A fall, an event that results in an individual coming to rest inadvertently on the ground floor or other lower level is an ongoing issue that hospitals face in the United States (WHO, 2021). About a million people fall each year in the hospital (Gantz et al., 2023), resulting in $19.2 billion annually in medical costs (Bohl et al., 2012). Ascension Saint Agnes Hospital (ASAH), a 271-bed community hospital in Baltimore, Maryland, reported ten patient falls in the Emergency Department (ED) between October 2022 and January 2023. A root cause analysis identified structure and process deficiencies possibly contributing to the fall rate. The Johns Hopkins Evidence-Based Practice Rating Scale was used to analyze eight studies (3 level I; 5 level II) to support this project. The review and analysis of current evidence-based literature support the incorporation of the 4Ps of hourly rounding (Pain, Potty, Positioning, and Possession) as practical strategies to decrease falls and improve patient quality and safety. This quality improvement (QI) initiative aims to implement and evaluate how the unit's structure can be changed by initiating hourly rounding in the ED to reduce falls. The initiative will be implemented over 15 weeks in the Fall of 2023. An anticipated 150 patients presenting to the ED will be evaluated during this QI initiative.
The project leader (PL) will oversee an interdisciplinary team consisting of nurse administrators (nurse leaders, informaticians, and director of quality and patient safety). Moreover, the QI project will include all ED staff (nurses and patient care technicians). Data collection will consist of the participant pre-readiness data survey and the participant post-implementation data survey to be distributed to staff in September and December 2023. Staff participants will receive a direct link to REDCap, a HIPAA-compliant, password-protected, secured data collection server) to complete the survey. Chart audits will be conducted weekly to assess staff adherence to the hourly rounding process. Tactics used to achieve the project's purpose consist of educating the staff on the importance of proper hourly rounding documentation, creating raffles for staff to improve buy-in, and engaging with interdisciplinary teams to ensure compliance with the project. Weekly data collection will assess implementation progress and determine if process changes need to be made. The Joint Commission Fall Tracer Observation Form will be used to evaluate how hourly rounding can enhance fall prevention further. All data for the QI project will be collected and stored within REDCap. To protect participant confidentiality, all identified data will be de-identified and coded by REDCap. Data will be analyzed weekly, displayed in run charts, and used to inform stakeholders and participants on adherence to hourly rounding documentation and whether hourly rounding resulted in decreased falls. The outcome of this QI project is for 100% of staff to incorporate the 4Ps of hourly rounding during their shift, and 0% of patients will experience a fall during this 15-week implementation period.
Audience Take Away Notes:
- Utilizing the 4Ps of hourly rounding in their unit to help decrease fall numbers
- Improvement in patient outcomes
- Improvement in patient satisfaction
- Decrease call light usage