Getting Back to Basics: Hourly Nursing Rounds to Decrease Patient Falls and Call Light Usage and Increase Patient Satisfaction

Monday, 7 July 2008: 10:30 AM
Melanie Kalman, PhD, RN , College of Nursing, SUNY Upstate Medical University, Syracuse, NY

Learning Objective 1: describe the hourly rounding process.

Learning Objective 2: appraise the results of the hourly nursing rounds study.

Falls among hospitalized patients are a persistent problem with an occurrence rate of 2.3 to 7 falls per 1000 patient days in United States hospitals. Approximately 30-48% of these falls result in injury, costing the hospital in excess of $4,200 per fall. Hospitalized patients often fall while performing elimination activities and they ring the call light for assistance with these same activities. The call light can be a lifeline for hospitalized patients, but can also impose considerable demands on nursing time. Studies have documented how call bell usage interferes with the nurse's ability to effectively manage time.

Implementation of hourly rounding has shown positive outcomes in reducing falls and patient call light usage as well as increased satisfaction. The purpose of this quasi-experimental, replication study was to determine if hourly nursing rounds effect patient fall rates, patient satisfaction, and call light usage.

Before the study, patient fall rates at a central New York hospital were 4.47 per 1000 patient days. The call light on one unit was used 6,909 times by patients over a 4 week period. Using two medical-surgical units, data were collected for patient falls, patient satisfaction, and call light usage prior to the implementation of nursing rounds. The same data were collected after implementation of rounds on the experimental unit. The sample consisted of all patients admitted to the units during the study period. All nursing personnel were educated on how to perform hourly rounds: what questions to ask and what actions to perform. Data was analyzed using measures of central tendency, Chi-square, rank sum, and rate ratios.

Results demonstrate a decrease in patient falls that is clinically but not statistically significant. The fall rate on the experimental unit dropped to 2.82 falls per 1000 patient days. Call light usage was inconsistent. Some weeks it was less and some the same. Patient satisfaction was obtained through post discharge surveys and showed no change, either on the control or experimental unit. However, the sample size was small (<50).

While technology is important for improving patient care sometimes low tech options are quick and inexpensive wins. Findings from this study will be used to improve nursing practice and promote clinical excellence. Hourly rounds will continue, first reviewing the rounding process with nurses. The results will continue to be reassessed.