Implementation Of A Nurse-Led Rounding Program To Reduce Patient Falls

Introduction Have you ever been a situation whereby an elderly patient with high fall risk was left alone in a toilet? Elderly tend to be more fragile and are prone to serious injuries when they fall. (Hill & Fauerbach, n.d.). In hospital wards, nurses do the best measurements to ensure zero falls, maintain a clean record and raise awareness to prevent falls. Description It was an incident that happened during one of my clinical placement in September.

The conclusion of the article was that hourly rounding that has leadership involvement and staff that buy into the program is an effective fall prevention program. This conclusion was based off the results from the study. This review was of good quality. Hourly rounding and patient falls was a study that was conducted to see if hourly rounding was an effective fall prevention strategy. The study involved 2 units.

Literature Review Some of the databases that were searched for information about my PICOT questions were not directly related to patients in long-term care facilities. The Databases that were searched included CINAHL, National Guideline Clearing House, Ovid, and EBSCO, articles related to my PICOT was found on National Guideline Clearing House and Ovid. Some of the key words that were used during the search were Hendrich II fall risk tool, fall in Long-term care facilities, Geriatric falls, fall prevention and predicting fall. National Guideline Clearing (www.guideline.gov) produced about ten results directly related to the content in the PICOT question and CINAHL had thirty nine results.

Falls of critically ill patients admitted to the ICU routine should be avoided developing certain strategies used outside this area, such as prevention of displacement, promote stability, elimination of sliding hazards routinely ensure that the patient is oriented to the environment and the bell is at the fingertips, keeping the beds in the lowest position and braking, providing adequate lighting, and provide anti-slip footwear and technical assistance in lifting patients bed. The response time of the call prolonged ringing patient or family is just one of the potential causes of falls, firstly because if the response time is greater serve their needs later, and partly because no response to the patient may start feeling agitated. Shift schedules nurses can be particularly effective in preventing falls, as they allow the staff to anticipate and address the needs of each patient. The tubing, drains and cables must be securely to prevent tripping when lifting or embody patients. Although falls can happen without warning, subsequent falls can be avoided if the etiology of them is

This is reviewed with any change in patient status, a fall, and/or quarterly. Patients, depending on screening, might receive services from physical therapy (PT), occupational therapy (OT), nutritional services, bed/chair alarms, floor mats, medication adjustment, and change in room to closer to the nurses’ station, or other services. All at risk patients are easily identifiable by notation on wrist band, footwear, room and equipment signage, in the electronic medical record, and on any paper records. The fall rate of patients at SAVAHCS continues to be at or slightly below the benchmark, but our goal is to have zero falls. The intervention not fully utilized at this hospital, that does show promise in the literature, is the post-fall huddle.

The elderly in nursing home are at an increased risk for falls, more than any other area. An average of 5% of all persons over the age of 65 reside in nursing homes. On average, over 1,800 people over the age 65 fall while in nursing homes every year and 20% of all fall related deaths occur from falls while living in nursing homes (Centers of Disease Control & Prevention, 2012). Falls result in decrease of quality of care through decline in functional ability, fear, restricted activities, and serious injury (U.S. Department of Health and Human Services, 2014). Not only does falls have an effect the overall quality of the persons whom live there and their families, but it also effects the facility and the staff.

Significance of the Problem for Nursing: Prevention of falls in the elderly is an extremely important facet of nursing. Elderly falls often result in fractures, pain, decreased mobility, traumatic hemorrhages, as well as increased healthcare costs. Due to the increased prevalence of injuries acquired from elderly falls, increased risk of morbidity in the elderly experiencing falls, and the growing number of elderly patients, it is of vast importance that nurses research and incorporate evidence-based fall prevention practices to prevent falls in the elderly

“Fall risk assessment and post fall assessment are two very different and distinct approaches for falls prevention” ( Boltz, 2012). Knowing why the fall has occurred is crucial information to know. If you can do a post fall assessment and learn the underlying cause the nurse can create a care plan individualized and appropriate for each client. “The PFA is a comprehensive, yet fall-focused history and physical examination of the present problem (falling), coupled with a functional assessment, review of past medical problems, and medications. Clinical fall prevention guidelines are very clear about all of the necessary components for inclusion for patients who have fallen, which include fall history; fall circumstance; medical problems; medication review; Mobility assessment; vision assessment; neurological examination, including mental status; and cardiovascular assessment” (Boltz,

Before this study, nurses were using general fall precautions for these patients at risk for falls and were not using fall prevention interventions specific for patient’s fall risk factors (Wilson et al., 2016). There were major themes and minor themes to go along with each major theme. There was a study before the fall prevention intervention practice that was described as a fall that occurs, either the patient is at a fall risk or the patient passed the fall risk assessment. Action was then taken by implementing general fall prevention practices for these patients that were shown as a risk. Before the study, one example of a general fall prevention practice was “We had

Change is inevitable not only in the hospital setting but also in all other organizations that put the safety of stakeholders at hand. It is, however, sometimes challenging to have all stakeholders adopting a proposed change since some individuals would rather stick to the old ways of doing things as opposed to trying out new interventions (Guse, Peterson, Christiansen, Mahoney, Laud, & Layde,, 2015). Nevertheless, positive change is essential, especially when such a change is expected to positively impact on the safety of patients (Johnson, Veneziano, Green, Howarth, Malast, Mastro, Moran, Mulligan, & Smith, 2011). The purpose of this paper is to critique the adoption of hourly rounding as a nursing intervention for preventing falls.

Fall rates should be assessed prior to implementation, post 1 month and post 6 months of implementation. In addition, a survey provided to nursing staff can assist in the evaluation of increased resources and collaboration with physical therapy increasing their ability to assist with ambulation and exercise. This survey may include questions relating if nurses feel they have increased time to assist patients in education and exercises to decrease fall risk. Conclusion

In this step residents who are at high risk of fall will be given first priority such as residents with the previous history of falls, generalized muscle weaknesses, delirium, poor vision, use of psychoactive medicines. Most effective interventions will be implemented based on the likelihood of success, cot involvement and range of benefits. For instance, placing alarms on the bed and wheelchair, continuous monitoring of patients with delirium, application of bedside rails and health education to healthcare workers on fall prevention are crucial factors of fall prevention program because older people in the nursing home are dependent on healthcare workers. If health care workers are well trained and educated on fall prevention, they will be able to apply most effective strategies to prevent falls. Personally, I have seen many nursing assistants who ignore the fall safety alarms and forget to buckle the seat belt of the person in the wheelchair so it is most crucial to focus on the basic and most effective strategies of fall prevention program (Australian Catholic University,

(Joint Commissions, 2014).It is important for nurses to explain how to use the call light to the elderly patients, and also to ask for help before getting out of bed. Vulnerable patients should be placed close to the nursing station for close monitoring. It is very important to educate health care workers on the approaches used to prevent falls. The measures used to prevent falls in the elderly could include; carrying out a risk assessment during admission, placing colorful stickers outside their doors, stopping the use of psychotropic medications, teaching them the best way to use their assistive device, placing their call light and belonging within their reach, placing their beds in the lowest position with brakes /wheels locked at all times, removing throw rugs from their surroundings, making sure that they are wearing non-skid shoes/socks before ambulating and also giving them their prescribed Vitamin D supplement as well as encouraging them on the use of their corrective glasses or hearing aids. It is very important to educate health care workers on the approaches used to prevent

It also provided the use of critical thinking and clinical judgment on how to prevent falls, support, and be accountable for a client professionally. The practical knowledge I have learned helped me become aware of assessing and assisting a client. As a nurse, our job is to provide “safe, compassionate, competent and ethical care” (p.8) and collaborate as an interprofessional team to deliver safe care and prevent risks from happening while offering quality nursing care (CNA, 2017). I will always provide the professional care under the code of ethics to promote health and wellness for an older adult and prevent risks from happening. As well as following the plan of care, use communication strategies, be aware, acknowledge, and accommodate individuals with different diseases such as with dementia, to promote fall prevention strategies (RNAO, 2017).

The initiation of change in clinical practice is a common process and can be emotionally demanding to adapt. One support strategy that can be implemented to assist staff in managing and sustaining purposeful rounding is coaching and mentoring. It is evident that there is a lack of understanding in the purpose of nurse rounding and integrating it into the staff’s routine (Fabry, 2014). Hence, the lack of awareness in the rationale behind rounding can affect the engagement of the change. Coaching staff may include providing in-service two-way learning program before implementation of rounding.