Introduction

The American Nurse Association defines a fall as an unplanned drop to the floor. Patient falls are seen to increase mortality, morbidity, and increased fear of repeated falling. Research has shown that the number of falls reaches as high as 25 falls in 1000 patient days resulting in more than 30% serious injuries. Hospitals spend a lot of money to cover the direct and indirect costs related to patient falls. From the year 2008, the Centers for Medicare and Medicaid Services do not reimburse hospitals for such costs since the hospitals can prevent patient falls. The major aim of this project is to document systematically the implementation, effectiveness, adherence, comparators, and components of hourly rounding by nurses that can be used to prevent patients fall rates in the hospitals of the United States of America.

Search Strategies

A search for materials was conducted on several databases including Medline, the Cochrane Database of Systematic Reviews, Academic Search Premier, and Cumulative Index to Nursing. The keywords used include “nurse hourly rounding,” “patient fall prevention,” “patient safety,” and “acute care.” Research for peer-reviewed articles published between the years 2011-2016 resulted in 18 articles. However, after using the inclusion/exclusion criteria, 5 articles were used for this review.

Inclusion/Exclusion Criteria

After the search, articles found addressed the reduction of falls by the intervention of nurses, comparison of nurses who implemented the hourly rounding and those who assumed it, patient safety, and fall prevention as well as the perception of hourly rounding by the patients. Inclusion criteria included articles that included the implementation of hourly rounding by nurses, studies conducted on inpatients and studies that included the perception of patients on the hourly rounding.

Summary of Articles

The article titled” Hourly rounding and patient falls: What factors boost success” looks into the impacts of an hourly rounding on patient falls. The article describes the patient-centered hourly rounding process from development through implementation and to the evaluation. The study was done on two units and considered pre and post implementation for 30 days. The intervention was designed by pharmacists, clinical nurses, physicians, physical therapists and the researcher. Hourly rounding at the time of the study was done every hour for half 12 hours and after 2 hours for the next 12 hours to cover for a whole day (Goldsack et al., 2015). The study revealed that the patient-centered hourly rounding reduced the rate of patient falls. However, failure to include the leadership and front line staff did not affect the rate of patient fall.  The major limitation of the study was the research period, which was limited to 30 days.

The article titled “Change for the better: An Innovative Model of Care delivering positive patient and workforce outcomes” looks into the outcomes after implementing a practice model of care working in partnership. The model under study has 4 components including working in partnership, comfort rounds, clinical handover at the bedside and environmental modifications.  The study was conducted in a regional hospital with 400 beds (Cann & Gardner, 2012). The study concentrated with the acute surgical ward. Before the study, feedback was collected from the nurses using a questionnaire including what changes needed to be made. The respondents were dissatisfied with the level of patient care they offered, and thus the study was conducted. The study revealed that the implantation of the partnership model was associated with reduced call bells and patient falls. However, the study was faced with a limitation since using a surrogate measures makes it difficult to determine if the model is related to the encouraging outcomes.

The article titled “How do patients perceive hourly rounding” investigates the perceptions of the patients on hourly rounding. The article recognizes that if the patient does not value hourly rounding, then its implementation may not have any positive effect on patient care. The study conducted data from six hospitals for 3 months (Bragg et al., 2016). The questionnaire was generated by nurse representatives from each of the hospitals under study. The questionnaire was designed to investigate the hourly rounding experience in the patient’s point of view. The study revealed that hourly rounding leads to patient’s satisfaction. In addition, it was also revealed that the perception of quality care depends on the ability of the nurse to meet the needs of the patient.

The article titled “Exploring the Barriers and Facilitators of Nurse Engagement in Comfort Rounds” explores the barriers that hinder the nurses from implementing an initiative known as comfort rounds. This is similar to hourly rounds since it is done regularly. The study sought to understand the experiences of the nurses involved in the comfort rounds and the barriers to nurses’ participation in the initiative. The study employed observations, interviews, and documents. The study revealed that different health care providers had different views on the implementation of comfort rounds and why it is implemented (Virk, 2015). There was a lack of clarity about the purpose of the comfort rounds. Many of the nurses in the study, however, considered the comfort rounds part of their practice while other considered it as a way of providing comfort to the patients. The major limitation of the study is that it concentrated on one medical unit. However, the strength of the study was the rigors data collection and analysis.

The article titled “The nursing rounds system: Effect of patient’s call light use, bed sores, fall, and satisfaction level” explores the effects of nursing round system on patient calls, patient falls, bed sores and patients satisfaction. The study was conducted in a rehabilitation center. Participants included all the males in the stroke unit and ran for 8 weeks. Data collected during this period was to be compared with data collected before the implementation of the nursing round system (Saleh et al., 2011). The study revealed that nursing rounding intervention is capable of reducing the use of call bells by the patients as well as the occurrence of patient falls. The results suggested that a 1 hour round positively affected not only the patient but also the nursing welfare given that nurses have other tasks.

Conclusion

The hourly rounds by nurses are seen to reduce the number of patient falls. In addition, the initiative satisfies the patients meaning that patients would not be a hindrance to its implementation. The purposes of the initiative must, however, be clear to the nurses to ensure it is successful and serves its purpose. Patients fall is a financial consumer in most of the health institutions in the United States of America, and due care needs to be taken to reduce its occurrence.

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