Evidence Based Inquiry for Scholarship and Practice-MSN563

Can hourly rounding reduce falls, injuries and healthcare associated infections?

Patient safety in healthcare facility is affected by injuries, falls, and healthcare associated infections. These problems interfere with the quality of the healthcare services that are supposed to be received by the patients. Nurses employed in long-term care like the medical-surgical units are always under pressure to provide healthcare services and to improve the safety of the patients. The majority of the patients in medical-surgical units are elderly and most of them are older than 65 years. These populations are therefore exposed to the risk of falls and injuries (Daniels, 2016).

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Project purpose Statement

The purpose of the capstone project is to focus on the effects of the hourly rounding on the safety of the patients. The procedure of the hourly rounding considers positioning area, the proximity of the personal items, bathing, and pottying. Informing the patients about the role of the nurses is important in improving the comfortability that is needed by the patient. Making the patients aware of the work and the intention of the nurses is helping in reducing the level of stress especially when there is no nurse around. It also assists in reducing the patients’ need for ambulance thus reducing the risk of falls (Flynn et al., 2016).

Background

In healthcare facilities, elderly patients are exposed to a higher level of stress as a result of the rising healthcare conditions, treatment, nursing care they require. Nurses are also not free from these problems since they are socially and emotionally affected by the increased level of responsibilities. The elderly patients in the medical-surgical units experienced a decrease in their ability to perform the general ADLs. This, therefore, implies that in addition to the provision of nursing care to the patients, nurses help patients to meet their basic needs such as repositioning, eating, and elimination. The lack of information about the routines in the medical-surgical units increases assistance seeking by the patients thus increasing the nursing. This problem, therefore, requires evidence-based interventions to ensure that there is an improvement in the safety of the patients. One of the interventions that are considered effective in dealing with the above issues is hourly nursing rounding (Gormley, et al., 2019).

Significance of the problem

The process of dealing with the problem presented in this case i.e. safety of the patients is important in revealing some of the pressing issues that patients and the nurses are facing concerning safety. In the healthcare facilities especially medical-surgical units, patients are at higher risks of falls, nosocomial infections, and pressure ulcers. The process of dealing with these issues requires effective strategies which must be implemented fully or the goal of achieving the patients’ safety is realized (Brosey & March 2015).

Addressing some of the issues that affect the safety of the patients is helping in revealing other forms of challenges that are faced in having effective strategies of addressing the issues such as falls, injuries, and nosocomial infections among others. It reveals some of the barriers that nurse managers are facing when it comes to the provision of the necessary resources and support required for the successful implementation of the intervention (Al Kuwait & Subbarayalu, 2017).

Usually, healthcare facilities are faced with the problems of a low nurse-to-patient ratio. This makes the implementation process of the intervention such as hourly nursing rounding to be unsuccessful in addressing the problem of the patients’ safety. When nurses are faced with an increased workload, it makes it hard to handle every need of the patients thus exposing patients to danger as a result of lack of emergency attendance. Therefore, this is significant in informing about the need to have an increase in the number of nurses to help in ensuring that the hourly rounding intervention is fully implemented to meet the needs of every patient (Daniels, 2016).

The possible impact of the project on the anticipated outcome of the betterment of health and or health outcomes

One of the most important effects of the successful implementation of the intervention is the overall reduction in the rates of falls. The reduced rate of falls implies that the safety of the patients is improving. It is also related to the drop in the healthcare cost since there need for the readmission for the fall-related injuries would not be there. It is also expected that the hospital reputation would be improved since the reported rising cases of hospital readmission, morbidity, and mortality associated with injuries, falls, and hospital-acquired infection would no longer be the case or concern. This is likely to benefit healthcare facilities due to the possibility of having an increase and continuous flow of reimbursement from the Centers for Medicaid and Medicare (CMS) (Brosey & March 2015).

The intervention is also addressing the patients’ anxiety since it creates a proactive and regular checking of the patients which ensures that nurses are always closer and present near the patients. Usually, patients are emotionally affected in the absence of the nurses and this interferes with the patients’ healing process. The implementation of the intervention, therefore, helps in the promotion of the coping skills that are helping in the successful healing process of the patients (Brosey & March 2015).

The implementation of the intervention is helping in ensuring that the needs of the patients are met. Some of the important patients’ needs such as bathing, pottying, positioning, control of the pain, and the proximity to the necessary items are addressed by the hourly nursing rounding. The intervention helps in creating a structured format that assists in ensuring that the needs of the patients are met (Gormley, et al., 2019).

PICOT Formatted Clinical Project Questions

Population: the targeted population is elderly individuals admitted to the medical-surgical units 60 years and older. The patients have a reduced ADLs, therefore, they rely mostly on the help of the patients for their bathing and pottying. These demands expose these patients to stressful situations due to the absence of the nurses in their units. The overdependence on the nurses implies that patients have to rely solely on nurses for their daily needs.

Intervention: the intervention to be implemented is focused on the hourly nursing rounding to ensure that the needs of the patients are addressed for their safety. The majority of the nurses in these units are exposed to the risk of falls and injuries when they attempt reaching out to their items, pottying, and bathing. Therefore, the intervention would be important in ensuring that the patients are assisted with these needs.

Comparison: the proposed intervention is compared to the non-scheduled rounding of the nurses.

Outcome: the anticipated outcome is the reduction in falls, injuries, and nosocomial infection thus assisting in the achievement of patients’ safety.

Time: the implementation of the program is expected to take at least six months for the implementation with the medical-surgical units.

References

Al Kuwait, A., & Subbarayalu, A. V. (2017). Reducing patients’ fall rate in an Academic Medical Center (AMC) using Six Sigma “DMAIC” approach. International journal of health care quality assurance. https://doi.org/10.1108/IJHCQA-03-2016-0030

Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159. http://doi:doi:15505065.

Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Evidence Synthesis, 14(1), 248-267. http://doi:10.1097/NNA.0000000000000101

Flynn, F., Evanish, J. Q., Fernald, J., Hutchinson, D. E., & Lefaiver, C. (2016). Progressive care nurses improving patient safety by limiting interruptions during medication administration. Critical Care Nurse, 36(4), 19-35. https://doi.org/10.4037/ccn2016498

Gormley, D. K., Costanzo, A. J., Goetz, J., Israel, J., Hill-Clark, J., Pritchard, T., & Staubach, K. (2019). Impact of nurse-led interprofessional rounding on patient experience. Nursing Clinics, 54(1), 115-126. https://doi.org/10.1016/j.cnur.2018.10.007