On an orthopedic and medical-surgical unit there was increased falls, basic rounding (peek and go), heavy call light use, spread out RN assignments, and patients being left alone in the bathroom. Analysis of unit safety events identified 62% of falls were toileting-related with last void time being greater than two hours. Purposeful hourly rounding has been supported by the literature as an appropriate, safe, and useful strategy for fall prevention and patient safety.
Purposeful rounding is defined as the intentional planned action of nursing staff through proactive anticipation of patient care needs by rounding each hour. In their article investigating the benefits of purposeful rounding, Sherrod, Brown, Vroom, and Sullivan (2012) found that of the individuals who fall, 20% to 30% suffer moderate-to-severe injuries that make it hard for them to stay independent and decrease life expectancy. Incorporating hourly rounding into an already established fall prevention program can strengthen the program and decrease fall rates. According to Hicks (2015), hourly rounding is one of the most important actions nurses can take to improve patient safety and reduce falls as much as 50% in hospitals.
Interventions were implemented in seven phases. In phase one, the 5Ps of purposeful rounding were identified: potty, pain, possessions, pump, and position. Staff were educated on how the 5Ps can be integrated into nursing practice. An education sheet in our admission packet is used to educate our patient population on purposeful rounding and what they should expect. The RN is to present the education sheet upon admission to our unit. An example script was created for staff to use to explain purposeful rounding to patients in about 25 seconds. In phase two, staff were informed that they must be within arm’s reach at all times while toileting for any patient requiring any ambulation assistance. For phase three, block RN/NA assignments were created in order to keep staff closer to patients. In phase four, lunch buddies were initiated to provide coverage at all times. In phase five, safety rounds were initiated at every shift change. Topics discussed in shift change safety round include falls, bed alarms/confused patients, patient attendants/remote video monitors, extra precautions, behavior issues, elopement risk, number of heavy patients, and admits and discharges expected for the shift. In phase six, UCC (iPhones) were introduced to the unit, making communication among staff members easier and more efficient. In phase seven, the patient care visual board was initiated to enhance communication among staff members about patient care needs.
After implementation of interventions, overall falls decreased by 56% and bathroom related falls decreased by 52%.