Hourly Rounding, Communication Sheets, and Fall Risk Assessment to Decrease Inpatient Falls
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Evidence-Based Practice in the Clinical Setting
Initiatives that have recently been launched on the inpatient Progressive Care Unit in
which I work are the implementation of hourly rounding, fall communication sheets, and fall risk
assessments to prevent patient falls. During our hourly rounding, we are to ask the patients if
they need assistance with pain, positioning, bathroom assistance, personal needs, ensuring that
the room is clutter-free and having needed items within reach. Along with hourly rounding, we
also utilize a fall communication sheet (which elaborates what kind of equipment is utilized for
patient mobility) along with a fall risk assessment (which provides us with a score for each
patient indicating their fall risk). We also provide other interventions such as usage of non-slip
footwear, education to patient/family, post-fall safety huddles, and bed/chair-exit alarms. I
believe that these interventions are evidence-based. A systematic review completed by Miake-
Lye et al. (2013) shows that multicomponent interventions can reduce patient falls by up to 30%
(p. 391). In another study completed by Leone and Adams (2016), use of hourly rounding,
safety huddles and signage decreased patient falls from 4 per 1,000 patient days to less than 1 per
1,000 patient days (p. 30).
Background Questions
Which individual interventions produce the greatest decrease in patient falls? What is the
significance of patient falls in terms of cost and length of stay? What risk factors are most
pertinent in determining a patient’s fall risk? How are fall prevention programs best
implemented?
PICOT Question
In hospitalized patients, what is the effect of hourly rounding compared to fall risk assessment on
patient falls over one year?
Policies, Procedures, and Culture
At my current job, policies are continually being updated so much that I may get six or
more emails per week regarding new policy changes. Our hospital is doing a lot of updating
because we joined a larger health system about 2 years ago and are now in the process of
merging our own policies with theirs. Procedures and policies are very complicated for us right
now as we must look several places to find what we need while the merging process occurs,
whether it be our old webpage or the system webpage. While our hospital frequently updated
policies, the system that we have joined has some policies that have not been reviewed in many
years which is why the merger is taking so long, thus making the work of staff more difficult to
carry out. However, with the joining of our hospital to the larger system the culture of the
hospital in which I work has greatly changed. We now have Professional Practice Committees
(PPC) for each nursing unit where nurses are encouraged to come up with ideas for our
respective units to improve workflow, increase safety, increase satisfaction, and many others. I
feel like being involved with the decisions that affect you and your work has greatly increased
buy-in of the nurses to the current ideas. However, I feel like our leadership and education
within the hospital is greatly lacking as management is not very supportive of new
ideas/evidence and education is not being provided regarding new evidence based practice,
policy changes, and/or with orientation of new employees as it should.
Barriers and Strategies to Overcome Barriers
The biggest barriers present in my current facility to adopting evidence-based practices
are lack of management support, lack of time, and lack of understanding needed to interpret
research articles. According to Majid et al. (2011), management support is a key factor in
implementing evidence-based practice (p. 232), however our current manager likes the
traditional policies adapted by our facility and is not very open to new practices. This barrier
could likely be overcome with leadership and research education through mandatory requirement
of obtaining a master’s degree. Lack of time is another huge that could be resolved through
management and educator support. Working on a busy telemetry floor means that nurses do not
have a lot of extra time for learning, but providing 30 minutes every day or a few hours each
week of paid education time could be beneficial in enabling the nurses on the unit to become
educated in current evidence-based practice in our field. The final barrier is the lack of
knowledge to be able to understand research articles as about half of the nurses on my unit only
have an Associate’s degree in which research classes were typically not a requirement. Initiation
of a research class could help these employees to obtain the needed knowledge so that they may
be more capable of interpreting research articles.
References
Leone, R. & Adams, R. (2015). Safety Standards: Implementing Fall Prevention Interventions
and Sustaining Lower Fall Rates by Promoting the Culture of Safety on an Inpatient
Rehabilitation Unit. Rehabilitation Nursing, 41, 26-32.
Majid, S., Foo, S., Luyt, B., Zhang, X., Theng, Y-L., Chang, Y-K., & Mokhtar, I.A. (2011).
Adopting evidence-based practice in clinical decision making: Nurses’ perceptions,
knowledge, and barriers. Journal of the Medical Library Association, 99 (3), 229-236.
Miake-Lye, I., Hempei, S., Ganz, D., Shekelle, P. (2013). Inpatient Fall Prevention Programs as
a Patient Safety Strategy: A Systematic Review. Annals of Internal Medicine, 158 (5),
390-397.
