¶ … Hourly Nurse Rounds to Help Reduce Falls, Call Light Use, and Pressure Ulcers The objective of this paper is to carry out the literature review to investigate whether the hourly rounding is able to reduce pressure ulcers, falls, and call light use and contribute to the overall increase in patient satisfactions. The outcomes of the literature review assist in identifying the gaps in the literature.

Hicks, (2015) in his study, "Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature Review." (p 51) defines fall as an unexpected descent from a sitting, standing or supine position. Typically, falls are the critical problem within the healthcare organizations and are the top cause of injury-related deaths among older adults. More than "20% of people who fall suffer moderate-to-severe injuries, such as head trauma bruises or hip fractures." (Hicks, 2015, p 51). In 2000, the costs of managing fall injuries were more than $19 billion, and would be over $54 billion by 2020. Hicks (2015) identifies hourly round that involves checking patients at a regular interval in order to meet patients proactive needs, as an effective strategy to reduce patients falls. Typically, hourly rounding is an effective strategy to improve patient's safety.

Hicks, (2015) uses the integrated review as a research design that involves summarizing the outcomes of different independent studies in order to determine the current knowledge that guides the nursing practice. The author performs a search of research articles between 2009 and 2014. The key concepts used for the search include nursing hourly rounds, fall prevention, and hospital. The author also carries out the data analysis by reading the articles several times to identify the similarities, differences, and patterns among the selected articles. Hicks (2015) uses 14 integrated articles to present the findings revealing that hourly rounding is an effective tool to reduce patients' falls. Part of the articles reviewed show that 50% of the falls are recorded within 4 weeks of implementing the hourly rounding. Moreover, "falls decreased from 4.001 to 2.613 per 1,000 patient days." (Hicks 2015, p 52).

Ford, (2010) in his article "Hourly Rounding: A Strategy to Improve Patient Satisfaction Scores" (p 188) argues that patient satisfaction is very critical for the healthcare organizations. An effective patients-nurse relationship can enhance safety, and compassion, service quality. Typically, nursing services play an important role in quality of care, patients' satisfaction, and safety. According to Ford (2010), hourly rounding is an effective method to enhance a quality of care, which involves a proactive approach to achieve patient's positive results as well as improving patient's satisfaction.

Ford, (2010) research design involves collecting the feedback of the "BWMC (Baltimore Washington Medical Center)" (Ford, 2010 p 188) to evaluate the effectiveness of hourly rounding for patients' satisfaction. However, Ford (2015) seeks for the approval from the BWMC's management before evaluating the effectiveness of hourly rounding at the hospital for 3 weeks. "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).

Ford presents the findings by revealing that call light logs have been reduced by 52%, and the outcome of hourly rounding show that patient's falls have been reduced within the hospital. Overall, a positive improvement has been recorded leading to patient's safety. Essentially, when the nursing staff is able to meet the needs through a regular round on patients and address their basic needs every hour, the risks of falls decrease. Ford (2010) also presents in his findings that when the nursing staff integrates repositioning and turning in their nursing care, the pressure ulcer rates decrease by 56%. Moreover, patient satisfaction increases through hourly rounding because of a better quality of care. Moreover, nursing care is less stressful and more efficient when the hourly rounding is performed, which ultimately leads to nursing satisfaction.

Hodgson, (2012) also carries out the integrated literature review to reveal the benefit of hourly rounding. The research design is by conducting a comprehensive literature search from "CINAHL (Cumulative Index to Nursing and Allied Health Literature), Medline and Google." (Hodgson, 2012, p 35). The author uses the concepts 'hourly rounds', 'patient safety', intentional rounding', 'and pressure ulcers' and falls in their search terms. Hodgson, (2012) also discusses the method the rounding log is performed at the Leeds Teaching Hospital. The assessment was carried out over a two weeks to determine the effectiveness of hourly rounding at the hospital. The implementation strategy is by using the informal verbal training as well as sending training documentation to the nursing staff through the emails. The rounding logs were carried out for 44 patients out 51 patients. The result reveals that patient's fall was not recorded during the two-hour trial period. Moreover, there was no patient complaint during the trial period.

Saleh, Nusair, Zubadi, et al. (2011) define the NRS (nursing round system) as the strategy of checking patient on an hourly basis. Typically, the hourly round is initiated every 2 hours to access patient pain control, observing patient general health condition along meeting patients' non-medical needs. The authors evaluate the effectiveness of hourly round using a private hospital. The concept used is "NRS...

2011 p 301). Another concept is the "traits of nursing staff who are rounding and the quality of care provided to patients.." (Saleh, Nusair, Zubadi, et al. 2011 p 301).
The research design consists of using the 26 beds, and 104 patients to evaluate the effectiveness of hourly round for 2 months. The study instrument consists of using the "patient's call light survey along with the patient's demographic data." (Saleh, Nusair, Zubadi, et al.2011 p 301). The nursing round is carried out by assessing patient comfort every two hours that involves controlling the patient health as well as assessing the patient general condition. The authors implement 8-week study for the data collection and analysis. The nurses also collected the data in the stroke units for 4 weeks. The data collected include patients' satisfaction and patients' demographic characteristics. The results reveal that call bells were reduced, and the pressure ulcers also reduced by 50%.

Tucker, Bieber, Attlesey-Pries, et al.(2011) support the argument of the previous authors by revealing that patients falls can be reduced by initiating the hourly rounding. The authors use the descriptive statistics for the research design. The sample consists of "two 29-bed postoperative orthopedic units in a large academic medical center in the Midwest of the United States." (Tucker, Bieber, Attlesey-Pries, et al.2011 p 20). The variables include fall risk scores, fall rates, fall risk scores, and SNRI fidelity. The results reveal that fall rates are reduced by 60%.

Conclusion

The paper carries out the literature reviews to answer the PICOT question to determine the effectiveness of hourly rounding on patient falls, call light use and ulcer pressure. The outcome of the literature review reveals that the hourly rounding is an effective hospital strategy to reduce the patient falls and call light use. All the literature reviewed support that patients fall can be reduced by more than 50% if an effective hourly rounding is implemented. Despite the findings from the literature, there is still a paucity of the study that discusses the effectiveness of hourly rounding for the reduction of ulcer pressures. Since the ulcer pressure is one of the top causes of death in the United States, the effectiveness of hourly rounding is very critical to reduce the incidence of ulcer pressures in the United States. This study will attempt to fill the gap by carrying out the integrated study on Evidence-Based Practice.

Literature Review Summary Table

Type of Study

Design Type

Framework/Theory

Setting

Key Concepts/Variables

Findings

Hierarchy of Evidence Level

Hicks, D. (2015). Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature Review. MEDSURG Nursing. 24 (1):51-55.

Type of Study:

Integrative Literature Review

Design Type:

Experimental

Framework/Theory: Nurse Standard of Care

A literature search yields 14 articles that meet inclusion criteria.

Concepts:

Independent Variable: nursing rounding

Dependent Variable: patients Falls,

Controlled Variable: patient satisfaction

Hourly rounding has been identified as autonomous intervention strategy

to help nurses keeping patients safe because it makes falls decreasing from 4.001 to 2.613.

IV

Ford, M.B. (2010). Hourly Rounding: A Strategy to Improve Patient Satisfaction Scores. MEDSURG Nursing. 19(3):188-191.

Type of Study:

Quantitative

Design Type:

Pilot

Framework/Theory:

Four Ps (Pain, Personal Needs, Positioning, and Placement)

3-week hourly rounding test at BWMC (Baltimore Washington Medical

Center BWMC)

Concepts:

Independent Variable: rounding logs

Dependent Variable:

Call light data

Controlled Variable: Tracking patients who did not receive call light use.

Call light logs decline by

52%.The pressure ulcer rates also decrease by 56%.

III

Study

Design Type

Framework/Theory

Setting

Key Concepts/Variables

Findings

Hierarchy of Evidence Level

Saleh, B.S. Nusair, H. Zubadi, N.A. et al. (2011). The Nursing Rounds System: Effect of Patient's Call Light use, Bed sores, fall and Satisfaction Level. International Journal of Nursing Practice. 17: 299-303.

Type of Study:

Quantitative

Design Type:

Experimental

Framework/Theory:

Krug Model

104 stroke unit patients call to participate in the survey

Concepts:

Independent Variable: nursing staff rounds

Dependent Variable:

patient's call lights.

Controlled Variable: not stated

A significant reduction on the use of call light. Pressure ulcer also reduced by 50%

I

Hodgson, G.L.L (2012). Hourly rounding in a high dependency unit. NURSING STANDARD / RCN. 27(8): 35-40.

Type of Study:

Integrated Literature Review and Experimental

Design

Type:

Pilot Program

Framework/Theory:

Four Ps' (Pain, Potty, Position, and…