Rounding By the Hour; A Time to Focus on Fall Prevention

Purpose:
The purpose of this quality improvement project was to reduce falls and call light utilization and improve patient satisfaction on 7 med/surg units in a public safety net hospital using evidence based strategies. The goal was to meet or exceed the NDNQI fall benchmark.

Significance:
Acute care falls account for the greatest number of non-fatal injuries in hospitals, extending LOS, increasing costs of care, and pain and suffering. CMS no longer reimburses for treatment of falls occurring in hospitals. Falls rates on the sample units were consistently above national benchmarks.

Strategy and Implementation:
An extensive lit review revealed evidence supporting hourly rounding as a successful strategy for reducing falls and call light utilization and improving patient satisfaction. Utilizing current literature, expert consultation from an outside hospital, and input from unit leadership and staff, a rounding toolkit was developed. The toolkit included patient and staff education materials, reminder pocket cards, signage, documentation sheets, and handouts. Pilot testing of the toolkit, education strategies, and rounding process occurred on 3 units followed by implementation across the division. Rounding was integrated into the work flow as a shared responsibility for all nursing staff and included the 4 P's – positioning, personal, pain, placement. Over 10 months 350 audits were done to determine effectiveness. Results were communicated through unit fall data boards and staff meetings. Other strategies included fall de-brief process and interdisciplinary fall committee and rounding teams.

Evaluation:
Significant reduction in fall rates occurred 3 quarters post implementation – 6 out of 7 units fall rates were at or better than the NDNQI benchmark, the best results in 3 years. Patient satisfaction scores showed a marked improvement. Call light data was eliminated due to confounding bed alarms.

Implications for Practice:
Hourly rounding is effective in fall prevention when conducted using evidence based practices. Adequate integration into the unit work flow and appropriate implementation is facilitated by consistent leadership support / role modeling, coaching, de-briefing, and timely communication of data.