ROI for a Fall Prevention Intervention: Invest a Little, Save a Lot.

Patient falls within the hospital setting continue to be a significant challenge globally with almost one million hospital falls occurring in the U.S. annually. Recent calculations showed that the average total cost of a hospitalized patient fall was $62,521. One evidenced-based tool that has been shown to be effective is a colorful laminated poster, Fall TIPS poster, that was designed to engage and involve the patient in their fall prevention. One academic medical center utilized this implementation showing a successful return on investment (ROI). This project used a pre-post implementation design. After a successful pilot using the poster on one unit, the implementation was spread to all Adult Acute Care units (n = 10) within the institution. The outcome measures were fall and fall with injury counts and rates. The process measure was the completion of the fall prevention poster measured via audits. The calculation of ROI was completed using a four-step framework. The outcome data of fall and fall with injury showed a decrease from the pre-intervention months with both the fall count and rate decreasing by 23% and the fall with injury count and rate decreasing by 40%. The overall ROI calculation estimated an ROI of $982,700. The successful results from this project support the evidence that shows this program and the use of the Fall TIPS poster helps reduce patient falls within the hospital and yields a favorable ROI.

Empowering nurses to increase engagement in advance care planning in a medicine transitional care unit: a best practice implementation project.

INTRODUCTION AND OBJECTIVE: Advance care planning (ACP) communication and documentation are often inadequate, leading to care that is inconsistent with patients' preferences and moral dilemmas for family members. Nurses are patient advocates optimally positioned to initiate ACP but many feel that they lack the training and skills to navigate these conversations. The objective of this project was to increase nurses' capacity to engage in ACP. METHODS: This project used the JBI audit and feedback method to implement evidence into practice. The JBI Practical Application of Clinical Evidence System and Getting Research into Practice audit tools were used to incorporate ACP into nursing workflow. Eight audit criteria were created based on a JBI evidence summary. Compliance was measured by reviewing ACP notes from electronic health records and online survey responses. A baseline audit was followed by educational presentations and development of posted materials. Three follow-up audits examined sustainability. RESULTS: Compliance with the best practice recommendation for nurses to engage in ACP discussions increased from 55% to 80%. There was improvement from zero ACP notes at baseline (0% compliance) to 12 ACP notes in the final audit. Of these notes, 42% included all best practice elements and 92% included patients' treatment preferences. CONCLUSIONS: Development of an integrative nursing education plan for ACP empowers nurses to engage in vital conversations. Informing nurses of their scope of practice, defining terms and expectations, and encouraging them to attempt and document conversations will benefit patients. Future initiatives would benefit from incorporating practical opportunities without real-life implications and providing continued support to cohorts.

Providing a scaffold for considering theoretical frameworks in evidence implementation projects: the JBI approach to evidence implementation.

ABSTRACT: There are many theories, models, and frameworks that have been proposed in the field of implementation science. Despite this, many evidence implementation or practice improvement projects do not consider these theories, models, or frameworks in their improvement efforts. The JBI approach is one example of an implementation theory, model, or framework. This approach has been developed particularly with health care professionals in mind and is designed to clearly guide pragmatic evidence implementation efforts based on the best available evidence. In this paper, we discuss how the JBI approach to evidence implementation can interact with and support theory-informed, pragmatic evidence implementation projects.