Culture Shift and Intentional Rounding Decreases Falls

Purpose:
Using a focused approach, the purpose is to improve NDNQI fall outcomes on a medical and medical/surgical nursing unit. Secondary outcomes include “hardwiring” the use of huddles and the nursing care of intentional rounds, improving patient satisfaction, nursing satisfaction and culture of safety.

Significance:
Fall rates were higher than comparative NDNQI data. Evidence-based literature supported hourly rounding, but with staffing below the 25th percentile, it was not reality. On a daily basis, they intentionally looked at details about causes of falls, and barriers in place from preventing falls.

Strategy and Implementation:
With staffing below the 25th percentile, hourly rounding was not a reality to reduce falls. The team met at least monthly to discuss falls and build a safer culture. The daily focus and communication of falls started at change of shift nursing huddles. Staff began Intentional Rounding every two hours with five “Ps”: proactive “potty” - intentional toileting schedule on patients requiring assistance, “pain”, “position”, “prevent” environmental hazards, and “plan” of care. The driver became a nursing quality focus on culture of safety and accountability. Use of the Influencer Model to identify competency and motivation for fall prevention, scripting for patient education, identification of barriers, peer accountability resources, fishbone diagram, root cause analysis, and Who, What, When (WWW)tools were used. Other interventions included sleep hygiene, bedside report, safety checklist, revision of the activity flowsheet, and patient care technicians for ambulation and “sitting”.

Evaluation:
Evaluation includes daily audits of toileting schedule and bedside report. Huddles provide updates on patients' toileting schedules, daily safety report, and weekly safety focus. Monthly NDNQI metrics are posted on the huddle dashboard. Falls improved by 0.55 and 1.75 falls per 1000 patient days.

Implications for Practice:
This abstract is not an in-depth review of work in the last year. However, it does demonstrate improved fall rates, culture shift, ownership and accountability by nursing. The continous review of evidence-based best practice leads to the relentless pursuit in perfecting practices to reduce falls.