefits of multidisciplinary fall prevention strategies in the acute inpatient setting.

This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting.

The authors found that precautionary care including a falls safety champion reduced the occurrence of injurious falls by 58.3% (n=36).

Appraisal

Describe the general worth of this research to practice. What are the strengths and limitations of study? What are the risks associated with implementation of the suggested practices or processes detailed in the research? What is the feasibility of use in your practice?

Adherence methodologies are of specific significance for long haul changes

A broad eligibility criterion was incorporated in the study and questions were clearly reviewed and addressed.

Participants had their balance, strength and mobility assessed upon referral for the exercise programme and then again prior to discharge.

The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls.

General Notes/Comments

N/A

N/A

N/A

N/A

Levels of Evidence Table

Use this document to complete the levels of evidence table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article

Article #1

Article #2

Article #3

Article #4

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017

DiBardino, D., Cohen, E. R., & Didwania, A. (2014).

Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017).

Spiva, L., & Hart, P. (2014).

Study Design

Theoretical basis for the study

Systematic review using a qualitative method

systematic reviews and meta-analyses

Randomized controlled trial, subgroup analysis.

Cluster randomized study

Sample/Setting

The number and

characteristics of

patients

U.S. acute care hospitals.

Information on number of fallers, number of falls, fall rate (per 1,000 patient days), and number eligible to fall.

Sample sizes were not reported but the number of 1,000-patient days in treatment groups ranged from 4.3 to 160.3.

5038 total participants. 1958 Male and 3080 Female.

Comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients).

Evidence Level *

(I, II, or III)

Level V

Level VII

Level 1

Level 1

Outcomes

A critical analysis of the qualitative studies surrounding the use of interventions placed to reduce the number of elderly falls in the hospital.

Fall prevention strategies had a statistically significant but small effect on fall rates despite the use of complex, multidisciplinary interventions.

Provides a meta-analysis

from randomized controlled

trials involving exercise

The review addressed a clear question and used broad eligibility criteria.

General Notes/Comments

N/A

N/A

N/A

N/A

* Evidence Levels:

· Level I

Experimental, randomized controlled trial (RCT), systematic review RTCs with or without meta-analysis

· Level II

Quasi-experimental studies, systematic review of a combination of RCTs and quasi-experimental studies, or quasi-experimental studies only, with or without meta-analysis

· Level III

Nonexperimental, systematic review of RCTs, quasi-experimental with/without meta-analysis, qualitative, qualitative systematic review with/without meta-synthesis

· Level IV

Respected authorities’ opinions, nationally recognized expert committee/consensus panel reports based on scientific evidence

· Level V

Literature reviews, quality improvement, program evaluation, financial evaluation, case reports, nationally recognized expert(s) opinion based on experiential evidence

Outcomes Synthesis Table

Use this document to complete the outcomes synthesis table requirement of the Module 4 Assessment, Evidence-Based Project, Part 4A: Critical Appraisal of Research

Author and year of selected article

Article #1

Article #2

Article #3

Article #4

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017

DiBardino, D., Cohen, E. R., & Didwania, A. (2014).

Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017).

Spiva, L., & Hart, P. (2014).

Sample/Setting

The number and

characteristics of

patients

Same as above

Same as above

Same as above

Same as above

Outcomes

Studies had to report on the outcome of inpatient falls.

Fall prevention help should be considered along patient’s cultural differences.

Properly implemented fall prevention strategies and interventions are important for older adults

Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age.

Key Findings

Meta-regressions showed some evidence of the importance of adherence levels to reduce falls

Fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions.

This exercise programme provided in addition to usual care may assist in the prevention of falls in the sub-acute hospital setting

The analysis of this study show that fall prevention strategies according to risk category and insufficient to prevent falls, especially low risk patients.

Appraisal and Study Quality

Population control study

Random control study

Cohort review study

True experiment evidence from the RCT

General Notes/Comments

Feasibility of the entire study through examination of recruitment, Eligibility,

Protocol, adherence and

missing data

Comprehensively reviews literature thus efficient in

boosting the knowledge of

clinical experts on about the

Clinical issue. Generally

ineffective unless supported by other sources

Comprehensively reviews literature thus efficient in boosting the knowledge of clinical experts on about the clinical issue.

Being a level one evidence with favourable outcomes, it

helps to solve the clinical question and provides a

comprehensive answer to the study question

Critical Appraisal Tools Worksheet Template

© 2018 Laureate Education Inc. 1

,

Running head: Critical Appraisal of Research

Critical Appraisal of Research

Part 4B: Critical Appraisal of Research

Walden University: NURS-6052.

October 13, 2019

Part 4B: Critical Appraisal of Research

Given my examination, the best practice that rises out of the exploration I checked on is Evidence-Based Practice (EBP), whereby in a clinical setting, it is considered as a fundamental component for guaranteeing that patients are given quality care just as treatment services. EBP is viewed as reasonable just as meticulous use of clinical practices that depend on current evidence. Also, medical care experts, with the help of EBP, can settle on successful decisions in connection to medicinal services operations. EBP depends on various pieces of evidence that incorporate qualitative just as quantitative research, controlled preliminaries, case reports, expert opinion, and scientific standards.

In this specific case, the clinical practices dependent on EBP help with giving better care just as treatment benefits as per patient values alongside clinical aptitude (Forrest, 2008). EBP depends on evidence gathered from qualitative research. Consequently, the quantitative analysis assumes a significant role in collecting data about current practices to be effected for the improvement of clinical skills and in gathering the patient's values. The research examines that are ineffectively structured, and inadequate reporting is contended to influence quantitative analysis crosswise over various spheres that incorporate medicinal services, future research, decision making, and health policy. In such manner, distinguishing reporting rules including diagnosis test studies (STARD), observational studies (STROBE), meta-analyses of observational studies (MOOSE), consolidated criteria for reporting qualitative research (COREQ) and randomized controlled trials (CONSORT) were used in these peer-reviewed articles.

Recognizing that clinicians have time constraints but then need to give the ideal care to their patients, the evidence-based methodology offers clinicians an advantageous technique for discovering current research to help in making clinical decisions, answer patient questions, and investigate alternative therapies, strategies, or materials. With a comprehension of how to viably use EBDM, professionals can rapidly and helpfully remain current with scientific discoveries on points that are essential to them and their patients.

References

DiBardino, D., Cohen, E. R., & Didwania, A. (2014). Meta‐analysis: multidisciplinary fall prevention strategies in the acute care inpatient population. Journal of hospital medicine7(6), 497-503.

Forrest, J. L. (2008). Evidence-based decision making: introduction and formulating good clinical questions. J Contemp Dent Pract1(3), 042-052.

Haines, T. P., Hill, K. D., Bennell, K. L., & Osborne, R. H. (2017). Additional exercise for older subacute hospital inpatients to prevent falls: benefits and barriers to implementation and evaluation. Clinical Rehabilitation21(8), 742-753.

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & Ganz, D. A. (2017). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society61(4), 483-494.

Spiva, L., & Hart, P. (2014). Evidence-Based Interventions for Preventing Falls in Acute Care Hospitals.