Hourly Rounding Case Study

i. Does the patient need to use the restroom, urinal or ambulate to bathroom and if so, assist them to prevent falls and stay with them until completed

After all these setbacks, Mr. Grieg and his teams continued to strategize ways to resolve this issue. The team where knowledgeable about VH’s in house repairs of certain hospital equipments and had to figure out if the company where capable of repairing the endoscope due to the complicated nature of the equipment. One of the team members, Steve Elder suggested a coordination process between Victoria Hospital and its affiliated partners. This suggestion was due to a meeting Mr. Elder had attended in Toronto where multiple hospitals combined their purchasing budgets to form an in house repair department.

During hourly rounds assess the patients pain level and take necessary intervention to alleviate pain, reposition patients who need assistance and make sure that urinals and call light and telephone are within reach of the patient. Taking care of these needs in a timely manner will make the patient comfortable, which will reduce anxiety and stress levels in the patient and reduce the risk of falls. The nurse should always make sure that the environment is safe for the patient by keeping the area clutter free. Comfort measures like tightening the wrinkled bed, giving warm blanket, changing moist dressings or repositioning the tubes or other objects that bothering the patient can enhance their comfort level Monitor high risk patients with delirium, dementia, hypotension, medications, and other conditions which can increase the risk of fall. Providing safety companions for continuous observation and to help the patients will reduce the number of falls. Nurses should educate and encourage patients to use the call light and phone to call for help. Provide patients with appropriate assistive devices like cane, walker as needed to keep them steady. I believe the concept in this theory of comfort can be utilized to reduce the occurrence of falls in health care settings.

If there is a fall with injury, the manager has the ability to go back and check how long the call light was on prior to a fall. However, this information is not used to prevent and emphasize the relationship between the length of time a call light is on and the rate of fall. Most nurses and patient care technicians are not aware that the manager can back-track the call light and find out this information. To measure the rate of falls to the length of time a call light is answered, the nurse working on the project choose the histogram. This illustrates the length of time in the Y axis and the rate of falls in the X axis during the period of study (time frame). The histogram itself will include a control group, average answers, and delay answers to call light. This example was imported and modified from a previous study done comparing the numbers of call lights and nursing rounds by (Meade et al. 2006).

Quality improvement is referred to as “the use of data to monitor the outcomes for care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care” (Sherwood & Barnsteiner, 2012). Data is used as the reflection of quality care that is provided by nurses and presents whether or not improvement is needed. In order for nurses to be mindful of the care that they give, they must be taught a systematic process of defining problems, identifying possible causes of those problems, and methods for trying out new solutions to prevent those problems (Sherwood & Barnsteiner, 2012). Currently, quality improvement measures are being utilized throughout hospitals to reduce the risk of patient falls and fall injuries.

In addition, high risk participants received education relating to falls which involved nurses instructing participants not to get out of bed without assistance, to press the call-bell for assistance and how to use the call-bell. As part of this study protocol, participants in the intervention group received usual care which include: fall risk assessment, placing the call-bell, TV remote control, eyeglasses, dentures, and hearing aids within the patient’s reach. Other interventions that have been used were bed and chair alarms, bed was in the lowest position at all time except when care was being provided and bed brakes were locked at all times. The patient’s elimination needs were scheduled every two hours, bedside commode was provided for frequent elimination needs, the patient was not left unattended while on bedside commode or in the bathroom. For a safe bathroom environment toilets was raised, toilet seats were secure, and handrails was strong enough to support patients, and patient was also instructed to pull the call light if feeling dizzy or in need of any assistance . Furthermore, the room temperature was

On May 23rd, 2017 I had the opportunity to attend a surgical floor UBC (unit based council) meeting. During this meeting, they discussed that they were having issues with their floating policy. It was brought up that there is no consistency in which surgical floor nurses are required to float to medical floor and PCU. For example, within a two week timespan, one nurse may have to float five times while their coworker only had to float twice. The staff members at the meeting proposed that they would like to weigh their possible options and come up with a fair solution.

During the practicum, one detailed assesses the organization as well as collaborate with the mentor and intraprofessionals. The major issue with the organization, Pacific Alliance Medical Center (PAMC), is the patient safety issue, fall. The capstone project topic would be Fall Reduction and Prevention. PAMC is a small community-based healthcare facility with only total 138 beds. There were total 72 falls in 2015 and 35 falls in 2016. Moreover, in the first quarter of 2017, 11 falls had occurred and just one week before my practicum, 3 falls happened within one week (these would be counted in the second quarter of 2017). The facility has spent ample expenditure in updating the new technological

VMPS has helped patient safety teams reduce the incidence of patient falls and bedsores. Prevention resources are brought to the bedside of patients determined to be at-risk, hourly rounding is done, and there is staff education and training. VM reduced patient falls from 3.33 falls per 1,000 patient days in 2006 to 2.48 falls per 1,000 patient days in 2009. Nationally, about 15 percent of patients will acquire a bedsore in a hospital or nursing home. At VM, bedsores were reduced from 8 percent to 2 percent.

Formative Evaluation is the method I will use to determine if hourly rounding does indeed increase productivity (and job satisfaction) of senior nursing students. According to Gallagher (2006), “[Formative evaluation’s] goals are to find out whether the program is being effective in order to change procedures to increase efficiency” (p. 122). Formative Evaluation will consider the level of which the nurses are

Hourly rounding is something that has been around for a while. One of the first things we learned in nursing school was that you should check on your patient every hour or every 2 hours (depending on nursing aid assistance). I started my research by looking at what hourly rounding entails. From there I found the majority of articles that think hourly rounding really does affect patient care and only a few opinion articles that think the opposite.

Falls among elderly individuals have continued to be a major challenge for health care providers. Individuals hospitalized for falls incur a higher health cost compared to other hospitalized patients. Despite efforts to reduce the number of falls through the use of some strategies, fall rates continue to be high in hospitals. According to Massachusetts Department of Public Health, and a recent summary performed by the Bureau of Health Care Safety and Quality (2011), Massachusetts acute care hospitals reported 57% of serious reportable events as environmental; 98% of those serious events were attributed to patient falls (Nientimp & Peterson, 2012). There is limited research that supports the idea that hourly rounding performed by nurses has an impact on reducing patient falls (Lascom, 2015).

Devote effort to focus on patient’s need for help with toileting, pain level, and positioning.

There has been a significant increase in the numbers of fall the past two weeks. Many resulted in serious head injuries. Please meet with the staff on your unit/shift to identify possible cause and develop strategies to prevent falls. Here are some suggestions:

Falls are one of the most common inpatient adverse events. According to the World Health Organization, a fall is defined as an event that results in a person coming to rest inadvertently on the ground or floor or other lower level (WHO 2016). In 2012, the cost of fall injuries totaled more than $36 billion. As the population ages, the financial toll for older-adult falls is projected to reach $59.6 billion by 2020. (NCQA 2015). Fall-related injuries account for up to 15 percent of rehospitalizations in the first month after discharge from hospital (Currie). Based on data from 2000, total annual estimated costs were between $16 billion and $19