Sample of Effective EBP Application

Following is a sample of a well-written, effective application for funding of an Evidence-Based Practice Project. It is here to provide you with an example of the kind of thinking and detail our reviewers are looking for as they consider your application.

We hope you find this helpful as you draft your own application.

Purpose of Project (200 words): The purpose of this project is to support the acquisition of various fall risk products and to develop an educational program to assist the staff, patients and families to participate in this evidence-based intervention. Evaluation of the success of this EBP initiative will include comparison of fall rates, falls with injuries and the use of restraints per 1000 patients and cost of using constant observers pre- and post-intervention. Additionally nurses and family satisfaction with the toolkit of interventions will be assessed.

While the entire hospital population will be studied, the highest risk group and the care areas with the most constant observers are our oncology units. We will conduct a subset analysis of the effectiveness of this EBP intervention for this group of patients. This targeted evaluation meets the goals of the J. Patrick Barnes research and EBP program and will enable us to enhance care for this very high risk group of patients.

Background (400 words): Delirium may occur in as many as 56% of hospitalized older adults according to a literature review by Inouye and colleagues.¹ Delirium is an independent risk factor for hospital associated injuries including falls and dislodging tubing and lines. Falls in oncology patients, who may be at increased risk for bleeding, may have devastating consequences. One method to ensure the safety of patients with delirium is to use a constant observer or sitter. The CO, who is usually a hospital or nursing aid She or he watched over and supervised the patient to prevent such behaviors as unsafe ambulation and tube or line removal. COs provided an alternative to using restraints, which have been associated with the development of delirium¹ and can also result in the loss of muscle strength, pressure ulcers, incontinence, and even strangulation.² Nurses in all inpatient areas could request a CO from the staffing office and one would be sent from an internal resource pool or an external staffing agency. The use of COs increased steadily over the years and reached an annual cost of more than $1.5 million in 2004. In addition to their high cost, it was found that COs did not consistently decrease the incidence of unsafe patient behaviors. If she or he were not close enough to the patient, for example, the CO could not always react quickly enough to prevent the patient from injury. Therefore, we are seeking to implement and evaluate evidence-based alternatives to ensure patient safety in a cost effective manner.

An interdisciplinary team (Psychiatric Clinical Nurse Specialist, Oncology Clinical Nurse Specialist, Physical Therapy, Occupational Therapy, Pharmacy, Social Work, and Medicine) has been created to review of the literature to identify possible alternatives. We have identified the following strategies: fall risk prevention products (bed/chair exit alarms), self-releasing belts, non-skid slippers along with strategies to decrease the development or severity of delirium.

Describe proposed change (500 words):

The purpose of this proposal is to support the acquisition of various fall risk products and to develop an educational program to assist the staff, patients and families to participate in this evidence-based intervention. Examples of the strategies/evidence-based interventions that will be used:

TEAMWORK: (1) Institute teamwork among nursing staff; for example, check on each other’s patients. (2) Implement frequent scheduled checks by both nurses and hospital or nursing assistants. (3) Involve family and friends in patient care. (4) Encourage teamwork across disciplines; for example, all staff respond to bed alarms. (5) • Improve the nurse-to-patient ratio to increase nurse’s availability to confused patients. ENVIRONMENT: (1) Move the patient to a room with high visibility for nursing staff. (2) Perform charting in the patient’s room. INTERVENTIONS: (1) Use fall risk prevention products, such as bed and chair exit alarms, bed and chair self-releasing belts, chair wedge foam cushions, floor mats, nonskid slippers. (Note – our medical facility is purchasing these fall-risk prevention products) (2) Use a gait belt for patient transfers and ambulation. (3) Place a No Fall Zone poster in the patient’s room with the patient’s safety plan noted including universal fall precautions and patient-specific needs such as assistive devices (walker, cane) and the assistance required for transfers. (4) Provide the patient and family with education on the fall risk prevention plan (a pamphlet will be created based on literature and designed in collaboration with the Patient/Family Advisory Panel and the Patient/Family Education Center at our hospital). (5) Implement scheduled or frequent toileting. (6) Review medications and discontinue or minimize the use of medications that cause delirium. (7) Evaluate the need for as-needed medications for delirium such as antipsychotic medications. (8) Use physical restraints as a last resort only. Other interventions will be added based on a review of the literature and input from multidisciplinary team and the Patient Family Advisory Council.

Outcomes (400 words): The following outcomes will be used to evaluate the effectiveness of our EBP intervention.

(1) Fall rate, falls with injuries and the use of restraints per 1000 patients with full-time COs (historical data) versus fall rates, falls with injuries and use of restraints per 1000 patients receiving new interventions.

(2) Cost of COs for 6 months pre/post implementation of the intervention.

(3) Nurse satisfaction with the interventions. The survey will be developed to reflect specific interventions. Face validity of the survey will be obtained before use.

(4) Family satisfaction with the interventions, including their perception of their role in ensuring patient safety. A review of the literature failed to find any instruments specific to the aims of this study. A family satisfaction survey will be developed based on a review of the literature for similar types of projects. Input will also be sought from the Patient/Family advisory council and the survey will be pilot tested and face validity established before use. Survey instruments for nurses and families will be developed and validated as a part of this project.

Family members of the Patient/Family Advisory Council will be invited to participate in the role-out of this project and the creation and validation of the evaluation instrument and the results will be presented to the Patient/Family Advisory Council.

Analysis of the outcomes data will be performed by the nurse researcher at our medical center in collaboration with the team and our Center for Clinical Excellence.  No identifiable data will be analyzed – only performance improvement data in aggregate and cost estimates related to constant observers.

Timeline

Budget: Funds are available for direct expenses only. Institutional overhead may not be included. Provide budget using the following chart, and describe/provide justification for how you will use the grant funding to support your project (e.g., cost for reproduction of booklets - 500 booklets @ $2/booklet = $1000). If the funding level offered by The DAISY Foundation is not adequate for your project, please email bonniebarnes@DAISYFoundation.org to discuss.

(Note – this example was based on a QI project conducted at the University of Washington Medical Center – Sweeny SJ, Bridges EJ, Sayre C, Wild L. Care of the patient with delirium. Am J Nurs, 2008, 108(5), 72CC-72GG).

Equipment/Supplies:

Reusable “No Fall Zone” signs will be created – these will be placed on the doorway of any patient identified as high risk for falling ($300).

A Family Information pamphlet will be created based on the specifics of the program and developed in collaboration with our Patient/Family Advisory Council and our Patient/Family Education Center. The pamphlet will explain the program and provide suggestions of what family members can do to keep a family member safe and to aid in the resolution of their confusional state ($300).

References