Outcomes and Challenges in Implementing Hourly Rounds to Reduce Falls in Orthopedic Units

Abstract

Patient falls remain a common adverse event in acute care facilities. Findings from research into structured nursing rounds interventions (SNRIs) indicate promise as a fall prevention practice. Translating, adapting, and sustaining SNRI in real world clinical practices is an important next step. The purpose of this study was to evaluate the feasibility of adapting and translating a SNRI to reduce the risk and incidence of patient falls on two orthopedic inpatient units. It was hypothesized that SNRI would reduce fall rates up to 1-year postintervention and that patient risk factors and documented SNRI activities would predict falls. Using a repeated measures design, fall rates and risk assessment data were collected at baseline, during the 12-week SNRI implementation, and 1-year following implementation. The adapted SNRI included hourly prescribed rounding activities documented on a study specific form. Medical records of patient falls were reviewed for each period. Focus groups were conducted with nurses' postintervention. Observed (probability) fall rates were 1.8%, 0.8%, and 1.1% for the three periods, respectively. Numbers of falls per 1,000 hospital days (incidence) were 4.5, 1.6, and 3.2 for the three periods. Mean fall risk assessment scores were 2.7 ± 1.1, 2.7 ± 1.1, and 2.5 ± 1.1 for the three periods. Fall rates declined during SNRI (borderline trend), yet 1-year follow-up rates drifted back toward baseline. SNRI dosage and fall risk scores did not predict fall rates. Patients who fell during the three periods were not at greatest risk. Nurses interpreted SNRI as an imposition and the documentation a burden. Findings illuminate the multiple challenges in translational research. SNRI appeared to reduce fall rates initially, but fidelity to the SNRI implementation and documentation was variable and fall reduction gains appeared lost 1 year later. Nurses expressed the importance of balancing intervention fidelity and individualizing patient interventions.