HCA 699 Section C: Solution Description

Falls among hospitalized patients should be prevented at all costs to improve patient outcomes. The incidences of in-hospital falls are increasing within the organization and are the second leading cause of accidental or unintentional deaths. These occurrences are preventable accidents yet continue to be a highly prevalent patient safety issue (Walsh et al., 2018). There is increasing evidence that fostering safety and cautious culture within clinical teams can help reduce or prevent falls and other harmful events. This project has described, in the previous sections, in-hospitals and how they impact patients’ health status. However, this section of the project provides a project solution in the following criteria: the proposed solution, organization culture, expected outcomes, methods to achieve outcomes, as well as outcome impact.

Proposed Solution

The proposed solution to prevent falls among admitted patients is hourly rounds. Rounding is a process where healthcare providers intentionally check patients at regular intervals to meet their needs proactively (Grillo, Firth, & Hatchel, 2019). Hourly rounds are a very important activity that nurses can employ to promote patients’ safety as well as reduce falls by as much as 50% and above in the clinical setting. Major components of hourly rounds include addressing the 4ps (pain, potty, position, and possession), reducing anxiety, assessing patients’ environment for safety concerns, and informing the patients when staff will return.

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Hourly rounding is associated with reduced patient falls, improved patient experience, and increased staff satisfaction. Therefore, in this project, the proposed solution is hourly rounds which are expected to reduce the prevalence of falls among admitted patients and the overall nursing care. Different studies have also supported the use of hourly rounds For instance, Brosey and March (2015) employed a standardized hourly rounding for three months and monitored the outcomes. The hourly rounding study was carried out in a 24-hour bed medical-surgical unit. The authors stated that the results of the study indicated a reduction in falls from 7.02 to 3.18 per 1000 patient days. This is evidence-based support that hourly rounds can prevent inpatient falls in a surgical unit.

Organizational Culture

Organizational culture can be described as shared beliefs, values, and norms related to patient safety. The safety culture within the organization will support the implementation of hourly rounds. Considering the importance of roles of nurses to promote patient safety, their knowledge, and experiences, it is without a doubt that the solution will be successful. (Linehan & Linehan, 2018). The facility has enough healthcare providers including nurses, physicians, doctors, and clinicians which will promote the effectiveness of the project. Hourly rounding has faced major problems in terms of implementation in hospitals with staff shortage.

The effective components of patient safety such as teamwork, communication, and leadership support are well evident within the employees. Furthermore, the facility has always promoted reporting and learning culture to ensure competency is maintained. The organizational leadership has been outstanding in promoting and supporting safety projects including training and education (Walsh et al., 2018). The decision-making process is always inclusive of all staff as opposed to some workplaces where all decisions are reached by one or a few people. Besides, the organization has well-established policies that require everyone to participate in activities that bring benefits to patients, staff, and the organization. Everyone must work towards achieving organizational goals, vision, and mission.

Expected Outcomes

These are forecast results that are yet to be achieved as a result of implementing hourly rounds. It is expected that after the implementation of hourly rounds, the prevalence of falls among the adult inpatients in the medical-surgical units will reduce to below 2 percent cases per month. Additionally, the risks that may lead to future falls will be identified and appropriate measures are taken to ensure falls among patients in the surgical unit do not occur in the future (Jarrell, 2016). The number of deaths, disabilities, and other adversities associated with falls is expected to reduce in the surgical unit. Nurses will also get the opportunity to compare the effectiveness of nursing rounds and call lights regarding the reduction of the prevalence of falls among patients in the surgical unit. Furthermore, patient satisfaction is expected to dramatically improve. Nurse workload per shift is expected to reduce since the burden of work caused by patients who experienced falls will no longer be available. The organizational goal of achieving and maintaining high-level patient safety measures will be achieved. This achievement is worth celebrating not only in the surgical unit but for the entire organization (Jarrell, 2016). This strategy is expected to be adopted in the entire organization (by all units) after its success is manifested in the surgical unit.

Method to Achieve Outcomes

The setting of the project is the surgical unit of the hospital where falls are mostly reported. It will be a 30-day prospective pilot study to determine the effectiveness of hourly rounds on the prevention of inpatient falls in the surgical unit. The patient-centered hourly rounds will be designed collaboratively with clinical nurses and physicians (Farokhzadian, Nayeri, & Borhani, 2018). Educating the staff is the first step in implementing hourly rounds. A one hour class will be introduced at regular times for both nurses and physicians two weeks before project implementation. There will be one-hour training three times a week two weeks before the implementation. Several vignettes will be shown during the lessons to reinforce positive behaviors.

The objectives of the training sessions were to ensure staff understands the hourly rounds, recognize its value, and receive the knowledge required to effectively implement them. Also, the training sessions were meant to ensure that the rounds are patient-centered and that they happen at specific times (Linehan & Linehan, 2018). The rounds will be conducted every hour between 6 am and 10 pm and every 2 hours between 10 pm and the rounding will majorly be performed by nurses and nurse leaders and physicians. The Mann-Whitney test will be used to compare baseline fall rates with the project period. The evaluation will be carried out based on the fall rates and other factors such as reduced accidents and deaths due to patient falls in the surgical unit.

Some of the limitations that need to be addressed to ensure success in the implementation process include financial resources, staff adequacy, management support, and training. There must be enough resources to implement the project. Also, there must be enough nurses to ensure that workload does not compromise the process (Farokhzadian et al., 2018). Nurse workload due to staff shortage may make nurses miss some scheduled hourly rounds. Additionally, training is important to show nurses and physicians the process and the value of implementing the intervention. Management support is highly required to ensure the project succeeds.

Outcome Impact

The outcomes will impact positively on quality care improvement, patient-centered quality care, the efficiency of processes, environmental changes, and/or professional expertise. In healthcare quality improvement is the framework used by the hospital to systematically improve the ways care is provided to patients (Alves et al., 2016). The outcomes will impact positively on quality care improvement. For instance, the care setting is likely to adopt the new ways of delivering quality care to the patients. There will be increased teamwork among and between nurses and physicians to improve patient care. The process of the intervention includes environmental assessment (Alves et al., 2016). It will improve the patient’s environment to prevent risks associated with falls. The patients’ environment will change positively by ensuring that it is well arranged, dry, and other aspects.

Furthermore, the hospital system is likely to change in terms of patient-centeredness. The solution is patient-centered hourly rounds which will, in turn, promote the aspect of patient-centered care in the entire organization. The aspect of patient-centered care will be adopted not only in the surgical unit but also in other units such as the stoke unit to promote quality patient outcomes (Brosey & March 2015). The process of care will be positively impacted. The outcomes associated with reduced falls will, in turn, lead to a decreased workload for the nurses and physicians. Reduced workload smoothens the process of care hence its effectiveness. Finally, the outcomes impact positively on professional expertise since the nurses will gain competence required in managing falls as well as those required to carry out hourly rounds.

Conclusion

The proposed solution for the problem is the implementation of hourly rounds. Hourly rounds are a very important activity that nurses can employ to promote patients’ safety as well as reduce falls by as much as 50% and above in the clinical setting. The organizational culture is likely to promote the intervention. The expected outcomes include reduced incidences of falls as well as deaths and disabilities associated with falls. The outcomes will impact positively on quality care improvement, patient-centered quality care, the efficiency of processes, environmental changes, and/or professional expertise.

References

Alves, A. H. C., Patrício, A. C. F. D. A., Fernandes, K. D. A., Duarte, M. C. S., Santos, J. D. S., & Oliveira, M. S. D. (2016). Occurrence of falls among elderly institutionalized: Prevalence, causes and consequences. Journal of Research and Fundamental Care, 8, 4376-4386. doi:10.9789/2175-5361.2016.V8i2.4376-4386

Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30, 153-159. doi:10.1097/NCQ.0000000000000086

Farokhzadian, J., Nayeri, N. D., & Borhani, F. (2018). The long way ahead to achieve an effective patient safety culture: challenges perceived by nurses. BMC health services research, 18(1), 1-13. doi: 10.1186/s12913-018-3467-1.

Grillo, D. M., Firth, K. H., & Hatchel, K. (2019). Implementation of Purposeful Hourly Rounds in Addition to a Fall Bundle to Prevent Inpatient Falls on a Medical-Surgical Acute Hospital Unit. Medsurg Nursing, 28(4), 243-250.

Jarrell, J. L. (2016). Systematic Appraisal of the Literature on the Effectiveness of Fall Prevention Interventions in Acute Care Settings. Retrieved from http://purl.flvc.org/fsu/fd/FSU_libsubv1_scholarship_submission_1461099355

Linehan, J., & Linehan, J. (2018). Fall Prevention in Long Term Care Using Purposeful Hourly Rounding. Journal of the American Medical Directors Association, 19(3), B17. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=4811&context=dissertations

Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal trends in fall rates with the implementation of a multifaceted fall prevention program: persistence pays off. The Joint Commission Journal on Quality and Patient Safety, 44(2), 75-83. doi: 10.1016/j.jcjq.2017.08.009.