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  1. Quality improvement opportunity in an organization or practice 


    Identify a quality improvement opportunity in your organization or practice. In a 1,250-1,500 word paper, describe the problem or issue and propose a quality improvement initiative based on evidence-based practice. Apply “The Road to Evidence-Based Practice” process, illustrated in Chapter 4 of your textbook, to create your proposal.    



Subject Nursing Pages 7 Style APA


Improving Patient Safety Through Hourly Rounding

Quality improvement is a systematic approach deployed by healthcare organizations to establish areas where performance needs to be improved. Various approaches are used in the collection and analysis of data and hence, inform any future changes that can be made. Improving quality through various performance enhancements leads to cost-effective and reliable provision of health services (Gleeson et al., 2016). Additionally, quality improvement initiatives result in better patient outcomes and henceforward, improved satisfactions from the patients (Kanamori, Shibanuma, & Jimba, 2016). One of the areas where quality improvement is required is in the hospitalized settings especially in the inpatient department. There is a need to improve on the monitoring of the patients in the inpatient settings to reduce the rates of falls and its associated adverse outcomes. This paper provides a discussion of the problem of patient falls in the inpatient settings and how hourly rounding initiative can lead to better patient monitoring and patient safety.

Overview of The Problem and The Setting in Which It Occurs

            The problem being addressed, in this paper, is lack of patient safety because of high rates of patient falls. Notably, patient falls refers to unplanned descents to the floor, which can lead to injuries in the form of lacerations, fractures, among other effects. According to Agency for Healthcare Research and Quality (2020), each single year, there are reported 700,000 to 1,000,000 falls in hospitals in the US. However, close to one-third of falls that happen in hospitals can be prevented. Principally, patient falls are at an increased rate in the inpatient settings of major hospitals in the United States. In the US, between 20% and 30% of older people who experience falls suffer moderate to severe injuries (Hartholt et al., 2019). The effects of the patient falls include increase length of stay in the hospitals, rehospitalizations- which lead to increased usage of healthcare resources, and pain experienced by those patients who become victims of the falls. Additionally, healthcare facilities suffer from the costs of litigation because some of the patients bring up legal cases to demand compensation for the effects of the falls (Røyset et al., 2019). Also, hospitals with high rates of falls ruin their reputation, which means that they will not attract many clients compared to those with lower fall rates. As such, it is vital to address this problem and ensure patient safety.

Why A Quality Improvement Initiative Is Needed and The Expected Outcome

            A quality improvement initiative in the form of hourly rounding is needed in reducing patent falls and ensuring patient safety in the inpatient department of hospitals. This initiative is needed because it will ensure proper monitoring of patients, especially those who have problems with their mobility (LeLaurin & Shorr, 2019). With hourly rounding, it is expected that any patients who are at risk of falls will be identified and helped before they can encounter the unexpected descents. Notably, failure to adopt an initiative to prevent patient falls and ensure patient safety may lead to injuries to the patients, which may increase the costs of care due to rehospitalizations (Røyset et al., 2019). Additionally, hourly rounding is required to make sure that the rates of patient satisfactions are improved through improved patient safety. The expected outcomes from the quality improvement initiative of hourly rounding include reduced falls rates, improved patient safety, increased rates of patient  satisfaction, reduced rates of rehospitalizations, and better patient outcomes among others (Hartholt et al., 2019). The choice of hourly rounding as the initiative that can improve patient safety in hospitals is based on the huge wealth of evidence that supports its usage.

How the Results of Previous Research Demonstrate Support the Initiative

            A plethora of studies conducted in the past have demonstrated support for the effectiveness of hourly rounding in reducing patient falls and ensuring patient safety. According to the study by Brown (2016) to establish the effects of hourly rounding on patient falls, it was established that the rates of patient falls decrease and patient safety is ensured. Also, the study by Linehan and Linehan (2018) on the best initiatives that can ensure patient safety in the inpatient settings, it was found out that hourly rounding topped the list as one of the strategies that when purposefully adopted can lead to reduced falls and improved patient safety. Previous research has also demonstrated that hourly rounding ultimately leads to increased patient satisfaction. For instance, the study by Bragg et al. (2016) found out that apart from ensuring heightened patient safety, hourly rounding was responsible for better patient outcomes and hence increased patient satisfaction. Hourly rounding was also found to lead to increased staff satisfaction because the members of staff can be comfortable that their patients will not experience injuries or rehospitalizations due to falls (Ryan et al., 2019; Pond, 2017). However, despite these previous researchers which demonstrate support for hourly rounding, it has been found that hospitals that do not purposefully implement the initiative do not enjoy the full benefits (Ram, John, & John, 2019). As such, it is critical to examine the necessary steps that should be used in the implementation of the quality improvement initiative of hourly rounding.

Steps Necessary to Implement the Quality Improvement Initiative

            The implementation of hourly rounding as a quality improvement initiative involves several key steps. One of the key steps is recruiting additional nursing staff members who will conduct the hourly rounding. Notably, hourly rounding is making regular visit to the hospital wards every one hour. As such, there is a need to establish the staffing needs and hence determine the additional nursing personnel that should be recruited (Pond, 2017). The second step is training the staff members about the practice of hourly rounding and how they can implement it and maximize its benefits for the advantage of the patients and those of the hospital (Toole, Meluskey, & Hall, 2016). The third step is the actual implementation of the hourly rounding initiative whereby nurses go around the inpatient departments and visit patients after every one hour; whether the patients have pressed the bell or not. The hourly rounding process is conducted throughout the day and night and nurses should thus, have flexible shifts, which ensure that at no particular hour will the patients not be monitored. The next step after implementation is the evaluation of the outcomes of the hourly rounding process to determine whether it has achieved the desired outcomes.

How the Quality Improvement Initiative Will Be Evaluated

            The evaluation of the hourly rounding initiative will be done through an examination of reported outcomes and via surveys done on the patients. The first mode of evaluation will be comparing the rates of patient falls during the time that hourly rounding was not implemented to when it became fully integrated into the hospital (Toole, Meluskey, & Hall, 2016). A comparison of the data on rates of patient falls will tell whether the initiative has been successful. Also, the rates of rehospitalizations will tell whether the initiative has led to the desired improvement. The variables in this mode of evaluation are the rates of patients falls and the rates of hospitalizations. Using a Chi-square test can tell whether there is an association between hourly rounding and the rates of patient falls. Surveys will also be used to measure the variable of patient satisfaction. Specifically, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys will be used to measures the perceptions of the patients of their hospital’s experience (East et al., 2020). The aim of this survey will be to determine the rates of patient satisfaction, which is one of the expected outcomes after hourly rounding is implemented. Similarly, Chi-square test would be needed to test whether the quality improvement initiative has succeeded.

In sum, implementing the quality improvement initiative of hourly rounding can lead to the improvement of patient falls and ultimately, patient safety in the inpatient departments of hospitals. Patient falls can lead to injuries, increased costs of healthcare, increased rehospitalizations, and legal costs. However, hourly rounding, which involves checking the patients every one hour has proved to be an effective and evidence-based initiative to reduce fall rates. This strategy is implemented by recruiting additional nursing staff members and training them on how to ensure constant monitoring of the patients. The evaluation of the effects of the initiative will be done by measuring the variables of the rates of patient falls and the rates of patient satisfaction. Also, using the Chi-square test can lead to a comparison of the effects of hourly rounding on patient safety.


Agency for Healthcare Research and Quality. (2020). Preventing Falls in Hospitals. Retrieved from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtkover.html#Problem

Bragg, L., Bugajski, A., Marchese, M., Caldwell, R., Houle, L., Thompson, R., … & Lengerich, A. (2016). How do patients perceive hourly rounding?. The Journal of Excellence in Nursing Leadership47(11), 11-13.

Brown, C. H. (2016). The effect of purposeful hourly rounding on the incidence of patient falls. Hunt School of Nursing.

East, L., Targett, D., Yeates, H., Ryan, E., Quiddington, L., & Woods, C. (2020). Nurse and patient satisfaction with intentional rounding in a rural Australian setting. Journal of Clinical Nursing29(7-8), 1365-1371.

Gleeson, H., Calderon, A., Swami, V., Deighton, J., Wolpert, M., & Edbrooke-Childs, J. (2016). Systematic review of approaches to using patient experience data for quality improvement in healthcare settings. BMJ open6(8).

Hartholt, K. A., Lee, R., Burns, E. R., & Van Beeck, E. F. (2019). Mortality from falls among US adults aged 75 years or older, 2000-2016. Jama321(21), 2131-2133.

Kanamori, S., Shibanuma, A., & Jimba, M. (2016). Applicability of the 5S management method for quality improvement in health-care facilities: a review. Tropical medicine and health44(1), 21.

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine35(2), 273.

Linehan, J., & Linehan, J. (2018). Fall Prevention in Long Term Care Using Purposeful Hourly Rounding. Journal of the American Medical Directors Association19(3), B17.

Pond, M. (2017). Fall prevention safety bundle: Collaboration leads to fewer falls. American Nurse Today12(7), 1-2.

Ram, M. S., John, J., & John, S. (2019). Purposeful Hourly Rounding by Nurses: A Best Practice Implementation Project. International Journal of Nursing Care7(2), 16.

Røyset, B., Talseth-Palmer, B. A., Lydersen, S., & Farup, P. G. (2019). Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments. Clinical interventions in aging14, 145.

Ryan, L., Jackson, D., Woods, C., & Usher, K. (2019). Intentional rounding–An integrative literature review. Journal of advanced nursing75(6), 1151-1161.

Toole, N., Meluskey, T., & Hall, N. (2016). A systematic review: barriers to hourly rounding. Journal of nursing management24(3), 283-290.


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