Hourly Nurse Rounds: Fall and Pressure Ulcer Prevention
This paper examines the effectiveness of hourly nursing rounds as a strategy for reducing patient falls, preventing pressure ulcers, and improving overall patient satisfaction in healthcare settings. The paper introduces pressure ulcers and their causes, outlines repositioning as a primary prevention strategy, and discusses fall prevention guidelines from The Joint Commission. Drawing on studies from oncology and elderly care settings, it presents a PICOT question exploring optimal round intervals, departmental applicability, and the integration of repositioning with hourly rounds. The paper also identifies relevant search keywords and rationale, concluding that evidence-based practices such as structured nurse rounds and periodic repositioning can meaningfully improve patient outcomes.
- Introduction to Pressure Ulcers and Repositioning: Defines pressure ulcers and repositioning prevention strategies
- Fall Prevention and Hourly Nursing Rounds: Reviews Joint Commission guidelines and oncology fall study
- Clinical Questions and Rationale: Five sub-questions on round intervals, departments, and training
- PICOT Question and Variables: Formal PICOT question with population, intervention, and outcomes
- Keywords and Search Rationale: Search terms used to locate relevant nursing literature
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What makes this paper effective
- The paper clearly connects two related clinical problems — pressure ulcers and patient falls — under a single evidence-based intervention framework, showing how hourly rounds address both simultaneously.
- The use of direct quotations from peer-reviewed sources (Marsden et al., Moore & Cowman, Callahan et al.) grounds the clinical claims in credible evidence and models proper APA citation practice.
- The inclusion of a structured PICOT question with clearly defined population, intervention, treatment, and outcome variables demonstrates strong command of the evidence-based practice research format.
Key academic technique demonstrated
This paper demonstrates the PICOT framework, a standard tool in nursing and health sciences research for formulating focused clinical questions. By identifying population, intervention, comparison, outcome, and time elements, the author systematically narrows a broad clinical topic into a researchable, actionable question — a technique essential for evidence-based practice proposals at the undergraduate nursing level.
Structure breakdown
The paper opens with a clinical background section defining pressure ulcers and repositioning strategies, then transitions to fall prevention guidelines and supporting study data. It follows with five numbered clinical sub-questions with rationale, a formal PICOT question with variable definitions, and a keyword list with search rationale. It closes with an APA reference list. This progression moves logically from problem definition to research framing.
Introduction to Pressure Ulcers and Repositioning
Pressure ulcers — also referred to as bed sores, pressure sores, or decubitus ulcers — are categorized as localized areas of damaged tissue caused by shearing forces and excess pressure, usually from maintaining the same position over a prolonged period. Pressure ulcers typically occur in people who have nerve damage and/or limited mobility. When a person experiences pressure from sitting or lying on a particular body part for too long, this often results in nutrient and oxygen deprivation to the affected area. Strategies to prevent this involve repositioning — moving the person into a different position so that the body can redistribute or relieve pressure from the affected area. As Marsden et al. (2015) explain, "Pressure ulcers are distressing events, caused when skin and underlying tissues are placed under pressure sufficient to impair blood supply. They can have a substantial impact on quality of life and have significant resource implications" (p. 2879).
Repositioning remains a primary prevention strategy; however, it can be labor- and resource-intensive, which often leads to variations in practice. Although repositioning may not heal an existing pressure ulcer, it may prevent new ones from forming. Research therefore attempts to identify which time intervals are most effective for pressure ulcer prevention. As Moore and Cowman (2012) note, "People who cannot reposition themselves require assistance. International best practice advocates the use of repositioning as an integral component of a pressure ulcer management strategy" (p. 1).
Fall Prevention and Hourly Nursing Rounds
The Joint Commission's National Patient Safety Goals (JCNPSG) state that hospitals and other healthcare facilities must minimize the risk of patient harm resulting from falls that occur without nursing supervision. Accordingly, the organization recommends fall reduction programs and periodic assessment to gauge their effectiveness. Current research provides evidence that hourly nursing rounds, combined with periodic and continual medication review, are associated with a decrease in the number of patient falls. Some departments may benefit from this program more than others.
Oncology units and bone marrow transplant departments, as well as facilities serving elderly patients, tend to experience higher rates of patient falls. Fall prevention programs incorporating hourly rounds have nurses check for pain, positioning and comfort, personal needs, toileting, and safety. Pharmacists also complete medication reviews for high-risk patients, and daily team meetings allow staff to evaluate the overall process and address barriers in real time. A 2011 study observed a hospital that implemented such a program and found that patients experienced higher satisfaction and a reduction in falls and injuries.
The study reported that the program contributed to a 100% reduction in the fall-with-injury rate during the study period and a 67.8% reduction by the end of fiscal year 2008. Press Ganey scores reflected increased patient satisfaction during this quarter compared to the previous quarter: teamwork improved by 3.7%, attention to special and personal needs by 2.1%, overall nursing care by 1.9%, and pain control by 1.2% (Callahan et al., 2011, p. 1).
These positive results were consistent with the overwhelmingly positive feedback received from patients. Programs combining hourly rounds with repositioning strategies offer an excellent way to assess patient problems and prevent larger complications from developing over time. Evidence-based practice is the most effective approach for incorporating the latest research into solving real-world healthcare problems.
Clinical Questions and Rationale
1. What is the longest wait time between turning intervals that will still remain effective at preventing pressure ulcers?
Although hourly rounds are considered most effective at preventing incidents such as falls, nurses carry a heavy daily workload. If nurses can wait two to three hours between turning a patient rather than doing so every hour, adherence may be more feasible across all patients who require repositioning. This question is primarily concerned with maximizing efficiency without sacrificing patient safety.
2. Are bi-hourly rounds just as effective in fall prevention and pressure ulcer prevention as hourly rounds?
Nurses have limited time to complete all of their daily tasks. While hourly nursing rounds would be ideal, they may not always be realistic. If the same positive outcomes can be achieved with bi-hourly rounds, this would make implementation considerably more viable. Research on pressure ulcers has already identified some efficacy at time intervals greater than one hour.
3. Which departments could most benefit from hourly nurse rounds for fall prevention?
Some departments require closer patient monitoring than others. For example, oncology units include many patients at elevated risk of falling. Similarly, facilities serving elderly populations may have a higher proportion of individuals at risk. In these settings, more frequent nursing rounds would be especially important.
4. Should hourly nurse rounds include repositioning?
Repositioning for pressure ulcer prevention can be carried out at intervals greater than one hour, while fall prevention rounds are typically conducted hourly. If nurses attempt to integrate both tasks, they may either reposition at the wrong interval or expend unnecessary effort by repositioning too frequently. Keeping the two activities separate may lead to greater accuracy and efficiency.
5. Can team meetings and additional education and training help promote hourly rotations and periodic repositioning among nursing staff?
Although evidence-based practice is growing in adoption, many hospitals and other healthcare settings do not adequately educate staff on performing specific tasks at prescribed intervals. Additional team and staff meetings, as well as training for new nurses, can help address knowledge gaps regarding patients who require additional intervention. Such initiatives can also foster a work environment that is both communicative and accountable, ultimately increasing patient satisfaction.
References
Callahan, L., McDonald, S., Voit, D., McDonnell, A., Delgado-Flores, J., & Stanghellini, E. (2011). Medication review and hourly nursing rounds: An evidence-based approach reduces falls on oncology inpatient units. Nursinglibrary.org. Retrieved December 12, 2015, from http://www.nursinglibrary.org/vhl/handle/10755/164025
Marsden, G., Jones, K., Neilson, J., Avital, L., Collier, M., & Stansby, G. (2015). A cost-effectiveness analysis of two different repositioning strategies for the prevention of pressure ulcers. Journal of Advanced Nursing, 72(12), 2879. http://dx.doi.org/10.1111/jan.12753
Moore, Z., & Cowman, S. (2012). Repositioning for treating pressure ulcers. Cochrane Database of Systematic Reviews. http://dx.doi.org/10.1002/14651858.cd006898.pub3
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