Patient Falls and Nursing PICO Question -- Research Paper

Patient Falls and Nursing

PICO Question -- Among acute care patients on a Medical-Surgical Unit, does hourly rounding, as opposed to only setting the bed alarm, significantly reduce patient falls (at least by 50%)?

Modern healthcare and nursing are more complex than ever before. The nurse's role is far more than simply an assistant, and requires the understanding and application of a large toolbox to deal with many different situations within the course of any given time period. (Borkowski, 2011). More often than not, nurses tend to act as the "moral agents" within the system because they are the locus of communication between the physician, the patient, and the family. The modern nurse leader must act with moral courage and conviction since "nursing leaders are responsible for creating cultures that support acts of courage in nursing… [because] these acts have the potential to increase nurse retention, promote patient comfort, relieve patient suffering, and enhance the reputation of the organization" (Edmonson, 2010).

The costs of patient falls is estimated to reach almost $44B by 2020, increase insurance premium costs, increase staff pressure, and contribute to greater risk of accidental injury and death. In 1999, for instance, the Institute of Medicine issues a report that noted there were almost 30 safety events that were easily preventable in most healthcare organizations. Stakeholders, too, are increasingly concerned about the issue of patient falls to the point in which patient death or disability associated with a fall is now part of the lexicon of HAC (Hospital Acquired Conditions). Two major views are quite polarized regarding the use of hourly rounds as a preventive strategy for patient falls. On one side, the research shows that hourly rounding actually increases nursing efficiency, decreases paperwork, and improved overall patient satisfaction and safety. On the opposite side, opponents are concerned about increased documentation, the loss of effective nursing time, and over-regulation of nursing activities by management (Hourly Rounding, 2012).

Literature Review Summary - In general, most of the scholarly literature shows that hospital units that use hourly rounding decreased call light usage and patient falls (Berg, et al., 2011). In fact, typical bed alarms tend to be relatively ineffective in preventing patient falls (Davis, et al., 2011), while hourly rounding not only decreased falls, but improved patient satisfaction and awarness of safety issues (Ford, 2010; Hutchings, 2012). Quantitative research confirms this showing that there is at least a 30% decrease in patient falls using hourly rounding (2.6/1,000 patient days instead of 3.37/1,000) (Kalman, et al., 2012).

Of course, the concept of hourly rounding is not new nor unique. During most of the 20th century, nurses commonly rounded every 1-2 hours on their wards, then technology improved and staff shortages worsened, making rounding occur less frequently. Interestingly, when hourly rounding is practiced regularly, hosptial-wide census numbers tend to decrease. For rounding to work, however, it must become a robust part of the shift responsibilities. This requires training, managerial commitment, and a culture that understands patients are the reason for the hospital's existence. Also, when patients know that a nurse will be checking on them each hour, they tend to feel safer, calmer, and will…