Title: Decreasing the incidences of inpatient falls with structured, purposeful rounding
Abstract:
Patients who fell incurred injuries and lost reimbursement ensued at the host hospital. Hence, the project aimed to implement structured, purposeful rounding (SPR) to decrease falls in two medical-surgical units. John Kotter’s Eight-Steps of Change Model and the Iowa Method of Evidence-Based Practices supplied the theoretical and conceptual frameworks for the project. The quality improvement project incorporated SPR to decrease falls. In addition to conducting SPR, the team documented the rounds in the Epic electronic health record (HER). Due to the Stay with Me program, the staff remained within arms reach during ambulation. As a result of the interventions, Five-North’s falls per patient day rate was 0.86 in July and zero in August. Correspondingly, Six-North’s was 0.85 in July and 4.07 in August. One behavioral health (BH) patient skewed the data by intentionally lowering to the floor to avert discharge. Despite the two falls, there were no other falls on Six-North, and patient safety improved. Thus, Six-North would have zero falls. Five and Six-North’s current fall rates were the lowest for 2023. Integrating SPR proved successful. Although the staff was initially apprehensive, they adapted to the new protocols. At its conclusion, the team engaged in rounding more willingly. The project aimed to add to the literature regarding structured, purposeful rounding (SPR) because the literature supporting its effectiveness is limited and not regarded as rigorous. SPR is valuable and will extend to all network hospitals upon revision.
Keywords: Falls, patient falls, purposeful hourly rounding, structured rounding, intentional rounding.
Audience Take Away Notes:
• Direct care staff and their leadership team learn how to incorporate structured, purposeful rounding into their current protocols to decrease the incidences of inpatient falls
• Structured purposeful rounding decreases the amount of call bells. Patient satisfaction/patient engagement scores increase with structured, purposeful rounding. Direct care staff has additional time to focus on other priority needs. Publicly-reported data is better with structured, purposeful rounding. Other faculty could use structured, purposeful rounding to expand their research and teaching. Structured purposeful rounding provides a practical solution to falls, which decreases the amount of time spent documenting, sending patients for testing, and discussing falls with physicians and family members. By adding structure to hourly rounding, less falls occur, and hospitals do not lose funding related to adverse events. Finally, by conducting structured purposeful rounding, sitters may be reduced and decrease costs
