Literature Review Paper

Table of Contents

IntroductionMany patients die from falls or fall related injuries each year in acute healthcare settings. Some patients sustained injuries such as head trauma, fractures and internal injuries which can prolong and complicate recovery time. Patient falls in healthcare settings has cost the U.S healthcare system billions of dollars each year. Medicare and Medicaid reimbursements are also affected based on the type of injury patients have sustained while being hospitalized. Intentional nursing rounds is a structured approach whereby nurses conduct checks on patients at set times, typically every hour to two hours to asses and manage their fundamental care needs. Fundamental care needs include the 4 P’s, which are positioning, personal needs, pain and possession. Hourly nursing rounds is one of the many steps that can be used to increase patient safety in any acute healthcare setting. By making sure that all patients basic needs are being met, patient falls, and injuries are less likely to occur. The use of hourly rounding has been noted to be a promising intervention in preventing patient falls (Tucker et al., 2012). It has been reported that hourly rounding can reduce patient falls as much as 50% in the acute care setting (Hicks, 2015). Hourly rounding has also been reported to increase patient satisfaction, reduce call-light use, reduce medication errors, and increase staff satisfaction. PICOT questionIn the adult acute care setting, how does hourly rounding impact patient falls compared to rounding every two hours?Current evidence onA number of studies reviewed showed evidence that hourly rounding does not only impact patient falls, but also plays a crucial role in reducing call light usage and increasing patient satisfaction (Mitchell et al, 2014). When patients believe in the process, they begin to build a trusting relationship with the nurse which may lead them to not use the call light as often because they know the nurse will be returning soon to care for their needs. Hourly rounding has a positive impact on reducing call light usage and increasing patient satisfaction which can lead to better patient outcomes (Mitchell et al., 2014).Hourly rounding may be more effective if proper nursing training and implementation is provided. Hourly rounding is an autonomous intervention that nurses can perform to keep their patients safe (Hicks, 2015). Without commitment and believability of the process, a positive outcome for hourly rounding is unattainable (Hicks, 2015). Hospital administration should be aware that for proper implementation of hourly rounding, special attention should be placed on training, promoting commitment to the cause, and compliance by nursing staff members (Olrich et al., 2012). Research designThere were four different articles that were reviewed for this literature review. The research design for all four studies had similarities and differences. All four articles that were reviewed investigated “how does hourly rounding prevent patients falls in acute health care settings”?. Two of the articles included in the studies in the research literate were systemic reviews of non RCT and Two of the articles were of studies that were conducted in order to explore how effective is hourly rounding to reduce patient falls and to increase safety. Mitchell literature review was design with 11 studies, but only nine of the studies were directed towards hourly rounding to prevent patient falls in acute health care settings. Hicks literature review was conducted using 14 articles, all 14 studies that were conducted explore the effectiveness of hourly rounding on towards hourly rounding to prevent patient falls in acute health care settings. Both system literature reviews, design the study to transition from hourly rounding in the morning to rounding two hourly on the evening shift to allow for the patients to be able to get adequate rest. For both micthelle and hicks systemic letrature reviews, the maximu that a study was conducted was 1 year, but for the minum about of time that the study was conducted for was 2 weeks for mictchell and 3 months for hicks. Both systemic literures from hicks and Mitchell had of a pre/post designs. There were two other studies that were used in this literature research review (Gold and kik). One of the studies were a qualatatve method was used to conduct the study and the other study was quanatative method was used to conduct it. The quantitative pilot study was conducted over 30 days on two medical units at the Christiana Hospital, which is a 907-bed Delaware hospital. The study was conducted on two different units, Unit 1 was a 35-bed adult stroke unit and Unit 2 of the study was conducted on a hematology/oncology unit. A qualitative study was conducted within an emergency department at a large teaching hospital in England. The emergency department sees an average of 450 patients a day and employs around 250 clinical staff members. In the wuantatice study, On Unit 1 the nurse leader and a staff champion were involved in the entire process of the study, while Unit 2 staff were introduced to the project shortly before it began. In the qualitative study the nurses that were involved in the study were aware of the study before it began. For both studies The intervention that study implemented to reduce patients falls was patient centered proactive hourly rounding. Rounding were performed by nurses and patient care technicians in the quanatative study. While only nurses conducted the rounding in the qulatative study. In the quanataive study the tool that was used to collect data was the random selection of a patient’s flow chart each day by the nurse manager for the recorded time of the rounding for prior 24 hours and the random selection of one staff member from each unit during the pilot to survey the last the last round he or she completed. In the qualitative study, in-depth interviews were conducted in order to collect data for the study (Kirk & Kane, 2016). There were no discussions of the human subject’s protection or inform consent given by the patients in both studies. The does not state the length of study in qulatative, but it is stated in qunatative which is 30 days. For the qulatative study Non-random, purposive sampling was used to ensure that the respondents were able to give an insight into a specific set range of perceptions, perspectives and beliefs. In the qualitative stiduy that was conducted. For the quannative study a ramdon slection was usedSample sizeThe sample size for all studies plays a vital role in the accuracy of the results of the study conducted. The two systemic literature reviews sample used different amount of articles to review for the studies that were conducted. Hicks systemic literature review used 14 articles that were used to conduct the systemic review. Mitchell intergrated liyertaure review used 11 article to conduct the ssystemic review, but only 9 were directly related to rounding on an hourly basis to prevent patient falls. In the quanttaative study the sampling size was much larger than the qualitative study sample size. In the quannatative study, The study was conducted on two different units, unit one was a 35-bed adult stroke unit and the second unit of the study was a 40-bed hematology/oncology unit. In the qulatative study, the sample size was only five nurses from the emergency department from which the study was being cconducted. ResultsAll studfdies concluded that hourly rounding or intentionsla nursing rounds can reduce patient falls in acute helath care settings.Hicks (2015) found 10 studies where falls were decreased, 3 studies that showed no change and 1 study that had variations in the results. Mitchell et al. (2014) found 9 studies where the median fall reduction rate was 57% and two studies were able to report statistically significant decreases when hourly rounding was implemented. The results from the study showed that the emergency department nurses felt the introduction of intentional nursing rounding improved patient safety and overall care experience(Kirk, Kate & Kane, Roslynz). Nurse leaders and a staff cham-pion from Unit 1 were involved in the process from the start of the imple-mentation period, while Unit 2 was introduced to the project for training shortly before the intervention beganNurse leaders and a staff cham-pion from Unit 1 were involved in the process from the start of the imple-mentation period, while Unit 2 was introduced to the project for training shortly before the intervention beganThe fall rate data results showed fall rate decreased from 2.5 to 1.3/1,000 patient days during the pilot on the stroke unit (Unit 1) and from 2.6 to 2.5/1,000 patient days on the hematology/oncology unit (Unit 2). Two of the studies showed a reduction in falls of 36% and 50% each (Forde). All article condcluded that intetnal rounding is a necessary intervention to reduce the risk o fpatient falls.Recommendation The authors of the article recommend that other comparative studies be carried out in other emergency departments in the UK. The authors also recommended that an increase in the sample size would make certain that the study data saturation was reached (Kirk & Kane, 2016). The authors recommended further investigation of the impact over a longer period is needed due to much of the literature coming from the 30-day pilot. The authors also recommend that an investigation into whether hourly rounding is a robust stand alone fall prevention strategy is required. Further studies should consider whether any fall prevention program that is suitable for the patient population may be effective if implemented through a process characterized by leadership support that engages front line staff in program design.( Qyanattaive)ConclusionRefrencesGoldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: What factors boost success?  Nursing, 45(2), 25-30. doi:10.1097/01.NURSE.0000459798.79840.95Hicks, D. (2015). Can hourly rounding reduce patient fall in acute care? An integrative literature review. MEDSURG Nursing, 24(1), 51-55.Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: A systematic review. The Journal Of Nursing Administration, 44(9), 462-472. doi:10.1097/NNA.0000000000000101Kirk, Kate & Kane, Roslyn. (2016). A qualitative exploration of intentional nursing round models in the emergency department setting: Investigating the barriers to their use and success. Journal of Clinical Nursing. 25. n/a-n/a. 10.1111/jocn.13150.