Fall Prevention: A PICO Model
Keyana Butler
Saint Joseph’s College
November 16, 2018
Fall Prevention: A PICO Model
The purpose of this paper is to evaluate the effectiveness of performing hourly rounding compared to every 2 hours in decreasing the incidence of patient falls in hospitalized adult patients. Patient falls are preventable and should be avoided at all costs as they can be detrimental to the overall health of hospitalized patients. Any injury or death that results from a patient fall is considered to be a “never event,” or an event that should not have occurred (Schub & Woten, 2018). Many nursing interventions are implemented in hospitals already to decrease accidental patient falls; however, research shows promise in providing hourly rounding as another way to decrease patient falls.
Definition of Terms
• Intentional rounding: A process of interacting with patient on a planned, regular basis to anticipate their fundamental care needs, also known as hourly or comfort rounding (Hutchings, Ward & Bloodworth, 2013).
• Never event: A serious, preventable and costly medical error (Schub & Woten, 2018).
Identify the Question
Why is this relevant and what are implications to nursing? At least 1 page!! Do not fluff it, make it simple. Why do nurses care?
The question being studied is as follows; in hospitalized, adult patients, does hourly rounding by registered nurses, compared to Q 2 hours, decrease the incidence of falls? It is important because accidental patient falls are associated with many different consequences such as longer hospitalization, significant healthcare costs, injuries, and even death (Schub & Woten, 2018). One study showed that at a 728-bed hospital, the average length of stay of patients who had fallen was approximately 11 days longer than those patients who did not. The study also showed that the patients who did not fall were 2.4 times more likely to be discharged early from an acute care setting (Schub & Woten, 2018). This topic is important to hospitals because the Centers for Medicaid and Medicare Services, CMS, will not reimburse a hospital for any care that was required as a result of the accidental fall. In 2015, the cost related to accidental falls in all settings was $637.2 million with the cost of non-fatal falls reaching $31.3 billion. For one individual patient fall, the average cost of medical care was about $9,780 (Schub & Woten, 2018).
Nurses care about accidental patient falls because they are one of the leading causes of injury in the hospital setting and can be easily prevented. Since the responsibility of a nurse includes maintaining patient safety, identifying risk factors and preventing falls is a top priority in nursing care (Hicks, 2015).
Literature Search
For this search process, three databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, and The Cochrane Library, were systematically searched using the Boolean operators. The inclusion criteria used in the search were full text, peer-reviewed, and the year of publication limited to 2013 or newer. The search terms used in the search included fall prevention, hourly rounding, intentional rounding, hospitalized patients, and acute care. With the use of the listed search terms, 9 to 23 articles came up depending on which of the three databases were used.
One study (Hutchings, Ward & Bloodworth, 2013) reported results from a process spread across 79 wards in Nottingham University Hospitals. A problem identified was poor staff engagement, so a nurse spent three months at hospitals in the United States observing hourly rounding. A nurse placed a clock at the patient’s bedside which would state when the nurse would visit the room again. It would also include important things to be aware of as well as important topics that were discussed between the nurse and patient; these were called the patient’s P’s and Q’s. Doing hourly rounding was found to increase patient safety, decreased the number of patient falls by 52%, decreased the amount of call lights by 37% and increased patient satisfaction overall. (Hutchings, Ward & Bloodworth, 2013).
An integrative review (Hicks, 2015) looks at results from 14 studies on performing hourly rounding to reduce the numbers of patient falls in acute care settings. This article discusses the seriousness of patient falls and how harmful they are to a patient’s health. Studies took place over a few months to multiple years of observation in hospitals, particularly medical surgical units to aid in the research findings. Since falls are an ongoing safety concern in hospitals, taking every action to avoid them is crucial. In this integrative review, findings from a variety of independent studies are summarized to conclude that hourly rounding showed promising results in decreasing patient falls. In each of the 14 studies, the findings did conclude that falls did decrease, but were reported in various units of measurement. Some of the studies reported no falls at all during the time of the study or reported a decrease in the percentage of falls being a 36%, 39%, and 57% decrease. Others used a ratio of falls per 1000 patient days (p=0.01, p=0.04, p=0.672, p=0.07) all of which reported a significant decrease in patient falls. The interventions used included hourly rounding using the 4 P’s; pain, personal needs, position, and possessions. Both decreased the incidence of falls, but more frequent rounding, hourly rounding, was more effective (Hicks, 2015).
A review (Forde-Johnson, 2014) defines what intentional rounding is and why it is important to meeting fundamental needs of a patient. This study explores what are known as the four P’s in risk assessment. The four P’s include positioning, personal needs, pain and placement. By performing hourly rounding, also known as intentional rounding, the nurse is able to group all tasks in one visit to provide proactive care while meeting all of the patient’s needs. Nine studies were examined for the effect that hourly rounding had on patient outcomes. Within the studies, rounding was done every hour or every two hours. This study, much like the ones above, found that performing intentional rounds reduced patient falls and pressure ulcers, use of call bells, patient complaints, and increased the patient’s satisfaction with their care. The incidence of patient falls decreased by 50%, the use of call bells by 38%, pressure ulcer incidence 14%, and a 12-point increase in patient satisfaction (Forde-Johnson, 2014).
A systematic mixed-method review (Christiansen, Coventry, Graham, Jacob, Twigg, Whitehead, 2018) was used to determine the impact of intentional rounding on patient and nursing outcomes. It was also used to identify any barriers in implementing intentional rounding. The Joanna Briggs Institute methodology was used, and 21 studies were included. The effectiveness of intentional rounding was reported on in 11 of those studies; 6 studies reported a significant reduction in patient falls and 5 reported a reduction. One study reported a reduction of 7.02 per 1000 patient days to 3.18 per 1000 patient days which equates to a 57.7% reduction in patient falls. Another study reported a reduction in falls from 25 to 12 during the time of the study. Again, the studies did not have a standardized unit of measurement to report their rate of patient falls, so the results did vary. In general, patient falls decreased with the use of intentional rounding (Christiansen et al., 2018).
Action Plan
Give a recipe of what you would do in your hospital. A plan as to what to do, step by step? Measure falls before intervention & after intervention or a group getting hourly rounding or just shift assessments. What you are going to do, how you measure/look at outcome? Who is responsible for carrying it out? Make it about half of a page, get right to the point.
Follow-Up and Evaluation Plan
How you measured, what scale you used? If you use a scale, you can define that scale in the definition of terms. Short and sweet. “Success of trial will be done by…”
Conclusions/ Special Considerations
Do you need assent/consent? Ethical dilemmas? Wrap up the paper.
A good paper is 5 pages (not including title & references), do not go over 10 pages!!!
(Last name, pub year, p. #).
References
Christiansen A, Coventry L, Graham R, Jacob E, Twigg D, Whitehead L. Intentional rounding in
acute adult healthcare settings: A systematic mixed-method review. J Clin Nurs.
2018;27:1759–1792. https://doi.org/10.1111/jocn.14370
Forde-Johnston, C. (2014). Intentional rounding: a review of the literature. Nursing
Standard, 28(32), 37–42. https://doi.org/10.7748/ns2014.04.28.32.37.e8564
Hicks, D. (2015). Can Rounding Reduce Patient Falls in Acute Care? An Integrative Literature
Review. MEDSURG Nursing, 24(1), 51–55. Retrieved from
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rue&db=a9h&AN=100884141&site=ehost-live&scope=site
Hutchings, M., Ward, P., & Bloodworth, K. (2013). “Caring around the clock”: a new approach
to intentional rounding. Nursing Management – UK, 20(5), 24–30. Retrieved from
http://ezproxy.sjcme.edu:2048/login?url=http://search.ebscohost.com/login.aspx?direct=t rue&db=rzh&AN=104223637&site=ehost-live&scope=site
Schub, T., & Woten, M. (2018). Fall Prevention in Hospitalized Patients. CINAHL Nursing
Guide. Retrieved from
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