EVIDENCE BASED PROJECT PROPOSAL

Hourly Rounding to Improve Patient Safety

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Introduction

PICO 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)?

I have chosen this PICOT question because I want to shed light on the importance of hourly rounding in an acute care setting. Nurses and other staff members must understand the tenets behind hourly rounding because it not only minimizes the number of encountered falls in the unit but also providing a safe environment for the patient. The PICOT question will be supported with evidence-based knowledge to enhance a safer outcome which whose results are reduced anxiety among patients, improved satisfaction, and quality patient care (Allatzas, 2018).

In order to meet the best of the patient’s interests, nurses must seek to advance their delivery skills of care, especially in providing quality, safe care. In order to achieve this goal, some studies have highlighted the importance of introducing hourly rounding in hospitals (Daniels, 2016). Hospitals that have implemented this EBP strategy have recorded positive results like recording a minimal number of falls and increased patient safety. As indicated by Mitchell (2017), a fall prevention strategy can be used when conducting hourly rounding. It allows developers of the program to implement policies and guidelines that aim to reduce fall fatalities, more significantly, as a conduit of encouraging patient comfort, quality health, and safety. Hourly rounding refers to the process of synchronizing the schedules used to check on patients (Allatzas, 2018). In hourly rounding, the nurses have a schedule showing which patients they are assigned to and the time of the next patient round, ensuring the nurses are on time

Nurses' fundamental roles and input are integral in the health care system since their mission is to provide quality care services. Therefore, various duties must be met by nurses to promote safe and quality care. These roles include; reporting to physicians, recording patient’s conditions, administering drugs, monitoring, and observing patients (Daniels, 2016). Past studies have recommended the significance of introducing hourly rounding in hospitals to help improve patient care, safety, and satisfaction (Allatzas, 2018). Although, the implementation of hourly rounding has remained to be a controversial topic in the past years due to the implementation challenges it carries with. Conversely, many evidence-based studies have proven the benefits of introducing hourly rounding in acute care settings that increase patient satisfaction, decrease fall rates, and create a safe clinical environment (Allatzas, 2018). Despite the rounding strategy impacting patients positively, a significant number of RN’s claims that the hourly rounding mandated protocols are time-consuming, improper balance of patient ratios, and poor documentation (Mitchell, 2017). Undoubtedly, nurses play an essential role in the implementation and efficiency of hourly rounding. And hence, when a hospital administration plans to implement an hourly rounding program in their facility, it is essential to consider the nurse's input and role (Daniels, 2016). It means, not only does hourly rounding deemed valuable to patients but also enhance staff satisfaction as well as all-purpose feasibility of hourly rounding.

Mitchell (2017) says that the utmost outcome for using hourly rounding in a hospital setting is to improve patient satisfaction. This is true in the 21st-century healthcare facilities that patient satisfaction scores are determined by the level of value-based purchasing and reimbursements (Allatzas, 2018). Accordingly, most of the used patient surveys during hospitalizations capture patient care experience, measured by nursing responsiveness.

Therefore, this primer will seek to uncover the importance of implementing hourly rounding in the health care setting and its applicability in improving nursing practice when delivering quality and safe patient care. Therefore, I will purposefully use knowledge, information, data, and continuum of nursing wisdom to reinforce my understanding of hourly rounding to help reduce the number of reported falls in an acute care setting. I will also explore both positive and negative outcomes with the application of EBP, and its lack.

Problem Statement 

Patient fall is a common subject in all medical facility settings. Falling rates in acute care clinics go from 1.4 to 9.0 falls per 1000 inpatient days, where 30% of these falls bring about grave fatalities (Allatzas, 2018). Commonly, the hour of care for the acute care setting is the patient's stay in the medical clinic. The emphasis is frequently on the interventions or the remedies administered while the patient is in the clinic, and the related results are detectable while the patient is still in the hospital. For instance, if the intervention of interest is whether hourly rounding by medical caretakers on patient care units decreases fall rates, it would not be suitable to observe patient falls after the patient's release from the hospital. The assigned episode of care would be the patient's stay in the care unit. The hourly rounding intervention model is a multidisciplinary activity meant to improve the patient experience. It is an intervention to proactively associate with patients consistently during the day utilizing focused keywords to assess the patient's personal needs, education, and pain (Daniels, 2016). Evidence from this intervention exhibit a flattening curve in skin breakdown, anxiety, patient falls, and higher ratings of patient satisfaction. The intervention model allows medical caretakers to provide intensive care at the bedside. It additionally leads to decreased patient use of chimes/lights and a decrease in pressure ulcers. The safety of the patients is the priority of all the medical care group in hospitals.

Hourly rounding engages patients in their own care and guarantees them their demands are met while in the medical clinic. This is a proactive approach to patient care and builds a good relationship between medical attendants and patients. Patient fulfillment and quality of care correspond with nurses' accessibility, medical attendants' permeability, and medical caretakers' capacities to address their issues suitably and effectively. Hospitals that have implemented hourly rounding into their daily regimens have reported having increased patent satisfaction (Allatzas, 2018). Hourly rounding is a crucial part of focusing on a culture of safety and preventing patient falls. Safety is improved when attendants are attending their patients consistently. Medical caretakers are better ready to avoid falls and keep an elevated awareness of every one of their patients by observing their patients hourly. Medical attendants can address their patients' issues every hour to address the Ps: pain, positioning, potty, and patient-care items within reach. This reduces the probability of patients using the call light for these reasons when they are addressed consistently. Hourly rounding improves patient safety and increases nurse’s time management, and hence, it aids in preventing patient falls from happening.

Different reasons make the implementation of hourly rounding difficult into nursing practice, especially when nurse administrators are uncertain about future hospital reimbursement levels. The way nurses spend their time must be determined by nurse administrators to determine whether more staff are needed and if the benefits will surpass costs. Therefore, evidence supporting change must be understood by nursing leaders to make a persuasive case for changing the nursing care delivery process. Understood hourly rounding concepts help stakeholders make sound decisions concerning the value of nursing practice changes that transform every healthcare system aspect.

References

 Allatzas, R. (2018). The Effects of Hourly Rounding on Patient Safety and Satisfaction.

Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Evidence Synthesis, 14(1), 248-267.

Mitchell, R. (2017). Hourly Rounding: A Fall Prevention Strategy in Long-Term Care.