Elderly patients aged 65 years
Discuss the care for elderly patients aged 65 years
PICOT Research Question with Brief Literature Review
PICOT Question: In elderly patients aged 65 years and more (P), does hourly rounding (I) compared to extended rounding practices (C) reduces fall incidents (O) within 4 weeks of hospitalization (T)?
Falls and fall-associated injuries are common incidents in long-term care environments. These incidences contribute to increased cost of care (Mitchell, 2017). Falls can have adverse effects in patients include permanent or temporary harm and even death (Savage, 2020). Fall injuries accounts for 2.8 million visits to the emergency department per annum. About 25% of these falls causes serious injuries such as traumatic brain injury and bone fractures (Moncada & Mire, 2017). Purposeful hourly rounding practical approach employed by the nurses to identify patient needs and to achieve positive fall prevention outcomes. Patients in the long-term care environments are generally age 65 years and more with prolonged lengths of stay. Besides, they are likely to be hospitalized for multiple comorbidities, experiencing function decline, and taking multiple medications. These factors make the residents in long-term healthcare environments more vulnerable to falls and fall-associated injuries (Mitchell, 2017).
Purposeful hourly rounding is considered as an evidence-based for reduction of falls and fall-associated injuries (Mitchell, 2017). Purposeful hourly rounding is the best nursing practice for meeting patient needs, guaranteeing patient safety, proactively prevent complications before they occur, and decrease the occurrence of preventable events. Hourly rounding reduces use of call lights and fall injuries (Daniels, 2016). Fall prevention strategies ought to be multifactorial and should address physical, functional, educational, and psychological components. Purposeful hourly rounding is described as a nurse-led pro-active strategy to envision patient needs while at the same time using evidence-based interventions. During hourly rounding, nurses usually check on their patients during explicit timelines. Nurses are also required to make critical assessments of the environment and take active actions so as to promote the quality of care, patient safety, and improve team communication (Mitchell, 2017).
During hourly rounding, nurses often check evidence-based outcomes. These outcomes include position, pain, placement, and personal needs (Mitchell, 2017). Purposeful nurse hourly rounding should involve five essential elements. The first element is pain. The nurse should assess the discomfort or pain and intervene if need be. The second element is potty, which involves assessment of toileting needs as well as help patients if need be. The third element is assessing position of the patient as well as repositioning in bed. The fourth element involve protection of the patient through removal of fall-associated hazards in the environment. The fifth element is provision of necessary items, tools and support to reduce the risk of falls (Masangkay, 2021).
Patients who are at risk of falls should be monitored and evaluated hourly to guarantee that their personal needs have been met. Besides, hourly rounding aids identification of obstacles in the environment that increases the risk of falls and fall-associated injuries (Mitchell, 2017). Nurse hourly rounding is a practical and evidence-based intervention applied in acute care hospitals so as to reduce incidence of patient falls. There is a positive associated between hourly rounding and decrease in incidences of patient falls. Hourly rounding can facilitate achievement of about 39% to 54.7% reduction in patient falls per 1,000 patient-days (Masangkay, 2021).
Purposeful hourly rounding has been demonstrated to improve fall rates over a period of 30 days (Savage, 2020). In Savage’s (2020) study, baseline fall rates was 4.11 falls per 1,000 occupied bed days while the fall rate after implementation of the purposeful hourly rounding was 5.07 falls per 1,000 occupied bed days. Thus, in Savage’s (2020) study purposeful rounding did not lead to decrease in patient falls. However, Daniels’s (2016) study, purposely hourly rounding reduced patient falls by 50%, improved patient toileting by 41%, and increased in responsiveness of the healthcare staff by 15% (Daniels, 2016).
During hourly rounding, nurses can ensure implementation of fall prevention strategies. These strategies include encouraging patients to perform physical exercises, vitamin D supplementation especially among older patents, gait training, medication management, and management of footwear problems, foot problems, postural hypertension, and vision problems (Moncada & Mire, 2017). Purposeful hourly rounding can facilitate realization of better outcomes through management of modifiable risk factors such as muscle weakness, gait impairment, balance impairment, and medication use. Fear of falling among elderly patients can lead to loss of function, increased social isolation, and more falls (Moncada & Mire, 2017).
Daniels, J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Database System Rev Implement Rep., 14(1), 248-67. https://doi.org/10.11124/jbisrir-2016-2537
Masangkay, R. (2021). Purposeful Nurse Hourly Rounding: A Plan To Decrease Patient Falls During a Pandemic. USF Scholarship: a digital repository. https://repository.usfca.edu/cgi/viewcontent.cgi?article=1281&context=dnp
Mitchell, R. (2017). Hourly rounding: a fall prevention strategy in long-term care. Walden Dissertations and Doctoral Studies. https://scholarworks.waldenu.edu/cgi/viewcontent.cgi?article=4811&context=dissertations&httpsredir=1&referer=
Moncada, L. V., & Mire, L. G. (2017). Preventing falls in older persons. Am Fam Physician, 96(4), 240-247. https://www.aafp.org/afp/2017/0815/p240.html
Savage, A. (2020). Reducing patient falls through purposeful hourly rounding. University of St. Augustine. https://soar.usa.edu/cgi/viewcontent.cgi?article=1013&context=scholprojects