Hourly Rounding and Fall Prevention among the Elderly in Long Term Care: A Change Process
Falls are a common and serious problem for elderly people living in long term care facilities. According to the Centers for Disease Control and Prevention (CDC), one out of four older adults falls each year, and about 20% of falls cause serious injuries such as head trauma or fractures (CDC, 2021). Falls can also lead to reduced mobility, increased dependence, decreased quality of life, and increased risk of death. Therefore, preventing falls is a crucial goal for long term care providers and staff.
One of the strategies that has been shown to reduce falls and improve patient outcomes is hourly rounding. Hourly rounding is a systematic process of checking on patients every hour to address their needs and ensure their safety. Hourly rounding can include tasks such as assessing pain, offering toileting assistance, repositioning, providing hydration, and ensuring that the environment is safe and comfortable (Tucker et al., 2012). By performing these tasks regularly, staff can anticipate and prevent potential problems that could lead to falls, such as urinary urgency, poor positioning, dehydration, or clutter.
Hourly rounding also has benefits for staff and the organization. Hourly rounding can improve staff satisfaction, communication, teamwork, and efficiency. It can also reduce workload, interruptions, call light use, and complaints. Furthermore, hourly rounding can enhance the quality of care, patient satisfaction, trust, and engagement. By providing consistent and proactive care, staff can build rapport with patients and their families, and demonstrate their commitment and professionalism (Ford et al., 2019).
However, implementing hourly rounding in long term care settings is not easy. It requires a change in the culture, behavior, and attitude of staff and managers. It also requires adequate resources, training, support, and feedback. Some of the barriers that can hinder the adoption of hourly rounding include resistance to change, lack of time, staff turnover, competing priorities, and insufficient leadership (Meade et al., 2016). Therefore, to successfully implement hourly rounding and sustain its benefits, a systematic and evidence-based change process is needed.
One of the models that can guide the change process is the Plan-Do-Study-Act (PDSA) cycle. The PDSA cycle is a simple and iterative method for testing and improving changes in practice. It consists of four steps: plan a change, do the change on a small scale, study the results, and act on what is learned (Institute for Healthcare Improvement [IHI], 2020). The PDSA cycle can help staff and managers to identify problems, generate solutions, test their effectiveness, monitor outcomes, and make adjustments as needed.
The following is an example of how the PDSA cycle can be applied to implement hourly rounding in a long term care facility:
– Plan: The first step is to plan the change. This involves identifying the aim, the measures, and the plan for testing the change. For example, the aim could be to reduce falls by 50% in six months by implementing hourly rounding in one unit. The measures could include the number of falls per month, the percentage of patients who receive hourly rounding, the call light use per day, and the patient satisfaction scores. The plan for testing the change could involve selecting a small group of staff who are willing to try hourly rounding for one week.
– Do: The second step is to do the change. This involves carrying out the plan and collecting data. For example, the staff who agreed to try hourly rounding would perform it for all their patients during their shifts for one week. They would document their rounds using a checklist or an electronic system. They would also collect data on falls, call light use, and patient satisfaction.
– Study: The third step is to study the results. This involves analyzing the data and comparing them to the baseline or expected results. For example, the staff would review the data and see if there was any improvement in falls, call light use, or patient satisfaction after one week of hourly rounding. They would also identify any problems or challenges they faced during the implementation.
– Act: The fourth step is to act on what is learned. This involves deciding what to do next based on the results. For example, if the results showed that hourly rounding reduced falls and improved patient satisfaction, the staff would decide to continue doing it and spread it to other units. If the results showed no improvement or negative effects, the staff would decide to stop doing it or modify it based on feedback.
The PDSA cycle can be repeated as many times as needed until the desired outcome is achieved. By using this cycle, staff and managers can implement hourly rounding in a systematic and effective way.
CDC. (2021). Important facts about falls. Retrieved from https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
Ford B.M., Hartman C.L., & Teske J.A. (2019). Hourly rounding: Perspectives and perceptions of the frontline nursing staff. Journal of Nursing Management, 27(1), 165-171. https://doi.org/10.1111/jonm.12647
IHI. (2020). How to improve. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/default.aspx
Meade C.M., Bursell A.L., & Ketelsen L. (2016). Effects of nursing rounds on patients’ call light use, satisfaction, and safety. The American Journal of Nursing, 116(9), 58-63. https://doi.org/10.1097/01.NAJ.0000494679.79846.f2
Tucker S.J., Bieber P.L., Attlesey-Pries J.M., Olson M.E., & Dierkhising R.A. (2012). Outcomes and challenges in implementing hourly rounds to reduce falls in orthopedic units. Worldviews on Evidence-Based Nursing, 9(1), 18-29. https://doi.org/10.1111/j.1741-6787.2011.00227.x