Nursing theory: Fall Incidents and Hourly Rounds
Working in a hospital unit where fall incidents can be prevalent because of various patient conditions, we Rehab nurses have to be more proactive and diligent with our hourly roundings. A recent study shows that falls are a persistent problem in all healthcare settings, with rates in acute care hospitals ranging from 1.3 to 8.9 falls per 1,000 inpatient days, about 30% resulting in serious injury (Goldsack, Bergey, Mascioli & Cunningham, 2015). Weakness due to recent CVA, surgery, fracture or other musculosketal problems, Dementia, changes is cognition, a concoction of high-risk medications—added to non-compliance of safety measures—these make for a significant increase in fall risk. We encountered patients in Acute Rehab have a fall due to one or more of these issues. Night shift nurses cannot be complacent that patients are fast asleep just because these patients are quiet and do not call the nurses’ station for anything at all. A few times, a patient has been found sitting on the floor, very quiet and reported that he/she just fell trying to reach for something or go to the bathroom, and thought that he/she could get back up on his/her own and so did not attempt to call for help. Although bed alarms are constantly on for safety purposes, sometimes it is just too late or for some reason, they fail to work the way they should. This makes our hourly roundings even more important especially at night—coupled with other safety precautions.
What is hourly rounding and how does it help prevent falls?
Hourly rounding is a safety practice within an institution that encourages nurses and staff to check on every patient at least once every hour. The objective is to check on the patients, if they are comfortable and safe and to ask them if they need anything. During hourly rounds, staff should assess the patient’s pain, position, possessions and need to use the restroom, and help patients as needed. Staff should also ensure that the bed is in its lowest position, siderails are raised, the environment is uncluttered, and bedside table, phone, call light, eyeglasses, assistive devices and footwear are within reach (Pittman, 2020). These assessments make the roundings purposeful or meaningful. Purposeful and timely rounding is best practice intervention to meet patient care needs on a routine basis, ensure patient safety, reduce the occurrence of preventable patient events, and address potential problems even before they occur. “The Institute for Healthcare Improvement (IHI) endorsed hourly rounding as the best way to reduce call lights and fall injuries and improve both quality of care and patient satisfaction” (Daniels, 2016).
More frequent rounds is recommended for patients that have bladder or sleep problems, anxiety issues, disoriented/confused patients and those who are deemed to be non-adherent to safety protocols or treatment regimen. Based on experience, these types of patients would insist doing things on their own, would stay cognitively or physically active even at night, are not aware of precautionary measures and may not have a proper sense of time and/or space or simply do not have the patience to wait for assistance. By constantly checking on their needs in a consistent manner, we give them the impression that we are prepared to assist them with their needs in a timely fashion and that help is always available as soon as possible. Nurses are then able to increase patient satisfaction and patient safety outcomes by employing nursing round strategies to enhance patient experience and staff responsiveness (Daniels, 2016).
Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Database of Systematic Reviews and Implementation Reports, 14(1), 248–267. https://doi.org/10.11124/jbisrir-2016-2537
Goldsack, J., Bergey, M., Mascioli, S. & Cunningham, J. (2015). Hourly rounding and patient falls. Nursing2019, 45(2) 25-30. https:// doi: 10.1097/01.NURSE.0000459798.79840.95
Pittman, M. (2020). 4 ways hospitals can prevent patient falls. Clean Hands Safe Hands. Retrieved from https://cleanhands-safehands.com/4-ways-hospitals-can-prevent-patient-falls/