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Hourly Rounds & Patient Falls

Nursing interventions should be specifically directed at preventing patient falls.

Patient safety is a top priority to all members of the healthcare team.

As a team member, nurses are responsible for carrying out important interventions that aim to ultimately do no further harm and secure the safety of our patients within our care.

One of the foremost concerns for nursing practice is the risk of patient falls.

When hospitalized patients fall, they are at an increased risk for injury, which contributes to increased hospital stays, longer recoveries, and possibly longer periods of time out of the work force.

"The average hospital stay for patients who fall is 12.3 days longer, and injuries from falls lead to a 61 percent increase in patient-care costs," American Nurse Today reported last year. While in an effort to alleviate this problem, one of the Joint Commission's National Patient Safety Goals is to reduce the risk of patient harm resulting from falls.

According to Massachusetts Department of Public Health, and a recent summary performed by the Bureau of Health Care Safety and Quality (2011), Massachusetts acute care hospitals reported 57 percent of serious reportable events as environmental; 98 percent of those serious events were attributed to patient falls.

It is imperative that nursing interventions be specifically directed at preventing patient falls.To prevent falls, nurses must examine contributing factors related to these dangerous situations.

According to the Centers for Disease Control and Prevention (CDC), any number of variables contribute to patient falls, including tripping over or entanglement in IV tubing, inadequate lighting, trying to get to the bathroom, and height of the hospital beds.

One way to reduce patient falls is by nurses completing hourly patient rounds.

Read More

Seeking Fall Solutions

New Jersey hospital creates a 15-minute rounding program that helps prevent patient falls.

Common Hypothesis

Driven by National Patient Safety Goals, and by the prudent nurse's concern, to impact nursing practice a sufficient amount of evidence-based research is required.

Several studies have attempted to implement differing protocols using nursing hourly rounds with the ultimate goal being to decrease patient falls.

The common hypothesis that various types of hourly rounding would decrease the number of patient falls and therefore eliminate patient harm resulting from this cause was noted in these studies.

After outlining the need for this intervention, several more specific questions were identified, such as:

"How much of a difference is noted between hourly rounds versus rounding every 2 hours? Who should complete the rounding? How much of a difference does nursing hourly rounds actually make on the number of patient falls?

Expert Findings

Nurses' physical presence is essential to keeping patients safe.

Many patients do not want to be a burden to their healthcare professionals, or fear losing their independence and therefore do not ask for help. Thus it is crucial for nurses to check on their patient's wellbeing by completing hourly rounds to meet patients' basic safety needs.

Meade, Bursell, and Ketelsen (2006) discovered some nurses were concerned about the time required to perform the rounding. Others found nurses were concerned about rounds not being a team effort and other nursing professionals sharing the responsibility.

Although checking on patients hourly is a commitment to be made by the nurse, this policy has been adopted and implemented by some nursing departments, which then requires all nurses, often as part of a multidisciplinary team, to perform hourly rounds.

Meade et al. (2006) evaluated experimental hourly rounds verses 2- hour rounds and found patient falls were reduced in both cases.

The researchers also noted nurses found "they were more satisfied with the additional time they had to care for their patients as well as to perform other tasks such as charting and patient education, because the rounding reduced the number of call lights they had to answer, thus freeing up more time for other tasks."

Nursing Interventions

In order to reduce falls and increase patient satisfaction, nurses can further extend their assistance by checking on their patients hourly.

Simple interventions such as moving the phone closer to a patient during the interaction may possibly prevent a fall.

Nursing interventions are most significant to keeping patients safe and therefore it is most advantageous for nurses to check on their patients and increase patients' safety by anticipating their needs.

The Institute for Health Improvement and Robert Wood Johnson Foundation "Transforming Care at the Bedside (TCAB)" joint initiative focuses on patient falls with particular attention to busy med-surg nursing units.

As a result of 2 years of TCAB data collection, nursing rounds were correlated with decreasing average fall rates in the hospital's units (Stefancyk, 2009). In one study, personal care assistants asked patients specific questions and reported back to the nurses, if needed. However, this required a cultural change that limited the initiative's success (Stefancyk, 2009).

The cultural change caused much prompting and cueing by nurses as PCA's adapted their established routines to actively anticipate and meet patient's needs. To avoid this prompting, nurses also had to learn to manage their PCAs to ensure they completed the rounds and incorporated them into their routine (Stefancyk, 2009).

When nurses perform the hourly rounds, these problems can be eliminated. Moreover, rounding would no longer completely change a PCA's routine. It also would allow the nurse to put more time and effort into their patient's care versus into learning how to delegate tasks to PCAs.

When rounding hourly nurses also would be able to complete regular assessments of patient's mental status, medication response or skin integrity. Hourly rounds also encourage nurses to complete more complex assessments and interventions for those patients with more significant illnesses.

The call bell has been a significant tool by quickly alerting nurses to patient's needs. However, research suggests many nurses have not responded immediately to call bells due to their overuse by patients who do not require immediate care.

Garder et al. (2009) examined the effects of nurses performing scheduled rounds every 1 hour and every 2 hours. Dubbed "comfort rounds" by the researchers, they resulted in better patient satisfaction and less use of the call bell. While hourly rounds by nurses also contributed to greater patient safety.

Nurse Role

The empirical literature linking nursing hourly rounds to patient falls is limited but increasing.

One Nurse's Story

A Patient's Point of View

Retired nurse recommends performing mobility assessments following surgery to an extremity.

Additional research regarding nursing rounds must be conducted to support the hypothesis that implementing nursing hourly rounds has a significant effect on decreasing patient falls.

Given the severity of risks patient falls poses on patient recovery, health care costs, and length of hospital stay, hourly rounding must become a priority to nursing research.

By using hourly rounding with attention to patient fall interventions, nurses have the power to dramatically change patient care outcomes and potentially eliminate the costs incurred by hospitals due to these accidents.

Nurses have the greatest amount of patient contact during hospitalization and are the best suited to asses the risk for patient falls. Nurses are also most likely to witness falls and have the greatest opportunity in preventing the falls.

Hourly rounds further illuminate the importance of patient contact.

It is of utmost importance that nurses evaluate their patients hourly, whether it is for help toileting, ambulating or to assist with position change, these actions further alleviate the risk of patient falls.

Hourly rounding has relevance to current nursing practice, while studies of implementation and outcomes will further contribute to current literature supporting evidence-based nursing practice.

References for this article can be accessed here.

Darcy Nientimp and Ellen Peterson are student nurses, both at the Massachusetts College of Pharmacy and Health Sciences, Boston.

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