Fall Prevention: A Purposeful Rounding Quality Improvement Project

Abstract

Problem: Patient falls within the hospital setting continue to be a problem and are associated with increased patient morbidity and mortality. A medical-surgical unit within a community hospital has identified falls as a problem and fall rates have exceeded the unit assigned benchmark. Many healthcare facilities are using the method of rounding addressing the 4P’s (possessions, position, pain, and potty). Despite using the 4 P’s rounding, there has been an increase in patient falls and miscommunication among staff and patients. Purpose: The purpose of this project was to increase utilization of the rounding clock, a complementary tool for purposeful rounding which assesses the 4P’s on a medical/surgical unit of a community hospital. Methods: The QI project focused on utilizing the rounding clock, which encompasses the 4P’s. Through random observation of the nursing assistant and patient interaction, weekly data collection and analysis highlighted purposeful rounding while achieving the goal of 100% reduction in falls by the end of the QI project. Data collection was entered weekly and analyzed by the project leader. Falls knowledge and self-assessment of competency was collected pre-implementation. Results: Nursing assistants (81%) received education pre-implementation. Compliance averages for rounding observations increased 16%, rounding clock 18%, and communication board documentation (24%) from September which was used as a baseline to October through December. The unit had 16 falls in calendar year 2020 with a falls rate of 3.16 (falls rate per 1,000 patient days); total falls decreased to 9 in calendar year 2021 with a fall rate of 1.187, which was below the target of 1.86 or less. Conclusion: The goal of 0% falls was not met. Though the QI project did not yield the target goal of 0% falls, with the increase in purposeful rounding, despite the multifaceted limitations, the overall patient fall rate decreased by 44% which is supported by the literary reviews. Keywords: purposeful rounding, hourly rounding, fall prevention, nurse communication, patient satisfaction, patient outcomes.