Evaluating Evidence-Based Interventions to Prevent Falls and Pressure Ulcers

Despite the presence of evidence-based clinical practice guidelines (CPGs) and the purchase of numerous patient care products and devices, pressure ulcer (PU) prevalence and fall rates remain higher than targeted benchmarks. Nurse education has been validated as a strategy to improve CPG compliance (Gerhardt et al, 2007) and evidence supports bedside rounds as an effective intervention to decrease patient fall rates (Meade et al, 2006). Using processes outlined in the Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler et al, 2001) this project will change nursing from tradition-based to science-based practice implementing bedside rounds to translate evidence embedded in the CPGs into improved quality of fall and PU prevention care.

This project will answer the question: Does participation in innovative evidence-based interventions designed to promote and sustain the use of falls and PU prevention CPGs improve nursing care processes, patient outcomes, and nursing outcomes? A randomized, controlled, counterbalanced design and data collected from nurse and patient surveys, pre-post tests, hospital incident reports, nurse observations, and inpatient electronic records will be utilized. The sample includes 120 nurses, 1,266 patient records, and 450 patient surveys. Four inpatient units from one military hospital will be randomly assigned to one of two groups'Evidence-Based Bedside Rounds (EBBR) followed by Evidence-Based Practice Education (EBP ED) or EBP ED followed by EBBR. Evaluation measures include adherence to CPGs, fall rates, PU prevalence, patient satisfaction, EBP and CPG knowledge uptake, nurse staffing effectiveness, nursing staff perception of patient care quality, and nursing job satisfaction.

This proposal addresses TriService Nursing Research Program directives and meets the program priorities of Translating Research Findings into Practice in a Military Context and Developing and Sustaining Military Nursing Competencies. In addition, two high priority National Patient Safety Goals for 2009 are addressed'Goal #9: Reduce the risk of patient harm resulting from falls; and Goal #14: Prevent healthcare associated pressure ulcers. Project findings may re-define routine bedside rounds and/or standardized EBP education as valuable patient safety interventions.