Evaluating Evidence-Based Intervention to Prevent Fall and Pressure Ulcers.

摘要

Purpose: To determine if participation in evidence-based practice (EBP) interventions designed to promote and sustain the use of fall and pressure ulcer (PU) prevention clinical practice guidelines (CPGs) improves nursing care processes or patient and nursing outcomes. Design: A randomized, controlled, counterbalanced design; data were obtained from nurse and patient surveys, pre-posttests, hospital incident reports, nurse observations, and inpatient electronic records. Methods: Four inpatient units at a military hospital were randomly assigned to receive either Evidence-Based Bedside Rounds (EBBR) followed by EBP education (EBP ED) or EBP ED followed by EBBR. Sample: 354 patient surveys and 339 nurses from four medical, surgical and step-down units at one Army medical center. Analysis: Descriptive statistics, t-tests, Chi square, change scores, and RM-ANOVA. Findings: RN & LPN PU CPG adherence increased (65% to 92%) PU prevalence decreased (12.5% to 3.2%) Nurses perceptions of care quality and their unit s ability to respond to emergencies improved significantly (p=0.04 and p=0.05) Implications for Military Nursing: Whether at home or in theater inpatients are at risk for falls and PUs and nurses have a role in preventing them. When consistently implemented, prevention strategies decrease the number and severity of these events. However, the unique characteristics of military nursing environments, including deployments, backfill with Reservists and contractors, and a burdened civilian workforce, can compromise patient safety. This project s interventions were developed to provide nurses with standardized tools necessary to effectively implement and sustain fall and PU prevention CPGs. Emerging evidence and patient safety principles were the foundation for the toolkit produced by the project. EBBR and EBD ED were both proven to be beneficial and the project was hailed as a great success at all levels of the participating hospital.