NRS 490 GRAND CANYON ENTIRE COURSE

The Implementation of Intentional Rounding Policy Marissa Bachaus Grand Canyon University-NRS490 April 30, 2017 The Implementation of Intentional Rounding Policy Hospital fall rates are monitored and reported through the National Database for Nursing Quality Indicators (NDNQI) (Fisher, Horn, & Elliot, 2014). “Inpatient falls range from 5.09 to 6.64 per 1,000 patient days across the nation” (Fisher et al., 2014, p. 15). In order to improve patient safety, Mayo Clinic hospital has a policy in place for nursing staff to conduct hourly patient rounding. At this time, this policy is not being enforced or monitored by the leadership team, in turn; nursing staff is not participating in intentional hourly rounding. This paper will analyze evidence supporting that adult patients in an acute care setting have improved safety and satisfaction during their hospital admission when a rounding schedule between the patient and nurse is established. Background The Mayo Clinic Hospital Phoenix was opened in the fall of 1998. The seven-story inpatient hospital has “268 licensed beds, 21 operating rooms and a Level II emergency department” which is available 24 hours a day. (Mayo Clinic, 2017, para. 2). Per the Mayo Clinic policy, registered nurses (RN) and certified nursing assistants (CNA’s) are to participate in intentional rounding. This means that every hour during the day, the RN or CNA should be at the bedside to address any patient needs and every two hours at night. Problem Statement The clinical problem is the authors unit has had increased incident reports specific to inpatient falls, specifically falls with injury. In order to improve patient safety, we need to start adhering to and prioritizing a Mayo Clinic’s policy. Mayo Clinic hospital has a policy which states registered nurses (RN) and certified nursing assistants (CNA) are expected to work together to meet the needs of the patient through intentional rounding. Purpose of Change Proposal The proposed topic is significant because it sets an expectation for the patient and staff, in turn, developing a trusting relationship between the patient and nurse. “Hourly rounding is one of the most important actions nurses can take to improve patient safety and reduce falls as much as 50%” (Hicks, 2015, p. 51). Currently, this authors unit has had higher than the national average for inpatient falls with injury. The purpose of implementing the intentional rounding policy is to reduce inpatient fall rates in turn, increasing patient safety. Embracing consistent rounding will create an environment for patients to anticipate visibility from both their RN and CNA, and the ability for the staff to organize their day for patient care that results in positive health benefits for their patients. What is Hourly Rounding? Hourly rounding establishes a relationship between nursing staff and the patient. This process involves setting a clear expectation between the nursing staff and patient. The patient is educated that every hour from the RN or CNA will be at the bedside to assess the patient needs, specifically, the 4 P’s; pain, personal needs, positioning, placement (Ford, 2010, p.189). During hours of sleep, , rounding will still take place, but every two hours. Patients are still educated to use their call light if they need anything; however, when there is a clear expectation that someone will be in the room within an hour, the goal is the patient will wait for rounding time for less urgent requests. The patient and nurse will establish a trusting relationship through consistent on-time rounding. PICOT In adult patients in an acute care setting (P), does establishing a rounding schedule between the patient and nurse (I) compared to purposeful rounding (C), affect patient safety and communication (O) during the patient’s hospital stay (T)? Literature Search Strategy The author used multiple databases to locate evidence-based articles, such as; CINAHL, Joanna Briggs Institute EBP, OVID Nursing Essential Collection, and ProQuest Nursing & Allied Health Source (Grand Canyon University Library, 2017). Google scholar was also utilized to find journals and locate a DOI. Then, the Grand Canyon University Library was used to locate the DOI. Key words used included: rounding, hourly rounding, intentional rounding and inpatient falls. Evaluation of Literature: Comparison of Research Questions Fall Prevention Bouldin et al., (2013) and Fisher et al., (2014) are research studies focused on national trends regarding hospital inpatient falls and the need for staff involvement to improve patient safety through education. Bouldin et al., (2013) conducted their research in anticipation of the Centers for Medicare and Medicaid Services (CMS) no longer reimbursing hospitals for care related to injury due to falls. Fisher et al., (2014) implemented hourly rounding and increased staff education to reduce falls and improve patient satisfaction. The paper will explore that fall prevention statistics correlated to patient rounding. Call Light Response Time and Falls Tzeng & Yin, (2009) conducted an exploratory study to determine if call light use and the average response time contributed to increased fall rates. The research design also encompasses