Hourly Rounding to Reduce Falls and Improve Patient Safety

Introduction: The Problem of Patient Falls

Among adults aged 60 years and above, falls have been identified as a leading cause of both fatal and non-fatal injuries. In the United States, nearly 50% of hospitalized adult patients face the risk of falling, and nearly 80% of patients who fall suffer fatal or non-fatal injuries (CDC, 2010). When patients fall, the consequences include longer hospital stays, elevated costs, and longer recovery times. An average hospital stay can increase by more than 12.3 days, which consequently raises the cost of hospitalization by 61%. The Centers for Disease Control and Prevention notes that the older adult population is particularly vulnerable to severe head or leg injuries after a fall, which can ultimately increase the risk of head trauma and hip fractures (CDC, 2010).

Numerous organizations have employed different strategies to prevent falls. Current practices include bed alarms, adequate lighting, side rails, call lights, and clutter-free environments. While these interventions are important for maintaining patient safety, they are not consistently effective in preventing falls among older adult patients. Call lights, for example, can help prevent falls; however, overuse of call lights to alert nurses for immediate attention may result in some nurses not responding promptly.

Hourly rounding has been identified as a current and proactive practice used to prevent falls among hospitalized patients. Because patient satisfaction is a key metric influencing reimbursement and hospital ratings, hourly rounding has become an effective tool that healthcare organizations use to improve patient satisfaction. The objective of this paper is to investigate whether hourly rounding can be used to reduce call light use, falls, and pressure ulcers, and whether it contributes to overall patient satisfaction.

PICOT Question

This paper develops a PICOT question to investigate the effectiveness of hourly rounding in reducing call light use, falls, and pressure ulcers, and its contribution to patient satisfaction. The question is as follows: Among hospitalized adult patients (P), what is the impact of hourly rounding (I) compared to no hourly rounding (C) on patient health and satisfaction (O) within three months (T)?

Justification: Evidence Supporting Hourly Rounding

Hourly rounding is defined as a systematic and proactive nursing intervention that healthcare organizations design to meet the needs of hospitalized patients and promote patient safety, satisfaction, and quality within a healthcare environment. Since the 1970s, regular proactive checks on patients have been recognized as an effective tool for decreasing patient anxiety. Hicks (2015) identifies patient falls as a critical clinical problem within healthcare settings, defining falls as an unexpected descent from a standing or sitting position, which has become a leading cause of injuries among older adults. In 2000, the United States spent more than $19 billion to manage fall-related injuries, and those costs were expected to reach $54 billion by 2020.

Hicks (2015) describes hourly rounding as a method of regularly checking on hospitalized patients to meet their needs and reduce falls. Through an integrative review of the literature, the findings reveal that hourly rounding is an effective current practice for reducing falls and ultimately enhancing patient safety.

Ford (2010) supports this position by pointing out that hourly rounding serves as a proactive approach to enhancing safety and improving patient satisfaction. To support this claim, Ford (2010) investigated the effectiveness of hourly rounding among hospitalized patients at Baltimore Washington Medical Center (BWMC) over three weeks. As Ford (2010, p. 189) describes: "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." The outcomes of the investigation show that hourly rounding reduced call logs by 52%, pressure ulcers by 56%, and falls by 54%.

Polit and Beck (2012) support Ford's data collection strategy by confirming that quantitative research is an effective tool for collecting data in nursing research. Keough and Tanabe (2011) also identify advantages of the survey method, noting that it is cost-effective and time-efficient during the data collection process.