1. The Impact of Nurse Hourly Rounding on Patient Falls
An integrated literature review
Kristina A. Zurita, RN, MSN Candidate
University of central Florida

2. PICO Question:
In the adult acute care setting, how does hourly rounding impact patient falls?

3. Significance and Background
Patient falls result in morbidity, mortality, and an increased fear of repeat falls
One of the most common adverse events in hospital setting
Inpatient falls range from 1.7 to 25 falls per 1,000 patient days
Falls can cost hospitals $5,317 per patient fall
By 2020, patient falls are projected to cost hospitals over $54 billion in annual costs.
Since 2008, CMS no longer reimburses hospitals for patient falls
(Tucker et al., 2012; Hicks, 2015)

4. Significance and Background
One-third of falls are preventable (US DOH, 2015)
Majority of falls occur near the patient’s bed, in the room, or in the bathroom (Tucker et al., 2012)
Nurses play an important role in preventing falls and maintaining patient safety (Cann & Gardner, 2011)
Reports state that hourly rounding can reduce patient falls by 50% (Hicks, 2015)

5. Significance and Background
Hourly rounding is the process of intentionally checking on the patient to addresses a patient’s basic needs by the nursing staff at regular intervals (Hicks, 2015)
Pain management
Repositioning
Use of the bathroom
Checking that items are within reach of the patient
Assuring the patient that the nurse will return in an hour
(Mitchell et al., 2014)

6. Methods Databases Searched Search Terms Medline Adult
Academic Search Premier
Acute care
Cochrane Database of Systematic Reviews
Hospitalization
Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus
Nurse
Rounding/Hourly rounding
Falls/Fall prevention
Patient safety

7. Methods Inclusion Criteria Exclusion Criteria Adult population
Age groups other than the adult population
Inpatient units in a hospital setting
Other types of setting (ie. emergency department, outpatient units)
Nurses who implemented hourly rounding
Focus on leader rounding
Nurses who did not implement hourly rounding
Focus on other personnel rounding
Patient safety/falls prevention was evaluated

8. Methods Results: 34 articles found 10 articles met inclusion criteria
2 articles were systematic reviews of non-RCT (Level II evidence)
8 articles were cohort studies or quasi-experimental studies (Level III evidence)
All studies were ranked Level III for validity using the Quelly tool (2004)
Total number of participants unknown due to some studies not reporting

9. Findings Coding themes for hourly rounding: Decreases patient falls
Increases patient satisfaction
Decreases patient call light usage
Proper training, implementation, and compliance is necessary for success

10. Findings: Decrease in falls
9 studies showed decrease in patient falls
Cann & Gardner (2012); Goldsack et al. (2015); Hicks (2015); Kessler et al. (2012); Mitchell et al (2014); Olrich et al (2012); Saleh et al. (2011); Spanaki et al (2012); Tucker et al (2012)
2 studies showed statistically significant results
Goldsack et al (2015) p=0.006
Saleh et al. (2011) p<0.01
1 study was inconclusive
Krepper et al (2012)

11. Findings: Increase in patient satisfaction
4 studies showed an increase in patient satisfaction
Cann & Gardner (2012); Kessler et al. (2012); Olrich et al (2012); Saleh et al. (2011)
(p=0.081; not reported; p=0.383; p<0.05)
1 systematic review found 4 studies that showed statistical significance
Mitchell et al (2014)

12. Findings: Decrease in call light usage
3 studies showed a decrease in call light usage
Krepper et al. (2012); Olrich et al (2012); Saleh et al. (2011)
(p=0.001; number not reported; p<0.001)
1 systematic review found 10 studies addressing call light usage
Mitchell et al (2014)
Median reduction of 54%

13. Findings: Proper training, implementation, and compliance needed
4 studies discussed the importance of training, implementation, and compliance to hourly rounding
Goldsack et al. 2015
Kessler et al., 2012
Olrich et al., 2012
Tucker et al., 2012

14. Limitations Non-randomization samples Weak research design
Small sample sizes
Variations in the length of time
Lack of follow-up

15. Recommendations for Nursing
Hourly rounding should be implemented as it may:
Help nurses to keep patients safe by reducing patient falls.
Improve patient’s satisfaction.
Decrease patient call light usage.
Proper implementation, compliance, and training of nurses should be offered to promote successful hourly rounding by decreasing patient falls.
Strength of Recommendations: A

16. Conclusion
Hourly rounding is an autonomous intervention that nurses can easily implement to ensure patient safety and reduce patient fall rates
Hourly rounding can also increase patient satisfaction and decrease call light usage
With proper training, nurse buy-in, and consistency to the intervention, hourly rounding can benefit both nurses and patients
Hourly rounding can help reduce unnecessary hospital costs