AN INTEGRATED LITERATURE REVIEW

KRISTINA A. ZURITA, RN, MSN CANDIDATEUNIVERSITY OF CENTRAL FLORIDA

The Impact of Nurse Hourly Rounding on Patient

Falls

PICO Question:

In the adult acute care setting, how

does hourly rounding impact

patient falls?

Significance and Background

Patient falls result in morbidity, mortality, and an increased fear of repeat falls

One of the most common adverse events in hospital setting

Inpatient falls range from 1.7 to 25 falls per 1,000 patient days

Falls can cost hospitals $5,317 per patient fallBy 2020, patient falls are projected to cost

hospitals over $54 billion in annual costs.Since 2008, CMS no longer reimburses hospitals

for patient falls(Tucker et al., 2012; Hicks, 2015)

Significance and Background

One-third of falls are preventable (US DOH, 2015)

Majority of falls occur near the patient’s bed, in the room, or in the bathroom (Tucker et al., 2012)

Nurses play an important role in preventing falls and maintaining patient safety (Cann & Gardner, 2011)

Reports state that hourly rounding can reduce patient falls by 50% (Hicks, 2015)

Significance and Background

Hourly rounding is the process of intentionally checking on the patient to addresses a patient’s basic needs by the nursing staff at regular intervals (Hicks, 2015)

Pain management Repositioning Use of the bathroom Checking that items are within reach of the patient Assuring the patient that the nurse will return in an

hour(Mitchell et al., 2014)

Methods

Databases Searched Search TermsMedline Adult

Academic Search Premier Acute care

Cochrane Database of Systematic Reviews

Hospitalization

Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus

Nurse

Rounding/Hourly rounding

Falls/Fall prevention

Patient safety

Methods

Inclusion Criteria Exclusion Criteria

Adult population Age groups other than the adult population

Inpatient units in a hospital setting

Other types of setting (ie. emergency department, outpatient units)

Nurses who implemented hourly rounding

Focus on leader rounding

Nurses who did not implement hourly rounding

Focus on other personnel rounding

Patient safety/falls prevention was evaluated

Methods

Results: 34 articles found 10 articles met inclusion criteria 2 articles were systematic reviews of non-RCT (Level

II evidence) 8 articles were cohort studies or quasi-experimental

studies (Level III evidence) All studies were ranked Level III for validity using the

Quelly tool (2004) Total number of participants unknown due to some

studies not reporting

Findings

Coding themes for hourly rounding:Decreases patient fallsIncreases patient satisfactionDecreases patient call light usageProper training, implementation, and

compliance is necessary for success

Findings: Decrease in falls

9 studies showed decrease in patient falls Cann & Gardner (2012); Goldsack et al. (2015); Hicks

(2015); Kessler et al. (2012); Mitchell et al (2014); Olrich et al (2012); Saleh et al. (2011); Spanaki et al (2012); Tucker et al (2012)

2 studies showed statistically significant results Goldsack et al (2015) p=0.006 Saleh et al. (2011) p<0.01

1 study was inconclusive Krepper et al (2012)

Findings: Increase in patient satisfaction

4 studies showed an increase in patient satisfaction Cann & Gardner (2012); Kessler et al. (2012); Olrich

et al (2012); Saleh et al. (2011) (p=0.081; not reported; p=0.383; p<0.05)

1 systematic review found 4 studies that showed statistical significance Mitchell et al (2014)

Findings: Decrease in call light usage

3 studies showed a decrease in call light usage Krepper et al. (2012); Olrich et al (2012); Saleh et al.

(2011) (p=0.001; number not reported; p<0.001)

1 systematic review found 10 studies addressing call light usage Mitchell et al (2014)

Median reduction of 54%

Findings: Proper training, implementation, and compliance needed

4 studies discussed the importance of training, implementation, and compliance to hourly rounding

Goldsack et al. 2015 Kessler et al., 2012 Olrich et al., 2012 Tucker et al., 2012

Limitations

Non-randomization samples Weak research design Small sample sizes Variations in the length of timeLack of follow-up

Recommendations for Nursing

Hourly rounding should be implemented as it may: Help nurses to keep patients safe by reducing patient falls. Improve patient’s satisfaction. Decrease patient call light usage.

Proper implementation, compliance, and training of nurses should be offered to promote successful hourly rounding by decreasing patient falls.

Strength of Recommendations: A

Conclusion

Hourly rounding is an autonomous intervention that nurses can easily implement to ensure patient safety and reduce patient fall rates

Hourly rounding can also increase patient satisfaction and decrease call light usage

With proper training, nurse buy-in, and consistency to the intervention, hourly rounding can benefit both nurses and patients

Hourly rounding can help reduce unnecessary hospital costs