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Protecting the Patients Patients who are aged 65 and above with conditions that cause disorientation and confusion sometimes fall while admitted in hospitals. Commonly, the falls occur when they attempt to move from their beds to other places that the underlying situation may necessitate such as going to the bathroom or reaching for a belonging. The risk of falling is high in those patients who have chronic illness and mental concerns as their stability and cognitive function is highly reduced. The issue of falls in elderly patients is a concern for both the patient and family as they can have very devastating effects on the recovery and finances of the patient. For instance, patients who fall sometimes suffer injuries which mean that they undergo further care at the hospital. This care comes at a cost to the patient as well as the hospital. Normally, these costs are unplanned for the initial cost estimation for the care services to be offered to the patient. Therefore, falls result in inefficiencies because of the duration and addition of further care. As a result of falls occurring, the increase in injury rate at a hospital reduces the facility’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) rating as the level of customer satisfaction goes down. It is possible that patient falls can also incapacitate the patients in one way or the other, making it a lifetime issue for the affected. In this regard, it is vital that a befitting mechanism be developed to help reduce the occurrence of hospital falls especially to patients who are above 65 years old. Nursing aims at providing better and quality patient care. As a result, nurses must ensure the safety of patients. Therefore, they need to make sure that quality degrading incidences such as patient falls while in inpatient care are minimized to help enhance the quality of their services.
The Purpose of the Project
This project will focus on the issue of falls in the inpatient department for patients aged 65 and above suffering from disorientation and confusion caused by a number of diseases and their process’. This population can also be termed as the elderly or gerontological patients. The project aims at discussing one intervention approach for minimizing this issue. In this case, the intervention approach selected is the use of hourly rounding as an intervention to the problem of patient falls in the inpatient departments of most health care facilities. The selection of the project is based on thoughts of scholars such as Make-Lye et al. (2013) who believe that patient falls in hospitals represents the largest quality degrading effect that occurs at a health care facility. The proposed solution of initiating hourly rounds at a hospital involves nurses making rounds on inpatient units every hour and make appropriate patient needs assessments. (Brose and March, 2015). If carried out effectively, this practice is likely to allow nurses to assist patients who want to move; for instance, go into the bathrooms instead of the patients going alone which is the usual case in situations where they fail to get help. The best way to understand the effects of this intervention with regard to existing clinical evidence based on practice is to use the accepted clinical research question development format known as PICOT. Ideally, PICOT assesses nursing issues as having five variables.
These characteristics are patient or population which refers to the characteristics of the people in a health care who are affected by a certain health issue, intervention or indicator which refers to risk behaviours or a prognostic factor that is related to exposure to a disease or underlying health condition, comparison or control which refers to techniques or measures which can lead to the absence of risk or a prognostic factor, then there is the outcome variable which consists of factors such as the accuracy of disease diagnostic or the rate at which adverse outcomes occur from having a certain health condition, and lastly, time which primarily refers to the period taken by intervention approaches to achieve a notable outcomes in the mitigating the nursing issue at hand (Krepper, et.al, 2014).
PICOT Question
In the inpatient department with disoriented and confused patients of 65 years and older (P), does the use of hourly rounding (I) reduce the future risk (T) of patient falls (O) compared to the use of bedside reporting (C)?
Search Limits and Strategies
In order to obtain adequate information for this problem, only peer reviewed and evidence based practice artciles were chosen. Therefore, in developing and formulating this study, a systematic review was mainly done in the Livingston Lord Library on studies tackling care and maintenance of the elderly patients in inpatients department regarding their mobility and susceptibility to falls. The search range for the sources was between 2010 and 2017 yielding 217,000 results the first search. I was able to distinguish which articles I would use further by selecting peer reviewed articles, this significantly reduced the amount of articles available to 1300. I then read through the first five articles, which did not seem to fit the criteria for this assignment. I refined my search even further by changing the search from 2010 to 2012-2017. This reduced my results to 56, to which I read the first few articles with interesting titles regarding patient falls in the hospital. I finally setteled with the articles in this paper by reading through them, proof reading the information and authors.
The specific search phrases used included;
- Care for elderly in inpatient departments
- Incidences of patient falls in hospitals
- Rationale for hourly rounds by nurses.
- Effect of hourly rounding on patient
- Factors that lead to falls in hospitalized patients over 65
Presentation of Evidence
There have been a number of studies looking at the effectiveness of hourly rounding on fall prevention in hospitals, but there are other factors that play into complex scenarios. In recent studies conducted by Lancaster General Health (2014), there have been a coorelation between the sodium level of the elderly and the amount of falls that are experienced. Sodium is known for being an electrolyte that plays many key roles in the body. The most important roles are in cognitive function and in blood pressure (University of Rochester, 2017). In the study conducted by Lancester General Health, two-thousand and seventy elderly and confused patients were studied on how mild hyponatremia caused mental incapacity, confusion and lead to falls. This study took place in the emergency department, where trauma patients from falls were increasing steadily. The motive of this study it to identify factors that lead to falls in the confused elderly patients. Of these patients, there were 1841 (77.7%) falls admissions and 293 (12.4%) patients who were hyponatremic (Lancaster General Hospital, 2014). This is crucial information because it shows a direct coorelation of hyponatremia and how it can effect the elderlies mindset. By testing patients electorlytes in the hospital, I can help assure their safety and wellbeing.
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Critique of Evidence
The evidence, including the two quantitative studies identified above, are effective at demonstrating that hourly rounding can prevent falls, and are also effective at demonstrating that age is a factor in increasing falls. However, the literature does not discuss or provide adequate information regarding implications for practice. The study findings indicate that the incidences of patient falls in hospitals are increasing. In this regard, the major risk factors associated with the falls are morbidity, age, and absence of care or assistance. Therefore, the only variation that can be varied is the provision of close attention which can be achieved through hourly rounding. Because of the diverse effects patient falls have on nursing such as reduced patient satisfaction levels, it is prudent that certain practice measures are changed so as to incorporate the patient hourly rounds in inpatient departments (Singh, Okeke, & Edwards, 2015). In this regard, the major organizational change will be hospital scheduling of their nurses. There needs to be some set-aside time for nurses to make rounds in the inpatient section. The rounds must be done on an hourly basis, but they do not need to be a carried out by a specific nurse. Nurses can alternate if the concept of hourly rounding is adhered to rounding on preventing patient falls in those who are at greatest risk for falling. In the longterm care setting, this information and statistics is very important not only for the patient but for the personnel that work with them because any intervention that can be made to reduce falls for the elderly needs to be implemented.
Implications for Practice
The study findings indicate that the incidences of patient fall in hospitals are decreasing with hourly rounding and the use of the Morse fall score. In this regard, the major risk factors associated with the falls is morbidity, age, and absence of care or assistance. Therefore, the only variation that can be varied is the provision of close attention which can be achieved through hourly rounding. Because of the diverse effects patient falls have on nursing such as reduced patient satisfaction levels, it is prudent that certain practice measures are changed so as to incorporate the patient hourly rounds in inpatient departments (Singh, Okeke, & Edwards, 2015). In this regard, the major organizational change will be hospital scheduling of their nurses. There needs to be some set-aside time for nurses to make rounds in the inpatient section. The rounds must be done on an hourly basis, but they do not need to be a carried out by a specific nurse. Nurses can alternate if the concept of hourly rounding is adhered to. It is also very important for the nurse to be able to delegate tasks timely and properly to nursing personnel in order to maintain the safety of the resident. By effectively delegating tasks such as, hourly rounds, water refills and linen changes it can have a positive effect on the patients safety.
This proposed change will significantly improve the safety of patients especially those susceptible to falls. Consequently, their quality of life will be improved. Another patient-centered advantage will be a reduction in the amount of extra costs incurred for treatment as they will not again seek treatments for hospital incurred injury because of unplanned decent (Brosey & March, 2015). However, nurses will have to make sure that their time is managed well. This is because time spends in making inpatient rounds might have been used for other purposes. This can lead to the development of a need to hire more nurses to ensure that all hospital activities are going as per the schedule. If this change is implemented, the hospital will only be tasked with maintaining a certain number of nurses which can effectively attend to the increased duties. As Goldsack, et.al (2015) explains, evaluation of the effectiveness of the practice change will be based on percentage reduction in patient falls. In this regard, if the rate of falls reduces, then the changes would be regarded as having a positive effect.
Conclusion
In conclusion, the proposed change will be based on the significance of hourly rounding in reducing the rates of patient falls in the inpatient units of healthcare facilities. Primarily, the issue of patient falls affects the safety of patients more so those suffering from chronic and mental illness. This problem affects nursing in that their care becomes unsatisfactory to patients. The proposed solution is significance in nursing in that it leads to the use of the most appropriate evidence-based intervention. Ideally, it affects nursing since the intervention, which is hourly rounding, relies on the services provided by the nurses who have to make regular visits to the wards and assess the needs of each patient. This project will, therefore, argue a case for hourly rounding as an evidence-based practice for the reduction of patient falls.
