Effect of Hourly Rounding on Pressure Ulcers Call Light Use and Falls Preventions

Evidence-Based Practice on Hourly Rounding

Impact of Hourly Rounding on Falls Preventions, Reduction of Pressure Ulcers and Call Light Use

In the contemporary health environment, falls are the common phenomenon that may cause fatal injuries to older adults of 60 years and older. Nearly 50% of hospitalized older adults face the risks of falls that can lead to a fatal or non-fatal injury. Consequently, falls can lead to negative effects that include elevated hospital costs and longer hospital stay. To overcome high rates of falls within a healthcare environment, different organizations have devised different strategies for hospitalized older adults. While these health practices are devised to enhance safety among patients, however, all these health practices are ineffective to prevent falls. For example, call lights use may be effective to prevent falls, however, its overuse can increase the nursing workloads, and consequently reduce nursing satisfactions.

An hourly rounding has been identified as an effective proactive health practice that can reduce falls, pressure ulcers, and improve patient's satisfactions. In other words, hourly rounding is defined as a proactive and systematic health intervention that healthcare organizations design to meet the need of in-patients in order to promote patient safety and satisfactions. Typically, an hourly rounding is particularly effective for the management of the pressure ulcer since the disease is one of the top causes of untimely death in the United States. Thus, pressure ulcer occurs among people having a nerve damage or limited mobility. A patient with a pressure ulcer suffers from oxygen deprivation in the affected area. Repositioning is an appropriate strategy to manage a pressure ulcer where patients are moved into a different position to allow the body to remove pressure and redistribute the body to enhance an effective blood circulation. Since patient satisfaction is very critical for health organizations, hourly rounding has been identified as an effective health strategy to improve patients' satisfactions.

PICOT Question

The study develops the PICOT question to enhance a greater understanding of the effectiveness of hourly rounding in reducing the pressure ulcers, call light use, and falls, which ultimately enhance patient's satisfactions.

Among adult patients aged 60 years and above (P), what are the effects of hourly rounding (I) as compared to patients not receiving hourly rounding clinical attentions (C) for patient's satisfaction (O) using the heath intervention for 3 months (T).

Literature Review

This section carries out the literature review to enhance a greater understanding of the impact of hourly rounding on fall rates reduction, reduction of pressure cancers and call light use for patients' satisfaction. Olrich, Kalman & Nigolian (2012) carry out a qualitative research on the impact of hourly rounding on fall rates and the use of call lights by inpatient who have undergone medical-surgical operations. Despite that that the research is well written, nevertheless, the authors do not provide a research question that reflects a phenomenon guiding a research process. Moreover, the authors did not provide a comprehensive review of the literature. While the researchers described the sampling method, however, the authors did not provide an adequate information on sample size. Although the study described the data collection and analysis process, however, the researchers did not follow appropriate steps when conducting the data analysis. While the findings are delivered in an appropriate context, however, the study did not discuss the appropriate ethical procedures used to protect the subject participants,

Meade, Bursell & Ketelsen (2006) in their research use the quantitative technique to investigate the impact of hourly rounding and call light use on patients' satisfaction. While the researchers provide the literature review, however, the literature review section is merged with the introductory section. Additionally, the authors do not provide a conceptual or theoretical framework that the research is based. Despite this shortcoming, the authors develop the hypothesis that guides the research process as well as identifying the target population, inclusion, and exclusion criteria. By using the STATS software for the statistical data analysis, the authors are able to provide the finding in a clear and coherent method.

Hicks (2015) describes falls as a clinical problem that refers to a sudden or unexpected slip from sitting or standing that has become one of the top clinical problems among older adults in the United States. In 2000, the U.S. spent over $19 billion on managing injuries from falls. Hicks (2015) identifies hourly rounding as the strategy of checking in- patients regularly to meet patients' health needs and satisfaction. Fords (2010) supports the argument of Hicks by pointing out that the concept hourly rounding is an effective health proactive approach to improving patient satisfaction. To support his argument, Ford uses the hourly rounding practice of "BWMC (Baltimore Washington Medical Center)" (Ford, 2010 p 188) where

"Quantitative call light data were collected during this time, along with data from rounding logs and discharge phone calls made to those patients within 48 hours of discharge." (Ford, 2010 p 189).

The results of the investigation reveal that hourly rounding is able to reduce falls among patients by 54%, pressure ulcers by 56%, call logs by 52%. The results of the study that investigates the impact of hourly rounding on patients

"reflects a 100% reduction in the fall with injury rate achieved during the study period and contributed to a reduction of 67.8% by the end of the fiscal year 2008. Press Ganey scores reflected increased patient satisfaction during this quarter (as compared to the previous quarter) in teamwork=3.7%; attention to special/personal needs=2.1%; overall nursing care=1.9%; and pain control=1.2% (Callahan et al., 2011, p. 1).

Based on the impact of hourly rounding on patients' outcomes, healthcare organizations that refuse to integrate hourly rounding in their clinical and health practice may record a fall in sales and revenue at the end of a fiscal year because they may be unable to improve patient's satisfactions.

The outcome of the literature review reveals that qualitative research provides a scientific approach based on the strength on the data collected. Typically, the qualitative research provides a descriptive insight for a data collection through interviews, case studies, and observation. Contrarily, quantitative research uses the numerical data to evaluate the phenomenon. In essence, both quantitative and qualitative research can assist in providing a valuable insight to research strengths. Thus, both quantitative and qualitative research deliver a valuable information regarding the impact of hourly rounding on patients' outcomes with regards to reducing pressure ulcers, call light use and preventing falls.