PROFESSION CAPSTONE PROJECT

HOURLY ROUNDS TO PREVENT PATIENT FALLS

NRS-441V-OL191

ABSTRACT

Patient falls are often are often associated with increased morbidity and mortality especially in extremely ill patients or those that require constant attention. Most falls in the hospital set up are often due to preventable causes and these can be easily averted. Falls have been classified as the most common cause of injury in hospitalized patients. These are usually most likely to occur at night or during shift changes. They occur due to inadequate staffing especially of nurses, increased number of patients and insufficient security especially of the patient beds among other reasons.

The key solution to preventing patient falls is to introduce hourly rounding on patients. This will not only prevent anticipated falls but will also improve on the security of the patient. It will also improve on patient satisfaction and better patient outcomes in the long run. For a facility to function without hitches, they have to be equipped proper staffs and experts, at any given time. If this is done in all hospitals, it will ensure sufficient staff to be able to do the proposed hourly rounding by the staffs like nurses and doctors. The management will then easily ensure that the hourly rounding for all patients is properly done. Any lack of management and staffs can lead to serious life problems and even death of a patient, if one goes unattended.

This project will go through six phases. The first phase is presenting the project to the Institution Review Board. The second stage will look at the research, statistic data, and development hourly rounding. The third phase concentrates on research and analysis of project viability. The fourth phase is refers to the education phase. This phase focuses on educating the staff for better outcome. The fifth phase will concentrate on implementation of this project. While the final phase will looks at the analysis and the project development. The implementation logistics is a framework that monitors the changes proposed and implementation. Each point are properly checked and monitored whether the changes are made according to the plan or not.

PROBLEM DESCRIPTION

One of the major causes of hospital injuries for hospitalized patients is falls. Falls are directly associated with the quality of nursing care. The Joint Commission (2014) states falls are responsible for 11,000 deaths annually in America, the Center began working on new measurement systems and solutions to try and combat this problem. Lack of negligence and trouble in hourly rounding could bring forth terrible issues one or the other times. The image and reputation of the health care organization is also greatly impacted.

Nature of the Problem

Lack of management and organization is the key issue behind negligence shown towards patients. There have been several aspects that have contributed reducing the risk of falls to some of these factors are the elderly population, high patient acuity, staff shortages, and work environment for caregivers. This can all contribute negatively and make any process improvement a challenge. Leadership plays an instrumental role in understanding the problem, establishing a safety climate culture, and improving the work environment of caregivers so that much needed direct nursing time for patient care can be increased. Hourly rounding could also be the most appropriate and suitable way in ensuring a reduction in hospital falls

Setting

The setting for this problem is mostly on a medical /surgical ward. It has been observed that there is an increase of falls mostly overnight. This happens over a twelve hour shift. Falls in the hospital environment are often as a result of different complications. Patient often get more confused when in an unfamiliar environment. Unfamiliar environments can signify a change, mostly for patients who are elderly or face more difficulties to adjust to changes in their environment

Detailed Description

Ford (2010) states hourly rounding is a proactive nursing intervention designed to antedate and address the needs of hospitalized patients. Studies indicate when there is hourly rounding; it promotes quality and safe care for patients. Hourly or Purposeful rounding turns up as the most eminent issue and looks forward to better management and reduced hospital falls Purposeful Rounding seeks to improve the patient experience through the use of a structured hourly rounding routine. Rounding every hour helps nurses identify those patients who are at risk of fall due to sundown syndrome.

Impact of the problem

Major impact of the problem is the cost on healthcare. The average hospital cost for a fall injury is $35,000. This cost is subject to increase depending on patient’s age. The states (Medicare) will pick up about 78% of the actually cost. This still puts a major pressure on individual hospital budget. The safety of patients hospitalized in health services is one of the priority concerns in quality control systems. The falls suffered by the patients during their hospitalization are one of the most important occurrences in the breakdown of security. This suggests that the hourly rounding should be given importance and significance in order to realize for better growth and progress in the most likely way (Mitchell & Haroun, 2011).

Gravity of the problem

According to Sherrod et al., (2012), the incorporation of hourly rounding into an existing fall prevention program will decrease fall rates by 40%. Hourly rounding will cut cost as well as promote pate safety. With this, it could be made out strongly understood that the conditions are Its significance to nursing could also be make out in a way that the patient’s care and treatment could take place in the most hopeful and fruitful manner.

SOLUTION DESCRIPTION

Hourly rounding is the proposed solution to address the problem. This will benefit patients by keeping them safe when in hospital, and also benefit hospitals by reducing the cost of inpatient falls. It’s essential to remember that purposeful rounding is ultimately about building relationships and trust as much as it is about meeting the physical needs of the patient.

Patient care and satisfaction is usually at the forefront of every healthcare providing facility and hospital. It is for this reason that several theories have been proposed to improve patient care and maximize patient safety. Inpatient facilities continue to have increased number of falls. This compounded with their initial illness worsens their prognosis and complicates their present management.

The Watson Caring Theory is a theory mostly associated with the elderly. The theory focuses mainly on patient satisfaction in partnership with other support services to give essential care to the patients. It has several components which include multilevel rounding, words and ways that work, relationship and partnership components. The Watson Caring theory focuses on regular leader and staff rounds on patients to improve the quality of care given.

Hourly rounding is a strategy that will ensure patients’ needs are addressed promptly in an anticipatory manner and that will limit their movement which leads to falls. Hourly rounds also give patients a forum to express and request for their needs which then get to be addressed as soon as they occur.

The theory will be incorporated into the project as a part of the preventive solutions within the nursing care. It has always been stated that prevention is better than cure. Hourly rounds and reviews on patients is a great preventive mechanism to several patient falls which then translates into better patient outcomes and decreases patient morbidity and mortality. Staff can learn the appropriate skills for consistent purposeful rounding more readily and perceive purposeful rounding as a useful behavior that can be achieved through teamwork

IMPLEMENTATION PLAN

The purpose of this implementation plan is to uncover the issues faced in today’s healthcare institution I will attempt to provide a solution to reduce falls in our hospitals. This will be implemented and hopefully improve hospitals visits and cut costs. One of the current hot topics in the healthcare facilities is the hourly rounding of the nurses and the staffs to prevent falls. The major issue for most healthcare institution is preventing falls in the hospital post the treatment or operation. This implementation plan is an attempt to take care of this issue and bring a solution to it.

Background

Healthcare facilities are the life-saving departments that treat people using a combination of medical practices and technologies. People trusts the healthcare facilities with their lives and believe they are there for a better health. However, due to mismanagement it has becomes evident patients can come into harm’s way when in hospital. A healthcare Institution has to be sure that they are equipped with proper staffs and experts, twenty-four-seven. This includes the hourly rounding by the staffs like nurses and doctors. The management needs to ensure that the hourly rounding for all patients are properly done. Any lack of management and staffs can lead to serious life problems and even death of a patient, if one goes unattended.

Obtaining necessary approval

For the implementation of the plan, it is necessary to have the permission in order to integrate the plan with the daily living of work. I intend to present my project to my manager who will present it to the hospital board review, because if accepted this project will be implemented to the entire hospital not just my ward. My colleagues will also take part in the approval of this section; this is because they will take part in the implementation and running of the project.

Issue

Patients are often admitted into hospitals for verity of medical problems. While the patients occupy the beds in the hospitals, it is the responsibility of the nurses to take care of them and their requirements. This needs staffs to be available all twenty-four hours in order to attend the patients. However, due to the shortage of the staffs and mismanagement, it has been noted that there is an increase of falls occurring within patients rooms.

Rationale for Proposed solution

Hourly Rounding is one of the best solutions that can reduce this issue to the minimal. The implementation plan proposes increase in the number of staffs, which will help in carrying out hourly rounding in the wards. This shall help in taking better and much efficient care of the patients as well as the staffs and members of the healthcare. Hourly rounding helps in monitoring all the patients at a regular interval and checks if they require anything or need any kind of assistance. This will not only reduce the efforts of the staffs but also help them work at proper hours without wasting extra hours; plus the patients demand are fulfilled.

Method

In order to convince management, I will need to present the idea of the proposed solution and the points will be high-lighted, Pro and cons will be discussed as well as recent statistical figures will be looked at. These data will support the evidence that hourly rounding will reduce falls in our hospitals and elderly facilities. Management will need to be convinced that it is going to be a win-win situation for them with nothing to lose.

Implementation logistics

For an implementation plan to be effective, it is important that it is efficiently incorporated and implemented with the original plans & policies. For this project to be successful the implementation logistics will have to go through six phases. The first phase is presenting the project to the Institution Review Board; this will be done through my manager. The second stage will look at the research, statistic data, and development hourly rounding. DiGioia (2011) states third phase concentrates on research and analysis of project viability. The fourth phase is refers to the education phase. This phase focuses on educating the staff for better outcome. The fifth phase will concentrate on implementation of this project. While the final phase will looks at the analysis and the project development. The implementation logistics is a framework that monitors the changes proposed and implementation. Each point are properly checked and monitored whether the changes are made according to the plan or not.

Integration of changes

The changes being proposed are not independent and are to be integrated with the previously functioning plans and policies. These changes are only to be implemented when it is seemed necessary and not otherwise.

Responsible department

The department that shall be taking care of the implementation and incorporation of these plan are all the management heads of the healthcare facility. They shall be monitoring that the new plan has been properly implemented and that how effective it’s been.

Technology

Along with increase in the staffs, there is also the need for improvement and increase in the technology currently used by the healthcare facility. Improvement and up-gradation of the technology ensures that the treatments of the patients are done efficiently and more conveniently. Along with the increase in staff, there is need to increase the technology as well because there can be a shortage of such technologies and such situations can arise, where the staffs for operations and other functions are available but the system and technology required is unavailable.

Funding

In the implementation plan, it has to be also incorporated the required finances for funding the project and changes. Funding is going to be required for various purposes such as increase in the number of staffs, training of the staffs, up-gradation of the technologies, and increase in the technologies.

Assessment of the changes

After the implementation plan has been incorporated, it is necessary to assess the changes and monitor its effects. This assessment will help in the evaluating and implementing plan and also making required changes, when necessary.

EVALUATION PLAN

The data collected from the assessment of the healthcare and the implementation plan is to be analyzed and checked to ensure its effectiveness and see if the plan succeeded in its objectives and make any changes or include new terms/policies/regulations, if required. For this, all the reports and data collected are to be carefully checked and compared with the previously functioning plans to notice any positive or negative changes and to ensure that the positive changes are further improved and the negative changes are well taken care of. The negative changes are the signs of even the slight discomfort experienced by any parties related to the healthcare.

DISSEMINATION PLAN

There are several strategies aimed at dissemination of the project’s results. These include the use of continuous medical evaluations, print media, newspapers, journals, medical websites, emails, and the use of reports. Following the completion of the project, I will come up with a project report that captures all the parameters of the project from the beginning. I will then upload this to my website and disseminate it within the hospital so that most hospital staff get access to it. Print outs will also be made and disseminated within the nursing department to assess their response to the project. These will also be made available to the various stakeholders and the nursing community at large to ring them on board and to ensure their input is incorporated into the study .

Next, with the help of the administrative and human resource section, I will advocate for a continuous medical evaluation session, inviting all the stakeholders and the nursing community at large. It is within this continuous medical evaluation that I will launch my project plans, explain the justification and the benefits that will be brought about if the project is to be implemented. These are often the most effective forums since individuals are usually very attentive. There will also be a face to face interactive session to ensure grey areas are clarified and any arising issues addressed. Direct mails and newsletters will also be used to update the stakeholders of the progress. This will be done almost immediately following the submission of the report to ensure they are kept abreast with the results of the project .

One to one contact with the stakeholders and the nursing community at large will also be incorporated. This will ensure individual concerns are addressed. The media will also be used. Medical websites such as Medscape, PubMed and NCBI will also be used to ease the access of the report and make it easy to comment on and add other recommendations, especially by the stakeholders and the nursing community .

LITERATURE REVIEW

Sartini M, Cristina ML, Spagnolo AM, et al. The epidemiology of domestic injurious falls in a community dwelling elderly population: an outgrowing economic burden. Eur J Public Health 2010; 20:604–6. Fall is one of the major problems that cause severe problems and discomfort among the people, especially to the older people. It has become of the major issue all over the globe and has become a matter of concern for the major medical groups. The author of this article conducts a study of the patients suffering from fall and its effects along with the medical expenses incurred by the patients for the recovery. The author efficiently studies the people of older age group and discovers that fall injuries are found more among the subjects ho are being diagnosed with other diseases. Also few other factors like drugs are responsible for the fall, hence suggesting that preventive measure have become necessary for the protection of the people from the fall.

Nitz JC, Low Choy NL. Falling is not just for older women: support for pre-emptive prevention intervention before 60. Climacteric 2011; 11:461–6. In this study, the likely factors for the fall among the women of the age forty to eighty are being studied and it tries to provide the necessary requirements and steps to prevent such fall. The author of this article beautifully incorporates all the necessary points and evidences, including the numerical figures necessary for the study that depicts the exact age group of the subjects of the study and the causes and factors responsible for such falls. At the end, the author summarizes the overall article in a well decorated manner with suggestions of preventive measures

Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma Acute Care Surg 2011; 50:116–9. The authors of this article conducts a study of the patients to discover and disclose the facts regarding the falls and its related mechanism and effects. The author considers 1,512 subjects of varied age group and tries to find the main reason for their fall and makes a brief discussion of the subjects of all age group. They quite sensibly stick strictly to the facts and data collected and discloses that the same level fall has varied effects upon the people of different age group and the severity & mortality rate is higher among the people of older age.

Spink MJ, Menz HB, Fotoohabadi MR, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain:randomised controlled trial.BMJ 2011;342:d3411. Fall in the elderly results in severe problems which can lead to deaths. The author in this article narrows down the patients suffering from such problems and categorizes them into two separate groups, naming them as intervention group and controlled group. The people of intervention group are trained and made to do physical exercises and the results are studied, mainly intending to find better results and comparing them with the subjects of the controlled group. The author discovers that the people of the intervention group has shown much improvement than the people of controlled group and hence such strategies and intervention programs must implemented at the medical facilities to help the patients suffering from the fall.

Gillespie WJ, Gillespie LD, Parker MJ. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev 2010(10):CD001255. Hip protector is the mechanism introduced by the medical facilities to protect the people from further injury or problems in the hip resulting from the fall on the hip. However, to find the true effectiveness of the hip protector, the author conducts a study and witnesses 5,135 community dwelling participants and discovers that the protection not just fails to provide any security against the fall, but also causes discomfort. The authors of the article statistically narrates all the conditions and effects while using the hip protection and its inability to help the people.

Stafford AC, Alswayan MS, Tenni PC. Inappropriate prescribing in older residents of Australian care homes. J Clinical Pharm Ther 2011; 36:33–44. Inappropriate prescribing of drugs among the people, especially the older people leads to the severe drug related problem like adverse drug reaction. The study tries to find such problems among the Tasmanian residents. It is discovered that such problem of inappropriate medical prescription are common in the nursing homes of Australia and proper guide to medication and prescription can help resolve such problems. The author uses the appropriate points and words to describe the condition and makes an outstanding conclusion, helping in creating awareness as well as providing a solution.

Muir SW, Gopaul K, Montero Odasso MM. The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age Ageing 2012; 41:299–308

Taking the participants of age group less than 60 years and considering all the falls, the authors of this article perform a study analyzing the impairments resulting from the falls among the old people, and recognizes the significant factors and the impairments. The authors collects all the information from the study and discloses all the impairments resulting from the fall and agreeably states the problems associated with the falls.

Chase CA, Mann K, Wasek S, Arbesman M. Systematic review of the effect of home modification and fall prevention programs on falls and the performance of community-dwelling older adults. Am J Occup Ther 2012; 66:284–91? Fall is not a common phenomenon and is one of the leading cause of the deaths of the older people. Falls are quite risky and apart from deaths, it can also cause several severe physical problems. Hence, this study has been conducted to study the results of the fall and the effectiveness of the home therapies in improving the condition of the patients suffering from the fall. The authors describes the home therapies as an effective solution to the problem of fall and suggests its implementations to the people, creating awareness with this study.

Sherrington C, Tiedemann A, Fairhall N, Close JC, Lord SR. Exercise to prevent falls in older adults: an updated meta-analysis and best practice recommendations. New South Wales Public Health Bulletin 2011; 22:78–83. Falls among the older people can risk their lives and even cause them to be disabled for lifetime. It is well known that prevention is better than cure. Hence, this study describes various preventive measures and exercises in order to prevent the people from the disaster of falling. The study provides a brilliant solution, not just for older people, but to the people of all age group and appropriately and practically tries to create awareness among people by letting them prescribed exercise, disclosing the fact that with proper exercise and balance, falls can be prevented and life can be secured.

Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatric Soc 2011; 59:148–57. In this study, the strategies and the intervention programs are discussed that can help the health care specialists in reducing the falls among the old people and helping them lead a healthy life. The authors of this article explains the various exercises and physical therapies that can help the people reducing falls and improving the lifestyle. It takes both benefits and harms into consideration and to introduce various therapies that can be immensely helpful. The article concludes by stating that the intervention programs and other therapies can help reduce the falls.

Michael YL, Whitlock EP, Lin JS, Fu R, O’Connor EA, Gold R. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 2010; 153:815–25. As stated in this article, falls are both prevalent among the community dwelling adults as well as preventable. Relevant interventions can prevent the people from the injuries due to fall and protect their lives. This study aims at describing those benefits and harms from the intervention programs and making use of it to help the primary care practitioners reduce the falls among the adults and providing healthy guidelines for better lives. The authors of this study well efficiently described the benefits of the healthcare interventions and recommended true methods for the prevention and reduction in falls.

Cameron ID, Murray GR, Gillespie LD, et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010(1):CD005465. Fall is definitely one of the biggest problem for the older people. There are many intervention programs that are there to help the people not only to recover from the fall injuries but also to prevent it. However, are these programs really useful? This study is conducted to answer this question. The study considers 60,345 subjects and separates them into two settings, one in hospital setting and other in care facilities. The study proves that the interventions and care at the hospitals are more effective than the care facilities and the interventions at the care facilities are questionable. The authors make an in depth analysis of the data and the reports and wonderful explanations of the results with proper conclusion and summary, thus making it a careful report regarding the prevention of falls in older people.

Thomas S, Mackintosh S, Halbert J. Does the ‘Otago Exercise Programme’ reduce mortality and falls in older adults? a systematic review and meta-analysis. Age Ageing 2010; 39:681–7. Mortality rate and the falls rate is said to be reduced by “Otago Exercise Programme”. This study has been conducted to check the efficiency of this programme. The total participants analyzed in this study were 1,503 people. The authors or the people behind the study made careful analysis of the patients and the conditions along with the effectiveness of the programme and concluded that the OEP is truly effective in its efforts and helps people in prevention and protection from fall and other physical injuries reducing the mortality rate.

Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiol 2010; 21:658–68. In order to protect the people from falling and is injuries as well as mortality rate, it is necessary to have a complete understanding of the factors and reasons responsible for the fall. This study conducts a thorough analysis of such factors. These factors shall help in development of programs and therapies that can protect the older people from falling and the severe damages it creates. The study quite efficiently discovers the major factors and even the minor ones that can cause the fall and helps in creating awareness in avoiding such factors, thus helping not only the healthcare facilities but also the common people and educating them the ways to prevent the falls.

Sanders KM, Stuart AL, Williamson EJ, et al. Annual high-dose oral vitamin D and falls and fractures in older women: a randomized controlled trial. JAMA 2010; 303:1815–22. This study was conducted to know whether the UI Cholecalciferol reduced the risk of fracture and falling. A thorough research and study was conducted and the 2256 community dwelling people were studied in order to find the desired result. The regular and monthly check along with proper monitoring were done an finally it was concluded that the oral doses of Cholecalciferol increased the risk of fractures and falls and was very damaging to the older women. The authors made a practical and in-depth analysis and explained in a well-mannered method, thus clarifying the doubts.

CONCLUSION

Patients often entrust the healthcare personnel with their lives in the weakest point of their lives. They often trust that the service provider present will ensure utmost care to them and this includes taking care of them within the facility in preventing accidental occurrences that happen within the hospital environment. Instances such as patient falls should therefore be minimized as much as possible to ensure patients don’t get complications within their stay in the hospital. In order to prevent patient falls, my proposed solution has been the increase in the number of rounds done on the patients by the doctors and nurses. This translates into increase in the number of staff to ensure that the staff turnover is high to prevent burn out. In the long run this will ensure that the patients are seen every single hour to help their needs to be addressed and to aid them in every way in which they may need assistance of any kind that would lead to their instability and in the long run, a fall. By so doing, in patient accidents such as falls will be drastically reduced and the patient outcomes will be greatly improved.

APPENDIX A

REFERENCES

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Cameron ID, Murray GR, Gillespie LD, et al. Interventions for preventing falls in older people in nursing care facilities and hospitals. Cochrane Database Syst Rev 2010(1):CD005465.

Deandrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C, Negri E. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiol 2010; 21:658–68.

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