EVIDENCE BASED PROJECT PROPOSAL
Literature Review and Critical Appraisal
MSN 563
United States University
Title: Reducing Patient Falls to Increase Patient Safety
Revised PICOT Question: On a medical-surgical hospital unit (P), how does implementing hourly nursing rounding (I), compared to no scheduled rounding (C), affect patient safety (O), within 6 months of implementing (T)?
Introduction
There has been an increase in patient falls that threaten the safety of patients especially in the medical-surgical hospital unit. Patient falls refers to situations when patients trying to get out of bed fall or when a patient tries to walk within the unit and falls. These falls lead to serious injuries and even disabilities. 30–50% of falls result in some physical injury and fractures occur in 1–3% (Morris, & O’Riodarn, 2017). Specialists indicate that the number of falls is especially high among elderly patients of 60 years and above. This has made the issue of patient falls something healthcare administrators are giving a lot of importance. Researchers and nurses are out trying to get a long-lasting solution that can help prevent problems resulting from patient falls. Some solutions such as technology have been introduced but the issue still persists. Technologies such as bed alarms have been fixed at the patient beds but they have not worked because even when patients press them to seek help, there is scarcity of personnel thus late response. However, all the techniques that have been employed have proved that they cannot work without enough nursing staff. Thus, increasing the number of nurses who will do hourly rounds is the best way to reduce patient falls and increase the safety of patients. Hourly nursing rounding will ensure enough surveillance in the surgical unit. The rounds will include occasionally monitoring and assessing the patients. However, it is important to note that other solutions like bed alarms are also important, only that hourly rounds by nurses will be the most effective.
Literature Review
Hourly rounds by nurses increases nurse responsiveness and this reduces patient falls, thus increasing patient safety. Brown (2016) conducted a research to evaluate the effectiveness of nurses conducting hourly rounds in reducing patient falls to increase patient safety. The results of the study indicated that there was no statistically significant difference between patient fall incidents and hourly nursing rounds. According to the researcher, hourly nursing rounds paly a vital role in promoting the safety of patients by reducing patient falls. An earlier study conducted by Mitchell et al., (2014) synthesizing evidence on the impact of regular hourly rounds conducted by nurses on increasing the satisfaction of patients indicated that there is enough evidence that nursing hourly rounds increases the responsiveness of nurses and this leads to a reduction in patient falls and an increase in patient safety. A later study by Mitchell (2017) showed that evidence based hourly rounding is important in increasing patient satisfaction, safety, and reducing issues such as patient falls and other errors. The author’s study was aimed at bringing out the essential role that nurses play in ensuring the safety of patients and why the use of EBP is essential. Mitchell also used models such as the Kurt Lewin’s change model to provide strong evidence that hourly rounding programs were very effective in ensuring the safety of patients. In his research, Daniels (2016) used observation to determine how nurses were using EBP and observing protocols when carrying out safety rounds. The results indicated that constant nursing rounds increased nurses’ responsiveness, a decrease of patient falls by 50%, increased pain management, and other positive outcomes. According to the author, by utilizing hourly rounds, nurses have the ability to increase patient safety. The same is echoed by Mireille (2018) who asserts that purposeful hourly rounds have been proved to be effective in reducing patient falls by increasing nurses’ responsiveness. What Mireille did was a quality improvement project to determine the effectiveness of evidence based hourly nursing rounds. According to the author, nursing hourly rounds can help ensure patient safety in the long term.
Critical Appraisal of Literature
All the studies providing evidence above are of significant importance to nurses especially when it comes to maintaining patient safety in the surgical unit. However, just like any other remedy, if not practiced carefully and applied well, it may cause more harm than good. The harm can be both on the side of the patient and the nurse. For instance, all literatures assert that hourly nursing rounds are effective in reducing patient falls and increasing patient safety without considering important variables. Factors such as the morale of the nurses are not considered. If nurses participated in hourly rounds out of demands by their administrators, patient falls will still be experienced because nurses will not do the rounds willingly. The fact that hourly nursing rounds have been found to be the most effective in reducing patient falls does not make it free of any complications. The hospital should ensure nurses are motivated enough to perform the hourly rounds. The study of Mitchell (2017) provides the significance of ensuring nurses are trained on conducting the hourly rounds and ensure this is clearly spelled in policies to increase awareness of what is expected of them.
Brown (2016) in his study provides a more inclusive and insightful approach to the use of hourly rounds by nurses. He enriches his study but recommends further research into the benefits of hourly nursing rounds. There is need for healthcare organizations to understand the benefits of hurly rounds, to stimulate implementation. Mitchell et al., (2014) reviews literature to provide evidence of the effectiveness of hourly rounds. The data provided by the researchers is all secondary and none is from a primary source. This makes their evidence somethings nurses cannot fully rely on. However, Daniels (2016), provides a significant ground to the study of the benefits of hourly nursing rounds on improving the safety of patients by considering factors such as communication between the nurse and the patient, and nurse responsiveness.
All studies are ethical and they followed the principles of ethical research. The researchers obtained ethical approvals before conducting the researches and beneficence and informed consent principles were observed. Observation is the main method used in studies concerning hourly rounds and this is an effective method considering the fact that it involves the safety of patients.
Conclusion
Patient safety is a priority to any nurse and that is why healthcare organizations are committed to ensure their patients receive high quality healthcare. In preventing patient falls to promote patient safety, nurses have a huge role to play. Despite employing various technologies such as bed alarms, hourly rounds by nurses have proved to be most effective in reducing patient falls and increasing the safety of patients. Hourly rounds also increase the responsiveness of nurses and increase the chances of positive relationships between nurses and patients. It is the role of a healthcare facility to ensure they have an effective program and guidelines of conducting hourly rounds.
References
Brown, C. H. (2016). The effect of purposeful hourly rounding on the incidence of patient falls.
Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Evidence Synthesis, 14(1), 248-267.
Mireille, C. Purposeful Rounding for Fall Prevention in the Nursing Home Setting.
Mitchell, M. D., Lavenberg, J. G., Trotta, R., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: a systematic review. The Journal of nursing administration, 44(9), 462.
Mitchell, R. (2017). Hourly Rounding: A Fall Prevention Strategy in Long-Term Care.
Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine, 17(4), 360.
PATIENT SAFETY
Running head: PATIENT SAFETY