Moving from evidence to education: An EBP project takes flight
After identifying an increase in patient falls, Debbie Durant, RN, BSN, director of the
med-surg unit at North Adams (MA) Regional Hospital, and Peg Daly, RN, BS,
education specialist at the 120-bed hospital, joined forces to develop an evidence-based
initiative to:
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Decrease falls by 10% within 12 months of plan implementation
Review and revise falls policy and procedures based on evidence-based data
Recommend necessary education for staff members
Develop ongoing performance improvement monitoring
Armed with the appropriate data, Durant and Daly organized a committee to develop a
plan to achieve these goals. One of the benefits of the committee is that committee
members come from various departments.
“We’re very excited about it,” says Durant. “Staff members who have a real interest in
resolving the problem were very interested in participating and having real input into this
project. Ancillary staff, who previously did not have a direct role in fall prevention, are
also very excited to have input and to receive training.”
Achieving buy-in
How did Durant and Daly get the rest of the organization to buy into a project that would
include not only education, but changes in patient care, documentation, responsibility,
and an ongoing need for data collection and evaluation? Most educators know what it’s
like to identify a need, develop a plan, and then have the implementation of that plan
blocked or hindered.
“We started by presenting the plan to the senior leadership team,” says Daly. “This
includes the CEO and all vice presidents. We presented our data, the purpose of the
change, and how the new fall prevention program would impact the organization, not
only in terms of job performance and patient outcomes, but in monetary savings as well.
In this economic climate, we needed to address the financial benefits too. It was a big
help to have evidence that supported the need for change.”
After receiving enthusiastic support from the senior leadership team, Daly and Durant
were asked to take the idea to a wider audience.
“If this initiative is going to work, all employees must become involved,” says Durant.
“Historically, patient falls were viewed as the responsibility of the nurses. We needed to
convince the managers that preventing falls is everyone’s responsibility—not just
nursing, not just the clinical departments, but everybody.”
“Whoever has contact with patients in any way, no matter if they are from housekeeping,
or a dietary aid, or a maintenance department staff member, must be prepared to
recognize a situation or condition that could increase the risk of falls and to do something
about it,” says Durant.
Education plans
Since Daly and Durant could not personally offer classes to all employees, they enlisted
the help of department managers. Managers from all nonnursing departments agreed to
provide training for their employees; Daly and Durant would train the nursing staff.
Daly and Durant knew that consistency in the teaching approach was important for
everyone to understand the reason for changing the falls prevention program and how
each employee assumed some responsibility for patient safety.
They prepared talking points and poster presentations explaining each department’s role
and employee responsibilities.
Daly and Durant also plan to be available to attend staff meetings to address questions
and concerns.
Nursing education
Training for the nursing department is set to begin in early April. Education will be
provided live because of the amount of information that needs to be covered, including
changes in the frequency and types of assessment for falls, additional interventions, and
changes in documentation.
In addition to didactic material, participants will engage in role-playing activities using
life-size puppets—affectionately named Fred Faller and Penelope Pill Pusher—to
complete the falls risk assessment. After completing the assessment, they will choose
relevant interventions based on the score.
About 150–200 nursing staff members, including RNs, LPNs, and CNAs, must attend
training. Programs will be offered during early mornings to facilitate night and day shift
attendance and in the late afternoons and early evenings to facilitate day and evening shift
attendance. Since training is required, employees will receive financial compensation
when attending before or after their scheduled shifts.
Facing challenges
It is always a challenge to enable nursing staff to leave their work areas to attend
education sessions. Daly and Durant plan on offering training multiple times and will
combine it with infection control training to reduce the number of separate mandatory
programs staff members need to attend.
The resistance to change that inevitably surfaces among some employees is another
challenge. “There are always some people who say that things are fine the way they are,”
Daly says. “We have the advantage of being able to present evidence for the changes we
need to make.”
An additional advantage is that the med-surg unit is being renovated. Nursing staff
members have provided input regarding safety issues, such as recommending retractable
phone cords and moving wall outlets near the floor behind patient beds to a more
reachable location for patients and nurses. “We’re very excited about it,” Durant says.
“It’s given nursing an active part in the decision-making process.”
But what about physician buy-in? Physician resistance can be a significant barrier to
change. Two key reasons this project has physician support is because physicians were
involved in the decision-making process and the falls prevention protocols were designed
to facilitate the physician order process.
“We have a standing order set,” Durant explains. “If a patient falls, the physician is able
to pull the standing order set, and all he or she has to do is review and sign it.”
“The template includes items such as how often to do neuro checks, assess vital signs,
etc. We have order sets for other problems, so the concept is familiar to our physicians,”
she says.
Project monitoring
The hospital holds a Joint Commission meeting every two weeks focusing on patient
safety goals, at which Daly and Durant report findings concerning their falls committee—
which is a subcommittee of the Joint Commission meeting—and progress being made on
the new falls risk assessment program.
They will report back to the committee regarding the falls prevention education and
training and, ultimately, the evidence concerning the effect of the falls prevention
initiatives on patient outcomes.
Durant, Daly, and the staff members at North Adams Regional Hospital are to be
congratulated on their evidence-based practice initiatives.
All parties involved in the process recognize the importance of presenting factual
evidence when planning and implementing change.
Source: The Staff Educator, an HCPro, Inc., publication.