HOURLY ROUNDS APRIL 13, 2015
1
PREVENTING FALLS WITH HOURLY ROUNDS INTRODUCTION DONNA ARIS RN AURORA UNIVERSITY PROBLEM METHODS OUTCOMES & IMPLICATIONS 1 2 3 4 6 Figure 1. Sample Hourly Round Checklist Table 1: Phases of Pilot Program Methods/Approach Figure 2. Fall rates pre & post hourly rounds pilot program RESULTS OF INTERVENTION FINDINGS & RECOMMENDATIONS . IMPLICATIONS REFERENCES In 2011, 22,900 older adults died from falls. 1 Injury from falls cost $30 billion in 2012, and is expected to increase to $68 billion in 2020. 1 Medicare & Medicaid are no longer paying facilities for treatment of in-facility fall. 2 ... Most falls are caused by multiple factors, both intrinsic (patient related) and extrinsic (environmentally related). 3 Multifactorial interventions; two or more interventions linked to each faller risks profile, there was a reduction in falls. 5 Patient-centered proactive hourly rounding, where front-line staff actively participates in the design of the pilot phase, record significant fall reduction rates. 4 EXPLORATORY FEB 01- 15 Audits of care/ CNA’S work flow Review fall protocol Chart review/fall Met multidiscipl inary teams Review of literature EDUCATION FEB 02- 06 Education sessions/ 1N Hourly Round 4P’s Poster board Hourly rounds & Hourly Round Observatio nal Audits/daily Review falls data weekly IMPLEMENTATION FEB 16- MAR16 Suggestion Box Hourly Round Forms Staff Teach back on Hourly Rounds Hourly Round Support & Audit checklist for compliance Staff feedback EVALUATION FEB 16 WEEKLY THRU MAR 16 Staff teach back Observatio nal Audits/Week ly & Daily Daily & Weekly Q & A Analyze data & final meeting with team Findin gs reviewed/D ON; to begin pilot 2014 NO - INTERVENTI ON FALLS = 37 PRE - INTERVEN TION FALLS=14 43% FALL REDUCTION IN 30 DAYS FALL RATES PRE- AND POST HOURLY ROUNDS 2014 2015 2015 Hourly Rounding Checklist Rounding completed on at risk residents. Star Team to participate as assigned. Date: 7am 8am 9am 10am 11am Noon 1pm 2pm 3pm Purposeful rounds completed by: (place initials in box indicating time of rounds, check all items below that apply for that time) 4 Ps Position Of Resident? Potty - Toileting schedule? Incontinent? Position of Bed Call light within residents reach? Position of Alarms - Bed & Chair? ENVIRONMENTAL SCAN Fall risk hazards: bed in low position, mats on ground. ***Pt. is able to "return demonstrate " the use of call light or light within reach *** Personal alarms bed & chair alarms activated. PATIENT CENTERED Ask, "Is there anything else I can do for you?" FINDINGS: Hourly rounds was not consistently done due to staffing shortages, staff could not round hourly in the rooms. Most falls occurred while residents were in their room. RECOMMENDATIONS: Continuous education about rounding and supervision is strongly recommended. This project demonstrates implementation of evidence based strategies can reduce falls in nursing homes. Commitment by the facility to reduce falls by engaging staff is vital to success of new initiatives. Quarterly reports on compliance with rounds and recognition of reduced fall 1. Cost of Falls. (2014) Center for Disease Control and Prevention www.cdc.gov . 2. Jorgensen, J. (2012) Reducing Patient Falls: a call to action. American Nurse Today, 7 (1) 10-20. 3. Stevens, J.A., Finklestein, E.A., Miller, T. R., (2006) The cost of non-fatal falls among older adults. Injury Prevention, 12 (3) 290-295 4. Tea,C., Ellison M., Feghali, F. (2008) Proactive Patient Rounding to increase customer service and satisfaction on an Orthopedic Unit. Orthopedic Nursing, 27 (4),233-240 5. Udell,J.E. (2015). Interviews for preventing falls in older people: an overview of Cochrane Reviews. Cochrane Database Of Systematic Reviews, (1), doi:10.1002/14651858.CD009074.pub2 Continuous education on hourly rounds needed to sustain fall reduction. CNA’s complained staff shortage affected hourly rounds. Low compliance with completing hourly rounds checklist/computer integration suggested. Direct observation audits increased compliance with rounds. OUTCOMES Reduction in use of call light. Reduction in falls by 43%. Reduction in CNA’s workload. Increased patient safety. Falls are the cause of an estimated1,800 deaths of residents in Long Term Care Facilities annualy. 1 How does patient-centered proactive hourly rounds for residents in the LTCF, along with the use of multifactorial fall prevention interventions, e.g. bed & chair alarms, reduce fall occurrence and promote patient safety.
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Transcript of HOURLY ROUNDS APRIL 13, 2015
PREVENTING FALLS WITH HOURLY ROUNDS
INTRODUCTION
DONNA ARIS RNAURORA UNIVERSITY
PROBLEM
METHODS
OUTCOMES & IMPLICATIONS
1
2
3 4 6
Figure 1. Sample Hourly Round Checklist
Table 1: Phases of Pilot Program Methods/Approach Figure 2. Fall rates pre & post hourly rounds pilot program
RESULTS OF INTERVENTION FINDINGS &
RECOMMENDATIONS
.
IMPLICATIONS
REFERENCES
In 2011, 22,900 older adults died from falls.1
Injury from falls cost $30 billion in 2012, and is expected to increase to $68 billion in 2020. 1
Medicare & Medicaid are no longer paying facilities for treatment of in-
facility fall.2...
Most falls are caused by multiple factors, both intrinsic (patient related) and extrinsic (environmentally related).3
Multifactorial interventions; two or more interventions linked to each faller risks profile, there was a reduction in falls.5
Patient-centered proactive hourly rounding, where front-line staff actively participates in the design of the pilot phase, record significant fall reduction rates.4
EXPLORATORY FEB 01-15 Audits of care/ CNA’S
work flow
Review fall protocolChart
review/fall hx. N=6
Met multidisciplinary
teams
Review of literature
EDUCATION FEB 02-06 Education sessions/ 1N
Hourly Round 4P’s
Poster board Hourly rounds &
Hourly Round Checklist
Observational Audits/daily
Review falls data weekly
IMPLEMENTATIONFEB 16- MAR16
Suggestion Box
Hourly Round Forms
Staff Teach back on Hourly
Rounds
Hourly Round Support &
Audit checklist for compliance
Staff feedback
EVALUATIONFEB 16
WEEKLY THRU
MAR 16
Staff teach back
Observational Audits/Weekly
& Daily
Daily & Weekly Q & A
Analyze data & final meeting with
team
Findings reviewed/DON;
to begin pilot program on other units
2014 NO - INTERVEN-TION FALLS
= 37
PRE - IN-TERVEN-
TIONFALLS=14
43%FALL REDUCTION IN
30 DAYS
FALL RATES PRE- AND POST HOURLY ROUNDS
2014 2015 2015
Hourly Rounding Checklist
Rounding completed on at risk residents. Star Team to participate as assigned. Date: 7am 8am 9am 10am 11am Noon 1pm 2pm 3pm Purposeful rounds completed by: (place initials in box indicating time of rounds, check all items below that apply for that time)
4 Ps Position Of Resident?
Potty - Toileting schedule? Incontinent?
Position of Bed Call light within residents reach?
Position of Alarms - Bed & Chair? ENVIRONMENTAL SCAN Fall risk hazards: bed in low
position, mats on ground.
***Pt. is able to "return
demonstrate" the use of call light or light within reach ***
Personal alarms bed & chair
alarms activated.
PATIENT CENTERED
Ask, "Is there anything else I can do for you?"
FINDINGS: Hourly rounds was not consistently done due to staffing
shortages, staff could not round hourly in the rooms.
Most falls occurred while residents were in their room.
RECOMMENDATIONS: Continuous education about rounding and supervision is
strongly recommended.
This project demonstrates implementation of evidence based strategies can reduce falls in nursing homes.
Commitment by the facility to reduce falls by engaging staff is vital to success of new initiatives.
Quarterly reports on compliance with rounds and recognition of reduced fall rates, maintains staff motivation for the program.
1. Cost of Falls. (2014) Center for Disease Control and Prevention www.cdc.gov.2. Jorgensen, J. (2012) Reducing Patient Falls: a call to action. American Nurse Today, 7 (1) 10-20. 3. Stevens, J.A., Finklestein, E.A., Miller, T. R., (2006) The cost of non-fatal falls among older adults. Injury Prevention, 12 (3) 290-2954. Tea,C., Ellison M., Feghali, F. (2008) Proactive Patient Rounding to increase customer service and satisfaction on an Orthopedic Unit.
Orthopedic Nursing, 27 (4),233-2405. Udell,J.E. (2015). Interviews for preventing falls in older people: an overview of Cochrane Reviews. Cochrane Database Of Systematic
Reviews, (1), doi:10.1002/14651858.CD009074.pub2
Continuous education on hourly rounds needed to sustain fall reduction.
CNA’s complained staff shortage affected hourly rounds.
Low compliance with completing hourly rounds checklist/computer integration suggested.
Direct observation audits increased compliance with rounds.
OUTCOMES
Reduction in use of call light. Reduction in falls by 43%. Reduction in CNA’s workload. Increased patient safety.
Falls are the cause of an estimated1,800 deaths of residents in Long Term Care Facilities annualy.1
How does patient-centered proactive hourly rounds for residents in the LTCF, along with the use of multifactorial fall prevention interventions, e.g. bed & chair alarms, reduce fall occurrence and promote patient safety.
