Using Evidence-Based Practice to Prevent Falls in Neuro Patients

This report addresses the critical issue of falls in neurological units by applying the evidence-based practice (EBP) process to identify the most effective interventions. It highlights the significance of falls in neuro patients due to factors like gait problems, cognitive deficits, and medication use, which lead to increased morbidity and healthcare burden. The EBP process is detailed, including formulating a PICO question, searching for relevant research, critically appraising evidence, integrating findings with clinical expertise, evaluating outcomes, and disseminating the evidence. The review of research emphasizes multidisciplinary fall risk assessment, supported by tools like the Assessment Sheet for Fall Prediction in Stroke Inpatients (ASFPSI), as a key strategy. The report concludes that a coordinated approach involving nurses, physicians, and other team members is crucial for successfully preventing falls in neurology units, ultimately improving patient outcomes and reducing healthcare costs.

Running head: EVIDENCE BASED PRACTICE
Evidence based practice
Name of the student:
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Author’s note

1EVIDENCE BASED PRACTICE
Introduction
Evidence based practice (EBP) is the judicious use of research evidence to identify best
practice interventions for the care of patient and effectively integrated it with clinical skills and
knowledge to improve patient outcomes, provide high quality care and reduce health cost. It
provides nurse the scope to professionally develop in practice and acquire evidence based skills
to improve the quality of care (DiCenso, Guyatt & Ciliska, 2014). The main purpose of the paper
is to analyse the issue of fall in neuro patients and then identify best evidence to prevent fall in
neuro patients using the steps of the EBP process.
Rational for fall in neuro patient as a practice issue:
Neuro patients involve those people who suffer from specific neurological conditions
such as stroke, dementia and other neurological conditions. Neurology inpatient units witness the
highest rate of fall events because of the presence of multiple risk factors for falls such as gait
problem, depression, cognitive deficits, muscles weakness, advancing age and use of
psychotropic medications (Hunderfund et al., 2011). Fall in such patients lead to many
psychological and physical morbidity for patients. Hence, fall in neuro patient may contribute to
serious injury and increased length of hospital stay. It also deteriorates health of patient and
make them dependent on social support and health care services for their activities of daily living
(Homann et al., 2013). It is also a practice issue for nurses or caregivers of neuro patients
because fall related injuries increased burden of care. Therefore, fall prevention is necessary to
ensure that neuro patients can lead an in independent life without the support from health or
social services.
EBP process to identify best evidence to prevent fall in neuro patients

2EVIDENCE BASED PRACTICE
To prevent fall in neuro patients, identifying the best evidence that prevent fall in neuro
patient is necessary. This can be done by identifying by following the six steps of the EBP
process which are as follows:
1. Developing a guiding research question:
To search for the best article that defines the most effective intervention to prevent fall in
neuro-patient, developing a clinically guiding research question is important. The PICO question
that can help in finding relevant best practice research evidence is as follows:
Which type of interventions can reduce the risk of fall in neuro patients?
2. Searching for evidence from appropriate source
Based on the research question, important keywords like fall prevention and neuro patients
and interventions for fall prevention in neuro patients can used to search for articles in databases.
Similar process was followed for identifying the best intervention to prevent fall in neuro
patients too (Hall & Roussel 2016). Based on the use of search terms, research studies were
found which reported about various types of fall prevention intervention in neurological care unit
were analysed.
3. Critical appraisal of the selected evidence
The review revealed fall risk assessment as an important strategy to reduce fall events in
neurology units. Two research evidences gave idea about the effectiveness of fall risk assessment
process in preventing falls. All the three studies used fall risk assessment protocol in the fall
prevention program. Goljar et al. (2016) used the Assessment Sheet for Fall Prediction in Stroke
Inpatients (ASFPSI) to assess fall risk. The credibility of the tool was defines by giving evidence

3EVIDENCE BASED PRACTICE
regarding the sensitivity and reliability of the scale. Identification of fall risk helped in taking
additional measures for individuals at risk of fall. This helped in the reduction of fall risk in the
rehabilitation ward. The research by Hunderfund et al. (2011) further proved the effectiveness of
fall risk assessment process for neurology patient by adapting a multidisciplinary risk assessment
process. Physician fall risk assessment process was address with nurse evaluation and Hendrich
II Fall Risk Model score. The evidence revealed the effectiveness and feasibility of multi-
disciplinary approach in correctly identifying patients at risk and preventing in-patient falls.
Hence, coordinated efforts of nurse, physicians and other medical team are crucial for the
success of fall prevention program.
4. Integration of the evidence with clinical expertise and patients values
Evaluation of the above two evidence confirmed fall risk assessment process 24 hours after
hospital admission as an important strategy to prevent fall in neuro patients. To utilize the
evidence, it will be necessary for nurse to coordinate with other team members to review fall risk
assessment tools that is being used to assess fall risk. Developing knowledge to effectively used
the tool and reporting the findings aand deciding fall prevention in collaboration with other team
members can reduce risk of fall in neuro patients.
5. Evaluation of outcome
To evaluate the success of the intervention, comparison of fall rate should be done before and
after the intervention. Number of reduced days in hospital and no reported fall events would
indicate the success of the strategy.
6. Dissemination of the evidence

4EVIDENCE BASED PRACTICE
If the evidence is found to be effective, then the finding can be disseminated to other team
members so that all can follow a common protocol to prevent fall in inpatient units.
Conclusion
To conclude, the paper aimed to address the issue of high incidence of fall in neuro units
by identifying the best evidence using the EBP process. Based on the review of research
evidence, the intervention related to multidisciplinary fall risk assessment along with the use of
evidence based fall risk assessment tool was considered as an appropriate strategy to control fall
events in neurology units. This strategy favoured implementing effective steps to control fall in
high risk individuals.

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References:
DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to
Clinical Practice. Elsevier Health Sciences.
Goljar, N., Globokar, D., Puzić, N., Kopitar, N., Vrabič, M., Ivanovski, M. and Vidmar, G.,
2016. Effectiveness of a fall-risk reduction programme for inpatient rehabilitation after
stroke. Disability and rehabilitation, 38(18), pp.1811-1819.
Hall, H. R., & Roussel, L. A. (2016). Evidence-based practice. Jones & Bartlett Publishers.
Homann, B., Plaschg, A., Grundner, M., Haubenhofer, A., Griedl, T., Ivanic, G., Hofer, E.,
Fazekas, F. and Homann, C.N., 2013. The impact of neurological disorders on the risk for
falls in the community dwelling elderly: a case-controlled study. BMJ open, 3(11),
p.e003367.
Hunderfund, A. N. L., Sweeney, C. M., Mandrekar, J. N., Johnson, L. M., & Britton, J. W.
(2011). Effect of a Multidisciplinary Fall Risk Assessment on Falls Among Neurology
Inpatients. Mayo Clinic Proceedings, 86(1), 19–24.