Developing an Implementation Plan: Hourly Nurse Rounds

Background Information:
Hourly Nurse Rounds Help to Reduce Falls, Pressure Ulcers, and Call Light Use, and Contribute to Rise in Patient Satisfaction based on Evidence-based Practice. The practice problem described above is shown in the PICOT framework below:
P = Population / patient = Non-ambulatory (bedridden) chronic care patients
I = Intervention / indicator = Hourly nurse rounds
C = Comparator / control = Nurse rounds at greater intervals than hourly
O = Outcome = Reduction in number of falls, pressure ulcers, and call light use (plus increased patient satisfaction).
T = Time = During the time that patients are unable to get out of bed on their own.
PICOT Question
The PICOT elements above are for an intervention/therapy known as hourly nursing rounds. The PICOT question that will be used to search for relevant research on this topic is directly below.
Details:
Consider the population in which the solution is intended, the staff that will participate, and the key contributors that must provide approval and/or support for your project to be implemented. These stakeholders are considered your audience.
Develop an implementation plan (1,500-2,000 words) using the "Topic 3: Checklist" resource. The elements that should be included in your plan are listed below:
Method of obtaining necessary approval(s) and securing support from your organization's leadership and fellow staff.
Description of current problem, issue, or deficit requiring a change. Hint: If you are proposing a change in current policy, process, or procedure(s) when delivering patient care, describe first the current policy, process, or procedure as a baseline for comparison.
Detailed explanation of proposed solution (new policy, process, procedure, or education to address the problem/deficit).
Rationale for selecting proposed solution.
Evidence from your Review of Literature in Topic 2 to support your proposed solution and reason for change.
Description of implementation logistics (When and how will the change be integrated into the current organizational structure, culture, and workflow? Who will be responsible for initiating the change, educating staff, and overseeing the implementation process?)
Resources required for implementation: staff; educational materials (pamphlets, handouts, posters, and PowerPoint presentations); assessment tools (questionnaires, surveys, pre- and post-tests to assess knowledge of participants at baseline and after intervention); technology (technology or software needs); funds (cost of educating staff, printing or producing educational materials, gathering and analyzing data before, during, and following implementation), and staff to initiate, oversee, and evaluate change.
Prepare this assignment according to the APA guidelines
Topic 3: Checklist
modules 1-4 will be documented using this checklist.
Topic
Task Completed Comments/Feedback Points
Developing an Implementation Plan
- Explains method(s) of obtaining necessary approval(s) and securing support for proposal. _____ / 10
- Provides thorough description of current problem, issue, or deficit requiring change._____ / 20
- Provides detailed explanation of proposed solution. _____ / 20
- Discusses rationale for selecting proposed solution. _____ / 10
- Incorporates evidence from review of literature in Module 2 to support proposed solution. _____ / 20
- Provides a detailed description of implementation logistics._____ / 40
- Identifies resources required for implementation (Staff, education materials, assessment tools, technology, funds, etc.). _____ / 10
Written Format & Length Requirements - Assignment formatted according to APA.
- Word Count (1,500-2,000). _____ / 10 _____ / 10
TOTAL POINTS _____ / 150
Please note: The topic of this paper should be based on ideas of the the 15 articles presented below. *****************
1. Dyck, D., Thiele, T., Kebicz, R., Klassen, M., & Erenberg, C. (2013). Hourly Rounding for Falls Prevention: A Change Initiative. Creative Nursing, 




Evidence-based nursing literature has demonstrated the efficacy of using nursing hourly rounds as a fall prevention measure, particularly with regard to elderly patients. The issue addressed in this study was primarily one of implementation and change in practice. The study demonstrated how a team-based action plan that engaged nursed and allied health memebers could bring about a sustainable change of practice.
2. Mitchell, M. D., Lavenberg, J.G., Trotta, R. L. & Umscheid, C. A. (2014, September). Hourly rounding to improve nursing responsiveness: a systematic review.
Journal of Nursing Administration, 44(9), 462-72. doi: 10.1097/NNA.0000000000000101.
This study reviewed the effects of hourly rounding on patient satisfaction, comparing that evidence with patient satisfaction with nursing care and discussed the evidence-based data with implications for nurse administrators. Patient satisfaction is a key business metric for hospitals and reimbursement, but systematic demonstration of these relationships are needed. The researchers reviewed the literature and conducted a GRADE analysis of the evidence related to nursing rounds. The review found little consistency for measuring the results of hourly rounds, a situation that did not support quantitative analysis. Moderate-strength evidence was shown for hourly rounding programs with regard to the following: 1) Patients' perceptions of nursing responsiveness, 2) reduction in patient falls, and 3) reduction in the use of call lights.
3. Salch, B. S., Nusair, H. Zubadi, A. Shloul, S. & Salch, U. (2011, June). The nursing rounds system: effect of patient's call light use, bed sores, fall and satisfaction level. International Journal of Nursing Practice, 17(3), 299-303. doi: 10.1111/j.1440-172X.2011.01938.x.
A number of studies have examined the relation between call bells, nursing rounds and patient satisfaction (Mitchell, et al., 2014; Salch, et al., 2011)). The study by Salch, et al. (2011) is remarkable as it illustrated the remarkable improvement when a rehabilitation center initially implemented nursing rounds on a strict schedule every hour or every two hours. The findings after the implementation of nursing round system (NRS) showed significant reductions in call bell use (P < 0.001), the incidence rate for falls (P < 0.01), with pressure ulcers dropping by 50 percent. In addition, following implementation of NRS, patient satisfaction increased by for five of the seven men patients in the stroke rehabilitation unit (P <0.05).
4. Tzeng, H-M. (2010), Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: an exploratory survey study in four USA hospitals. Biomed Central Health Services Research, 10, 52. doi: 10.1186/1472-6963-10-52 PMCID: PMC2841165
This research examined the perspectives of nurse regarding patient call light use, staff response time, and the reasons for patient call light use. Nurse responsiveness to call lights has been shown to be associated with patient satisfaction and the rate of inpatient falls. The reasons for call light use were shown to be aligned with staff priorities for quality care and patient safety first practices. The study demonstrated that nurses should be helped to understand that they are supporting in carrying out critical aspects of their nursing role by responding quickly to call lights—a finding that is in opposition to the dominant perception that answering call lights interrupts higher priority nursing care.
5. Tzeng, H. M. (2011, February). Perspectives of staff nurses toward patient- and family-initiated call light usage and response time to call lights.
Applied Nursing Research, 24(1), 59-63. doi: 10.1016/j.apnr.2009.03.003.
This article is related to the study listed above as it reports on the use of a survey designed to understand the perspectives of nurses about their response times to call lights and the actual reasons behind call light use by patients. The survey findings were as follows: Staff perceived call lights as being patient safety related (52%) and meaningful (81.6%), and answering calls prevented them from doing the critical aspects of their role (43.8%). Staff's perspectives toward call lights should be surveyed on a regular basis.
6. Tzeng, H-M, & Yin, C. Y. (2010, October). Predicting patient satisfaction with nurses' call light responsiveness in 4 US hospitals. Journal of Nursing Administration, 40(10), 440-447.
In this multihospital research, the authors studied the satisfaction levels of patients and their families with regard to the responsiveness of nursing staff to call light us. The researchers further compared the perceptions of patients and nurses to the actual reasons for call light use. Understandably, delayed responses to call lights can lead to poor patient satisfaction and to a patient falling out of bed or when attempting to ambulate unaided. The responses of 1,253 patients/family participants and 988 nurses were subjected to both descriptive and multiple regression analyses. The findings indicate that the perceptions of the top five reasons call lights are used were the same for both nurses and patients. Moreover, the patients who reported being more satisfied with nurses' responsiveness to call lights were as follows: Older patients; family participants; women; patients who reported that their problems were resolved after they used the call light to obtain assistance; patients who perceived that nurses often answered their call lights in person; and patients who reported that their call light use did not frequently involve safety issues.
7. Emerson, B. L., Chmura, K.nB., & Walker, D. (2014, July). Hourly rounding in the pediatric emergency department: patient and family safety and satisfaction rounds. Journal of Emergency Medicine, 47(1), 99-104. doi: 10.1016/j.jemermed.2013.11.098.
This study evaluated the institution of patient satisfaction and safety rounding (hourly rounding) in the pediatric emergency department (ED) setting. Although hourly rounds have been shown to be beneficial in a variety of settings, its use in urgent care pediatric settings has not been well researched. Staff received education, training, and observation to ensure standardization of approach. The measures of effectiveness were pre- and post-intervention data, frequency and type of nursing call bell usage, family discharge opinion survey, and vendor-collected survey results. The data were inconclusive showing no measurable improvement in patient satisfaction or provider-patient communication using call bell data.
8. Harrington, A., Bradley, S., Jeffers, L., Linedale, E., Kelman, S. & Killington, G. (2013, October). The implementation of intentional rounding using participatory action research. International Journal of Nursing Practice, 19(5), 523-529.
doi: 10.1111/ijn.12101. Epub 2013 Jul 8.
This study describes action research focused on the use of intentional or hourly rounding as a way of providing regular patient checks by nurses and as an alternate to responding to the summons of a call bell. The aim of the action research was to increase patient care, increase staff productivity and increase the satisfaction of care provision by patients and by staff. The results of the action research showed a decrease in the use of call bells, no observable threats to patient safety, and nursing staff and patient satisfaction with care provision. The study recommends future research consider staff skill mix issues, particularly when newly graduated nursing staff are involved in hourly rounds and consideration of the cognitive status of patients when implementing intentional rounding on acute care wards.
9. Hutchings, M., Ward, P., & Bloodworth, K. (2013, September). ‘Caring around the clock': a new approach to intentional rounding. Nursing Management, 20(5), 24-30.
This article provides a discussion of the experience of Nottingham University Hospitals NHS Trust with regard to its learning from implementing an innovative approach to intentional rounding across 79 wards. The shared wisdom about the experience include the need for education and for cultural shift to achieve the best results. Notably, Prime minister David Cameron announced that all nurses would be expected to do hourly rounds to improve care, following his reading of a report about patient failing that was published by the Parliamentary and Health Service Ombudsman (2011).
10. Tucker, S. J., Bieber, P. L., Attlesey-Pries, J. M., Olson, M. E., & Dierkhising, R. A. (2012, February). Outcomes and challenges in implementing hourly rounds to reduce falls in orthopedic units. Worldviews Evidence-Based Nursing, 9(1), 18-29. doi: 10.1111/j.1741-6787.2011.00227.x
This article reviews the use of nursing rounds in a format called structured nursing rounds interventions (SNRIs). The study used a repeated measures design in which fall rates and risk assessment data were collected at baseline, during the 12-week SNRI implementation, and 1-year following implementation of hourly prescribed rounding activities. Medical records of patient falls were reviewed for each period. Focus groups were conducted with nurses' post-intervention. Observed fall rates were 1.8%, 0.8%, and 1.1% and the numbers of falls per 1,000 hospital days were 4.5, 1.6, and 3.2 for the three periods, respectively. While fall rates declined during SNRI, the 1-year follow-up rates drifted back toward baseline. Moreover, SNRI dosage and fall risk scores did not predict fall rates. Patients who fell during the three periods were not at greatest risk. Nurses interpreted SNRI as an imposition and the documentation a burden, and expressed the importance of balancing intervention fidelity with individualized patient interventions. Notably, this study illuminated these issues: SNRI appeared to reduce fall rates initially, but fidelity to the SNRI implementation and documentation was variable and fall reduction gains appeared lost 1 year later.
11. Moran, J., Harris, B., Ward-Miller, S., Radosta, M., Dorfman, L., & Espinosa, L. (2011, April). Improving care on mental health wards with hourly nurse rounds.
Nursing Management, 18(1), 22-26.
The impact of hourly rounds in psychiatry has not been well researched, and there is no established model for hourly rounds would look like on inpatient mental health units. This article describes the introduction of hourly nurse rounds on inpatient mental health wards in an American hospital, and explains the adaptations that were made to the hourly rounds in order to best meet the needs of psychiatric patients. The article conveys the positive effects on patient care and staff.
12. Halm, M. A. (2009, November). Hourly rounds: what does the evidence indicate?
American Journal of Critical Care, 18(6), 581-584. doi: 10.4037/ajcc2009350.
Making nursing rounds has become an inherent part of practice in many areas. This study examines why it remains so controversial. The findings include the following: Nurses' concerns with the formal scripting of structured nursing rounds; the requirement for adequate support staff to partner with registered nurses by making rounds on alternate hours is crucial; frequent communication is needed to ensure follow-through on needed interventions or referrals; acuity levels provide additional challenges as there are times when an acute patient will require attention at the very time when a more stable patients are scheduled to be checked on rounds; and, documentation logs of rounds drive accountability, but they also may breed opposition and wavering adherence. Making hourly rounds is another apparatus in nurses' toolkit to advance nursing quality outcomes.
13. Meade, C. M., Bursell, A. L., & Ketelsen, L. (2006, September). Effects of nursing rounds: on patients' call light use, satisfaction, and safety. American Journal Nursing, 106(9), 58-70.
This study on patient call light is unusual in that it used a quasi-experimental nonequivalent groups design. Analyses were performed on data from 27 nursing units in 14 hospitals in which members of the nursing staff performed rounds either at one-hour or two-hour intervals using a specified protocol. Specific nursing actions performed at set intervals were associated with statistically significant reduced patient use of the call light overall, as well as a reduction of patient falls and increased patient satisfaction.
14. Sacred Heart Hospital Rounding Supplement. (2007). Studer Group. Retrieved from http://www(dot)mc(dot)vanderbilt(dot)edu/root/pdfs/nursing/hourly_rounding_supplement-studer_group.pdf
In a climate in which Medicare has announced that it will no longer pay for patient falls or skin breakdown that is acquired while in the hospital, outcomes similar to those achieved by Sacred Heart hospital are notable. Sacred Heart is a 476-bed acute care facility located in Pensacola, Florida, that has instituted hourly rounding. The following results are significant: Five months after implementation with 10 nursing units on board, Sacred Heart is seeing the following results on the units that are practicing hourly rounding. Call lights reduced by 40-50 percent Patient falls were reduced by 33 percent. Hospital-acquired pressure ulcer cases were reduced by 56 percent Overall patient satisfaction has increased 71 percentile points.
15. Bradley, D. & Dixon, J. F. (2009, March). Staff nurses creating safe passage with evidence-based practice. The Nursing Clinics North America, 44(1), 71-81, xi.
doi: 10.1016/j.cnur.2008.10.002.
Patient safety is one of the most critical issues for health care today, and nursing rounds have been shown to be an efficacious support to patient safety, quality of nursing care, and patient satisfaction. There is sufficient research about nursing rounds to identify it as an evidence-based practice (EBP) used at the bedside. Fidelity of implementation must always be top-of-mind in nursing, and this article provides an overview example of the concepts, structures, and processes used to increase evidence-based practice (EBP) and improve patient safety at Baylor Health Care System.