The effect of hourly rounds on fall prevention in the Medical Surgical Unit

Introduction

Cases of patients falling have tremendously increased in the hospital medical surgical unite. Falling may occur when patients transfer from one place to another. Major falls may cause fractures and several other physical and emotional instabilities to the patient. Minor injuries arising from falling also cause suffering to the patients and hinders their rehabilitation (Taylor 201). The nurses, doctors, and other medical petitioners should ensure that they make hourly rounds in the hospitals to prevent patients from falling in the medical surgical unit. There are major risks associated with patients falling range from agitation and confusion, muscle weakening, fractures and multiple diagnosis of patients by the doctors. Prevention of patient falls is important in the medical surgical unit in every clinical setting.

Patient falls are evidently ubiquitous and they need to be reduced in order to guarantee patient safety during their stay and visits to the hospitals. Since patient falls are unplanned events, the hospitals should come up with ways of preventing this problem. The most important way to reduce patient falls in the medical surgery unit is by ensuring that the nurses make hourly rounds to check on the patients. When nurses take hourly rounds, they secure the patients firmly in their beds to ensure that they are free from falling. Reduction and prevention of patients from falling will promote their quick and effective rehabilitation. This is because there will be no complications during the diagnosis of the patients by the doctors and nurses.

During the hourly rounds, nurses should asses the patients for any potential risk; for example, when a patient is constantly turning or constantly moving in bed, the nurse should come up with a way of restraining the patient without causing any injuries. The patients may be tied to the bed, or the bed be surrounded with restrainers. In the hourly rounds, the nurses may also intervene to prevent falls. When nurses find patients in compromising situations, they are expected to assist the patients by putting them back to proper positions in order to prevent falling.

The hourly rounds made by nurses in the medical surgical unit significantly reduce accidents involving the fall of patients. As the nurses do their hourly rounds, they should also collect data for progressive improvement in the prevention of patient falls at the medical surgical unit. The data collected is a very important tool in the analysis of patients. If a patient has the tendency to fall at certain times of the day or night, the nurses should be readily available to assist the patient and prevent him from falling. When nurses are taking hourly rounds, they should also educate the patients on ways to avoid falling.

Literature review

Surveys carried out in the United States of America indicate that approximately 2 to 3 people fall daily; this sums up to 1000 people yearly. It is evident that after patients have fallen, their healing process will take more time than the expected duration. The accidental falling experienced by the hospitalized patients also directly affects the hospitals cost per case and the length of patients stay.

Most of the patients who fall in hospitals are children and the elderly. This is because as patients continue to age and are exposed to vulnerabilities, their potential for harm increases. Likewise, as the practicing nurses age, risks associated with injuries during care giving escalate. Nurses and other healthcare workers may hurt their backs in the process of picking up a patient who had fallen. To reduce the problem of patient falling, the hospital should ensure that nurses and other hospital workers take hourly rounds in the medical surgical units. This will help the nurses in monitoring patients’ behavior and restrain them from falling.

The nursing profession has numerous theories that promote good medical care to the hospitalized patients. Dorothea Orem wrote about the Self Care theory. This theory states that the wholeness of a human is the structure of the body and the mental functioning. It also states that the goal of nursing is to provide care to the patients. Dorothea also emphasized that nursing and the provision of care should concur with proper cultural values, practices and believes. She states that there is no curing without care, but there can be care without curing. The health care providers should ensure that they provide the patients with the best care so as to ensure that they recover faster. This nursing theory is important because, with the hourly round, nurses are able to monitor hospitalized patients and prevent them from falling. The self-care ensures that the physical structure of patients is properly looked after with the avoidance of falling of patients.

A majority of scholars analyze the rate of patients falling decreases when a hospital implements the hourly rounds. This literature review focuses mainly on the ways of preventing the falling related to patients in the medical surgical unit. The aim of research in this field is to evaluate the importance of the hourly rounds by nurses in the reduction of fall of patients undergoing treatment in the hospitals and other health care units.

Research Question/Hypothesis

The objective of this study is to analyze the effect of hourly rounds on fall prevention in the medical surgical unit. The key research questions in this study assist the researcher to find out facts about the topic of the research. The research questions include:

What are hourly rounds?

What is a fall?

How can the rate of falls reduce in the hospital?

What are the causes of the falls in the medical surgical unit?

How does the hourly rounds prevent falls in hospitals?

What is the rate of falls when there is the presence of hourly falls?

Hourly rounds occur when nurses take deliberate checks on patients at usual intervals to ensure they are safe. In the hospitals, registered nurses go round the hospital on even hours, while the support staff makes rounds on all the odd hours. During the rounds, the nurses focus on the four areas, called the 4Ps that represent Pain, Potty or elimination, Positioning, and the Propinquity of all the patients’ personal items. It is evident that patients expect to be monitored at all times, these rounds assist in maintaining the patients’ expectations. These patients learn to trust that the process is effective and appreciate the awareness that someone will take care of any emergency; this confirmation makes patients to become less anxious (Tideiksaar 145).

The hourly rounds are vital in the hospital since they assist in attending to the patient’s wellbeing, comfort, and ecological needs. While maintaining the well-being of the patients, events like unrelieved pain, pressure ulcers, and falls reduce since the nurses often check on the patients hourly. In addition, hourly rounds assist the hospital to maintain an effective workflow by facilitating the nurses with ample time to proactively foresee and attend to all the needs of the patients.

Another vital variable in this study is a fall that is simply described as a sudden, unplanned, uncontrolled, and sudden downward disarticulation of the body to the floor or another object. Violent blows or other intentional actions cannot be falls since they do not occur suddenly. A near fall is another form of a fall experienced in hospital that occurs when an individual loses balance which does not cause falling or any form of injury (Doenges, Moorhouse and Murr p. 87). This includes an individual who slips or trips, but does not fall because s/he might be capable of regaining control before the fall. Lastly, an un-witnessed fall occurs when no one is watching; the nurses find the patient on the floor and neither the patient nor the nurse can determine what caused the fall.

The rate of falls can reduce gradually in hospitals if patients get regular checks from both the nurses and the support staff. These patients have to undergo monitoring throughout their stay in hospital because most of them lose control, thereby, causing sudden falls that they are unable to explain. High rates of falls are prevalent on the hospitals where hourly rounds are not critical. The nurses neglect their duty by assuming that the patient will call when they have an emergency. This neglect allows accidents to occur since there is lack of adequate care and help for the patients. Another cause of falls is extreme pain where the patient moves on the bed without restriction causing rampant movements that can result to falls.

Studies indicate that nurses are summoned by patients approximately 13 to 15 times in 12 hours to answer to needs that are not necessarily urgent; for example, toileting, pain relief and positioning. It is obvious that hourly rounds assist the nurses to anticipate the needs of the patients rather than waiting for the patients to interrupt with calls that are not urgent. Nursing care becomes more effective since fewer trivial calls are made when hourly rounds are effective in hospitals. Studies on the hourly rounds to check on the patients indicate that the fall rates reduced in some hospitals, but other hospitals indicate that the hourly rounds do not necessarily affect the fall rate of the patients.

Research indicates that hourly rounds increase the patient satisfaction, which will lead to referrals. The patient will be satisfied with the nursing care provided since there was attention to detail, and the patients noted the timeliness of nurses and the method of pain management. When a hospital has nurses going round hourly, the patients are satisfied that their needs will come first and they will certainly recommend the hospital to others in the event of an emergency or sickness.

Ethical Concerns and Human Rights

The Institutional Review Board (IRB) for human subjects has the mission to protect the human subjects in all research activities. First, this institution protects the welfare and rights of all the people through research. Secondly, it assists in fostering compliance with institutional policies and all the federal laws. This is achieved through aiding institutional recruit efforts in exploiting human subjects that are alive for research purposes, teaching and various scholarly searches analytically designed and attempting to contribute to the general knowledge available (Doenges, Moorhouse and Murr p. 89). Lastly, the IRB aims at educating institutional personnel on all the ethical issues concerning the use of human subjects in the research.

Ethics are vital in research since they determine the codes, policies, and rules that must guide all researchers in their work. The basic ethics incorporated in this research include honesty, objectivity, integrity, carefulness, openness and respect for intellectual property, confidentiality, and human subject protection. Honesty is vital in any scientific research since it dictates that results from the field should be true and accurate without any misrepresentation. Objectivity ensures that the researcher collects data without biasness and discloses all information the research requires. Integrity is another aspect of ethical concerns where the researcher has to fulfill the promises and agreements in the process of research.

Carefulness requires the researcher to avoid careless mistakes such as errors and negligence by comparing and analyzing his work with the work of peers. Openness allows the researcher to be capable of sharing ideas and allow critics to evaluate his work. Respect for Intellectual Property dictates the researcher to honour other peoples’ work since he is not allowed to utilise published work without permission. Confidentiality is an ethical consideration that dictates that a researcher must protect any confidential information submitted in the process of research. Lastly, the human Subjects Protection is vital because it educates the researcher on how to minimize all the risk and harm while maximizing the profits. Respect of human dignity, privacy, and independence in all the stages of the research should be a priority. During the research process, the burden and the benefits should be distributed accurately among the participants.

work cited

Doenges Marilynn, Moorhouse Frances, and Murr Alice. Nursing care plans guidelines for individualizing patient care. 6th ed. Philadelphia: F.A. Davis, 2002. Print.

Taylor, Carol. Fundamentals of nursing: the art and science of nursing care. 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008. Print.

Tideiksaar, Rein. Avoiding falls: a guidebook for certified nursing assistants. Clifton Park, NY: Thomson Delmar Learning, 2006. Print.