Fall Prevention by Hourly Rounding – Care Example

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"Fall Prevention by Hourly Rounding" is an outstanding example of a paper on care. Accidental falls in hospitals are still common events that lead to physical injury or even death. It is a public health problem that affects the elderly patients in hospitals around the world, with fall rates varying between 2.2 to 17.1 falls per 1000 bed days are reported. Falls are devastating to both the family and the patient with 33% to 60% of falls leading to injury and 15% resulting in severe harm (Tzeng H, 2010). Besides the physical problems that come about with falls, patients and their relatives may end up having not only physiological but financial burdens.

Patients who have experienced a fall are normally in fear of experiencing another, and this may in turn lead to a decrease in functionality due to decreased mobility. Consequently, this may result in increased dependence on care and social isolation. When one becomes increasingly independent, their ability to self-care is affected which may translate to a discharge too long extended care. Falls and fall-related injuries in the SNF (Short-term Nursing Facilities) lead to significant economic and health costs to the organizations due to extra diagnostic procedures and increased length of stay.

Other factors include the potential for litigation and possible surgery (Choi Y-S et al. 2011). It is reported that patients who fall have two times the hospital cost as case-matched to patients who do not experience falls. The focus on fall prevention has increased in a number of countries, with some implementing national health standards. The rules aim at ensuring quality, safety, and evidenced practice among hospitals taking care of the elderly (Ford BM, 2010).

However, despite the increased research activities that focus on prevention over the last decade, decreasing the fall rate remains an important challenge that continues to affect health care institutions. A number of both extrinsic and intrinsic factors have been identified that lead to patients falling. Some of the external factors include the condition of flooring, physical environment, poor lighting, some medications, improper use of devices, and inappropriate footwear. Intrinsic factors are patient-related and include reduced vision, previous falls, musculoskeletal system deficit, acute illness, and mental status deficiency. Research has revealed that hospitals can reduce the severity and incidences of falls by focusing on the risk factors and coming up with appropriate interventions to reduce the risks identified.

However, a systematic review by Jayasekara and Stern to determine the most effective interventions for reducing the incidences of falls in elderly patients found out that very few interventions were effective. Hourly rounding is one of those responses of interest that was found to be effective in preventing falls. It is a process whereby the nurse attends to the personal and immediate needs of the patient every hour, including helping the patient to the toilet or bathroom where required.

It is in a quest of improving patient satisfaction and patient safety. It is a proactive approach to organizing nursing care and reducing falls. Nurses can engage patients in checking on their ‘ 4P’ s’ : position, potty (elimination), pain, and proximity of personal items every one hour (Koh SL et al. 2009). A number of recently published reviews are talking about the best available evidence to prevent a fall. Currently, there is none that has particularly synthesized the research findings concerning the efficiency of hourly rounding.

This study is to determine the best available evidence that supports the effectiveness of hourly rounding in preventing incidences of falls in the elderly.

References

Choi Y-S, Lawler E, Boenecke CA, Ponatoski ER, Zimring CM. Developing multi-systemic fall prevention model, incorporating the physical environment, the care process, and technology: a systematic review. Journal of Advanced Nursing. 2011.

Ford BM. Hourly rounding: A strategy to increase patient satisfaction scores. MEDSURG Nursing. 2010; 19(3): 188-91.

Stern C, Jayasekara R. Interventions to reduce the incidence of falls in older patients in acute care hospitals: a systematic review. JBI Library of Systematic Reviews. 2009.

Tzeng H. Understanding the prevalence of inpatient falls associated with toileting in adult care settings. Journal of Nursing Care Quality. 2010.

Koh SL, Lee JY, Hafizah N, Loo YL, Muthu R. Impact of a fall prevention program in an acute hospital setting in Singapore. Singapore Medical Journal. 2009.

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