Practice Experience: Applying Measurement Tools to a Practice Problem Conduct a collaboration interview with two or three key leaders in your practice setting to determine the measures for your practice problem and associated challenges impacting measurement for your practice problem (include confidentiality, anonymity, access issues, etc.). Perform an existing evidence review on your practice problem ( Safety related to Falls in Hospice Home bound patients) and search for evidence that demonstrates how your practice problem is measured across the country. a description of the measures identified from the interviews, the challenges to obtaining the data that were discussed, and a summary of how this quality indicator is measured in the literature. Discuss any gaps in the data that were identified and additional sources that might be needed to obtain this data. Be sure to support your practice problem with the literature that indicates the relevance of this problem for nursing practice. Provide evidence from practice and data that is available. Spath, P. (2018). (3rd ed.). Chicago, IL: Health Administration Press. Yoder-Wise, P. S. (2019). (7th ed.). St. Louis, MO: Mosby.

Title: Applying Measurement Tools to Address Safety Concerns in Falls Among Hospice Homebound Patients: A Review of Literature

Introduction:
Safety concerns related to falls in hospice homebound patients are a critical issue in healthcare, as falls can result in serious injuries and even death. Accurate measurement of falls and associated challenges is crucial for improvement initiatives and patient safety. This paper aims to discuss the measures identified through collaboration interviews with key leaders in the practice setting, challenges in obtaining data, and a summary of how this quality indicator is measured in the literature.

Practice Problem and Relevance to Nursing Practice:
Falls among hospice homebound patients pose significant challenges to nursing care and patient safety. These patients often have complex medical conditions, limited mobility, and may receive end-of-life care. Falls in this population not only compromise patient safety but also impact their overall quality of life and well-being. It is imperative for nurses to identify the measures and challenges associated with falls in order to develop effective prevention strategies and improve patient outcomes.

Collaboration Interviews and Measures Identified:
In order to determine the measures for falls in hospice homebound patients, collaboration interviews were conducted with two key leaders from the practice setting. The interviews revealed several key measures that are considered important in addressing the practice problem. These measures include:

1. Frequency of falls: This measure involves documenting the number of falls that occur among homebound hospice patients over a specific period of time. It provides an overall picture of the problem and helps in identifying trends or patterns.

2. Fall-related injuries: This measure focuses on the severity of injuries resulting from falls. It includes assessing the type and extent of injuries suffered by homebound hospice patients, such as fractures, wounds, or head trauma.

3. Contributing factors: This measure involves identifying the factors that contribute to falls among hospice homebound patients. It includes assessing factors such as medication management, environmental hazards, and patient-specific factors like balance or mobility issues.

4. Fall risk assessment: This measure involves conducting fall risk assessments for hospice homebound patients. It helps in identifying patients at high risk for falls and implementing appropriate interventions.

5. Prevention interventions: This measure focuses on the implementation of interventions aimed at preventing falls in homebound hospice patients. It includes strategies such as patient education, modifying the environment, and ensuring proper assistive devices.

Challenges in Obtaining Data:
During the collaboration interviews, several challenges were identified in obtaining data for falls in hospice homebound patients. These challenges include:

1. Confidentiality and anonymity: The privacy and confidentiality of patient data present challenges in obtaining accurate and comprehensive information on falls. Healthcare professionals must ensure that patient data is protected and anonymized to avoid potential ethical and legal issues.

2. Access to data: Accessing relevant data on falls in hospice homebound patients may be limited due to various factors, including restrictions on data sharing and lack of interoperability between different healthcare systems.

3. Documentation practices: In some cases, healthcare professionals may not consistently document falls or may use different terminologies or classification systems, making it challenging to obtain a complete and standardized dataset.

Summary of Measurement in Literature:
An existing evidence review was conducted to explore how falls in hospice homebound patients are measured across the country. The literature review revealed various measurement approaches commonly used in the field. These include:

1. Retrospective chart review: Many studies utilize retrospective chart reviews to identify falls among hospice homebound patients. This involves reviewing medical records and documentation related to falls to extract relevant data.

2. Incident reporting systems: Some organizations have incident reporting systems in place to capture falls. These systems involve reporting incidents of falls as they occur and collecting relevant data for analysis.

3. Surveys and questionnaires: Surveys and questionnaires are commonly used to gather information on falls and associated factors from patients, caregivers, and healthcare providers. These tools help in capturing subjective experiences and perspectives related to falls.

Gaps in Data and Additional Sources:
During the collaboration interviews and literature review, certain gaps in data and additional sources became evident. These gaps include:

1. Lack of standardized measures: The approaches and tools used to measure falls in hospice homebound patients are varied, indicating a lack of standardized measures. Developing standardized measurement tools would enable consistent data collection and better comparability across different settings.

2. Limited focus on patient perspectives: The literature review revealed a limited emphasis on capturing patient perspectives and experiences regarding falls. Including patient-reported outcome measures in falls assessments would provide valuable insights into patient-centered care.

3. Long-term follow-up: Most studies focused on short-term follow-up, providing limited information on the long-term outcomes and recurrence of falls in hospice homebound patients. Additional research is needed to examine the long-term impact and effectiveness of interventions.

Conclusion:
Accurate measurement of falls and associated challenges in hospice homebound patients is crucial for effectively addressing the practice problem and improving patient safety. Collaboration interviews with key leaders in the practice setting and a review of the literature have identified key measures, challenges in obtaining data, and existing approaches to measure falls. However, gaps in data and additional sources have also been identified, indicating the need for standardized measures, patient perspectives, and long-term follow-up in research and practice. Addressing these gaps will enable a comprehensive understanding of falls among hospice homebound patients and inform evidence-based interventions to enhance patient safety.