Peer one: My project is based on the impact of fall and related injury occurring in patient unit in the hospital/ behavioral health unit.

Falls on inpatient psychiatry units are understudied. On the basis of fall injury program characteristics across multiple inpatient psychiatry units, we developed and implemented an operational strategic plan to address each falls prevention program element and enhance program infrastructure and capacity. Expert faculty provided lectures, coaching, and mentoring through biweekly conference and collaborative with calls and e-mails.

Findings support continued efforts to integrate measures to reduce serious fall-related injuries. Key words: fall prevention, fall-related injuries, falls; our program evaluation included both quantitative and qualitative methods. Quantitative methods analyzed changes in organizational fall injury program elements and analysis of fall and fall injury data over time. Qualitative data were extracted from unit reports during a face-to-face meeting from all sites to report lessons learned and interventions adopted injury prevention in psychiatric unit.

The primary objective of this program was to facilitate adoption and integration of fall and injury prevention practices and equipment into mental health units in participating hospitals.

Peer leadership at the hospital unit level offers the potential to reduce the occurrence of injurious falls by decreasing practice variations. Peer leadership has been successfully used in health contexts, mainly in health promotion for adolescent, adults and geriatric populations and especially persons with chronic mental illness.

Reference:

Reducing falls and Fall-Related Injuries in Mental Health

Patricia A. Quigley, PhD, ARNP, CRRN, FAAN, FAANP; Scott D. Barnett, PhD; Tatjana Bulat, MD; Yvonne Friedman, MS, OTR

Peer two: Evaluating the effectiveness is understanding how programs are implemented, translated, replicated, and disseminated into the real-world settings and can consider any aspect of further implementation. This includes the factors affecting implementation, the processes and the results of implementation, how to introduce potential solutions into a health system or how to promote their large-scale use and sustainability and looking at its effectiveness into the patients and related stakeholders (Li et al., n.d.). It is important for healthcare professionals to bring in use the best evidence-based practices. Measuring the effectiveness of change is essential to monitor success and helps guide the team to move towards the specific intervention goal.

After making a practice change based on the best evidence, it is critical to evaluate outcomes. Outcomes evaluation is essential to determine the impact of the practice change on healthcare quality and health outcomes. It is pertinent to target the outcomes that the current healthcare system considers important, such as complication rates, length of stay, re-hospitalization rates and costs, since hospitals are currently being reimbursed based on the performances of these outcomes. The use of strategies to adopt and integrate evidence-based health interventions and change in practice is important in determining the effectiveness of change proposals (Melnyk, 2016).

I am comparing the effectiveness of using the bundle method to reduce the incidence of Ventilator-Associated Pneumonia (VAP). There are two ways to evaluate the effectiveness, by determining if the suggested bundle method has been being used or not, they are questionnaire method and direct observation. Direct observation will be the best evaluation tool to evaluate effectiveness. Direct observation gives the opportunity to observe the skills, attitude, behavior of the staff while delivering bundle methods for the prevention of the VAP, and this method also gives the opportunity to observe how persistent the staffs are towards the goal of prevention of the VAP. Likewise, the second method is the questionnaire, where we can determine if the staffs are well informed and, it also provides me with the opportunity to determine the effectiveness of teaching provided regarding the prevention of VAP.

Reference

Li, J., Jack, B., Mittman, B., Naylor, M., Sorra, J.,…Project ACHIEVE Team (n.d). Project ACHIEVE-using implementation research to guide the evaluation of transitional care effectiveness. BMC HEALTH SERVICES RESEARCH, 16, https://doi-org.lopes.idm.oclc.org.10.1186/s12913-...

Melnyk, B. M., (2016). Improving healthcare quality, patient outcomes, and costs with evidence-based practice. Reflections on Nursing Leadership Retrieved from https://www.reflectionsonnursingleadership.org/fea...

Peer three: There are five simple steps to an evidence-based practice proposal process. These steps include formulating a clinical question, searching for the evidence, critically appraising the evidence, implementing the evidence, and evaluating the results (Cleveland Clinic, 2020). While each of these steps play an important role in the evidence-based proposal process, the last step of evaluating the evidence is a key component of this process. It is through the evaluation of evidence that the effectiveness and efficiency of the proposal is assessed. For my research proposal, I chose to propose the use of opioid screening tools in the emergency department (ED) setting to identify those individuals who are at risk for opioid dependency and misuse. It is the intent if we can identify those individuals at risk, there is an opportunity to reduce the incidence of opioid misuse and dependency.

When looking to evaluate the evidence in my proposal, I will need to evaluate and consider a number of different outcomes. I will need to evaluate the number of opioid prescriptions which were prescribed to the patients. This data will be collected pre-implementation and post-implementation of the screening tools. Ideally, by identifying those at risk, there should be a drop in the number of opioid prescriptions prescribed to patients by the ED providers. Next, it will be important to assess and compare the number of patients presenting to the ED with opioid dependency and misuse complaints. This will also be a pre and post implementation evaluation. Both of these evaluations can be done via electronic monitoring of the data. I am anticipating this data will need to be collected over a six-month period. Finally, there may be concerns from administration and key stakeholders that the use of these screening tools may affect patient satisfaction scores, and we all know how important these satisfaction scores are to an organization. I would use of a survey for the patients to complete regarding their satisfaction with the use of opioid screenings and their satisfaction with their pain management. It is important to remember it is not the intent to deny patients pain management. Their pain control will be addressed, whether they are offered and an opioid prescription or not. They may just be offered additional education and the use of alternative methods of interventions over opioid treatment. When doing research, I found a study published in The Journal of Emergency Medicine. This study concluded patient satisfaction scores were not affected by the use of an alternative to opioid approach (Duncan, Smith, Maguire, & Stader, 2019). This is important, because if I can show the use of these screening tools may be effectively used without affecting patient satisfactions scores, it will be huge in gaining support for the long-term implementation of my proposal.

Cleveland Clinic. (2020). Evidence-Based Practice: Nursing: What is EBP? Retrieved from https://my.clevelandclinic.libguides.com/nursingebp

Duncan, R.W., Smith, K.L., Maguire, M., & Stader, I.D.E. (2019). Alternative to opioids for pain management in the emergency department decreases opioid usage and maintains patient satisfaction. American Journal of Emergency Medicine, 37(1), 38-44. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajem.2018.04.0