Abstract
Practice Problem: Falls significantly affect patients, resulting in temporary or permanent harm, even death. In a large acute care facility, patient falls increased from 444 in 2016 to 556 falls in 2019. PICOT: In an adult inpatient hospital setting, does purposeful hourly rounding (PHR), compared to no rounding, reduce patient falls over a period of 30 days during the same time period from the previous year? Evidence: Of the 360 articles reviewed, 12 articles, varying from evidence levels two (1), level three (4), and level five (7), supported PHR as effective in reducing harm from falls in adult hospital settings. The majority of this lower level evidence supported implementation of PHR as a pilot. Intervention: PHR, shown to improve fall rates using the proper application of tools, specifically the Studer Group Purposeful Hourly Rounding LogSM (2020a), was implemented to decrease falls over a period of 30 days during the same period from the previous year, without the previously used bedside sitters. Outcome: The falls rate for the baseline period was 4.11 falls per 1,000 occupied bed days; and 5.07 falls per 1,000 occupied bed days for the implementation period. The incidence rate ratios of the falls rate between baseline and implementation was 0.81 (x2(1) = 0.140, p = 0.708; 95% CI = [0.27, 2.42]). Conclusion: In this EBP change project, PHR did not result in a decrease in patient falls; however, the potential ramifications from the clinical significance of PHR should be considered.
Highlights
Evidence shows that inpatient falls and falls with injury are complicated phenomena involving multiple factors that can be intrinsic to the patient, such as age, physical or mental condition, and extrinsic or environmental factors (Zhao et al, 2019)
For the current EBP change project, the PICOT question is: "In an adult inpatient hospital setting (P), does purposeful hourly rounding (I), compared to no rounding (C), reduce patient falls (O) over a period of 30 days from the previous year (T)?" The target patient population was specific to adult patients over 18 years of age who were admitted to the medical-surgical unit
Exclusion criteria were the following: articles in outpatient practices, pediatrics, ambulatory services, and the use of bedside sitters with documented suicidal ideation. This available knowledge assisted in building the answer to the PICOT question: "In an adult inpatient hospital setting, does purposeful hourly rounding, compared to no rounding, reduce the patient falls over a period of 30 days during the same time period from the previous year?" When synthesized, the amassed literature supported PHR as an effective strategy for reducing harm through falls in the adult inpatient hospital setting
Summary
Evidence shows that inpatient falls and falls with injury are complicated phenomena involving multiple factors that can be intrinsic to the patient, such as age, physical or mental condition, and extrinsic or environmental factors (Zhao et al, 2019). Literature shows that patient falls increase suffering through risk of injury, longer length of stay, pain, distress, and loss of confidence, independence, or even life (Hiyama, 2017) The site of this EBP change project, like all healthcare organizations, has the ethical obligation to reduce preventable hospital-acquired conditions, such as falls, reducing the physical, psychosocial, and financial burden to the patient and the community (AHRQ, 2019). For the current EBP change project, the PICOT question is: "In an adult inpatient hospital setting (P), does purposeful hourly rounding (I), compared to no rounding (C), reduce patient falls (O) over a period of 30 days from the previous year (T)?" The target patient population was specific to adult patients over 18 years of age who were admitted to the medical-surgical unit. The outcome, which the EBP change project aimed to accomplish, was a reduction in patient falls via PHR within this given time
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