Capstone Project Change Proposal Presentation
Create a 10-15slide Powerpoint presentation of your evidence-based intervention and change proposal to be disseminated to an inter-professional audience of leaders and stakeholders.
PICOT Question Paper Mananita Gerochi-Caparas Grand Canyon University NRS-493-O503 Professional Capstone and Practicum Davida Murphy Smith September 18, 2022
PICOT Question Paper
In elderly adult patients in the outpatient radiology clinic (P) what is the effect of placing push button alarms while changing in the dressing room (I) compared with no alarm system (C) reducing the incidence of falls (O) within four weeks (T)?
Falls are the most common and severe risk factors among elderly patients in any healthcare setting. It has been found that disability and morbidity are the leading factors resulting in falls among the elderly. Falls may develop severe injuries and a significant risk of death within the organization (Ang, Low & How, 2020). Some additional causal factors, such as chronic conditions, medications, hazards within the environmental setting (radiology setting), and other age factors, like low balance, may have significant risks to the fall. Changing clothes is a primary or daily personal duty that may also develop risks among the elderly towards falls. While seeking the services or screening for multiple tests in a radiology clinic, there is a need for undressing and putting on a gown (Berková & Berka, 2018). Therefore, it is vital to understand that there is a need for assistance when an elderly patient tries to change their clothes, as poor balance while changing clothes may result in falls. Since changing clothes is a private act, healthcare staff cannot provide necessary services or support.
An adequate nursing intervention would be providing support services to the elderly when they are in the dressing room of the clinical radiology setting. Therefore, patients are equipped with the push button alarms in clinical settings, where they would receive adequate support services while they are in the dressing room while changing (Santiago et al., 2017). Pressing the button will alert or inform the nurses to provide and connect to patients to understand their requirements. It has been found that such a portable alarm unit is efficient for the care providers as they would be able to identify the needs and provide the needful support to the patients (Wang, Ellul & Azzopardi, 2020). While changing clothes in the clinical setting, there could be a need for assistance in balancing and wearing oversized dresses or gowns. Therefore, the push button alarm is identified as an evidence-based intervention in healthcare to improve the overall health outcome.
Clinical Problem and Patient Outcome
The push button alarm would help and empower the elderly to have immediate and emergent accessibility to the help of nurses or technicians while performing any tasks or after any accident. Prompt attention and care should be provided to the elderly after the incident of falls. Therefore, the usage of push-button alarms would develop a significant enhancement in addressing the overall needs of patients. The clinical problems of falls would reduce with the effective implementation of push button alarms as it would also help provide emergency care services. Therefore, the push-button alarm system's performance would help develop a quicker way of delivering care services. More immediate intervention and identification of clinical issues or risks would help improve the overall patient outcome.
Ang, G. C., Low, S. L., & How, C. H. (2020). Approach to falls among the elderly in the community. Singapore medical journal, 61(3), 116–121. https://doi.org/10.11622/smedj.2020029
Berková, M., & Berka, Z. (2018). Falls: a significant cause of morbidity and mortality in elderly people. Pády: významná příčina morbidity a mortality seniorů. Vnitrni lekarstvi, 64(11), 1076–1083.
Santiago, J., Cotto, E., Jaimes, L. G., & Vergara-Laurens, I. (2017, January). Fall detection system for the elderly. In 2017 IEEE 7th Annual Computing and Communication Workshop and Conference (CCWC) (pp. 1-4). IEEE.
Wang, X., Ellul, J., & Azzopardi, G. (2020). Elderly fall detection systems: A literature survey. Frontiers in Robotics and AI, 7, 71. https://doi.org/10.3389/frobt.2020.00071
Capstone Project Change Proposal Presentation for Faculty Review and Feedback
Create a 10-15 slide Power Point presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in the digital classroom for feedback from the instructor.
PICOT Question (See other file uploaded)
Falling incidences can cause several complications, including health care costs, severe health issues, immobility, etc. With the severity of this issue, appropriate interventions should take place. In this context, proper monitoring is one of the significant interventions to prevent this incidence (Huang et al., 2020). Hence, incorporating educated and efficient technicians while providing patient care can be an essential step. Yet, due to decreased mobility or functionality, older people often require help in doing basic activities, in this aspect, providing help to the patients while changing to hospital-approved gowns (Liu-Ambrose et al., 2019). In addition, one significant and effective intervention is providing quick education to the patient regarding fall prevention strategies (Radecki, Reynolds & Kara, 2018). Another critical aspect is providing a safe environment for clinical care. Outpatient clinics should improve their workflow and environmental condition, such as removing hazardous materials, and keeping the floor clean and dry, so that the clinic can provide a safe area for older patients. These interventions can help prevent falls (Guirguis-Blake et al., 2018).
Benchmark – Capstone Change Project Objectives
1. Prevent elderly falls in an outpatient radiology clinic.
Rationale: Falls occur as age advances due to individual risk factors or environmental factors. For example, gait or balance deficits, chronic conditions, medications, and footwear the patient is wearing. Assisting these patient populations can prevent falls in the department.
2. Educate patients and people in the community on how to prevent falls.
Rationale: Educate patients regarding physical changes and chronic health conditions that cause or probability of falls.
3. Provide a safe environment for clinical care in the outpatient clinical setting.
Rationale: Design the clinical area accessible to patients in wheelchairs, with assistive devices, and with mobility deficits. Have handrails on walls and hallways for support, clean, non-skid floors, and lighted pathways in hallways, rooms, and bathrooms.
4. A patient care technician (PCT) is available in the outpatient clinical area for patients.
Rationale: Having a PCT in the clinical area, especially around the dressing rooms, would benefit the patients needing help when changing to hospital-approved gowns and monitoring patients for risk of falls.
5. Invest in a push-button alarm system in the dressing room area of the outpatient radiology clinic.
Rationale: The availability of a push-button alarm would aid patients if they need assistance while changing to hospital approved gown. A push-button alarm will allow patients to notify nurses or PCT when help is needed.
Capstone Change Project Resources
Implementing my change project would need resources to be readily available. After meeting and discussing with my preceptor, Randy Toquero, we have identified and agreed on four of the important resources that would be needed in order to implement the change project effectively. Below is the list of resources needed for my project change:
1. I will have to work within the existing clinic workflow to incorporate the fall prevention program questionnaire. Questions would include age, history of falls, and mobility – if the patient is able to walk with a steady gait, or with assistance. Also included is if the patient has any patient care equipment such as a cane, rolling walker, or wheelchair.
2. Request internal stakeholders – supervisor and manager for approval of extra staff to help or assist the patients needing help, especially patients needing to change to MRI-safe hospital gowns.
3. Offer education to employees of outpatient radiology clinics and patients scheduled for radiology diagnostic testing about fall prevention.
4. I will need to have approval from internal stakeholders on what kind of push-button alarm system to use.
Monitoring and assessing patients help in eliminating falls. Constant awareness of the staff in the outpatient radiology clinic about falls such as placing patients near staff stations for high-risk fall patients. Bringing the team together for fall awareness with effective communication will help prevent falls. Fall prevention education gives a clear perspective to the entire team.
1. Develop a falls guideline questionnaire or screening questions for ages 60 and above.
Rationale: An assessment tool to help detect the at-risk for fall patients. Help educate patients on key factors and external or environmental factors that cause falls. Approaches to prevent falls and decrease injury.
2. Placement of pushbutton alarms in high-risk areas of falls such as bathrooms and dressing rooms will prevent or decrease the incidence of falls.
Rationale: Having a tool near you for safety like a pushbutton alarm will alert healthcare workers of patient needs. The pushbutton alarm is a safety net that would prevent the incidence of falls and other injuries.
3. Having an extra staff like a patient care technician (PCT) would be a positive effect on elderly patients.
Rationale: The availability of a PCT would be a big help for elderly patients that come to the outpatient radiology clinic alone. There is a percentage of older adults with no companion or family members with them that come for radiology diagnostic testing. Having a PCT or extra staff would be beneficial for these patients for safety and decrease the incidence of falls.
Capstone Change Project Evaluation Plan
Address the following in your summary:
What data was collected?
Qualitative data collection will be used. Interviewing patients for history of falls, mobility, gait, and balance. While patients are in the outpatient radiology clinic staff observation will also be used for assessment and monitoring if a patient is at high risk for falls. Interviewing and observing patients will assist in the determination of patients who are a fall risk.
What tool will be used to collect the data?
Questionnaires, oral histories taken from patients, and observation while in the outpatient radiology clinic. The questions asked of patients will reveal if they are prone to falls. Patients sharing their histories will give the investigator or staff if a patient has a history of falls.
Who will be responsible for collecting data?
My preceptor and I started the initial education of the staff in the radiology clinic. Most of the staff will be involved in the collection of data or information. The bulk of the interview and questionnaires will be implemented at the front desk when patients check in during their diagnostic testing. Follow-up of fall education and reinforcement happens when a patient is with a nurse prior to any diagnostic testing. Diagnostic technicians will make sure that patients are safe from falls during testing. All employee members of the outpatient radiology clinic are responsible for observing for the best outcome – No Falls.
How will this data be communicated to the team?
Good communication is essential for business success. As lead of the change project, I prefer to communicate information to the team face to face. I believe doing face-to-face communication builds a positive rapport with each team member. Developing a positive relationship between employers and employees increases workplace productivity. However, as every workplace is different outpatient radiology clinic is no exception. Presently, I am using multiple forms of communication to include all people involved in the change project. The communication strategies I use consist of setting up meetings with managers and supervisors. Constant emails for updates and follow-ups to definitely and quickly relay the message. Patients are part of my change project, to educate them about fall prevention I printed some pamphlets to start fall awareness in the lobby and waiting areas. Lastly, face-to-face or one on one allows me to check on the progress of desk and scheduling staff for questions being asked. It also allows me to discuss and tweak issues. Most of all face to face and one to one gives me the chance to say thank you for allowing me to implement my project change.
Identify practices and interventions for reducing falls of elderly patients in the Outpatient Radiology Clinic.
The capstone change proposal concerns fall prevention for elderly patients in an outpatient radiology clinic. The change of practice serves both the community and leadership categories. Falls are common and happen anywhere. Falls result in injury and fear to patients. It also causes healthcare organizations a considerable amount of detrimental expenses. Most falls, whether inpatient or outpatient, are unwitnessed. The department’s practices are a factor in preventing falls. The outpatient radiology clinic is typically not monitored. Since it is an outpatient clinic, it is assumed that patients are walkie-talkies. However, the outpatient radiology clinic I work has multiple incidents of unwitnessed falls with injuries. The numerous falls have prompted my decision to make a project change proposal where I work. There is insufficient evidence underpinning the effectiveness of interventions to guide clinical staff regarding reducing falls in the elderly. (Vass et al., 2009). The proposed project change is community-based since the patients are within the community. The leadership part of the scope is to get support from the managers about the change proposal on unit practices to prevent falls in the department.
Proposed interventions would be:
• Monitoring elderly patients on their mobility and agility
• If patients need help changing from street clothes to hospital-approved gowns, a patient care technician (PCT) is available for service.
• The placement of push-button alarms must be accessible to patients in the outpatient radiology clinic, especially when they are in the dressing room while changing.
• The need to educate patients on the dangers of falls, especially in unmonitored settings, would prevent falls.
Vass CD, Sahota O, Drummond A, Kendrick D, Gladman J, Sach T, Avis M, Grainge M. REFINE (Reducing Falls in In-patient Elderly)–a randomised controlled trial. Trials. 2009 Sep 10;10:83. doi: 10.1186/1745-6215-10-83. PMID: 19744323; PMCID: PMC2753618. Retrieved from https://pubmed-ncbi-nlm-nih-gov.lopes.idm.oclc.org/19744323/
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