Proposed Evidence-Based Change and Implementation Plan

Chapter 4: Proposed Evidence-Based Change and Implementation Plan

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1. Chapter 4: Proposed Evidence-Based Change and Implementation Plan

1.1.             Evidence-Based Change Proposal

The change management proposal is an integrated approach that seeks to mitigate patient falls in Nursing Home X through a sound evidence base that responds to the identified inadequacy of education on fall prevention among the clinical staff, as outlined above. This integrated intervention is designed to achieve the best training measures for staff nurses and ensure that fall prevention practices implemented consistently are consistent with the evidence. The first dimension is the organizational cultural transformation that should encompass a broad employee training program to teach staff members in terms of such important issues as identifying fall risk factors, use of assistive devices appropriately, and enhancing communication within multidisciplinary teams (Czarnuch & Mihailidis, 2011). The second issue touches upon the common realization of evidence-based interventions that require standardization and focus on uniform protocols. These protocols are specifically designed to address the weaknesses identified in the gaps exposed by inconsistent implementation of evidence-based fall prevention strategies which ensures uniformity and standardization alleviate the risk associated with patient falls.

Based on the research evidence on the proposed change, clearly shows a high degree of support for staff training and standardized implementation. The works of Tzeng and Yin (2008) show how staff training is capable of minimizing falls in nursing homes. It underlines the positive correlation between higher training ratios and better resident outcomes, indicating that falling incidents correlate with staff’s level of preparation. This result can not only be applied to Nursing Home X where the administrator and assistant director of nursing have discovered a deepack, with more than 75% fall education missing for staff hired within the past month. These also bring to light the need and necessity of introducing a detailed system of staff training addressing this anomaly.

Quigley et al. (2017) introduce the capacity in which while at nursing homes inconsistently fall prevention approaches are being executed. This is in line with the breakdowns bordering poor coordination among cross-functional team members at Nursing Home X evident from the fishbone diagram. Available for each facility, the proposed standardized implementation of EBI addresses this inconsistency by incorporating a systematized approach that should improve collaboration and reduce falls.

What is proposed as a change is somewhat attached to improvement opportunities observed in Chapter 2 and the process flow diagram. The shortcomings in the staff training and selection of implementation strategies inconsistently based on evidence-based interventions identified as areas where improvement was needed are directly reflected by the proposed approaches. The focus of the process flow diagram on targeting root causes for areas categorization including people, procedure, and materials reflects very well with the complexity of the suggested change. This way of working ensures a systemwide and emerging approach for patient fall reduction at Nursing Home X that is not only focused on the gaps but also, along with them addresses its broader organizational context.

1.2.             Additional Strategies to Address Significant Root Causes

To supplement the core strategies, other interventions will be integrated to address substantial root causes implicating patient falls. There is, for example, a strategy that would major on solely fall risk assessments such as mandatory use of standardized and consistent protocols. The intervention seeks to introduce a rate of fall risk assessment with an enhancement standard for all new admissions that will have better detection of individuals at high risk for falling. This approach supports the conclusion of Oliver et al. (2004) in that a case-based evaluation of fall risk is an integral part of prevention by patients developing in healthcare facilities belonging to older individuals.

A second support strategy targets at improving the reporting systems geared toward fall events. The implementation of dependable and timely reporting for occurrences related to falls should be Act to ensure that the right information is collected as regards fall-related incidences. Such reporting systems are highlighted as key tools by Rubenstein (2006) with their important asset being the elucidation of details and factors about falls. By adopting this strategy, Nursing Home X can smoothen the picky trail that specifications are thrown out by the incomplete reporting system, thus ensuring a more detailed analysis of fall incidents and factors involved.

These accompanying techniques support the initial interventions by targeting focus origins as determined in the fishbone diagram and aggregate data. Through the inclusion of practices advocated for by Oliver et al. (2004), and Rubenstein (2006) the proposed strategies move beyond employee training and standardized implementation as evident in ABCD 3Rs, the TIRNC model, IASP Mindsite program for dissemination that offered little or no effectiveness facilitation They strive to reinforce overall concept of fall prevention at Nursing Home X, balancing principle of a prudential and scientifically grounded approach towards the prevention of patient falls (Schwartz et al., 2008). More precisely, these additional approaches are intended to reinforce the multi-layered character of the intervention aimed at responding adequately and comprehensively to all complex conditions that caused a twofold increase in falling rates in the patient population present within the nursing home.

1.3.             Alternative Strategies Not Included

In developing the plan of intervention, alternative approaches were critically analyzed and some options were either accepted or rejected because of numerous issues. An alternative strategy, which could have been contemplated, was introducing technical and technology-based fall detection and prevention solutions. Even though it might offer various promising advantages, such as real-time monitoring and immediate response, this concept was rejected from the proposed scheme (Natora et al., 2022). Challenges with high costs, feasibility issues, and even running into possible resistance not only from the staff but also the residents of the nursing homes stood as great threats to successfully implementing advanced technology in an environment like this.

A second strategy that was proposed was based on staffing level expansion, thus humanizing the caregiving process. Arguably, the suggested approach had a chance to increase supervision and treatment accounts when financial costs were considered with incalculable it was the case that became one of the biggest obstacles. The business response to such a strategy is a cost that prevented it from including it in the proposed intervention plan, after hiring extra employees (Czarnuch & Mihailidis, 2011). Although an increased level of nurses was recognized as an information basis for the problem under consideration, staffing levels that would have sufficed under normal conditions in Nursing Home X were not feasible due to limited economic capabilities and financial considerations.

1.4.             Cost-Benefit Analysis

1.4.1.        Cost-Benefit Analysis Table:

1.4.2.        Cost-Benefit Analysis:

The cost-benefit analysis compares financial, human, and system costs of the actual state versus the proposed future state; specific costs provided in the table are included. Under the staff training program, the reparative potential for cost reduction between $50,000 and 36,12 that is from one state to another in the future reflects a saving of $2 million. About uniformity, the amount of the present expense to $40;000 and depending on projections for the future we can expect savings in the cost of up to $25merding into expected saving = 15, as the cost will be reduced by $ 25 thereby providing revenue that could have been spent somewhere else. In this current fall risk assessment upgrade, its short-term cost is $15,000 and the future reduced cost per 34 years is in terms of amounting to be $10, or with a potential benefit of $5, 000. Analogously, better reporting systems are estimated to save a cost of $5000 more which will decrease from the current cost of $20, 00. These figures highlight the positive bottom line generated from the recommended advances where investment in staff training, standardized implementation of core modules, and system upgrades is forecasted to bring significant cost-savings designs demonstrating a true cost savings of intervention.

1.5.             Change Model and Implementation Steps

1.5.1.        Change Model: Kotter’s Eight-Step Model

The proposed change will be implemented using Kotter’s Eight-Step Model, an organized and exhaustive approach to addressing the issue of patient traumatic falls in Nursing Home X. In the first step, a sense of urgency towards fall risks will be established when high rates of fall occurrences with prospects to cause harm are made known to stakeholders that there is a need for intervention After this, a guiding coalition will be developed to comprise of the main stakeholders like administrators nursing directors or clinical officers heads physicians and DNP student shall champaign for change (Capezuti et al., 2008). This coalition will be vital in formulating a clear vision and strategy for the prevention of patient falls based on educating staff members, standard procedure implementation, proper selection protocols, and improved fall assessment procedures.

The third step of Kotter’s model will be to designate the change vision through a dissemination process by communicating not only needed but also the defined strategy vaccinated by all staff members. To do that, we will emphasize the importance of each person’s impact and contribution to fall prevention. Secondly, the rollout phase will commence with functional new momentum via popular action, and ensuring corresponding resources and support for the projected strategies (Bowers et al., 2003). The fourth and final step involves providing short-term victories at the beginning of the large-scale reform process through the use of low-level cycles of change in conjunction with popular strategies such as PDSA for demonstrating immediate outcomes after implementation. Building on these outcomes, the following steps will aim at stabilizing successes, introducing more wins, and securing novel techniques in organizational culture to improve the prevention of falls in Nursing Home X consistently (Moraes et al., 2017). This integrated model serves as a comprehensive guide for DNP students and the collaborative team through involved stages to ensure transparency during implementation with communication as an essential pillar for collaboration between all parties determining

1.5.2.        DNP Student’s Role in Implementation:

The DNP student will take on a vital role in the enactment of the proposed change, playing the part of a catalyst and rally chairperson. The responsibilities of the student involve spearheading the innovation of a complete staff training program together with its implementation and ensuring that content fully aligns with evidence-based practices. Strategic partnership with the major stakeholders, such as administrators in charge of tasks and nursing directors physicians as well as other staff members will be one of the core initiatives supporting integrated communication among litigant parties. The DNP student will continuously evaluate the impact of the intervention he or she uses by performing routine evaluations to determine if implemented strategies are working and make changes wherever necessary. Moreover, the student will interact with staff members, seeking proper redress or any obstructions seen along the implementation chain (Capezuti et al., 2008). This hands-on approach aims to shape a culture of continuous learning and development, which would underscore every individual within the agreed team’s responsibility toward its comprehensive results in fall prevention at Nursing Home X.

1.5.3.        Timing of Plan-Do-Study-Act (PDSA) Cycles:

The Plan-Do-Study-Act (PDSA) cycles, necessary for the implementation of change, will work in nine-month periods to progressively revise the fall prevention strategies at Nursing Home X. Under each cycle, some detailed interventions will be planned and completed eighteen months later allowing one period of observations through which performance would be measured or refined before proceeding to implement the timeframe period of three months aligns with the goal mentioned in the aim statement which envisions a 5% fall reduction within this specific period. Due to the incorporation of the PDSA cycles, a pertinent dynamic approach is guaranteed throughout action since changes can always be implemented in response to constant observation and evaluation. The uninterrupted cycle that will generate feedback to the subsequent interventions will ensure that the data collection is guided by an adaptive and evidence-based implementation process (Czarnuch & Mihailidis, 2011). This tactical time-setting intends to find a compromise between the urgency of some timely improvements in fall prevention and the comprehensive analysis needed for sustained, effective change within the nursing home’ pandemic.

Conclusion:

In summary, this evidence-based plan for change and implementation focused on reducing patient falls in Nursing Home X is detailed, well thought out, and based on research. All the issues of staff training, standardized implementation, fall risk assessment upgrades, and enhanced reporting systems are squeezing what was seen in Tzeng and Yin’s research (2008). These interventions target existing gaps and their sources with a subsequent multi-level prevention strategy that should decrease falling rates. The financial benefits are shown to be high in the cost-benefit analysis and this further proves that it is financially viable for the changes proposed. Cotter’s Eight-Step Model, considering the role of a DNP student makes the implementation process both systematized and involving all responsible parties. The 9-month intervention further secures adaptability and evidence-based methodology, making it effective through the PDSA cycles. This proposed plan offers a planned and integrated approach on how to develop an overview culture of PDCA, Continuous quality improvement, and patient safety in Nursing home X.

References

Bowers, B. J., Esmond, S., & Jacobson, N. (2003). Turnover reinterpreted: CNAs talk about why they leave. Journal of Gerontological Nursing, 29(3), 36–43.

Capezuti, E., Brush, B. L., Won, R. M., Wagner, L. M., & Lawson, W. T. (2008). Least restrictive or least understood? Waist restraints, provider practices, and risk of harm. Journal of Aging & Social Policy, 20(3), 305–322. https://doi.org/10.1080/08959420802050967

Czarnuch, S., & Mihailidis, A. (2011). The design of intelligent in-home assistive technologies: Assessing the needs of older adults with dementia and their caregivers. Gerontechnology: International Journal on the Fundamental Aspects of Technology to Serve the Ageing Society, 10(3). https://doi.org/10.4017/gt.2011.10.3.005.00

Moraes, S. A. D., Soares, W. J. S., Lustosa, L. P., Bilton, T. L., Ferrioli, E., & Perracini, M. R. (2017). Characteristics of falls in elderly persons residing in the community: a population-based study. Revista Brasileira de Geriatria e Gerontologia, 20, 691–701.

Natora, A. H., Oxley, J., Barclay, L., Taylor, K., Bolam, B., & Haines, T. P. (2022). Improving policy for the prevention of falls among community-dwelling older people scoping review and quality assessment of international national and state level public policies. International Journal of Public Health, 67, 1604604. https://doi.org/10.3389/ijph.2022.1604604

Oliver, D., Daly, F., Martin, F. C., & McMurdo, M. E. T. (2004). Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age and Ageing, 33(2), 122–130. https://doi.org/10.1093/ageing/afh017

Quigley, P. A., Bulat, T., & Hart-Hughes, S. (2007). Strategies to reduce risk of fall-related injuries in rehabilitation nursing. Rehabilitation Nursing: The Official Journal of the Association of Rehabilitation Nurses, 32(3), 120–125. https://doi.org/10.1002/j.2048-7940.2007.tb00163.x

Schwartz, A. V., Vittinghoff, E., Sellmeyer, D. E., Feingold, K. R., de Rekeneire, N., Strotmeyer, E. S., Shorr, R. I., Vinik, A. I., Odden, M. C., Park, S. W., Faulkner, K. A., Harris, T. B., & Health, Aging, and Body Composition Study. (2008). Diabetes-related complications, glycemic control, and falls in older adults. Diabetes Care, 31(3), 391–396. https://doi.org/10.2337/dc07-1152

Tzeng, H.-M., & Yin, C.-Y. (2008). Patient satisfaction versus quality. Nursing Ethics, 15(1), 121–124. https://doi.org/10.1177/0969733007080210