Hourly Rounding as the Solution to Patient Falls - Essay Example

Hourly Rounding as the Solution to Patient Falls Problem Identification Identification of work-Setting Problem Patient falls are among the adverse effects that are commonly reported in hospitals. The causes for patient falls include intrinsic factors, like the nature of the patient; situational causes like reaching and bending and extrinsic causes, including environmental pressures. Organizational factors like the unavailability of equipment or the shortage of staffs can also influence the rate of patient falls in hospitals (Oliver, Healey, & Haines, 2010). Some of the situations leading to patient falls include the cases where patients do not call for the assistance of nurses; where hospital personnel do not set the bed-exit alarm and the cases where a patient is under the influence of high-risk medication (Oliver, Healey, & Haines, 2010). Other situations that could lead to patient falls include where patient assessment is inadequate and where there are delays in responding to call alerts or care delivery. The Implications of Patient falls in Healthcare Service Delivery More than 1 million patient falls occur every year. Among US hospitals, falls rates range between 3.1 and 11.5 cases/1,000 patient-days (Quigley et al., 2009). Rates of patient falls differ, depending on the type of hospital unit; the highest rates of falls are reported in the medical and the neuroscience units. Fall rates are 3.48 and 6.12/ 1000 and 6.12 and 8.83/1000 respectively (Quigley et al., 2009). About 30 percent of the total number of patient fall cases cause some form of injury; 10 percent cause the patients serious injury, including the fracture or the trauma of the head. Among aged patients, these falls are extremely dangerous, including that they can cause death or further illness (Oliver, Healey, & Haines, 2010). The statistics reporting the incidence of patient falls and their effects among older patients are very critical and disturbing. Presently, older people of 75 years and above comprise about 22 percent of the patients admitted into hospitals (Wier, Pluntner, & Steiner, 2010). Further, major areas of hospital costs are related to patient falls: these include liability, length-of-stay and care services. The patients that suffered serious injuries, due to falls, while under the care of hospitals remained under care for 6.3 to 12 days more than their counterparts, and also registered higher healthcare costs by an average of USD 13,316 (Brand & Sundarajan, 2010). Additionally, starting 2008 the Center for Medicare and Medicaid Services revised their policies – directing that they will not compensate hospitals for the costs incurred on the treatment of these types of injuries (Inouye, Brown, & Tinetti, 2009). This leads to the major conclusion that a reduction in the number of patient falls will lead to a major reduction in the costs borne by hospitals and patients. Project Objective The objective of this report is to develop a framework showing the relationship between the improvement of service delivery among nursing personnel and the reduction in patient falls. Through the administration of an extensive review of literature, this paper will report the effects of initiating an hourly rounding program on patient fall rates (Pearson & Coburn, 2011). The analysis of the statistics reported through the wide array of sources will be presented as the outcomes of the project. Description of Proposed Solution Hourly rounding will be implemented to address the problem of patient falls. The program is expected to improve the care offered to patients, which will improve their experience – through the adoption of a structured hourly-rounding program. The contents of the program were reviewed by a team of managers and staff nurses from different units. The review of the best program strategies entailed the review of existing service practices, towards the development of the rounding protocol. The program will cover checking the four critical areas of care to be checked during the routine rounding. The areas checked routinely will include toileting needs, pain management, fall prevention, and patient positioning (Oldrich, Kalman & Nigolian, 2012). Other aspects of the program will include addressing the personal questions of patients; administering environmental checking for systems like IV pumps, bed alarms, urinals and hats; informing patients when the next routine check will be done and then documenting the completed rounding. The outcomes expected from the program include reducing the number of patient falls and reducing notifications made by patients over the notification system – which will increase patient satisfaction levels (Oldrich, Kalman & Nigolian, 2012). Description of Hourly Rounding Proposed Solution (hourly rounding program) The hourly rounding program is aimed at addressing the problem of patient falls. Hourly programs have been used before, as a model for the improvement of patient safety and increasing the safety of patients, but in this case it will be focused on reducing patient fall rates. The program will proactively organize the care offered to the patients within the hospitals covered by the program, towards reducing patient falls (Olrich, Kalman & Nigolian, 2012). The focal areas of the program will include checking the 4 Ps of patients, including pain management, potty needs, patient positioning and the proximity of personal items like call buttons. The adjustable aspects of the program include that toilet times can be rescheduled by the nursing staffs to suit different patients; assistance could be arranged whenever it is needed, prior to the scheduled rounding time (Olrich, Kalman & Nigolian, 2012). Consistency of Hourly Rounding with Current Research Mant, Dunning and Hutchinson (2012) following their study on the clinical effectiveness of initiating a hourly rounding program to address the problem of patient falls, concluded that the outcomes included a reduction in the adverse effects of patient falls. These adverse outcomes, which reduced in frequency, included long hospital stays, fall-related injury and fall-related mortality. According to the study by Mant, Dunning and Hutchinson (2012) the factors contributing to the incidence of patient falls included the experience of a previous falls, age, unsteady gait, reduced vision, musculoskeletal system weakness, acute illness and mental illness. Following the inferences of the study, the authors arrived at conclusions that are in line with those made by other studies, including Olrich, Kalman and Nigolian (2012). The emphasis of the different studies is that, many of the causes leading to patient falls could be eliminated through the initiation of the hourly rounding program, which will reduce the rates of patient falls. The conclusions of this study are in support of the adoption of the hourly rounding program, as a strategy for countering patient fall cases in hospitals. Deitrick, et al. (2012) explored the challenges related to the initiation of a hourly rounding program within the hospital environment, and finalized their study with the conclusions that the implementation can be difficult, but it can yield positive outcomes. The emphasis of the study was that a number of aspects should be taken into account, towards ensuring that the program will bear positive outcomes (Oldrich, Kalman & Nigolian, 2012). The areas that – according to the study – need to be checked include the careful planning of the program, an effective communication within the organization; a carefully monitored implementation and the evaluation of the different aspects of the program, so as to guarantee its success (Deitrick, et al., 2012). The conclusions of this study emphasize the importance of a careful and a well-planned adoption of the program, so as to guarantee its success, which supports the effectiveness of hourly rounding in addressing the problem of patient falls (Oldrich, Kalman & Nigolian, 2012). Similar to the study by Deitrick, et al. (2012), the study by Tucker, et al. (2012) explored the challenges of implementing the hourly rounding program, and its outcomes in reducing patient falls. The conclusions of the study included that the adoption of an hourly rounding program reduced the rates of patient falls, but emphasized that the success of the program was determined by the balance between the fidelity of intervention and the personalized attention of care (Tucker, et al., 2012). In general, the different evidence-based studies support the adoption of hourly rounding as an effective solution to the problem of patient falls. The Feasibility of implementing hourly rounding The integration of the findings of the wide range of studies emphasizes that hourly rounding reduced unit noise levels and the usage of call lights; it reduces patient falls and increases patient satisfaction. The increased effectiveness of service delivery also led to the reporting of higher satisfaction levels among medical personnel; they reported that the program allowed them more control over their patients (Olrich, Kalman & Nigolian, 2012). Taking into account the costs of patient falls, hourly rounding programs should be implemented in all hospitals, and they are fully feasible. However, towards increasing the feasibility of the program in hospitals, managerial personnel should engage hospital staffs in the planning, as well as the implementation of the program – so that the different groups can identify with the benefits of the program (Mant, Dunning & Hutchinson, 2012). The Consistency of Hourly Rounding with the Culture and the Resources of Hospitals The cultures of hospitals, as well as the resources – human and financial – are continually channeled towards the improvement of the satisfaction of their patients (customers). For that reason, noting that hourly rounding improves patient outcomes and reduces the resources spent on patients, including finances, time and improves health outcomes; it is evident that the program is consistent with the culture of hospitals (Oliver, Healey & Haines, 2010). References Brand, C., & Sundarajan, V. A. (2010). A 10-year cohort study of the burden and risk of i- hospital falls and fractures using routinely collected hospital data. Quality and Safety in Health Care, 19, 1-7. Deitrick, L., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly Rounding: Challenges with Implementation of an Evidence-Based Process. Journal of Nursing Care Quality, 27(1), 13-19. Inouye, S. K, Brown, C., & Tinetti, M. (2009). Medicare nonpayment, hospital falls, and unintended consequences. N Engl J Med, 360(23), 2390-2393. Mant, T., Dunning, T., & Hutchinson, A. (2012). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. JBI Library of Systematic Reviews, 10(56), S63-S74. Oliver, D., Healey, F., & Haines, T. P. (2010). Preventing falls and fall-related injuries in hospitals. Clin Geriatr Med, 26(4), 645-92. Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly Rounding: A Replication Study. MEDSURG Nursing, 21(1), 23-36. Pearson, K., & Coburn, A. (2011). Evidence-based Falls Prevention in Critical Access Hospitals. Policy Brief, # 24, 1-5. Retrieved from: http://www.flexmonitoring.org/wp-content/uploads/2013/07/PolicyBrief24_Falls- Prevention.pdf Quigley, P. A., Hahm, B., Collazo, S., Gibson, W., Janzen, S., Powell-Cope, G., Rice, F., Sarduy, I., Tyndall, K., & White, S. V. (2009). Reducing serious injury from falls in two veterans hospital medical-surgical units. J Nurs Care Qual, 24(1), 33-41. Tucker, S. J., Bieber, P.L., Attlesey-Pries, J.M., Olson, M.E., & Dierkhising, R.A. (2012). Outcomes and challenges in implementing hourly rounds to reduce fall in orthopedic units. Worldviews Evid Based Nurs, 9(1), 18-29. Wier, L. M., Pluntner, A., & Steiner, C. (2010). “Hospital utilization among oldest adults, 2008”. HCUP. Statistical Brief # 103. In: Agency for Healthcare Research and Quality, ed. Rockville, MD. Read More