In my practice, I see many patients come in with confusion, weakness, or some other diagnosis that in some way impairs the patient’s ability to cater for themselves fully thus needing extra attention to avoid falls. According to Morgan et al. (2017), between the year 2013 and 2014, there were approximately 19,579 patients who experienced injuries from a fall in the hospital. These injuries cost the hospital money and cause the patients discomfort and decreased satisfaction with their hospital experience. Patient satisfaction is a priority for the hospital as well as the nursing staff; patient satisfaction decreases with increased patient falls. Hourly rounding is one way to reduce falls and therefore increase patient satisfaction. Mitchell et al., (2014) performed a literature review on hourly rounding and discovered that hourly rounding practices decrease falls and improve patient satisfaction. In medical-surgical patients admitted to a hospital, do hourly rounding practices by nurses and patient care technicians rather than no hourly rounding practices improve patient satisfaction in a yearly quarter?
There is much evidence in support of hourly rounding practices leading to the reduction of falls. Kruschke and Butcher (2017) created a condensed version of the guideline for fall prevention in older adults. The guideline includes a ten-step fall assessment process that incorporates the patients fall history, fall risk, and possible prevention strategies. One of the strategies suggested for fall prevention for older adults in the hospital is hourly rounding. The article states that hourly rounding is an effective strategy in fall prevention. A weakness of this guideline is that it is meant for a specific population and therefore cannot be easily generalized to other patient populations. A strength of the guideline is that there is high quality research supporting the interventions suggested. The recommendations of the guideline are clinically significant and prove useful.
The literature review by Mitchell et al. (2014) discussed hourly rounding practices and its impact on patient satisfaction. Sixteen articles were found and examined for the literature review and their conclusions were similar. The authors performed a grade analysis on the articles to evaluate their quality. The evidence grade was moderate with the impact of hourly rounding on patient satisfaction being the most significant. The conclusion of majority of the articles studied in the review showed that fall reduction occurred with hourly rounding. Weaknesses of the review include weak pre-post study designs of the articles included in the review, variations in frequency of rounding within the articles, and different methods of measuring outcomes. The strengths of the review include the quantity of articles reviewed, and consistency of the effect of hourly rounding on patient satisfaction and fall rates. The findings were clinically significant because the conclusions from the review are meaningful and can make a difference in patient outcomes.
Krepper et al. (2014) performed a quasi-experimental study comparing a more rigid hourly rounding process to a less rigid one. The study was performed on two 32 bed cardiovascular surgical units. The intervention used in one unit was a structured hourly rounding process (SHaRP) that addressed staff education and patient/family awareness. Staff was educated on the rigid hourly rounding approach. The other unit used a less structured hourly rounding process without staff education. The findings of the study show that hourly rounding is effective in preventing falls and thus increasing patient satisfaction regardless of whether the process is rigid. A weakness of the study is that there was no significant difference between structured hourly rounding and less structured hourly rounding. Another weakness is that the SHaRP tool used is not reliable and valid. The strengths of the study include a strong experimental design, a large enough sample size, and being peer reviewed. The results of the study were clinically significant because they can be used in any clinical setting.
Another study supporting the use of hourly rounding is a study performed by Morgan et al. (2017). They performed a pre-post intervention study that evaluates the effectiveness of personalized intentional hourly rounding on fall reduction in patients in the acute care setting. The study was performed on a neurosurgical unit. The intervention used was intentional hourly rounding with log sheet documentation of activities performed. There was a 50% reduction in falls and thus an increase in patient satisfaction. Weaknesses of the study include the pre-post design that did not include a control group, the fact that it was performed on a neuroscience unit meaning the results cannot be generalized to the general medical surgical patients, and the small sample size involved in the study. Strengths of the study are that the data collected confirmed the hypothesis and the fact that it was published in a peer reviewed journal. The results are clinically significant.
Summary of Evidence
Each of the articles discussed showed, in their own way, the need for hourly rounding in an acute setting. The condensed guideline by Kruschke and Butcher (2017) shows the need for a fall prevention program that includes hourly rounding because rounding on patients decreases the risk of falls. The review by Mitchell et al. (2014) consistently shows that hourly rounding improves nurse responsiveness and decreases patient falls thus improving patient satisfaction. Even though the study by Krepper et al. (2014) did not show a significant difference between using a structured hourly rounding approach and a less structured approach, the study still shows that there is a need for hourly rounding by either the nurse or patient care technician. The quasi – experimental study by Morgan et al. (2017) shows the same conclusion as the other studies; with leadership support and staff involvement hourly rounding is effective in reducing patient falls and thus increasing patient satisfaction.
The effects of hourly rounding cannot be overstated. Hourly rounding reduces patient falls, increases communication, and decreases anxiety during the hospital stay which all in turn increase patient satisfaction. This paper concentrated on the effects of hourly rounding on patient satisfaction using decreased falls. The evidence provided was consistent in showing a positive relationship between hourly rounding and reduced falls. Nurses should always attempt to make patient satisfaction a priority. Knowing that reduced falls increase patient satisfaction, nurses and patient care technicians should endeavor to round on patients hourly