The purpose of this paper is to report on a systematic review of the evidence of the impact of intentional rounding (IR) on patient safety in adult acute healthcare settings.
Methods:
A systematic mixed method review was undertaken using the Joanna Briggs Institute (JBI) Reviewers Manual. An electronic search of CINAHL, MEDLINE, EMBASE, COCHRANE, and SCOPUS using key terms ‘nursing’ AND ‘intentional rounding’ OR ‘hourly rounding’ identified 89 English language citations. The titles and abstracts of the papers were reviewed independently by two researchers and 33 were deemed to meet the remit of the review. Following appraisal for methodological quality using the JBI-MAStAR and JBI-QARI nine studies failed to meet the minimum quality threshold and were excluded leaving 12 quantitative studies, 4 qualitative studies and 4 mixed method studies. The papers were published between 2006 and 2016 and reported on studies undertaken in the USA (n=13), Australia (n=5), Iran (n=1) and Saudi Arabia (n=1). Insufficient homogeneity of outcome measures precluded a meta-analysis of data so a narrative synthesis approach was used construct the data into themes.
Results:
Overall the methodological quality of the studies was weak. Quantitative designs included quasi-experimental pre-test post-test designs using one, two or three non-equivalent, separate samples design. Information relating to selection bias, study withdrawals and confounding variables were limited. A lack of standardised definitions and the use of a variety of data collection tools further compromised the comparison of study outcomes. Qualitative studies included ethnographic, descriptive and action research designs.
Study findings were contradictory. For example ten studies reported the impact of IR on the incidence of falls involving adults during an acute inpatient episode. Five studies reported a statistically significant reduction in the number of reported falls (Brosey & March, 2015; Dearmon et al. 2013; Goldsack et al., 2015; Meade et al., 2006; Saleh et al., 2011) and five studies reported a reduction in reported falls that was not statistically significant. Similarly ten studies reported the impact of IR on patient satisfaction with a focus on nurse responsiveness but only four of these reported a statistically significant improvement in patient satisfaction (Krepper et al. 2012; Meade et al. 2006; Negarandeh et al., 2014; Tea et al., 2008). Five studies reported on nurse call bell use as an indicator of how well patients’ needs were being proactively anticipated and as an indicator of patient satisfaction. However while a significant reduction in call bell use following IR implementation was reported in some studies (Meade et al.,2006; Cann & Gardner, 2012) another found that the total number of call bell use increased significantly in both the study and control groups (Krepper et al., 2012).
The effectiveness of IR was reportedly impeded by low compliance with IR protocols caused in part by competing initiatives, priorities and workloads (Deitrick et al., 2012; Harrington et al., 2013). Staff skill mix, staff patient ratios and staff turnover, unclear accountability lack of leadership support and the difficulty of integrating IR into nurses existing workflow was also identified as compromising the effectiveness of IR (Flowers et al., 2016; Harrington et al.,2013).
Conclusion:
This paper highlights a lack of consistent evidence to support or preclude the use of IR to enhance the safety and quality of patient care. The widespread adoption of IR clearly impacts on the processes of care and the capacity of nurses to keep patients safe. However an overly prescribed IR protocol may hinder the critical thinking and surveillance role of nurses by requiring an allocation of time to be spent all patients regardless of assessment and clinical need. A more rigorous evaluation of IR is therefore needed and this paper makes a number of recommendations in regard to future studies.
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