Falls and injuries related to falls are some of the most common and costly incidents that occur in the long-term care environment. Purposeful hourly rounding is a proactive way for nursing staff to identify patient needs and demonstrate positive fall prevention outcomes. This project examined a process improvement endeavor of a long-term care unit that experienced an increase in the number of falls over 3 months. The purpose was to evaluate whether staff education and implementation of an evidence-based hourly rounding program would affect the number of patient falls. The Johns Hopkins nursing evidence-based conceptual model, Kurt Lewin's change model, and the Shewhart cycle process improvement model were used to implement the change process as well as the Studer Group best practice hourly rounding tools. A sample of 40 residents was included in a quantitative descriptive design describing the implementation of hourly rounding. Staff were educated 30 days prior to implementation. Pre and post project fall rates were retrieved from the VA fall data management system and revealed a 55% decrease over 3 months post staff education. The use of evidence-based hourly rounding measures increased over the same time period. Nurse leaders must ensure rounding programs are evidence-based, clearly defined in policies, and include robust education plans. There are limited studies on the relationship between education and hourly rounding; therefore, future studies should focus on outcomes of initial and ongoing education for program success and sustainability. Falls are a healthcare concern nurses must address at any point-of-care to promote public safety through prevention and to facilitate positive social change by providing a safe hospital environment.

Timsrundor innebär en strukturerad regelbunden tillsyn av patienter och kan utföras för att upptäcka om patienters tillstånd försämras och för att förebygga trycksår, fall, smärta eller undernäring och för att patienterna inte ska behöva ringa på klockan för att få hjälp med till exempel toalettbesök. Akutsjukvården är i dag hårt belastad med ett ökat patientflöde. En hög arbetsbelastning kan medföra att sjuksköterskor inte alltid kan tillgodose patienternas omvårdnadsbehov. För att sjuksköterskor bättre ska kunna tillgodose patienters behov och upptäcka eventuella försämringar av patienters tillstånd, samt förebygga att skador uppstår kan timsrundor eventuellt vara ett arbetssätt. Syftet var att beskriva sjuksköterskors erfarenheter och upplevelser av timsrundor ur patientsäkerhetsperspektiv inom akutsjukvård. En litteraturstudie valdes som metod för att besvara studiens syfte. Databassökningen genomfördes i PubMed och CINAHL. Litteraturstudien är en sammanställning av resultaten i 18 inkluderade artiklar, publicerade mellan 2007 – 2017, med ett undantag för artikeln från 2006. Av artiklarna var åtta kvalitativa, tre var kvantitativa och sju var mixade studier. Resultatet sammanfattades i fyra kategorier; förbättrad kommunikation, ökad vårdkvalitet, minskning av vårdskador och timsrundor ökar tryggheten. Litteraturöversikten visar att delaktighet, noggrann implementering och att all personal, inklusive cheferna, arbetade mot samma mål var viktiga faktorer för att nå framgång med timsrundor. Flera av studierna visade att både patienter och sjuksköterskor upplevde att omvårdnaden förbättrades ur ett patientsäkerhetsperspektiv vid införandet av timsrundor, dock upplevde sjuksköterskor ofta tidsbrist samt att dokumentationen av timsrundorna kunde vara betungande. Flertalet av resultatartiklarna tyder på ökad patientsäkerhet med timsrundor genom att bland annat fall minskade eftersom ringklockan och patientens tillhörigheter placerades närmare patienten. Det framgick att patientnöjdheten ökade med timsrundor och att ringningar minskade. Slutsatsen som kan dras av denna litteraturöversikt är att timsrundor är ett nytt outforskat begrepp inom sjukvården i Sverige. Studien visar att timsrundor kan vara ett stöd i att förbättra patientsäkerheten. För att timsrundor ska fungera krävs en noggrann implementering där personal och ledning bör arbeta mot samma mål. Mer forskning inom ämnet timsrundor är önskvärt för att uppnå ökad validitet.

The clinical practice problems addressed by the DNP project were the low patient satisfaction scores and the high number of falls on a hospital neurological step-down unit. The purpose of this project was to improve the Hospital Consumer Assessment of Healthcare Providers and Systems score on one patient satisfaction question and decrease the number of patient falls by implementing hourly rounding, using a script related to patient comfort and toileting needs. The scripted questions were expected to increase the satisfaction of patients and decrease unassisted falls due to increased attention to patient pain and positioning and timely help with toileting and retrieving personal items. The project was guided by Rosswurm and Larrabee's change model and facilitated by the plan, do, study, act model for rapid change. The satisfaction scores on the survey question 'I received help as soon as wanted' and the number of falls were compared before and after hourly rounding with scripting was introduced. During the 3 months of the project, the average monthly number of falls increased from 3 to 3.6 and changes in the patient satisfaction score were within upper and lower control limits indicating normal variation in the process. These findings indicated that barriers to the change on the unit need to be examined further and another short-term, rapid change cycle initiated to meet or exceed the national benchmarks for patient satisfaction and falls incidence. The project may inform quality improvement efforts at other hospitals and assist in social change by increasing scripted communication between nursing staff and patients to ensure that patients' needs (pain, positioning, pottying, and proximity of personal items) are addressed during each hourly rounding encounter.

Falls and related injuries have affected residents in long-term care facilities for many years. It has been well-established that patient fall prevention includes staff education and hourly rounding in addition to adequate risk assessment. These steps, taken together, have the potential to decrease a 52.7% fall rate on the long-term care pilot unit. The purpose of this quality improvement project was to: (a) educate staff on the process of properly performing hourly rounding and (b) and achieve a decreased incidence of falls from the current fall rate. Thus, the practice-focused question for the project addressed whether rounding hourly on patients in a long-term care facility would decrease the numbers of falls and related injuries. The conceptual framework used for this evidence-based project was the Institute for Healthcare Improvement's rapid cycle improvement. A sample size of 40 residents' fall rates were compared for a 6-week period before the intervention of hourly rounding to the fall rates after 6 weeks of full implementation of the rounding process. A Wilcoxon Signed Ranks test (z = -4.169, p < .001) showed that there was a statistically significant improvement in staff knowledge when mean pretest scores (75.9%) were compared to posttest scores (94.5%). Nursing staff were also evaluated on competencies, and 100% of the staff successfully completed the competency checklist on the first attempt. Post project fall rates revealed a decreased fall rate by 22% over a 6-week period post implementation. Nursing leadership should ensure that staff are continually educated on policies being implemented to ensure an effective outcome. Having hourly rounding as a permanent policy can decrease the patient's fall rate and improve patient safety, a positive social change.