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M. Hedgpeth DNP 850A-8 - coursework
Aspen University
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PSYCH135Preview text
Purposeful Hourly Rounding Impacting Client Outcomes By Marie M. Hedgpeth
Purposeful Hourly Rounding Impacting Client Outcomes Presented in Partial Fulfillment Of the Requirements for the Degree Doctor of Nursing Practice
Aspen University August 1, 2022
Purposeful Hourly Rounding Impacting Client Outcomes Chapter One: Introduction and Overview Preventing falls has become a principal matter within acute care hospitals and other healthcare organizations across the globe. Irrespective of geographical settings, the etiology of falls and the risk factors may be identified as intrinsic and extrinsic (Severo, Kuchenbecker, Vieira, Lucena, & Almeida, 2018). According to the World Health Organization (WHO), falls are defined as “inadvertently coming to rest on the ground, floor or other lower level” (World Health Organization, 2017, p). With the immense financial costs of falls in healthcare organizations, it is unsurprising that the WHO recommends that healthcare facilities capitalize on strategies to prevent falls. On numerous occasions, the risks of falls can be substantially decreased by executing low-cost modifications to an individual’s performance. Even though falls are correlated with severe morbidities and mortalities, falls are not an anticipated component of the aging process (World Health Organization, 2017). Preventing falls and injuries continues to be a significant challenge throughout health care settings. With the nursing shortage on the rise, preventing inpatient falls in healthcare settings concerns the nursing staff. Modern hospital-based reports consider inpatient falls preventable; consequently, falls are categorized as adversarial events (Morris & O’Riordan, 2017). Inpatient falls are the most significant safety occurrences. Thirty to fifty percent of falls result in some type of physical injury, with fractures occurring in one to three percent of the falls (Severo et al., 2018). Falls may result in psychological consequences leading to a loss of confidence which delays recovery and results in prolonged hospitalization that results in additional expenses for the client. Fractures, indwelling catheters, the fear of falling, emotional
inadequate staffing-client ratios, communication failures, and inadequate lighting (Westle, Berkert, & Paulus, 2019). Current informatic technology focuses primarily on receiving a fall with little importance on preventing falls. Therefore, developing cost-effective policies to prevent falls is critical to decreasing the monetary and health liabilities associated with a fall. An urgency exists to develop preventive tools to minimize costs and improve client outcomes post- fall. Policies aimed at preventing falls are highly significant to achieving this task and can aid in decreasing the financial, physical, and emotional results (Rajagopalan et al., 2017). The project site is a medical unit at a rural community hospital with high client-to-nurse staffing ratios, moderate physical therapy, extreme client understanding, and a large elderly population that results in high falls, which confirms the need for the project. The Institute of Medicine (IOM) recognizes the importance of the client as a central component of achieving quality health. The IOM regards client-centered care as the way to ascertain an affiliation among the health care team and the clients to confirm their voice is heard during the decision-making process regarding the treatment modalities and take accountability for their quality of care. The current method for detecting fall risk does not allow the client to be a joint partner in the risk assessment to prevent falls (Lipschuets, 2017). This project aims to determine if purposeful hourly rounding completed by prelicensure nursing students will decrease falls on a medical unit at a local community hospital over six weeks. In collaboration with the nurse manager, the project has been deemed necessary to reduce the number of falls in the nursing unit. Problem Statement Falls are a significant issue in health care organizations nationally and globally. A fall is an unplanned descent to the floor with or without client injury (Shashank, 2017). Falls in health care facilities is one of the quality indicators measured by the National Database of Nursing
Quality Indicators (NDNQI) since 2003 (Lipschuets & Toren, 2017). Currently, health care facilities concentrate on evaluating the risk of falls founded on particular assessment scales assessing the client’s physical medical condition, mobility, cognition, toileting needs, fall history, and medications. Falls prevention policies and guidelines are based on vital factors which focus on safety procedures related to the client’s condition in the hospital environment (Lipschuetz & Toren, 2017). Everyday interventions to decrease inpatient falls are founded on determining the etiology of the fall and assessing risk factors that would precisely recognize the primary etiologies of the issue. Falls prevention guidelines in health care facilities are intended to control fall risk factors related to the client’s condition and environmental safety hazards. These guidelines apply to all inpatient clients regardless of their score on the fall risk assessment and consist of nursing staff providing client fall risk assessments and confirming universal safety practices such as call lights, bed rails, and non-slippery socks are maintained at all times (Lipschuetz &Toren, 2017). Where everyday interventions focus on the etiology of the fall, purposeful hourly rounding will focus on preventing falls with input from the client. For six weeks, the prelicensure nursing students will round on the clients every hour to address their personal needs two days a week. The goal is to obtain favorable outcomes for clients by reducing falls while decreasing the cost related to falls for the organization. The project results will implement a substantial purposeful hourly rounding policy for the organization. Project Purpose The prelicensure practical nursing students will address the Ps (position, potty, pain, pump, possessions, and periphery) to prevent a client that has the potential to fall from getting out of bed without assistance. The purpose and intent of purposeful hourly rounding go beyond
put in place by the healthcare facilities or not performing the rounding at all. Educating the prelicensure nursing students on the process and importance of purposeful hourly rounding will prepare the students to take an active role in upholding the quality of care that correlates with the mission and vision of the organization while enhancing client outcomes by reducing falls. The healthcare organization currently has no policy addressing purposeful hourly rounding. Therefore, it is not being completed as per the facility guidelines resulting in a high fall rate and falls with injuries that result in a high cost to the organization. Theoretical Framework The increasing utilization of healthcare services has led to budding competition among healthcare facilities. The societal trend of competence and globalization has endorsed expansion and the use of specialized services. Intensified expectations and public needs have let healthcare facilities seek higher quality healthcare services and remain constant with the continuously evolving healthcare environment. Assessing and evaluating falls is a vital component that might substantially influence the profits and management of healthcare facilities (Shin & Park, 2018). Kolcaba’s Theory Client safety and comfort are essential factors in hospital settings. The idea of Kolcaba describes comfort as a basic need of all persons (Kolcaba & Kolcaba, 1991). The theory determines that if a client’s comfort needs are met, the client will be more at ease with the care plan. The approach can be applied to purposeful hourly rounding in meeting client care needs. If a nurse conducts structured, purposeful hourly rounding, the client will feel more at ease and comfortable with their needs being met. The other part of the theory is transcendence, describing how clients rise above their challenges. Kolcaba’s idea of comfort consists of four contexts in
which client comfort can occur: 1) environmental, 2) physical, 3) sociocultural, and 4) sociocultural (Kolcaba &Kolcaba, 1991). Studer Group Model In the Studer Group model, rounding is performed on clients at an intentional time. Purposeful hourly rounding is expected to decrease the client’s nervousness and fears with the knowledge that the client will routinely see a nurse or nursing assistant to focus on physical and comfort needs. Purposeful hourly rounding enhances client safety while reducing call light use and the nurse’s workload. The Studer model emphasizes proactive tools for the nursing staff with scripted cues to utilize during scheduled times to address clients’ everyday needs while decreasing the risk of falls, decreasing impaired communication, and decreasing the risk of falls and clients’ frustration (The Studer Group Model, 2007). These frameworks and guidelines balance each other to attain client outcomes and create an organized environment that promotes safety, comfort, and satisfaction (Studer, 2007). The Studer Group model and Kolcaba’s theory of comfort use specific nurse behaviors in expectation of the P’s related to comfort, care, and needs of the client, such as (pain, position, potty, possessions, pump, and periphery (Kolcaba &Kolcaba, 1991; The Studer Group Model, 2007). Significance of Project Educational development for the prelicensure practical nursing students was essential to convey why the process change is necessary, who the change would affect, and what the project's impact would be after the implementation. The effect of purposeful hourly rounding is anticipated to result in a decreased number of falls, reduced cost in the after-effects of a fall during their admission, and increased reimbursement from the Centers for Medicaid and Medicare (CMS) due to progressively more positive client outcomes (CMS, n.). This project is
Nurse-sensitive indicators: Indicators that capture care or outcomes most affected by nursing care. Client fall rates are monitored quarterly and reported to the NDNQI. Pre-licensure practical nursing students: Refers to students currently enrolled in the nursing program at the local community college who have not yet taken the National Council Licensure Examination for registered nurses (NCLEX-PN) Quality measures: Tools that enable the measurement of health processes, outcomes, client perceptions, and organizational structure and systems that are associated with the ability to provide high-quality health care. Statistical significance: Determines that it is likely that events are happening. It seeks to disprove a negative and determine that the event did not occur. Nature, Scope, and Limitations of Project Nature of Project The project was conducted in a thirty-four-bed medical unit at a community hospital in Southeastern North Carolina. The sample population for the project consisted of thirty male and female pre-licensure practical nursing students who volunteered to participate. The participants were nineteen years of age and older, with no maximum age. The project design used a comparative, non-experimental, quantitative, and retrospective approach. The researcher collected baseline fall rates in the medical unit between June 2022 through July 2022. Educational sessions and simulation activities were held in August 2022. Fall rates were retrieved six weeks after the educational sessions and simulation activities took place while the students performed purposeful hourly rounding from September 2022 through October 2022. The researcher then compared pre-and-post intervention falls rate data to evaluate the
effectiveness of the purposeful hourly rounding. Client demographics and information were not included in the project. Scope of Project The prelicensure practical nursing students were educated about the benefits and consequences of purposeful hourly rounding. Educational opportunities were offered to all students as a portion of their laboratory experience required a competency evaluation. The goal of purposeful hourly rounding was to anticipate client needs, which resulted in decreased fall rates. Being proactive rather than reactive to client needs improves client outcomes. The assumption was that once education was conducted, the students would be appropriately prepared to utilize purposeful hourly rounding as intended, thus reducing fall rates. The project was a reference for the nurse manager regarding the importance of proper education before implementing the process, initiating a cost-saving for the organization, and improved client outcomes. Limitations of Project One major limitation of a non-experimental research design is the lack of ability to eliminate extraneous variables as successfully as in an experimental research design (Johnson & Christensen, 2008). A non-randomized sampling suffers from the inability to control differences between the experimental and control groups (Farrokhi, 2013). Using this type of data could result in biased results, misrepresentation of data, and incomplete conclusions (Farrokhi, 2013). Another limitation is that some participants may not have understood the concept introduced in the educational study. Even though education and simulation activities were provided, some students may have viewed this as another task to complete rather than understanding the
students understand how purposeful hourly rounding will benefit their nursing practice and improve client outcomes. While rounding will not prevent falls, purposeful hourly rounding can enable nursing staff to decrease fall rates by being proactive to client needs rather than reacting to a client’s fall. Purposeful hourly rounding requires education and training regarding the purpose and goal of hourly rounding. Once the project results are revealed to the nurse manager, the plan is to educate the nursing staff on the benefits of purposeful hourly rounding to decrease client falls and improve client outcomes that will benefit the entire organization with a policy change. By utilizing the concept of purposeful hourly rounding and implementing specific scripted questions during hourly rounding, the students are expected to take an active role in reducing the number of falls and improving client outcomes. In Section 2, a literature review of purposeful hourly rounding will be discussed and the impact that it makes on falls.
Chapter Two: Literature Review In inpatient acute care settings such as hospitals, client falls can adversely affect care. Fall occurrences affect the costs of medical treatment, outcomes, and client recovery. Annually, the hospital-acquired client falls cost approximately 50 billion dollars in medical care (CDC, 2015). Leaders in inpatient healthcare settings must educate their nursing staff on fall prevention strategies to reduce falls and improve safety. Therefore, nursing governance must ensure that policies and guidelines are in place to continuously provide staff with training grounded in theory and evidence. The literature review aims to ascertain fall prevention strategies and research gaps and combine data interconnected to educational techniques regarding fall prevention strategies. The study also surveys literature regarding staff insights into fall prevention intercessions and the efficiency of these strategies. The researcher used the CINAHL, PubMed, and Cochrane databases to search recent literature related to fall prevention. The search was based on keywords such as falls, hourly rounding, purposeful rounding, education, training, and staff insights to verify evidence-based practices that would answer the PICO question in an inpatient medical unit in an acute care setting; Does purposeful hourly rounding performed by prelicensure nursing students decrease the incidence of falls over three months? The search outcomes are constrained to works published between 2016 and 2021. A few articles were utilized as resources restricted to the acute care setting and fall rates but were not embraced as evidence-based and, therefore, not incorporated in the evidence table. Staff Perception of Fall Interventions It is essential to cultivate nurse leaders’ comprehension and understanding, beliefs, and practices to heighten their staff’s views of a safety culture to improve client outcomes
healthcare workers regarding the safe handling of clients to inhibit back injuries. Partakers of the educational program included 140 nurses and nursing assistants that participated in a lesson and practical training in secure client handling that lasted approximately five hours. The researchers performed direct observation and administered questionnaires to assess for enhancements resulting from the education (Carta et al., 2010). A different research study discovered that the nursing staff's perceptions were inconsistent regarding implementing effective fall interventions. Of the 560 registered nurses asked to ascertain the extremely effective fall interventions, 346 respondents emphasized 19 everyday practices (Tzeng & Yin, 2014). These interventions included applying fall identifiers, education, and regular rounding. The results discovered that staff members’ varying replies might be due to a failure to acknowledge and comprehend the significance of the fall risk factors and interventions. It was also determined that nurses were inclined to emphasize their clients’ autonomy before their safety (Tzeng & Yin, 2014). Healthcare inpatient leadership utilized several educational approaches to lead the fall prevention training. Eighty-three percent of the participants reported obtaining education regarding falls within the previous twelve months. Twelve percent of the participants said that they did not get any education regarding falls within the last twelve months. Approximately 47% of the participants obtained verbal education, 44% received printed education, 34% obtained computer training, and 19% got hands-on training. It was determined that there was an imperative need to find an ideal method to educate staff about preventing falls that would engage all learning styles (Tzeng & Yin, 2014).
Staff Perception A qualitative study was also conducted to examine the nursing staff’s perception and understanding of the significance of maintaining client beds in the lowermost position to counteract falls and injuries that result from falls. The study revealed that nursing governance should examine the efficacy of training and recognize needed changes. Nurse leaders should remain up-to-date on current strategies and deliver a more significant education when applying new fall protocols. The nurse leader should engage in nonstop quality improvement actions, such as identifying clients at risk for falls based on nursing-sensitive indicators (Tzeng &Yin, 2012). Adult clients in a 52-bed acute care surgical unit were questioned regarding their perception of falls. The overall rate of falls per 1,000 client days in the team ranged from 2 to 8. The study participants comprised 18 registered nurses and 13 nursing assistants (Tzeng & Yin, 2012). The researchers questioned the nursing staff on all shifts. Partaking in the research study was completely voluntary. The survey results found that staff members can express the significance of placing beds in the lowest positions. Still, in retrospect, the staff was not often aware the beds were not already in the most down position. The authors indicated that further research was necessary to investigate and analyze the nursing staff’s adherence to the policy. It was also recommended that additional research was essential to examine providers’ adherence to the policy that requires maintaining the beds in their lowermost position (Tzeng & Yin, 2012). Further research is necessary for other health care workers operating the bed controls when providing care to clients, such as physical therapists, respiratory therapists, case managers, and laboratory technicians.
Intentional Rounding Guidelines A pilot study utilizing the Plan, Do, Study, Act (PDSA) model due to the falls rate in the nursing unit to apply purposeful hourly rounding as a portion of current fall guidelines on a 112- bed medical-surgical unit is depicted where the present fall prevention utilized client identifiers, fall risk wristbands, bed/chair alarms, and non-skid socks (Grillo, Firth, & Hatchel, 2019). The instability of client decision-making, such as not asking for help when getting out of bed, needed to be addressed. The 5 P’s were addressed hourly while the client was awake and every 2 hours while the client was asleep, reinforcing education of the significance of fall precaution tactics and expectations of purposeful hourly rounding. Although no statistical difference was reported in falls after implementing purposeful hourly rounding in addition to current fall prevention strategies, the fall rate declined below the national average (Grillo et al., 2019). A trend of reduced falls continued to decline two months following the implementation of the rounding as the nursing personnel became progressively capable of thoroughly executing fall prevention guidelines, including purposeful hourly rounding. The healthcare team’s focus was altered to incorporate purposeful hourly rounding as a quality process to reduce client falls and call light usage (Grillo et al., 2019). Intentional Hourly Rounding Another research study examined the analysis of different models of care. It concluded that purposeful hourly rounding seemed to provide a technique to meet client needs yet reduce the measures included in providing nursing care and limit interruption in the workflow (Berg, Sailors, Reimer, O’Brien, & Ward-Smith, 2011). The outcomes of this study signify that purposeful hourly rounding does reduce call-light usage. The study site was an inpatient medical- surgical unit, which routinely provides care during the immediate postoperative period and acute
medical care needs. The findings of this study support the hypothesis that performing these activities consistently decreases unwarranted stages and reduces disturbances in workflow for the nursing staff. It was concluded that healthcare facilities should consider purposeful hourly rounding as an evidence-based practice to increase client satisfaction (Berg et al., 2011). Fall prevention is vital for client safety. All healthcare organizations rank falls as an essential safety issue governed by nurses daily. The National Database of Nursing Quality Indicators (NDNQI, 2019) identifies it as a nursing quality indicator. Multi-intervention creativities can impact a reduction in fall rates, and interventions can be effective when affecting communication, proactive toileting, and purposeful hourly rounding. Intentional hourly rounding meets client needs proactively, reducing unintentional falls when clients get up independently (Harden, Galunas, Eastman, & Frederick, 2021). Purposeful hourly rounding is expected to decrease the client’s nervousness and fears with the knowledge that routinely seeing a nurse or nursing assistant will focus on personal physical and comfort needs (Studer Group Model, 2007). Purposeful hourly rounding enhances client safety while diminishing call light usage and decreasing the nurse’s workload. The Studer model emphasizes utilizing a proactive tool for the nursing staff with scripted cues to use during scheduled times to address clients’ everyday needs while decreasing the risk of falls, decreasing impaired communication, and decreasing clients’ frustration. These frameworks and guidelines balance each other to attain client outcomes and create an organized environment that promotes safety, comfort, and satisfaction. Hourly Rounding Results A literature review was performed to ascertain the results of purposeful hourly rounding on fall rates, call light usage, and client satisfaction (Olrich, Kalman, & Nigolian, 2012). While
M. Hedgpeth DNP 850A-8 - coursework
Course: Project Proposal (DNP850B)
University: Aspen University
