Introduction
In acute care hospitals, one of the major risks is patient falls because, as indicated, it is one of the leading causes of injury among hospitalized patients, and this has implications in regard to patient safety. Hourly rounding, which is an organized program involving nurses checking on each patient at least once in every hour, has been advanced as effective by Gliner et al. (2021). This observation sets the stage for a critical inquiry formulated by using a PICOT question: In acute care hospital settings, does implementing hourly rounding, compared to not using hourly rounding, reduce the number of falls by 80% during a 6-month period? The focus of the inquiry involves exploring how the monitoring and consistent engagement of patients would reduce their fall rates, a very critical dimension of patient safety and quality of care.
Strategies and Results
Strategies
Advantage of Your Specific Strategy
Within the domain of acute care hospitals, the fact that falls among hospitalized patients have huge implications for hospitals with injury, among other contributing causes to delays in care for lengthier stays and higher costs within the facility, cannot be overemphasized. Hourly rounding, a proactive patient engagement strategy, has been posited as a potentially transformative approach to mitigate these risks. In other words, nursing staff engage with the patient on an hourly basis, following an hourly check consisting of safety assessment, positioning, fulfilling the needs of the patients, and security in the immediate surroundings. This constant interaction does not only take care of the immediate needs of the patient but also identifies and neutralizes fall risks to prevent them from occurring by being in a proper frame of mind. This highlights the efficacy of such engagement in the work of Sherrington et al. (2019), who reported empirically that the application of such engagement significantly reduces the incidence of falls. It follows that the strategy could change protocols in care, thus positioning it as one of the key cornerstones in the move to enhance patient safety and well-being within hospital settings.
Limitation of Your Specific Strategy
Even though hourly rounding is identified as one of the most promising methods to reduce falls in the acute care setting, a number of challenges concerning staffing and resources hinder the implementation of the same. The effectiveness of the method is based on the steady and thorough presence of the nursing staff with the patient, which demands a solid workforce that has the power to persist in such frequent interactions without compromising the quality of care for all patients. LeLaurin and Shorr (2019) have elucidated this point of view to state that it is quite resource-intensive. They illustrate how, in hourly rounding programs, maintaining such levels of staff engagement requires not only an increase in labour but also training and logistical support for the purpose of ensuring that each rounding actually meets its intended goal. This could strain limited hospital resources and possibly overburden staff, which requires careful planning of hourly rounding, sufficient staffing levels, and strategic resource allocation to overcome such inherent challenges.
Risks Associated with Your Strategy of Implementation
While hourly rounding in acute care settings is beneficial for fall prevention, there are associated risks of interruptions to patient privacy and workflow disruption. McCorie et al. (2019) highlighted that when these protocols are implemented, there will be required maintenance of the balance within the delicacy of the task. The breakdown of the hospital room every hour, wherein every patient is inspected, mostly elicits discomfort and loss of privacy to the patient, in which room access should be spaced further than rounding. Additionally, it is continuously perceived that constant engagement might disrupt the natural course of healthcare professionals and might delay them from other critical tasks.
Ethical Concerns Associated with Your Strategy of Implementation
While hourly rounding is being done to improve patient safety, ethical issues do pop up regarding heightened surveillance and possible impediments to patient self-determination. Montejano-Lozoya et al. (2020) have argued that patient engagement strategies should include attention to ethical considerations. It seems like frequent checks—despite all the measures taken in order to avoid that, could be felt as invasive and infringe on the privacy and self-determination of the patients, denying them free space. This heightened monitoring may subject patients to being under observation or managed rather than being properly cared for, which means that the health care workers must define the balance of security and respecting individual rights to privacy and autonomy.
Results
Improving Patient Outcomes
Some outcomes expected when hourly rounding is implemented in acute care will be the improvement of patient safety and a decrease in the number of days a patient is in the hospital. As reported by Leamy et al. (2023), it is evident that there is a need for evidence-based interventions. Hourly rounding has a systematic approach that involves addressing the potential risks of falls and quick responses to the needs of a patient, which would eventually reduce falls and help in recovery. The approach is proactive, focusing on safety in a hospital and the potential reduction of the number of days a patient has to stay due to injuries arising from falls. Hourly rounding stands among the strategic implementation measures that foster evidence-based practice within healthcare environments. This goes to underscore the fact that it is crucial to support safer and more efficient healthcare delivery through critical evidence-based practices.
Measuring Improvements
To accurately evaluate the effect that hourly rounding has on both patient safety and satisfaction, there is a need for an in-depth analysis that takes both qualitative and quantitative data. The aspect to be focused on is in line with recommendations made by Gliner et al. (2021) and includes the careful selection of particular metrics and feedback for a thorough assessment. For example, the rate of falls will be measured pre- and post-implementation of hourly rounding, with an average of the number of falls every 1,000 patient days, enabling one to have a direct comparison for assessment of the effectiveness in which the strategy helps in reducing falls. Also, the average length of hospital stay could be monitored to further the knowledge of the intervention towards faster recovery times of patients. For the qualitative part, much focus would be put on the filling out of quality surveys on patient satisfaction. The questionnaire may include rating the perceived level of safety and care received by the patient, with open-ended questions where patients could include anecdotal incidents where hourly rounding either directly or indirectly led to increased safety. This may involve complaints about the lack of safety of patients, identification of hospital staff engagements, and levels of patient experience. With such data, healthcare providers can get insights that will be helpful in improving the hourly rounding approach, further refining it to meet the varying needs of patients.
Conclusion
The hourly rounding approach in acute care to reduce falls would have obvious benefits in this regard: a systematic approach towards fall risk reduction and also improved patient satisfaction. However, issues of staffing, allocation of resources, and ethical considerations regarding patient autonomy need to be considered when adopting this approach if success is to be achieved. Continuous and ongoing evaluations and adaptations of fall prevention strategies, including hourly rounding, are therefore envisioned by Sherrington et al. (2019) to have been and to be some of the necessities still to ensure such an achievement and maintenance. This would mean that continuous assessment and refinement, based on the available data and feedback, would be necessary and could hence demand flexibility and responsiveness towards ongoing patient safety initiatives so that each patient care setting’s real needs may be met.
References
Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2021). Patient falls, nurse communication, and nurse hourly rounding in acute care. Journal of Public Health Management and Practice, 28(2), E467–E470. https://doi.org/10.1097/phh.0000000000001387
Leamy, M., Sims, S., Levenson, R., Davies, N., Brearley, S., Gourlay, S., Favato, G., Ross, F., & Harris, R. (2023). Intentional Rounding: a realist evaluation using case studies in acute and care of older people hospital wards. BMC Health Services Research, 23(1). https://doi.org/10.1186/s12913-023-10358-1
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007
McCrorie, C., Benn, J., Johnson, O. A., & Scantlebury, A. (2019). Staff expectations for the implementation of an electronic health record system: a qualitative study using normalization process theory. BMC Medical Informatics and Decision Making, 19(1). https://doi.org/10.1186/s12911-019-0952-3
Montejano-Lozoya, R., Miguel-Montoya, I., Gea-Caballero, V., Mármol-López, M. I., Ruíz-Hontangas, A., & Ortí-Lucas, R. (2020). Impact of Nurses’ Intervention in the Prevention of Falls in Hospitalized Patients. International Journal of Environmental Research and Public Health, 17(17), 6048. https://doi.org/10.3390/ijerph17176048
Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for Preventing Falls in Older People Living in the Community. Cochrane Database of Systematic Reviews, 1(1). https://doi.org/10.1002/14651858.cd012424.pub2
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