The Role of Safety Rounds in Fall and Pressure Ulcer Prevention

Purpose:
To pilot standardized Safety Rounds on 21 inpatient units to reduce falls and hospital acquired pressure ulcers by improving bedside prevention activities through rounding. Strategies to improve patient outcomes included: role modeling, performance coaching, real-time feedback and follow up.

Significance:
Falls and pressure ulcers are unintended adverse outcomes for patients and can lead to increased morbidity and mortality, costs, and length of stay. Using safety rounds to reduce these hospital acquired conditions will improve the quality of care, increase our culture of safety, and reduce costs.

Strategy and Implementation:
Standardized rounding was the innovation tested in this pilot study. Rounding was role modeled weekly on each inpatient unit so that it can be adopted by unit leaders to foster sustainable change in practice. Using the PDSA Model for Improvement, a plan was developed to implement safety rounds on each of our 21 inpatient units. Unit leaders would be required to be involved in rounding on patients at high fall risk and/or high pressure ulcer risk, focusing on prevention interventions present at the bedside. Staff nurses, care partners, and charge nurses were included in rounding when available. Engaging patients and families was a vital part of the value of our rounding. Managers, assistant managers, and educators were debriefed after every rounding session to review observed strengths, opportunities, and issues that required follow up.

Evaluation:
During this pilot,Fall rates have decreased 22 percent and Falls with Injury rates decreased 36 percent during the 1st qtr of 2012, from 0.61 down to 0.39. Pressure ulcer prevalence has decreased to 3.5 percent, our best results since 2007 with the exception of one survey per NDNQI reports.

Implications for Practice:
Overall awareness of individual patients safety risk has increased. Managers verbalize the conversations needed for individualized care and model that behavior. Nearly all units have implemented some form of Safety Rounds.Bedside staff demonstrate increased engagement with prevention interventions.