Hourly Rounding to Prevent Patient Falls
Explanation of How Gap Was Bridged
Falls are the largest category of reported incidents in hospitals and they vary depending on the patient population, risk factors, and prevention strategies available (Daniels, 2016). The problem of patient falls in the organization was identified to hinder safe care delivery by nurses and other healthcare personnel. It was observed that individual healthcare teams assumed responsibility to prevent falls rather than the use of multidisciplinary approaches. For instance, the nursing team was reluctant to implement the hospital falls prevention guidelines because other professionals assumed it was their role to ensure patient safety. The elderly population and patients in the medical/surgical units were greatly affected by the issue of falls. To help solve this problem, a quality improvement project was designed to implement evidence-based strategies in the facility.
To use of evidence-based practice today has helped to improve the quality of care delivered to patients alongside the improvement of patient safety. To solve the problem of patient falls in the facility, a literature review was done to identify the most appropriate measure. The use of a purposeful hourly rounding approach was identified to be the most significant in preventing falls. Most studies indicated that falls in healthcare can be prevented through timely identification of risk factors and prompt action taking (Schuchman & Graziano, 2020). The use of hourly rounding was recommended because it could encourage the participation of multiple healthcare teams including the patients and their families. A study by Morris and Riordan (2017) found out that hourly rounding was crucial in identifying patient needs that could otherwise prompt falls. For instance, the researchers indicated that hourly rounding could provide a routine assessment of mobility, toileting, and continence needs for unstable patients. Timely assessment of needs using purposeful rounding was crucial in ensuring the stability of the elderly and post-surgery patients which could prevent falls.
There is a lot of pressure for hospitals to implement protocols or strategies to prevent patient falls. To ensure the proposed strategy was effectively implemented in the organization, education and training was necessary. The nurses were educated on the purpose of hourly rounding and how to incorporate the 4P’s (Pain, Potty, Positioning, and Possessions) into their new norm (Daniels, 2016). Upon full implementation of the new change, the nurses are expected to be active in performing routine hourly rounding. During the rounding exercise, the nurses will incorporate the 4P’s strategy of assessing pain, position, placement, and potty. Upon full implementation, the new strategy is expected to minimize the number of falls across all units.
Supporting the Plan
Change management plans can support smooth transitions in healthcare organizations by ensuring employees are guided through the change process. It is established that lack of a change management plan causes negative attitudes towards change and eventually failure of new organizational strategies. To ensure patient falls are reduced in the facility, short-term and long-term plans are available to support the new fall prevention strategy. The first approach will involve the engagement of nursing leadership and unit champions into the implementation of the new change. This short-term strategy will serve to improve compliance with the hourly rounding sessions and provide support to staff. A study conducted to determine factors that boost the success of hourly rounding interventions found ou that the engagement of leaders acts as an influence to staff and ensures procedures are followed (Goldsack et al., 2016). The long-term plan to support the new change will involve education and training of staff, especially for the new employees. This strategy will serve to strengthen the spirit of fall prevention in the facility and to remind the nurses of their role in promoting patient safety. To further strengthen the new approach, setting policies and providing supportive guidelines for hourly rounding will be necessary.
Resources for Post-Implementation
Post-implementation of the project will require material and human resources for the realization of goals. The first material resource required is a computer system to collect and store data about patient falls in the organization. The new project will involve the education and training of nurses to conduct hourly rounding. Resources for education will include a hall, seats for staff, accessories such as monitors and microphones, books for taking notes, and attendance sheets to ensure all staff participates. Because of the education and training required, financial resources will aid in organizing the training sessions and facilitating stakeholder meetings. Regarding the personnel for post-implementation project support, the clinical nurse educator, unit champions, and other relevant guests will be available to guide the nursing team.
Chapter 5: Reflection
Clinical Reasoning Outcomes
The second MSN graduate program outcome requires the nurse to integrate clinical reasoning with organizational, patient-centered, culturally appropriate strategies to plan, deliver, and evaluate evidence-based practice. To demonstrate the fulfillment of this outcome, the project ensured that the chosen intervention was acceptable by the organization and the patients. During the initial stages of the project, the hospital administration was involved to approve the new change based on its effectiveness to improve quality and patient safety. Additionally, I understood that the clinical nurse educator, nurse unit directors, and managers were crucial to the acceptance of the new change in the organization. These individuals were involved in influencing the nurses and other healthcare team members to accept the new change. During the implementation phase, I understood that education and training were necessary for staff to promote understanding of the project including the relevance of the evidence-based intervention to reducing patient falls.
Applied Research outcome
The fifth MSN graduate program outcome requires the nurse to utilize applied research outcomes within the practice setting, navigating and integrating care services across healthcare systems. Throughout the project implementation, evidence from the research was used to inform decisions leading to the prevention of falls in the facility. For instance, a literature search was conducted to identify the fall prevention strategies including recommendations from professional organizations. In the previous section, I presented an evidence summary of 30 credible sources that provided information about falls prevention. To demonstrate the utilization of applied research, the hourly rounding strategy was chosen because it was supported by literature to reduce patient falls in healthcare. Additionally, the decision to incorporate education and training for nurses before implementation of the new change demonstrated the application of research outcomes.
Patient safety is fundamental to delivering quality healthcare services to the people. Falls that occur in hospitalized patients is a widespread and serious threat to their safety. The problem identified in the organization was poor adherence to the set guidelines on fall prevention. To address this challenge, the plan was to implement intentional hourly rounding for the nursing team to monitor patient activity. To implement the new change, the first step was meeting with the project managers to discuss the course of action. During the meeting, the stakeholders were informed about the importance of the new change and how their power and influence could lead to the realization of positive results. The second part involved the presentation and approval of the proposed strategy by the administration. Upon the approval of the project, an intensive literature review identified the use of hourly rounding to reduce patient falls in the organization. The last step of the implementation process involved the education and training of nurses. The nurses were educated on the importance of fall prevention and how to perform hourly rounding. Emphasis was put on the performance of intentional rounding while incorporating the 4P’s (Pain, Potty, Positioning, and Possessions) during the assessment of patients. Weekly meetings that discussed the new change process and solutions to perceived barriers were held by the project managers.
Daniels, J. (2016). Purposeful and timely nursing rounds: A best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 14, 248-267. https://doi.org/10.11124/jbisrir-2016-2537
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2016). Hourly rounding and patient falls: What factors boost success?. Nursing Management, 45(2), 25–30. https://doi.org/10.1097/01.NURSE.0000459798.79840.95
Morris, R., & O'Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine (London, England), 17(4), 360–362.
Schuchman, M., & Graziano, J. (2020). Management of frequent falls. In Home-Based Medical Care for Older Adults (pp. 49-55). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-23483-6_8
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