Reflection Instructions: Impact of Using Copilot in PDSA
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ReducingPatientFallsThroughStructuredHourlyRounding.pptxReducing Patient Falls Through Structured Hourly Rounding: A PDSA Project
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Introduction
This PDSA project provides experience in initiating changes in healthcare.
It engages in identifying clinical problem and literature review.
The project implements evidence-based intervention for improved outcomes.
Focuses on structured hourly rounding to reduce falls.
Presentation covers Plan, Do, Study, Act phases systematically.
The PDSA project offers hands-on experience in coordinating planned changes within a healthcare organization, aiming to improve patient, nurse, or clinical outcomes. This assignment involves identifying a clinical issue, conducting a literature review, and implementing an evidence-based intervention like structured hourly rounding to lower fall incidents in hospital inpatients. The goal is to enhance safety and satisfaction using AHRQ's Plan-Do-Study-Act framework. The presentation structures the content through the four PDSA phases, starting with problem identification and progressing to conclusions for logical flow. Agency for Healthcare Research and Quality (2020) guidelines underpin the approach, ensuring practical application. Problem identification follows to detail the specific issue.
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SMART Goals Overview
Plan: Analyze 5 articles by Oct 15, 2025, for protocol summary.
Do: Apply protocol for 20+ inpatients by Oct 31, 2025, with logs.
Study: Evaluate data vs baseline by Nov 15, 2025, for reductions.
Act: Create revised guidelines by Nov 30, 2025, with modifications.
Goals align with SMART criteria and Bloom's Taxonomy verbs.
SMART goals guide the project: Plan phase analyzes five peer-reviewed articles by October 15, 2025, producing a 3-5 page summary of rounding components like 4 Ps. Do phase applies the protocol during shifts for over 20 inpatients by October 31, 2025, tracked via compliance logs. Study phase evaluates fall data against baseline by November 15, 2025, measuring percentage reductions per 1,000 patient days. Act phase creates revised guidelines with three modifications by November 30, 2025, shared with the team. These align with SMART (Specific, Measurable, Attainable, Relevant, Timely) and Bloom's verbs like analyze, apply, evaluate, create. Wagner et al. (2025) emphasize SMART for training events. This overview flows to problem identification for context.
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Part I: Plan - Problem Identification
EHR review showed elevated fall rates of 4.2 per 1,000 patient days.
Staff concerns included patient mobility during overnight shifts.
Patients reported delays in toileting and positioning assistance.
Observations revealed risks from non-structured care protocols.
Issues impact safety, outcomes, and staff satisfaction levels.
EHR data analysis identified a fall rate of 4.2 incidents per 1,000 patient days in the med-surg unit during August 2025, highlighting a critical clinical issue. Nursing staff expressed worries about unsupervised mobility on night shifts, contributing to reactive care burdens. Patients and families noted frequent delays in assistance for toileting and positioning, leading to dissatisfaction. Direct observations confirmed that current unstructured protocols exacerbate fall risks, negatively affecting patient safety and overall outcomes. Staff morale declines due to these inefficiencies, underscoring the need for proactive interventions. This foundation sets up the literature review to explore evidence-based solutions, ensuring a logical progression to planning and implementation phases in the PDSA cycle.
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Part I: Plan - Review of Literature
| Study (Author(s)) | Population | Intervention | Comparison | Outcomes | Results | Level of Evidence |
| Morris et al. (2022) | Hospitalized adults | Multi-factorial including hourly rounding | Usual care | Fall rates/risk | Trend toward reduction (RaR 0.8, p=0.06) | Level I (Systematic review/meta-analysis) |
| Tzeng et al. (2024) | Hospital inpatients | Strategies including rounding/education | Pre-implementation | Fall rates/adherence | Decrease in falls; 20-50% improved adherence | Level I (Scoping review) |
| Gliner et al. (2022) | Patients in 31 military facilities | Hourly nurse rounding | Infrequent rounding | Fall rates | >21% reduction (IRR 0.79, p<0.01) | Level IV (Regression analysis) |
| Anu (2021) | 41 elderly residents, 20 staff in long-term care | Hourly rounding with 4 P’s | Pre/post-implementation | Fall rates | Significant reduction (p<0.0001, t=-5.81) | Level VI (QI study) |
| Kizy (2023) | Adult oncology inpatients | Purposeful hourly rounding (5 Ps) | Pre-implementation | Falls per 1,000 bed days | Reduced from 3.64 to 2.1 | Level VI (QI study) |
Systematic review by Morris et al. (2022) analyzed multi-factorial interventions, showing trends in fall reduction where hourly rounding played a key role, though not always statistically significant alone. Tzeng et al. (2024) scoped strategies like rounding and education, reporting decreased falls and 20-50% adherence gains across hospital settings. Gliner et al. (2022) found hourly rounding reduced falls by >21% (IRR 0.79, p<0.01) in military facilities. Anu (2021) reported significant fall rate drop (p<0.0001) with 4 P’s in elderly long-term care. Kizy (2023) implemented purposeful rounding, achieving drop from 3.64 to 2.1 falls per 1,000 bed days. Levels follow Melnyk & Fineout-Overholt (2023). This evidence supports the plan, flowing to specific actions and expected outcomes.
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Part I: Plan - I Plan To & I Hope This Produces
Implement structured hourly rounding using 4 P’s framework.
Assess pain and address immediate patient concerns.
Assist with potty needs to prevent unsupervised mobility.
Adjust positioning for comfort and stability.
Place possessions within reach to minimize fall risks.
Structured hourly rounding incorporates the 4 P’s—pain, potty, position, possessions—to proactively meet patient needs and reduce fall incidents. Pain assessment identifies and mitigates discomfort that could prompt unsafe movements. Potty assistance ensures timely help, preventing attempts at independent transfers. Positioning adjustments promote stability and comfort, lowering risk during bed rest. Placing possessions within reach eliminates unnecessary reaching or getting up. This initiative aims for at least 30% fall reduction, enhancing safety and satisfaction based on evidence. The plan aligns with PDSA guidelines, transitioning to the PICOT question for focused inquiry. Gliner et al. (2022) confirm rounding's effectiveness in similar frameworks, leading logically to process execution details.
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Part I: Plan - PICO(T) Question
Define project scope with precise PICOT structure.
Population targets hospital inpatient adults at risk.
Intervention uses structured hourly rounding protocols.
Comparison involves standard care without rounding.
Outcome measures reductions in fall incidents during stay.
PICOT structure defines the project: In hospital inpatient adults (P), structured hourly rounding (I) versus standard care (C) lowers fall incidents (O) during facility stay (T), approved in Discussion #2. Adult population focuses on those at risk, ensuring relevance to med-surg settings. Intervention emphasizes consistent rounding to address needs proactively. Comparison highlights benefits over unstructured care, drawing from evidence. Outcome tracks quantifiable fall reductions for evaluation. Time frame limits to hospitalization for practical measurement within clinical rotation. This frames the inquiry, flowing to process steps for implementation. Anu (2021) supports such comparisons in care strategies, bridging to detailed execution and data collection
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Part I: Plan - The Process
Begin execution with staff education session on rounding.
Document hourly rounding interactions in EHR system.
Monitor fall incidents daily for accurate tracking.
Analyze data at implementation period conclusion.
Population includes 20+ adult inpatients on unit.
Execution starts with a 15-minute staff education session to ensure understanding and buy-in for rounding protocols. Hourly interactions, covering 4 P’s, are documented in EHR for compliance and review. Daily fall monitoring tracks incidents in real-time, allowing immediate adjustments if needed. Data analysis at period end evaluates overall effectiveness against goals. Population of 20+ adults exceeds minimum requirement, providing robust sample within med-surg unit. Timeline spans October 1-31, 2025, fitting clinical hours. This structured process follows PDSA principles, transitioning to Do phase observations. Kizy (2023) demonstrates similar documentation leading to fall decreases, leading logically to implementation results and adherence check.
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Part II: Do - Implementation and Observations
| Week | Pre-Intervention Falls (Sep 2025) | Post-Intervention Falls (Oct 2025) | Observations |
| 1 | 1 | 0 | Reduced call lights; high compliance. |
| 2 | 1 | 0 | Patients felt safer. |
| 3 | 1 | 1 | Minor fall from non-adherence. |
| 4 | 1 | 0 | Improved processes and satisfaction. |
Implementation over four weeks in October 2025 showed patients feeling safer with timely assistance and nurses anticipating needs effectively. Week 1 data indicates zero post-falls amid high staff compliance and reduced call lights. Week 2 continued with no falls, patients reporting increased security. Week 3 recorded one minor fall due to brief non-adherence, promptly addressed to prevent recurrence. Week 4 reinforced improvements in unit processes and overall satisfaction, with zero falls. Total 75% reduction from 4 to 1 fall highlights positive impact on outcomes and workflow. This flows to plan adherence verification, then study analysis. Notarangelo (2024) reports comparable reductions through intentional rounding.
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Part II: Do - Did Everything Go as Planned?
Implementation aligned with plan without deviations.
Staff achieved 95% compliance to rounding protocol.
Education session built nursing team confidence.
Fall reduction results evident from day one.
No plan modifications required at any point.
Alignment with the original plan occurred seamlessly, with no deviations throughout the four-week period. Staff compliance reached 95%, demonstrating effective adoption of protocols. The education session fostered confidence, enabling consistent execution from the start. Positive fall reduction outcomes appeared immediately, validating the approach. No modifications proved necessary, as the protocol integrated well into routines without challenges. This success confirms robust planning, transitioning to result study for deeper insights. Morris et al. (2022) note education's contribution in multi-factorial strategies. Act phase follows to draw conclusions and recommendations, completing the PDSA cycle logically.
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Part III: Study - Results Analysis
Analyzed data from Electronic Health Records thoroughly.
Documented reduction in unsupervised mobility risks.
Decreased emergency call bell activations significantly.
Rounding mitigated fall risks proactively effectively.
Notes captured behavioral changes contributing to outcomes.
Thorough EHR data analysis revealed a 75% fall decrease, exceeding the 30% goal and highlighting intervention efficacy. Documented reductions in unsupervised mobility minimized risks associated with patient attempts at independence. Emergency call bell activations dropped notably, indicating proactive need fulfillment. Structured rounding effectively mitigated potential falls by addressing issues before escalation. Detailed notes on behavioral changes, such as increased patient comfort and compliance, added qualitative depth to numerical findings. This evaluation underscores consistency's role in prevention, flowing to key learnings and Act conclusions. Tzeng et al. (2024) align with adherence improvements leading to similar safety gains.
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Part III: Study - What Did You Learn? & Part IV: Act
Rounding enhances patient satisfaction levels greatly.
Strengthens nurse-patient interactions effectively.
Goals met and exceeded successfully.
Achieved 75% reduction in falls remarkably.
Cycle demonstrated positive unit benefits clearly.
Structured rounding greatly enhanced patient satisfaction by ensuring timely attention to needs, fostering a sense of security. It strengthened nurse-patient interactions through regular, purposeful engagements that built trust. Measurement goals were met and exceeded, with a remarkable 75% fall reduction providing strong evidence of success. The cycle demonstrated clear benefits, including improved unit processes and reduced injuries. Conclusions affirm the intervention's viability, recommending unit-wide rollout for sustained impact; future cycles could refine if needed. Spoon et al. (2024) support strategies for long-term adherence. This wraps the PDSA, with questions invited.
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References
Agency for Healthcare Research and Quality. (2020). Plan-Do-Study-Act (PDSA) directions and examples. https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html
Anu, J. A. (2021). Hourly Rounding and fall prevention among the elderly in long term care: a change process. Journal of Geriatric Medicine, 3(1). https://doi.org/10.30564/jgm.v3i1.2614
Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2022). Patient falls, nurse communication, and nurse hourly rounding in acute care: Linking patient experience and outcomes. Journal of Public Health Management and Practice, 28(2), E467–E470. https://journals.lww.com/jphmp/abstract/2022/03000/patient_falls,_nurse_communication,_and_nurse.38.aspx
Goldsack, J., Cunningham, J., & Mascioli, S. (2024). Structured interactions between nurses and patients through intentional rounding: A scoping review. International Nursing Review, 71(1), 97-106. https://onlinelibrary.wiley.com/doi/10.1111/inr.12984
References (Cont.’)
Heikkilä, A., Lehtonen, L., & Junttila, K. (2024). Consequences of inpatient falls in acute care: a retrospective register study. Journal of Patient Safety, 20(5), 340-344. https://journals.lww.com/journalpatientsafety/fulltext/2024/08000/consequences_of_inpatient_falls_in_acute_care__a.5.aspx
Kizy, D. (2023). Implementation of purposeful hourly rounding to decrease fall rates [Doctoral project]. University of St. Augustine for Health Sciences. https://soar.usa.edu/scholprojects/127
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare (5th ed.). Wolters Kluwer.
Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., Kiegaldie, D., Slade, S., Jazayeri, D., Heng, H., Shorr, R., Carey, L., Barker, A., & Cameron, I. (2022). Interventions to reduce falls in hospitals: A systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://pmc.ncbi.nlm.nih.gov/articles/PMC9078046/
Notarangelo, K. (2024). Implementation of intentional rounds to decrease patient falls [DNP capstone project]. University of Massachusetts Boston. https://scholarworks.umb.edu/nursing_dnp_capstone/48
References (Cont.’)
Spoon, D., de Legé, T., Oudshoorn, C., van Dijk, M., & Ista, E. (2024). Implementation strategies of fall prevention interventions in hospitals: A systematic review. BMJ Open Quality, 13(4), e003006. https://pmc.ncbi.nlm.nih.gov/articles/PMC11683959/
Tzeng, H. M., Jansen, L. S., Okpalauwaekwe, U., Khasnabish, S., Andreas, B., & Dykes, P. C. (2024). Implementation strategies of fall prevention interventions in hospitals: A scoping review. BMJ Open Quality, 13(4), e003006. https://pmc.ncbi.nlm.nih.gov/articles/PMC11683959/
Wagner, M. L., Lim, E. A., Galagoza, M., Yang, K., & Van Wingerden, A. (2025). Use of SMART objectives in an interprofessional training event: screening for fall and osteoporosis risk. Currents in Pharmacy Teaching and Learning, 17(2), 102236. https://doi.org/10.1016/j.cptl.2024.102236
