Appraising the Evidence for a Multi-Component Falls Prevention Program on a 32-Bed Medical Floor
[Author Name]
Nursing Program, Southern New Hampshire University
NUR 440: Research and Evidence-Based Practice
Module 5 Assignment
[Instructor Name]
August 11, 2026
Composite setting written as a model document. No real hospital, employer, staff member or patient is described.
Practice Problem and Clinical Question
The setting is a composite 32-bed medical floor in a community hospital. Across the past two quarters the floor recorded 23 patient falls in 5,600 patient days, a rate of 4.1 falls per 1,000 patient days, against its own prior-year average of 2.8. Three of the 23 falls caused injury: one wrist fracture, one facial laceration that needed sutures, and one head strike with no radiographic finding but four added days of observation. Seventeen of the 23 falls were unwitnessed, 14 happened within four meters of the bathroom door, and nine occurred between 11 p.m. and 5 a.m.
Current practice is a risk screening tool completed on admission and once each day, a yellow sock and a door magnet for anyone who screens at risk, and printed signage above the bed. Rounds are expected hourly by day and every two hours overnight, but they are documented as completed for about 60 percent of overnight hours in the past quarter. Nothing in the present process records why a given patient is at risk, so the same three interventions are applied to a patient sedated by a night medicine, a patient with urinary urgency and a patient with an unsteady gait after three days in bed.
The question was written in searchable form. In adults admitted to a medical floor, does a multi-component falls prevention program built on an individualized plan and structured rounding, compared with risk screening, signage and identification aids alone, reduce the rate of falls per 1,000 patient days over six months? Framing the outcome as a rate with a denominator rather than as a count of falls was deliberate, because the census on this floor swings with the season and a raw count would reward a quiet quarter that had nothing to do with the program.
The search covered CINAHL Complete, PubMed and the Cochrane Library, combining the terms accidental falls, inpatient, hospital, prevention and nursing, limited to English language publications from 2012 to 2024 and to adult inpatient settings. It returned 214 records once duplicates were removed. Titles and abstracts were screened against two inclusion rules, an acute inpatient population and a reported fall rate or fall injury rate, which left 12 records read in full. Four studies were retained for appraisal, with two agency documents kept separately as practice guidance rather than counted as appraised evidence.
Appraisal of the Evidence
The strongest single source is a Cochrane systematic review of interventions to prevent falls in care facilities and hospitals (Cameron et al., 2018). Its quality markers are the ones an appraiser looks for: a registered protocol, two reviewers screening and extracting independently, a formal risk of bias judgment for every included trial, and certainty of evidence rated rather than asserted. Its hospital findings are cautious. Multi-component programs show a modest reduction in falls, certainty for that estimate is low to moderate, and the included trials differ so widely in what they bundled together that pooling them conceals nearly as much as it shows.
The 6-PACK cluster randomized trial (Barker et al., 2016) tested a bundled program in acute medical and surgical areas across six hospitals, covering more than 31,000 admissions. It is well built: clusters were randomized, injurious falls were verified from records by assessors who had not delivered the program, and fidelity was measured rather than assumed. The result was null, with neither the fall rate nor the injurious fall rate differing from usual care. A null result from a strong design carries more weight than a positive result from a weak one, and that is the single most useful judgment in this appraisal.
The bed alarm trial (Shorr et al., 2012) is the second useful negative. A cluster randomized study raised alarm use several times over in the intervention areas and produced no change in the fall rate. Its limits are visible and stated: a single hospital, likely contamination between areas that shared staff, and an intervention that altered equipment use rather than what nurses did with patients. Read next to the 6-PACK result, it points at a pattern worth carrying into practice, which is that programs adding a device without changing the pattern of contact do not move the rate.
Weighed as a body, the evidence supports a modest effect at moderate strength. The systematic review sits at the top of the levels hierarchy used in this course (Melnyk and Fineout-Overholt, 2023), the two trials are strong primary studies, and the two agency documents are expert guidance rather than research. The consistent signal is that benefit follows individualized plans and reliable rounding, not identification aids or alarms. The consistent weakness is fidelity: the programs that failed were mostly delivered unevenly, and few reports state what share of intended rounds actually happened. That weakness is the one this floor already has.
What This Evidence Would Change at the Bedside
Applied to this floor, the evidence changes the shape of the program rather than its budget. The screening tool stays, because a score identifies who needs a plan, but the yellow sock and the sign stop being the plan. Every patient who screens at risk gets two lines on the care board naming the reason for the risk and the action that answers it: a sedating night medicine, urgency at 2 a.m., or an unsteady gait after three days in bed. The action that follows differs across those three, and producing that difference is what the current process cannot do.
The rounding change is the part the evidence supports most directly and the part that will be hardest to hold. Overnight rounds move to fixed times, every two hours between 10 p.m. and 6 a.m., and each one covers a spoken offer of the bathroom, the call light and water placed within reach, and the path from bed to bathroom door cleared and lit. Each round is initialed on a one-page sheet kept at the bedside. A huddle follows any fall within 30 minutes and records one thing above all others: what the patient was trying to do.
Measurement follows the question that was asked. The outcome measure stays falls per 1,000 patient days, posted monthly with the count and the denominator side by side, across six months. Two process measures decide whether the program was delivered at all: the share of at-risk patients with an individualized plan recorded within four hours of admission, and the share of scheduled overnight rounds initialed. Moving from 4.1 to 2.8 falls per 1,000 patient days would mean about 16 falls instead of 23 across the same 5,600 patient days, which is the size of change this evidence makes plausible.
The appraisal also says what not to do. It does not support buying an alarm system, and it does not support promising that injuries will drop, because injurious falls are rarer and the trials that measured them separately found no difference. Since certainty for the effect is low to moderate, the change is adopted as a monitored trial with a review at three months and a stated stopping point: if documented overnight rounds stay below 80 percent, the program has not been tested, and the rate that follows says nothing about the evidence behind it.
References
Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals: A toolkit for improving quality of care (AHRQ Publication No. 13-0015-EF). U.S. Department of Health and Human Services. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
Barker, A. L., Morello, R. T., Wolfe, R., Brand, C. A., Haines, T. P., Hill, K. D., Brauer, S. G., Botti, M., Cumming, R. G., Livingston, P. M., Sherrington, C., Zavarsek, S., Lindley, R. I., & Kamar, J. (2016). 6-PACK programme to decrease fall injuries in acute hospitals: Cluster randomised controlled trial. BMJ, 352, h6781.
Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database of Systematic Reviews, 2018(9), CD005465.
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing and healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., Kessler, L. A., & Miller, S. T. (2012). Effects of an intervention to increase bed alarm use to prevent falls in hospitalized patients: A cluster randomized trial. Annals of Internal Medicine, 157(10), 692-699.
The Joint Commission. (2015). Preventing falls and fall-related injuries in health care facilities (Sentinel Event Alert No. 55). https://www.jointcommission.org/resources/sentinel-event/sentinel-event-alert-newsletters/
How this NUR 440 Module 5 example is structured
In many sections the module 5 assignment in a research course asks for an appraisal of the evidence behind one practice problem rather than a full proposal; your classroom's instructions and rubric decide the exact form, so read them before using this NUR 440 Module 5 example as a shape. The paper runs in three parts. The problem and the searchable question come first, carrying the floor's own numbers, because an appraisal with no denominator has nothing to weigh. The appraisal itself comes second and judges each study on how it was built rather than on whether its result is convenient, which is the habit a BSN completion course is trying to form. The last part converts that judgment into named practice changes and the measures that would tell the floor whether the change worked.
NUR 440 Module 5 questions, answered
What does a NUR 440 Module 5 paper usually ask for?
In many sections the module 5 assignment in a research course is an appraisal: a practice problem, a searchable question, a described search, and a judgment about the quality of what was found. Your classroom's instructions and rubric decide the exact form, including how many studies are expected and whether a table is required. Read those first, then borrow this shape.
How do you appraise a study that found nothing?
Judge the build before the finding. A large cluster randomized trial with concealed allocation, blinded verification of injuries and measured fidelity that reports no difference is telling you something real. Written well, a negative result becomes the strongest paragraph in the paper, because it rules out an approach that looked convincing and often costs money.
How many sources belong in an evidence appraisal?
Your instructions decide the count, and quality beats quantity every time. Four studies appraised properly, with design, sample, limits and certainty named for each, reads far stronger than a list of ten summarized in a sentence apiece. Mix the levels as well: a systematic review, primary studies, and agency guidance kept clearly separate from the research.
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