Outcomes and Challenges in Implementing Hourly Rounds to Reduce Falls in Orthopedic Units
ABSTRACT Patient falls remain a common adverse event in acute care facilities. Findings from research into structured nursing rounds interventions (SNRIs) indicate promise as a fall prevention practice. Translating, adapting, and sustaining SNRI in real world clinical practices is an important next step.
The purpose of this study was to evaluate the feasibility of adapting and translating a SNRI to reduce the risk and incidence of patient falls on two orthopedic inpatient units. It was hypothesized that SNRI would reduce fall rates up to 1-year postintervention and that patient risk factors and documented SNRI activities would predict falls.
Using a repeated measures design, fall rates and risk assessment data were collected at baseline, during the 12-week SNRI implementation, and 1-year following implementation. The adapted SNRI included hourly prescribed rounding activities documented on a study specific form. Medical records of patient falls were reviewed for each period. Focus groups were conducted with nurses' postintervention.
Observed (probability) fall rates were 1.8%, 0.8%, and 1.1% for the three periods, respectively. Numbers of falls per 1,000 hospital days (incidence) were 4.5, 1.6, and 3.2 for the three periods. Mean fall risk assessment scores were 2.7 ± 1.1, 2.7 ± 1.1, and 2.5 ± 1.1 for the three periods. Fall rates declined during SNRI (borderline trend), yet 1-year follow-up rates drifted back toward baseline. SNRI dosage and fall risk scores did not predict fall rates. Patients who fell during the three periods were not at greatest risk. Nurses interpreted SNRI as an imposition and the documentation a burden.
Findings illuminate the multiple challenges in translational research. SNRI appeared to reduce fall rates initially, but fidelity to the SNRI implementation and documentation was variable and fall reduction gains appeared lost 1 year later. Nurses expressed the importance of balancing intervention fidelity and individualizing patient interventions.
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ABSTRACT: Structured hourly nurse rounding is an effective method to improve patient satisfaction and clinical outcomes. This program evaluation describes outcomes related to the implementation of hourly nurse rounding in one medical-surgical unit in a large community hospital. Overall Hospital Consumer Assessment of Healthcare Providers and Systems domain scores increased with the exception of responsiveness of staff. Patient falls and hospital-acquired pressure ulcers decreased during the project period.Journal of nursing care quality 09/2014; 30(2). DOI:10.1097/NCQ.0000000000000086 · 1.09 Impact Factor
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ABSTRACT: To gain knowledge of a nursing staff's perspectives and perceptions of hourly rounding in an acute care hospital setting. Research has shown hospitals that have successfully implemented hourly rounding have significant decreases in adverse patient events with improvements in patient and staff satisfaction. More recent studies and clinical observations by the author are revealing barriers and difficulties in translating this evidence-based practice to the bedside. An original survey was distributed to direct care staff on six inpatient units. Descriptive analysis of each survey item and subanalysis of the registered nurse (n = 52) and patient care assistant (n = 15) responses was reported and aggregated according to demographic data and Rogers' Theory of Diffusion of Innovation. Findings varied considerably between job category, shift worked, unit worked on and educational level of the registered nurses. Overall only 25% (n = 13) of the registered nurses felt a sense of ownership of the hourly rounding initiative and only 23.1% (n = 12) agreed that completion of the hourly rounding paper documentation tool was a true indication that hourly rounding was actually being done. Results from this study may give nursing leadership and educators' insight on how to lead and sustain a new initiative or evidence-based practice.Journal of Nursing Management 01/2014; 23(2). DOI:10.1111/jonm.12114 · 1.14 Impact Factor
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ABSTRACT: Objective: Identifying risk factors for the occurrence of falls in hospitalized adult patients. Method: Integrative review carried out in the databases of LILACS, SciELO, ME-DLINE and Web of Science, including articles published between 1989 and 2012. Results: Seventy-one articles were included in the final sample. Risk factors for falls presented in this review were related to patients (intrinsic), the hospital setting and the working process of health professionals, especially in nursing (extrinsic). Conclusion: The systematic screening of risk factors for falls was identified as a contributing factor to the reduction of this injury, helping the non-occurrence of this event that, despite being preventable, can have serious consequences including death.Revista da Escola de Enfermagem da U S P 06/2014; 48(3):540-554. DOI:10.1590/S0080-623420140000300021 · 0.50 Impact Factor