Running head: HOURLY ROUNDING AND THE EFFECTS ON PATIENT SAFETY AND

SATISFACTION

Hourly Rounding and the Effects on Patient Safety and Satisfaction

Leslie R. Wiley
The Robert B. Miller College
BSRN-430-01
Carol Moshier, Professor
April 23, 2014

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Hourly Rounding and the Effects on Patient Safety and Satisfaction

Introduction
Patient falls are dangerous and costly to the patient and the institution. Satisfaction
surveys are filled out by patients now and reimbursement is effected by the scores.
Nursing must adapt to these changes and find a way to keep patients safe and improve
satisfaction scores in the most efficient way possible. Hourly rounding in order to be
proactive for patient needs is one way of tackling this problem.
EBP Model
This project will be using the Iowa Model of Evidence-Based Practice as a format.
Trigger
A problem focused clinical issue: low patient satisfaction scores and an increase of
patient falls.
PICO
In hospitalized patients, how does hourly rounding to assess patient needs compared to
long call light times affect satisfaction and patient falls during a hospital stay?
Priority
This issue should be given a high priority. Hospitals are facing a reduction in
reimbursement due to the scores and ratings that are handed out by patients related to
many topics. Patient satisfaction and responsiveness of staff is one of them. It is also

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costly and detrimental to the patient and the hospital when a patient falls because there
was a lack of assistance. Patient safety should always be our first priority.
Team
My team will consist of department managers, educators, and a number of clinical staff
members. A member of the finance team could also be an asset to answer any questions
regarding why this is important from a financial perspective and not just a patient safety
perspective. It will also be beneficial to have upper management involved so that they
buy into the idea and can see firsthand the benefits. It is essential to have everyone
understand the importance of this change and to get 100% compliance in the new
changes.
Literature Review
Critique #1
Degelau, J., Belz, M., Bungum, L., Flavin, P., Harper, C., Leys, K., & Lundquist, L., Webb,
B. (2012, April). Prevention of falls (acute care). In National Guideline
Clearinghouse. Retrieved March 16, 2014
Date of Publication
The date of publication was initially March of 2008 but was revised in April 2012.
Authors
Each author was listed with their credentials. It also listed job title, department, and
affiliated organizations as well as national, regional, and local committee affiliations.

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The guideline included each authors related activities, research grants, and if they had
any financial or nonfinancial conflicts of interest. None of the authors were found to
have any conflicts.
Purpose and Patient Group
The objective or purpose of this guideline was very specific and did not go into a lot of
detail or background. The objectives are as follows:

To eliminate all falls with injury through a falls prevention protocol in the
acute care setting

To increase the percentage of patients who receive appropriate falls risk

assessment and falls prevention interventions

The patient population used was adult hospitalized patients. It didnt give any more
detail than that.
Evidence
This group searched electronic databases using keywords such as risk assessment tool,
acute care, impaired mobility, beds, and rounding in combination with falls/accidental
falls.
Description of the Methods
Once the evidence was obtained the researchers used a rating scheme to determine the
strength of the evidence. The methods for analyzing the evidence were systematic review
and meta-analysis.
Search Terms and Retrieval Methods

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All search words were listed in this guideline that the researchers used to collect
evidence. Some examples are listed above under the evidence section. The retrieval
methods are not clear other than information was pulled from the electronic database.
Well-Referenced and Comprehensive
This guideline details all of the developers and hospital affiliations. The source of
funding is listed as well as a composition of the group that developed and authored the
guideline.
Recommendations Sourced
Each recommendation is presented based on an annotation table that reflects 7 detailed
annotations. There is a table included in the guideline that explains what each
annotations means. For example, an annotation of C2 would mean it is from a primary
report of new data collections and is a case-control study.
Reviewed
This guideline was reviewed by internal peers.
Funding
This guideline that was established by the Institute for Clinical Systems Improvement
was funded by annual dues of member medical groups as well as five sponsoring health
plans in the states are Minnesota and Wisconsin.

Critique #2

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Tzeng, H., & Yin, C. (2010, September). Nurses' response time to call lights and fall
occurrences. In Medsurg Nursing. Retrieved March 17, 2014
Research Question
This quantitative study is based on finding out if there is a difference in the average
amount of time it takes to answer a call light for a patient that is a faller compared with a
patient that is a non-faller. A longer time to answer the call light may lead to a higher
incidence of falls. Once a patient falls, some believe that nurses answer call lights faster
due to the recent fall and the fear that it could happen again.
Research Design
The researchers used a non-experimental ex post facto design to conduct this study. A
consent form was not needed from each participant. All data was pulled from an
electronic medical record and analyzed after the patient had been discharged from the
hospital. The data was entered into the Statistical Package for the Social Sciences. This
matched patients together. All confidential patient identifiers were left out of the study.
This method was performed by two researchers which allowed the study to be less costly
while having more control.
Sample
Patients included in the study consisted of:

A primary diagnosis of admission for rehabilitation

Age 21 or older

A fall incident occurring within 72 hours of admission

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The first fall since admission was the only one included

Exclusion criteria consisted of patients that did not have a Functional Independent
Measures assessment completed at admission. The FIM is a tool that measures the
severity of disability in patients such as self care, dressing, bathing, toileting, social
cognition, and memory. Patients were pulled from the electronic medical record and put
into two groups, fallers and non fallers. With that information, patients were matched up
according to primary diagnosis, gender, and age (within 10 years). The researchers
started with 1,100 admission profiles and ended with 59 matches (118 patients) for the
study.
Independent Variables/Measures
A few independent variables were looked at. First is the nurses response time to call
lights. This was measured using a call light tracking system. The time starts when a
patient pushes the call button until the light is answered by turning the alarm off in the
patients room. Second are the 18 functional independent measures of disability. This
looks at what the patient is capable of doing rather than what the patient should be able to
do under other circumstances. The last independent variable that was used in the research
study is the amount of call light usage by the patient. This was also calculated with the
call light tracking system to look at the frequency of calls.
Dependent Variables/Measures
The only dependent variable is the fall occurrence.
Reliability/Validity

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Unfortunately, this study did not go into detail regarding strengths and weaknesses as far
as validity and reliability. The validity of this study falls under the category of
convergent. The variables that were tested should be related to each other. Results of
this study showed this to be the case. When the call light time was longer the patients
had greater falls. Cronbachs alpha was used to test reliability of this study. There was a
table included that gave information about the significance or test value as well as the
mean or average for each variable.
Results
The groups were paired together so that the characteristics were comparable between the
fallers and the non-fallers. The amount of usage for call lights in the 24 hours before and
after a fall incident was no different from a non-fallers usage. The responsiveness of the
nurse in the 24 hours prior to a fall was no different between the two groups. However,
after a fall had occurred the responsive time was significantly decreased for the faller
group than when a non-faller used the call light. The fallers tended to use their call lights
more frequently after a fall probably related to fear of falling again.
General Strengths
The research question/hypothesis was supported in this study. The information and tables
were easy to read and understand. The type of study conducted was cost effective and
easy to control with a small number of researchers. The idea surrounding this study is
definitely evidence based.
General Weaknesses

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There was little detail as far as reliability and validity. It was only conducted with data
from one teaching hospital, therefore, making this study hard to generalize to other
facilities. The sample size was fairly small and could have been done on a much bigger
scale.
Overall Quality of Study
I would give this study a rating of fair. There were as many weaknesses as there were
strengths. While this is a great subject it leaves questions to be answered. There is not
much information or credentials on the authors of this study and it never mentions if it
was reviewed by peers.
Summary Statements
Patient falls should be prevented at all costs. This study sheds light on one of the many
obstacles that nurses face on a daily basis. Call lights. It takes every hospital employee
to work together to keep patients safe. It shouldnt just fall on the nurses shoulders. Call
lights are everybodys responsibility. Minutes and seconds can make all the difference
when it comes to patients falling.
Critique #3
Tzeng, H. (2011, September). Perspectives of patients and families about the nature of and
reasons for call light use and staff call light response time. Medsurg Nursing, 20(5),
225-234.

Research Question

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This quantitative study was conducted to find answers to multiple questions surrounding
call light usage from the patient and families perspective. These included the reason for
the call light being activated, is the reason a matter of safety, on average how many times
does each patient push the call light per day, and how long does it take the staff to answer
the call light. The researcher decided to add two additional questions to the questionnaire
to find out if the nurse answered the call light in person or through the speaker and how
often does the problem get resolved once the light has been answered.
Research Design
An exploratory, cross-sectional study was conducted in the form of a survey for this
quantitative study. Researchers used three units that were acute adult units including an
oncology medical unit, a surgical unit, as well as a telemetry medical unit. Each unit
consisted of twenty beds. This single researcher used two trained research assistants that
went through a 2 hour session that included education on communicating with unit
managers, approaching potential participants, tracking to avoid duplication, and assisting
participants with the survey in a manner that avoids influence. An undergraduate student
research assistant was used for data entry under the supervision of the researcher. All
data was entered into the Statistical Package for the Social Sciences program for data
analysis.
Sample
Survey participants included in the study had to be:

21 years or older

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Conscious

Able to communicate in English

A convenience sample was used. Participation was voluntary, anonymous, and patients
were unable to be tracked as no personal information was included. Each unit was visited
up to six times until 40 surveys were obtained from that unit. Participants were awarded
a pen and a bag for participating in the study. 346 patients were approached but only 122
participated. Of those 122 surveys, 50 were collected during the week and 72 were
collected on the weekend.
Independent Variables/Measures
Four independent variables are used in this particular quantitative study.

Three units used for the study

Patient versus family responses

Age of the patient

Length of stay (days) at the time of survey completion

Dependent Variables/Measures
This study included three dependent variables.

Reason for the patient or family initiated call light

Call light usage

Call light response time

Reliability/Validity

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An analysis of reliability was not conducted because all questions on the survey were
scaled and tallied based on single items. Two conceptual models were utilized to get a
big picture on issues related to extrinsic and intrinsic factors that are related to falls. One
is the Hot Dog Model: Risk Factors for Inpatient Falls. The bun is the environment
related extrinsic factors, condiments are treatment and support factors, and the hot dog is
the patient related intrinsic factors. The other model used is the Model of Extrinsic and
Intrinsic Risk Factors for Falls in Inpatient Care Settings. This model lists all extrinsic
risk factors separately from intrinsic risk factors. It then shows when both are mixed
together the patient is at even greater risk than when one risk factor is present. Each item
of the survey was reviewed by a board of nine experts for validity in regards to
appropriateness and the usage of the wording.
Results
Each survey question is broken down with the results individually so that the researcher
could find a pattern. This researcher used the ANOVA and independent t tests and found
that there was no difference between the three units surveyed as far as the expected call
light response time and patient/family satisfaction. A correlation analyses was performed
on survey responses and it showed that as the patient was hospitalized longer the
perceived call light response times were longer.

General Strengths

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This study was based on evidence based practice and the idea that the results could
improve patient safety and satisfaction. The tables were easy to read and understand.
There was only one researcher and a couple of assistants so costs were kept to a
minimum. Surveys are easy and quick for patients to participate.
General Weaknesses
The biggest problem was that the study was conducted in the Veterans hospital. Only
6% of the participants were female. This study could not be generalized to the public.
The study should have used different types of facilities.
Overall Quality of Study
This study would be listed as fair. While the survey itself was reviewed by a panel of
experts the results were not peer reviewed. A quality study should be able to be
generalized to everyone receiving healthcare and that is not the case with this study. This
does leave us with more information to use in further studies as the topic is greatly
needed to be improved on.
Summary Statements
Nurses should be aware that call light response time is a big patient satisfaction point.
While healthcare staff may feel like the call light was answered quickly the time
perception varies greatly from the patient sitting in the bed. Pain, bladder/bowel issues,
and other needs are very important to that patient and when laying there helpless the time
probably seems longer that what it actually is. As long as nurses can be mindful of that

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and have open communication with their patients as well as being proactive with
toileting, pain medications, etc. patient satisfaction scores should improve.
Critique #4
Olrich, T., Kalman, M., & Nigolian, C. (2012, January). Hourly rounding: a replication
study. Medsurg Nursing, 21(1), 23-26.
Research Question
The purpose of this quantitative study to was to find out if hourly rounding decreased
patient falls, decreased call light usage, and increased patient satisfaction. There is a
great need for improvement in these areas at inpatient hospitals and skilled nursing
facilities. Patient falls add increased hospital stays as well as higher costs.
Reimbursement is starting to be based on patient satisfaction scores as well. According
to this article, falls among hospitalized patients account for 70% of hospital accidents
(Olrich, 2012). This can be avoided if healthcare becomes proactive by rounding hourly.
Research Design
A quasi-experimental design was used for the purpose of this study. The researcher chose
a nonequivalent control group design as well. Both the experimental group and the
control group had baseline data gathered. The intervention was completed on the
experimental group and then data was collected again to compare results. There was no
informed consent completed as no patient identifiers were used to collect data.

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Sample
This study was conducted over one year on two similar sized units in a 506 bed teaching
hospital. One unit was the control group and the other unit was the experimental group.
All patients that were discharged from each of the two units were included in the study.
This totaled 4,418 patients for the year.
Independent Variables/Measures
The independent variable is not specifically discussed in this study. However, it would
have to be hourly rounding. This is the task that affects the outcome of patient falls,
satisfaction, and call light usage.
Dependent Variables/Measures
The dependent variables that were analyzed in this quantitative study were patient falls,
call light usage, and patient satisfaction.
Reliability/Validity
This quantitative study doesnt go into great detail regarding reliability and validity. The
researchers used Chi-square and rank sum tests in order to compare characteristics
between baseline and post intervention details. Each dependent variable was looked at
separately. For example, the call light usage variable used an analysis of means (ANOM)
to find out if there was a statistically different rate during pre, initial, and post
implementation of hourly rounding.

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Results
Due to limitations of the study the results are not significant. Patient falls decreased
significantly clinically but didnt appear to have changed much statistically. Call light
usage was less frequent in the first week but the study showed not much change the
following weeks. Patient satisfaction didnt change statistically from post discharge
surveys but an increase was noted when nurse managers rounded and spoke with patients
in person. Pleased patients are less likely to send in surveys than a patient that is
dissatisfied.
General Strengths
The overall study was set up correctly and probably would have produced better results
with follow through. The team was small and consisted of one clinical nurse specialist, a
geriatric clinical nurse specialist, two nurse managers, a statistician, and a nurse
researcher. There was plenty of expertise on this team. This study was easy to read and
follow.
General Weaknesses
There were multiple limitations that occurred with this particular study. One of the nurse
managers pleaded to be the experimental group. That could have been a bias issue. The
hospital census was down significantly during the study. Only the staff on the
experimental unit was trained for hourly rounding so when a nurse floated from another
floor the standard of care didnt include the rounding thereby affecting the results of this
study. The sample size was small and because of this one particular patient, who was
delirious, pushed the call light 187 times within 6 days.

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Overall Quality of Study

This study would be given a poor rating. While the idea and outline for the study was
well written it wasnt followed through as planned. There was no foresight to the
problems that occurred.
Summary Statements
Hourly rounding can be very beneficial and even efficient for the nurses if everyone
follows the protocol. The problem in most places is getting all staff to buy into the idea.
Not only will it be better for the patient when it comes to safety and satisfaction but it
will benefit the nurse as well. There will be fewer interruptions from call lights if the
needs of the patients are met every hour.
Critique #5
Berg, K., Sailors, C., Reimer, R., O'Brien, Y., & Ward-Smith, P. (2011, December). Hourly
rounding with a purpose. The Iowa Nurse Reporter, 24(4), 12-14.
Research Question
A group of nurses that worked together on a shared governance team wanted to find a
way to increase patient satisfaction while decreasing the number of interruptions for
nursing staff, and reducing steps in the workload. They wanted to find out if hourly
rounding for the three Ps (potty, pain, positioning) would do just that.

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Research Design
This particular study was conducted using a longitudinal research design. An
Institutional Review Board approved the study to take place and consent was obtained
from the nurses that were willing to participate with the hourly rounding study. The
study took place on one unit that consisted of 28 beds. The census and acuity for this
specific unit was consistent so the researcher felt that would be the best for accurate
results. Data was collected prior to implementation of hourly rounding and then collected
again post hourly rounding. The data that was obtained after the hourly rounding was
implemented was studied by using a power analysis as a correlation study.
Sample
The sample used in this quantitative study was based on the nursing staff instead of the
patient. The unit was a 28 bed medical surgical inpatient unit. Sixty six percent of the
nurses agreed and signed consents to participate in the study. Only patients that were
assigned to those nurses were utilized in this study.
Variables
The variables mentioned in this study were the 3 Ps; pain, potty, and positioning. These
variables ultimately affect patient satisfaction scores and the amount of call light usage.
Reliability/Validity
A faculty member from the University of Missouri-Kansas City School of Nursing
reviewed the approach for the data collection as well as the procedure for analyzing the
data results and approved the methods for validity and reliability. All data was studied

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using correlational, factor analysis, paired sample t-tests, and descriptive methods. There
were many charts for each data source collected.
Results
After three months of hourly rounding, convenience samples of call light rosters were
collected. The results showed that as a result of hourly rounding, call lights were
decreased an average of 3.7 times per patient per day. The researchers broke it down
even farther and separated out the 3 Ps. Pain and positioning were not significantly
decreased; however, toileting needs were decreased significantly with hourly rounding.
Two Press Ganey evaluations were monitored for an increase after hourly rounding
began. Both promptness in response to call lights and nurses attitude toward requests
had increased. Tables were included for each analysis.
General Strengths
The results of this quantitative study support the research question. The tables and graphs
are easy to decipher and understand. The size of the study was small so it was cost
effective and easy to handle. The study was created and followed the framework
throughout.
General Weaknesses
This study would be hard to generalize to all populations as the unit was small and rural
with mostly postoperative and high acuity patients. Those patients have quite a lot of
pain so hourly rounding may be hard to catch pain before it occurs. The nursing staff that

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was a part of the study may have been influenced in the care that was given as this model
came from the shared governance team and they would have had a vested interest.
Overall Quality of Study
This study was well put together and very easy to understand. It gave a lot of detail on
those that authored this study and it was reviewed by the Institutional Review Board. I
would rate this study as good.
Summary Statements
This study was especially helpful due to the fact that it broke the results of the 3 Ps down
and didnt leave them as one result. It was also interesting to see the idea of consents
used differently. The nurses signed consents instead of the patients. The patients didnt
need to know that a study was being done.
Critique #6
Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of
patient comfort rounds on practice environment and patient satisfaction: a pilot
study. International Journal of Nursing Practice, 15, 287-293. doi:10.1111/j.1440172X.2009.01753.x
Research Question
Nursing is at the center of patient care during a hospital stay. Patient safety and
satisfaction are being measured for reimbursement by insurance companies. The nurse to
patient ratio as well as patient acuity continues to climb. This affects patients scores on
post treatment surveys and causes increased demands on the nurse leading to burnout,

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high turnover, and potential for errors. This study was proposed to look at these issues
through the practice of hourly rounding in an effort to improve conditions for patients and
nurses.
Research Design
This study used a quasi experimental pretest post test non-randomized parallel group
design to follow. Researchers developed a patient satisfaction survey that was tested with
a psychometric analysis for reliability. It contained 9 statements relating to timeliness
and having their needs met. Patients were given this survey upon discharge from the
hospital. The researchers then used the Practice Environment Scale of the Nursing Work
Index (PES-NWI) to record the nurses perspective. This scale had previously been
validated as a usable instrument. Items such as staffing, work environment, manager
ability, and resources available were included in this questionnaire. Nurses were asked to
fill this out at three points during the 8 week study period.
Sample
The study took place on two matching acute surgical wards. One unit was the control
group and one was the experimental group. A total of 129 patients consented to the study
and 39 nurses participated. The control group had 68 patients and 16 nurses. The
experimental group had 61 patients and 23 nurses. The mean length of stay for patients
was 6.9 days for the experimental group and 8.5 days for the control group.

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Variables
The researchers didnt go into detail regarding variables. The dependent variables would
be the patient scores on the Patient Satisfaction Survey and the nurse scores on the
Practice Environment Scale of the Nursing Work Index. These are all relative and as a
result of the hourly rounding.
Reliability/Validity
The method used to test the Practice Environment Scale of the Nursing Work Index was
not discussed as it had been previously tested for validity. The Patient Satisfaction
Survey was studied using a principal component analysis. This test is used to find the
variance between components. The table was then set up in rank in the order of the
magnitude within each component. This particular study used a two dimensional
structure and the Pearsons r correlation was figured. Cronbachs alpha was calculated
for the entire scale as well as all of the subscales.
Results
The results from the patient satisfaction survey didnt show much of a difference between
the experiment group and the control group. It was thought that this could be due to the
small sample size or patients fear of complaining about their care. The practice
environment scale showed that nurses who participated with the hourly rounding had an
increase in perception regarding quality of care, resource adequacy, and professional
relations.

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General Strengths
This study was found to be reliable and focused. It followed the framework and
developed a great tool with the patient satisfaction survey. This could be used for a larger
study. The reliability and validity was tested and explained well with graphs and charts.
The study was ethical and consent was signed by all nurses participating.
General Weaknesses
The sample size was half of what the researchers had originally planned for. This study
could not be generalized to all areas of nursing as only one type of inpatient care unit was
used for this study.
Overall Quality of Study
While the study was relatively small this would work well for a larger sample size. The
researchers were very detailed and specific in their writings. I would give this study a
rating of good.
Summary Statements
This was interesting due to the fact that this study looked at the patient safety and patient
satisfaction issue from a different angle. Instead of getting consents from patients and
letting the patients know that they were involved in a study, the researchers obtained
consents from nurses that were willing to participate in the study. There was no way that
the patient could be biased on their surveys. In the end, both options for completing
studies of this topic are useful and need to be tested further to ensure that we are giving
the best nursing care.

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Critique and Synthesize Research

All six research articles that are included for reference support the PICO question that
hourly rounding in order to be proactive to patient needs does affect patient falls as well
as patient satisfaction. Some studies were completed better than others but ultimately
ended with the same results. There were various studies completed in different areas of
inpatient units so generalizability will not be an issue. This implementation will work in
our hospital.
Applicability of Research to Practice
Patient falls can occur regardless of diagnosis or age. Medications are given that can
cause patients to fall, surgical patients can have mobility issues, and patients with
dementia may fall easily. Every patient is at risk and falls can be prevented with hourly
rounding and being proactive with toileting, positioning, and keeping items within reach.
This will not completely eliminate call light usage but will greatly reduce it. Each patient
that seeks medical attention at our hospital is given a survey; therefore, every hospital
employee is responsible for how satisfied that patient is with the care received. If a
patient believes that the nursing staff has gone above and beyond by being proactive that
will have a huge impact on our patient satisfaction scores.
Outcomes to be Achieved
The main objective is to achieve higher patient satisfaction scores and have less patient
falls. These goals are attainable with the correct guidelines put into place and the entire
hospital staff on board.

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Baseline
Information will be gathered on our current patient satisfaction scores from the Press
Ganey surveys that are mailed to patients upon discharge from the facility. These
statistics will be pulled from six months back to give us a bigger picture. The number of
patient falls will come from risk management. Patient safety reports are filled out when
an incident occurs. Reports will be pulled from the last six months to find out how many
falls there were and the possible reasons that may have caused the fall. This will allow us
to find trends and a possible starting point for addressing fall prevention.
Potential Barriers
One issue may be getting everyone on board with the hourly rounding. It is not just the
responsibility of the nurse. Patient care assistants are capable of helping patients to the
bathroom and repositioning. This must be a team effort. This can be overcome by
explaining the rationale behind the changes being made to staff at the hourly rounding
education so that they have an understanding on why this is happening. Communication
will play a big part in this process as well. If a patient care assistant is helping a patient
and the patient complains of pain, the nurse must be notified immediately. If not, the
patient will think that they were forgotten and that leads to dissatisfaction.
Communication seminars are available and will come to hospitals for staff training.
Another issue will be getting managers to audit this in order to hold staff accountable.
The managers have busy jobs but will have to find time to audit. Managers may have to
delegate other tasks to employees to make time for audits or come up with an audit team
that will just focus on auditing.

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Effects of Health System

The effects of this change could be very beneficial to the healthcare system. Health care
is getting very competitive and every effort must be made to attract and keep business by
giving the best care. Word of mouth can be very powerful and a satisfied and safe patient
spreads a good word. Patients are shopping around for the best service and we need to
make certain that we are fulfilling every expectation.
Guideline

Develop the new standard of care and train staff

Educate patient upon admission about hourly rounding and the importance of
using the call light in between

RN will round on odd hours, PCA will round on even hours

Each rounding will consist of toileting, repositioning, environment (are things in

easy reach for the patient?), pain assessment, and asking if there is anything the
patient needs

Before administering pain meds assist patient to bathroom if needed. This will
alleviate some trips while pain medication has affected balance and mobility.

Answer call light as soon as possible to prevent falls

Do not walk by a call light as patients may perceive that they are not being
noticed

Manager will perform audits by talking with patients to make sure they are getting
checked on hourly.

Pilot

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27

One floor of the hospital will be used to pilot this new standard of care. An evaluation
will be done at the end of week one and again at the end of week two. Each additional
floor will be rolled out every two weeks to assist the team in getting staff trained and
audited.
Evaluation Process and Outcomes
After all floors have put the new process into practice, evaluations will be done by patient
surveys and staff satisfaction surveys. Press Ganey scores will be monitored to watch for
an increase in patient satisfaction scores. The number of patient falls will be monitored
and tracked to watch for areas that can be improved upon. Managers will meet with the
team monthly to update on progress and make changes as needed.
Modification
Evaluations performed at week one and week two on each floor will give us the
opportunity to make changes as needed to the process. Once all floors have rolled out
with the new process the managers will meet monthly.
Continue to Monitor
Patient satisfaction scores will be monitored to watch for any changes positively or
negatively. Risk Management will keep track of patient falls when patient safety reports
are completed and see where improvement can be made. Staff will be encouraged to hold
each other accountable to the hourly rounding and keeping call light times to a minimum.
Department managers will continue to audit staff.
Conclusion

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28

As healthcare staff continues to take on more responsibility when it comes to patient/staff

ratio, documentation requirements, phone calls, etc. it is imperative that safety is always
the number one priority. Nursing is customer service. As healthcare becomes more about
the dollar than patient care, nurses must remember that both can be achieved by being a
little creative about how we take care of our patients. Its what we would want if we
were the patient.

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29

References
Berg, K., Sailors, C., Reimer, R., O'Brien, Y., & Ward-Smith, P. (2011, December). Hourly
rounding with a purpose. The Iowa Nurse Reporter, 24(4), 12-14.
Degelau, J., Belz, M., Bungum, L., Flavin, P., Harper, C., Leys, K., & Lundquist, L., Webb, B.
Institute for Clinical Systems Improvement. Prevention of falls (acute care).
In NationalGuideline Clearinghouse, April 2012
Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of patient
comfort rounds on practice environment and patient satisfaction: a pilot
study. International Journal of Nursing Practice, 15, 287-293. doi:10.1111/j.1440172X.2009.01753.x
Olrich, T., Kalman, M., & Nigolian, C. (2012, January). Hourly rounding: a replication
study. Medsurg Nursing, 21(1), 23-26.
Tzeng, H. (2011, September). Perspectives of patients and families about the nature of and
reasons for call light use and staff call light response time. Medsurg Nursing, 20(5), 225234.
Tzeng, H., & Yin, C. Nurses' response time to call lights and fall occurrences. Medsurg
Nursing, 19(5), 266-272.