Hourly Rounding for Falls Prevention: A Change Initiative

Abstract

Fall-related injuries are a particular concern within the elderly population, and trends toward an aging demographic will keep this issue at the forefront in health care. We are challenged to develop creative strategies to significantly reduce harm and fall rates among the elderly. This article describes the process of establishing an hourly rounding initiative in a health care facility. Hourly rounding is supported by the literature as an effective strategy for falls prevention and patient safety. When the initiative was not successfully adopted initially, the implementation process was critically examined and an innovative sustainability plan was developed to ensure that the change would be embedded in the organization's culture. Through this opportunity, nurses and allied health members from all levels were able to collaborate on strategies for this patient safety initiative.

Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation

“…Context-mechanism-outcome 1: intentional rounding ensures that consistent and comprehensive care is delivered to all patients by all nurses A total of 21 papers 4,9,11,24,[26][27][28][29][30][31][32][41][42][43][44][45][46][47]57,58,60 highlighted the link between IR and consistent and comprehensive care. The structured, systematic approach to IR prompted and guided the delivery of care to a required standard, helped staff to remember to conduct all aspects of care on each round 4,58 and identified tasks that might otherwise be missed.…”

“…l Outcomes: increased nursing workload, which means either that IR is omitted or the documentation is completed at the end of the shift. Context-mechanism-outcome 2: intentional rounding gives nurses allocated 'time to care' A total of 19 papers 4,9,22,24,28,29,31,33,[39][40][41]43,45,[48][49][50]57,58,60 discussed the 'allocated time' mechanism. There was no indication that nurses were given specifically allocated time in which to conduct IR (i.e.…”

“…24,28,43,45,50 It was felt by some that the documentation associated with IR took nurses away from delivering patient care 28 and others talked about having to fit in rounds around the rest of their workloads. 29,43,60 In these situations, higher-priority duties could take precedence 33 and more complex patients could be prioritised. 24,41,49,60 The need for cultural change in an organisation was an important influencing context for this mechanism, 4,24,28,48,49 as was successful teamworking.…”

Towards international consensus on patient harm: perspectives on pressure injury policy

“…In recent years evidence has emerged on the benefits of nurse rounding and other forms of work re‐design (Dyck et al . ); however, this evidence remains absent from pressure injury policy and guidelines. If patients’ journeys through the health‐care system are to be safe and pressure injury free, it is important to address the various components of the system and their inter‐linkages.…”

“…The CMS expects that up to 25% of hospitals will be subject to the penalty, and over time there are plans to increase the number events measured (Health Policy Brief 2015). In recent years evidence has emerged on the benefits of nurse rounding and other forms of work re-design (Dyck et al 2013); however, this evidence remains absent from pressure injury policy and guidelines. If patients' journeys through the health-care system are to be safe and pressure injury free, it is important to address the various components of the system and their inter-linkages.…”