Running head: IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
The Impact of Nurse Hourly Rounding on Patient Falls
An Integrated Literature Review
Kristina A. Zurita
University of Central Florida
1
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
2
Abstract
Patients fall in the hospital is a significant problem that health care organizations are facing
today. Falls are one of the leading causes of adverse events in the hospital and can cause injuryrelated deaths to the elderly population. Patient falls are also costing hospitals millions of dollars
and insurance companies are no longer reimbursing for falls and related injuries that happened in
the hospital. There is clearly a need for intervention to reduce patient falls and increase patient
safety. Hourly rounding is being used as a means to answer this need. Hourly rounding is an
autonomous intervention in which the nurse checks on the patient every hour to make sure basic
needs are being met which includes assisting the patient to the bathroom to ensure safety. Since
most patient falls occur in or near the bathroom, rounding has been indicated as a method to
reduce fall rates. This integrative literature review aims to show the impact that nurse hourly
rounding has on adult patient falls in the acute care setting. A literature search was conducted
using a number of databases that yielded 10 articles that matched the inclusion/exclusion search
criteria. The results showed that hourly rounding may decrease the incidence of patient falls in
the hospital setting. Additionally, the research showed that hourly rounding may also increase
patient satisfaction and decrease patient call light usage. Proper training, implementation, and
commitment to the process are needed to ensure quality hourly rounding is being conducted.
Overall, hourly rounding has been demonstrated to be an effective intervention that promotes
patient safety and satisfaction, leading to better patient outcomes.
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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Table of Contents
Abstract…………………………………………………………………………………………..2
Significance and Background…………………………………………………………………….4
Research Question………………………………………………………………………………..5
Methods…………………………………………………………………………………………..5
Search Strategies……………………………………………………………………….....5
Definitions and Terms…………………………………………………………………….6
Inclusion/Exclusion Criteria………………………………………………………………6
Validity and Level of Evidence……………………………………………………….......6
Findings...…………………………………………………………………………………………7
Study Characteristics……………………………………………………………………...7
Sample Characteristics…………………………………………………………………….8
Themes……………………………………………………………………………….........8
Recommendations for Nursing Practice……………………………………………………........10
Conclusion……………………………………………………………………………………….11
References………………………………………………………………………………………..13
Appendix A………………………………………………………………………………………16
Appendix B………………………………………………………………………………………23
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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The Impact of Nurse Hourly Rounding on Patient Falls: An Integrative Literature Review
Significance and Background
The American Nurses Association-National Database of Nursing Quality Indications
defines a fall as “an unplanned descent to the floor” (Tucker et al., 2012, p. 19). Patient falls can
result in morbidity, mortality, and an increased fear of falling again and are one of the most
common adverse events in the acute care setting (Tucker et al., 2012). The number of falls on
an inpatient unit have been reported to range from 1.7 to 25 falls per 1,000 patient days (Tucker
et al., 2012), with approximately 30% of these falls resulting in a serious injury (Goldsack,
Bergey, Mascioli, & Cunningham, 2015). It is estimated that falls can cost hospitals $5,317 per
patient fall and can cost $19,440 over one year period for an older adult patient fall (Tucker et
al., 2012). By 2020, patient falls are projected to cost hospitals over $54 billion in direct and
indirect annual costs (Hicks, 2015). The Centers for Medicare and Medicaid Services in 2008
recognized the financial costs of these falls and no longer reimburse hospitals for these
conditions, stating that these falls could have been prevented (Hicks, 2015). The occurrence of
patient falls now has an impact on hospital rankings as well as payment systems; therefore falls
prevention has become of great interest to hospital administrators, nurse managers, and nursing
staff (Goldsack et al., 2015).
The majority of falls in the hospital setting have been reported to occur near the patient’s
bed, in the room, or in the bathroom (Tucker et al., 2012). Most frequent falls are occurring
during ambulation to or from using the bathroom or bedside commode (Tucker et al., 2012).
Research shows that about one-third of falls could have been prevented (United States
Department of Health and Human Services, 2015). Nurses can play an important role in
preventing patient falls and maintaining patient safety (Cann & Gardner, 2011). There are a
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
5
variety of interventions that have been studied and utilized in order to reduce patient falls: falls
risk assessments, bed alarms, lab belts, direct observation, falls prevention agreements, and
restraints. One of the most current interventions is the use of nurse hourly rounding to improve
patient safety and prevent falls (Hicks, 2015).
The use of hourly rounding has been noted to be a promising intervention in preventing
patient falls (Tucker et al., 2012). It has been reported that hourly rounding can reduce patient
falls as much as 50% in the acute care setting (Hicks, 2015). Hourly rounding has also been
reported to increase patient satisfaction, reduce call-light use, reduce medication errors, and
increase staff satisfaction (Cann & Gardner, 2011; Olrich, Kalman, & Nigolian, 2012).
Research Question
In the adult acute care setting, how does nurse hourly rounding impact patient falls?
Methods
Search Strategies
A literature search was performed in a variety of databases, including Medline, Academic
Search Premier, the Cochrane Database of Systematic Reviews, and Cumulative Index to
Nursing and Allied Health Literature (CINAHL) Plus. The following keywords were used as
search criteria: “adult”, “acute care”, “hospitalization”, “nurse”, “rounding/hourly rounding”,
“falls/fall prevention” and “patient safety”.
After conducting a search of peer-reviewed articles published from 2010-2015, 12 articles
were found in CINAHL Plus, 10 articles in Medline, 12 articles in Academic Search Premier,
and none were found in the Cochrane Database of Systematic Reviews for a total of 34 articles.
10 articles were used for this review based on the inclusion/exclusion criteria.
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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Definitions and terms
Hourly rounding can be referred to as “intentionally rounding”, “rounds”, “nursing
rounds”, “comfort rounds”, “routine rounds”, “care rounds”, “Model of Care”, “patient-centered
hourly rounding”, and “patient rounds”. Hourly rounding is the process of intentionally
checking on the patient to addresses a patient’s basic needs by the nursing staff at regular
intervals (Hicks, 2015). Hourly rounding by the nurse requires the nurse to assess the patient’s
need to use the bathroom, repositioning, pain management, ensure a clean surrounding and
patient’s personal items within reach, and telling the patient when the nurse will return to reduce
patient anxiety (Mitchell, Lavenberg, Trotta, & Umscheid, 2014). Hourly rounding occurs every
hour, though some hospitals utilize a 2-hourly rounding during the evening hours to minimize
sleep disturbances of patients.
Inclusion/Exclusion Criteria
Articles that were included in this search addressed the adult population on an inpatient
unit in a hospital, nurses who implemented patient hourly rounding on the unit and those who do
not, and articles where patient safety and/or falls prevention was evaluated. Exclusion criteria
consisted of articles that included pediatric patients, articles that focused primarily on leader
rounding only or rounding by personnel other than the nurse, and studies that were conducted on
outpatient or emergency department units.
Validity of Findings and Level of Evidence
Each of the 10 articles used in this literature review were assessed for validity using the
Quelly tool (2007). Three studies yielded a score of 11 points (Hicks, 2015; Krepper et al.,
2012; Spanaki, 2012), six studies scored 10 points (Cann & Gardner, 2012; Goldsack et al.,
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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2015; Kessler et al., 2015; Mitchell et al., 2014; Olrich et al., 2012; Saleh et al., 2011) and one
study scored 9 points (Tucker et al., 2012). According to Quelly (2007), all of the articles used
in this review were ranked a level 3, meaning they were high quality studies.
The level of evidence was assessed based on the “rating system for the hierarchy of
evidence for intervention/treatment questions” published by Melnyk & Fineout-Overholt (2011).
Eight articles were ranked level III (Cann & Gardner, 2011; Goldsack et al., 2015; Kessler et al.,
2012; Krepper et al., 2012; Saleh et al., 2011; Spanaki et al., 2012; Olrich et al., 2012; Tucker et
al., 2012) and two articles were ranked level II (Hicks, 2015; Mitchell et al., 2014). Most of the
studies used a pre/post implementation design.
Findings
Study Characteristics
All of the articles included in this literature review were peer reviewed and ranked as
Level II systematic reviews or Level III cohort/quasi-experimental studies. All ten articles
addressed the impact that hourly rounding has on patient falls and some of studies stated other
benefits of hourly rounding as well. All of the studies compared hourly rounding to the previous
standard of care in the adult population. The measurement tool used for the cohort studies (Cann
& Gardner, 2012; Kessler et al., 2012; Spanaki et al., 2012; Tucker et al., 2012) and the quasiexperimental studies (Krepper et al., 2012; Olrich et al., 2012; Saleh et al., 2011) were that of a
pre/post evaluation design. The two systematic reviews (Hicks, 2015; Mitchell et al., 2014)
evaluated studies of a pre/post design as well. The standard method of previous care for all
studies was that of not using hourly rounding as a method of preventing patient falls. Five
studies implemented a 2-hourly rounding protocol during the evening hours (Hicks, 2015;
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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Kessler et al., 2012; Mitchell et al., 2014; Olrich et al., 2012; Saleh et al., 2011). The time
periods for assessing the impact of hourly rounding varied among the studies, lasting as short as
30 days to as long as 6 years. The majority of the studies lasted about one year. Limitations to
these studies included non-randomization samples, weak research design, small sample sizes,
and variations in the length of time that these studies were conducted. Follow-up on these
studies were also lacking.
Sample Characteristics
Of the ten studies reviewed, eight of the studies were conducted in the United States, one
in Australia (Cann & Gardner, 2012) and one in Saudi Arabia (Saleh et al., 2011). The majority
of the studies included both male and females of the adult population on medical-surgical units.
One study was conducted on an all male stroke unit (Saleh et al., 2011), one on an epilepsy
monitoring unit (Spanaki et al., 2012), and another study was done on an orthopedic unit (Tucker
et al., 2012). The age range of these subjects was from 18 to 90 years old. The total number of
participants could not be determined due to some studies not reporting the sample size.
Themes
Decreases patient falls. Nine of the studies reviewed concluded that some form of
hourly rounding has a positive impact on reducing patient falls. Of these nine studies, two
studies provided statistically significant results. Saleh et al. (2011) had 25 falls in a 4 week
period prior to implementation and then only 4 falls during implementation of hourly rounding,
(p < 0.01). Goldsack et al. (2015) compared two units that implemented hourly rounding. One
unit had trained and actively engaging staff participating in hourly rounding, while the other unit
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
9
had no training and non-compliant staff that did not engage regularly in hourly rounding
(Experimental Unit: p=0.006, Control Unit: p=0.799).
The other studies in this review showed increases in patient safety with the
implementation of hourly rounding; however, they did not show statistical significance. Cann &
Gardner (2012) used a “Model of Care” where hourly rounding was one component of a patientcentered quality improvement framework. There was improvement in falls post-implementation
(p=0.500), but not enough to show significance. Kessler et al. (2012) and Olrich et al. (2012)
had a decrease in the fall rate post implementation (p=0.07; p=0.672). Spanaki et al. (2012) and
Tucker et al. (2012) also showed that hourly rounding reduces fall rates but did not report
statistically significant results (p=0.694; p=0.088). The two systematic reviews showed that
hourly rounding did have an effect on decreasing patient falls. Hicks (2015) found 10 studies
where falls were decreased, 3 studies that showed no change and 1 study that had variations in
the results. Mitchell et al. (2014) found 9 studies where the median fall reduction rate was 57%
and two studies were able to report statistically significant decreases when hourly rounding was
implemented. Krepper et al. (2012) showed that fall rates on the experimental and control units
were similar and no conclusions could be made.
Increases patient satisfaction. Five of the studies in this literature review addressed the
impact that hourly rounding has on patient satisfaction. Cann & Gardner (2012), Kessler et al.
(2012), Olrich et al. (2012), and Saleh et al. (2011) concluded that hourly rounding has the
potential to increase patient satisfaction but none of the studies showed statistically significant
data (p=0.081; not reported; p=0.383; p<0.05). One of the systematic reviews found 4 studies
that showed statistically significant improvements in patient satisfaction (Mitchell et al., 2014).
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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Decreases call light usage. Four studies in this review addressed the impact that hourly
rounding has on patient call light usage. These studies revealed that hourly rounding
significantly reduces the amount of times a patient presses the call light. Mitchell et al. (2014)
revealed a median reduction of 54% in call light usage in 10 studies reviewed. Krepper et al.
(2012), Olrich et al. (2012), and Saleh (2011) all stated statistically significant decreases in call
light usage due to hourly rounding implementation (p=0.001; number not reported; p<0.001).
Proper implementation and compliance is necessary for success. Four studies
discussed the importance of how proper implementation is essential for hourly rounding to be
successful (Goldsack et al. 2015; Kessler et al., 2012; Olrich et al., 2012; Tucker et al., 2012).
Proper compliance by staff was also addressed in these four studies. Hourly rounding appears to
be effective when the patient trusts that the nurse will return when he/she says they will (Olrich
et al., 2012). If the nurse is not efficient in properly implementing the rounds, then the patient
will not trust the nurse, therefore leading to a breakdown in the process (Tucker et al., 2012).
Validation and consistency by those implementing hourly rounding is the key to success (Kessler
et al., 2012). The buy-in, commitment, and accountability by the staff become a crucial
component to hourly rounding (Goldsack et al., 2015).
Recommendations for Nursing Practice
The impact that patient falls have on hospital costs and overall patient well-being is
significant. The evidence reviewed in these studies indicates that hourly rounding positively
impacts the prevention of patient falls. Despite most of the evidence not demonstrating
statistically significant results, there is a decrease in patient falls when hourly rounding is
implemented. Using the Strength of Recommendation Taxonomy (SORT), the strength of
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
11
recommendation for implementing hourly rounding to prevent patient falls in the acute care
setting yields a recommendation A (Ebell et al., 2004). Of the ten articles reviewed, two Level II
systematic reviews and seven Level III cohort/quasi-experimental studies all found that hourly
rounding should be implemented as it may help nurses to keep patients safe by reducing patient
falls.
A number of studies reviewed showed evidence that hourly rounding does not only
impact patient falls, but also plays a crucial role in reducing call light usage and increasing
patient satisfaction (Mitchell et al, 2014). When patients believe in the process, they begin to
build a trusting relationship with the nurse which may lead them to not use the call light as often
because they know the nurse will be returning soon to care for their needs. Hourly rounding has
a positive impact on reducing call light usage and increasing patient satisfaction which can lead
to better patient outcomes (Mitchell et al., 2014).
Hourly rounding may be more effective if proper nursing training and implementation is
provided. Hourly rounding is an autonomous intervention that nurses can perform to keep their
patients safe (Hicks, 2015). Without commitment and believability of the process, a positive
outcome for hourly rounding is unattainable (Hicks, 2015). Hospital administration should be
aware that for proper implementation of hourly rounding, special attention should be placed on
training, promoting commitment to the cause, and compliance by nursing staff members (Olrich
et al., 2012).
Conclusion
Hourly rounding is an autonomous intervention that nurses can easily implement to
ensure patient safety and reduce patient falls. When nurses are trained properly and believe in
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
12
the process and cause of the intervention, hourly rounding has been shown effective to increase a
patient’s safe stay in the hospital. This review has also shown there are secondary benefits to
hourly rounding, such as an increase in patient satisfaction and a decrease in call light usage.
Hospital administrators and managers should consider implementing hourly rounding, as it may
also reduce unnecessary hospital costs as a result of patient falls. This review demonstrated the
benefits of hourly rounding in the acute care setting. Further longitudinal research may be
beneficial to ascertain the sustained effects of hourly rounding.
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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References
Cann, T., & Gardner, A. (2012). Change for the better: An innovative model of care delivering
positive patient and workforce outcomes. Collegian, 19(2), 107-113.
doi:10.1016/j.colegn.2011.09.002
Ebell, M. H., Siwek, J., Weiss, B. D., Woolf, S. H., Susman, J., Ewigman, B., & Bowman, M.
(2004). Strength of recommendation taxonomy (SORT): A patient-centered approach to
grading evidence in the medical literature. Journal of the American Board of
Family Practice, 17 (1), 59-67
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient
falls: What factors boost success? Nursing, 45(2), 25-30.
doi:10.1097/01.NURSE.0000459798.79840.95
Hicks, D. (2015). Can hourly rounding reduce patient fall in acute care? An integrative literature
review. MEDSURG Nursing, 24(1), 51-55.
Kessler, B., Claude-Gutekunst, M., Donchez, A. M., Dries, R. F., & Snyder, M. M. (2012). The
merry-go-round of patient rounding: Assure your patients get the brass ring. MEDSURG
Nursing, 21(4), 240-245.
Krepper, R., Vallejo, B., Smith, C., Lindy, C., Fullmer, C., Messimer, S., & ... Myers, K. (2014).
Evaluation of a standardized hourly rounding process (SHaRP). Journal For Healthcare
Quality: Promoting Excellence In Healthcare, 36(2), 62-69. doi:10.1111/j.19451474.2012.00222.x
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Melnyk, B. & Fineout-Overholt, E. (2011). Evidence-based practice in nursing and healthcare:
A guide to best practice (2nd ed.). Philadelphia: Lippincott Williams & Wilkins.
Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014). Hourly rounding to
improve nursing responsiveness: A systematic review. The Journal Of Nursing
Administration, 44(9), 462-472. doi:10.1097/NNA.0000000000000101
Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly rounding: A replication
study. MEDSURG Nursing, 21(1), 23-36.
Quelly, S. (2007). Determining quality and validity of findings.
Saleh, B. S., Nusair, H., AL Zubadi, N., Al Shloul, S., & Saleh, U. (2011). 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.1440172X.2011.01938.x
Spanaki, M. V., McCloskey, C., Remedio, V., Budzyn, D., Guanio, J., Monroe, T., & ... Schultz,
L. (2012). Developing a culture of safety in the epilepsy monitoring unit: A retrospective
study of safety outcomes. Epilepsy & Behavior: E&B,25(2), 185-188.
doi:10.1016/j.yebeh.2012.06.028
Tucker, S. J., Bieber, P. L., Attlesey-Pries, J. M., Olson, M. E., & Dierkhising, R. A. (2012).
Outcomes and challenges in implementing hourly rounds to reduce falls in orthopedic
units. Worldviews on Evidence-Based Nursing, 9(1), 18-29. doi:10.1111/j.17416787.2011.00227.x
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United States Department of Health and Human Services. (2015). Preventing falls in the hospital.
Retrieved from http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/
Running head: IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
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Appendix A
Literature Table
Citation
Cann &
Gardner
(2012)
Patient Group
and Sample
Size
Study Design
and Level of
Evidence
29-bed surgical Pre/post test
unit over a one design
year period:
Cohort study
1115 patients
pre-implement,
1069 postLevel III
implement
Outcome
Variables
Comfort rounds,
previous care,
patient safety
N=2,184
Key Results
Validity
DATA
Per 100,000 patient Quelly score: 10
hours:
Possible bias due
Preto self reporting,
implementation:
no randomization
13.9
Large sample size
PostAdequate length of
implementation:
time
10.9
Themes
“Model of
Care” (hourly
rounding)
increases patient
safety
“Model of
Care” increases
patient
satisfaction.
P=0.500
Not statistically
significant
Goldsack et al.
(2015)
Unit 1: 35 beds
Unit 2: 40
beds
Pre/post
implementation
evaluation
Hourly rounding,
previous care,
nurse
compliance,
Unit 1: P=0.006
Quelly score: 10
Unit 2: P=0.799
Short pilot period,
convenience
sampling, no
Hourly
rounding is
effective in falls
prevention
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
For 30 days
Cohort study
17
patient falls
Statistically
significant for Unit
1
randomization
Staff
compliance and
leadership
involvement is
critical to
implementation
Hourly rounding,
2-hourly
rounding,
previous care,
patient falls
Fall rates decreased
in 10 studies,
unchanged in 3
studies, and varied
in 1 study.
Quelly score: 11
Hourly
rounding has an
effect on
decreasing
patient falls
Hourly rounding,
previous care,
nurse
compliance,
patient safety
Hourly rounding
fall rate: 2.19%
Quelly score: 10
Level III
Hicks (2015)
Kessler et al.
(2012)
14 studies
reviewed
addressing fall
rates
Systematic
Review of nonRCT
Two critical
care units and
three medicalsurgical units
Pre/post
implementation
surveys
Level II
Cohort study
6 year study
Previous care fall
rate: 5.46%
P=0.07
Level III
Not statistically
significant
No randomization,
varying sample
sizes, varying
lengths of time
Decrease in
patient falls due
to hourly
rounding
Length of time (6
year study),
variations in staff
members
Hourly
completing rounds, rounding can
no randomization
promote patient
and staff
satisfaction
Staff
compliance and
continuation is
key in
implementation
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
Krepper et al.
(2012)
Two 32-bed
cardiovascular
surgery units
6-month study
period, 6month post
study
A two-group
quasiexperimental
design
Level III
Quality/safety of
patient care,
hourly rounding
with extensive
training, hourly
rounding with
very little
training, previous
care
18
Prior to study:
Experimental: 3.97
Control: 2.6
P=0.25
During study:
Experimental: 2.68
Control: 2.42
P=0.70
6-montsh post
study:
Experimental: 2.42
Control: 1.43
P=0.07
Not statistically
significant
Quelly score: 11
No significant
differences
Small sample size, possibly due to
no randomization
infrequency of
Adequate length of falls
time
Hourly
rounding
significantly
reduced call
light usage.
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
Mitchell et al.
(2014)
11 studies
reviewed, 9
studies focused
on reduction of
falls (pre/post
test)
Systematic
review of nonRCTs
Hourly rounding,
2-hourly
rounding,
previous care
Level II
19
Reduction in falls
ranged from 24%80%, with a
median reduction
of 57%
2 studies were able
to report
statistically
significant decrease
in falls rate
Quelly score: 10
Variations sample
size and length of
time, no
randomization,
publication bias
Hourly
rounding
reduces patient
falls
Reduction in
call light use
Improves
patient
satisfaction
Improves
patients’
perceptions of
nursing staff
responsiveness
Olrich et al.
(2012)
Two med-surg
units over 1
year
N=4,418
Quasiexperimental
Level III
Rounding,
previous care,
patient falls
Experimental unit:
23% reduction in
falls, P=0.672
Control unit: falls
increased
Not statistically
significant
Quelly score: 10
Small sample size,
no randomization,
hospital-wide
patient census
decreased during
study
Hourly
rounding
decreased fall
rates.
Proper
implementation
is needed to
gain positive
results
Hourly
rounding has the
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
20
potential to
increase patient
satisfaction
Hourly
rounding has the
potential to
decrease call
light usage.
Saleh et al.
(2011)
Male stroke
unit (26 beds),
104 patients
over 4 month
period
N=104
Quasiexperimental
non-equivalent
groups design
Level III
Hourly rounding,
2-hourly
rounding,
previous care, fall
incidence
Hourly rounding: 4 Quelly score: 10
falls during
Short study period,
implementation
no randomization
(second 4 weeks)
Reduction in
fall incidence
due to hourly
rounding
Previous care: 25
falls prior to
implementation
(first 4 weeks)
Hourly
rounding
yielded a
significant
reduction in call
bell usage
P<0.01
Hourly
rounding
reduced the
occurrence of
pressure ulcers
Statistically
significant
Hourly
rounding
increased
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
21
patient
satisfaction
Spanaki et al.
(2012)
971
consecutive
patients in a 4
year study on
epilepsy
monitoring unit
Pre/post
implementation
evaluation
Retrospective
cohort study
Hourly rounding,
previous care,
“falls prevention
agreement”
Two 29-bed
postoperative
orthopedic
units
Descriptive and
repeated
measures
design
Cohort study
2,295
hospitalizations
Level III
during study
timeframe (682
baseline
period, 775
intervention
period, 838
post-
Quelly tool: 11
Post: 7 falls
Large sample size,
adequate length of
time for study, all
patient data used
on this specific
unit, no
randomization
15% reduction
P=0.694
Level III
Tucker et al.
(2012)
Pre: 12 falls
Not statistically
significant
Fall rates, fall
risk scores,
hourly rounding
fidelity, previous
care
Implementation vs.
baseline: P=0.088
Postimplementation vs.
baseline: P=0.375
Postimplementation vs.
implementation:
P=0.319
Not statistically
significant
Quelly tool: 9
Fidelity of
implementation,
no randomization,
no control group,
low baseline fall
rates, large sample
size
Hourly
rounding
decreased fall
rates
Hourly
rounding
significantly
decreased the
amount of
missed seizures
Rounding
reduces fall
rates
Proper and
consistent
implementation
effects
outcomes of
rounding
IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
intervention)
1 year study
Primary Theme:
Hourly rounding decreases patient falls.
Secondary Themes:
Hourly rounding increases patient satisfaction.
Hourly rounding decreases call light usage.
Proper implementation and compliance is necessary for the success of hourly rounding.
22
Running head: IMPACT OF HOURLY ROUNDING ON PATIENT FALLS
Appendix B
Determining Quality and Validity of Findings
1. Research question, hypothesis, or problem is clearly stated.
2. Purpose is clearly stated and relevant to research question or problem.
3. Review of literature and background evidence supports study purpose.
4. Research design is appropriate for research question or purpose.
5. Variables are appropriate for study purpose.
6. Methodology is strong and clearly stated.
7. Sampling method is appropriate and adequate in size and demographics to support
external validity.
8. Instrument validity and reliability are appropriate and clearly described.
9. Data is collected and managed systematically.
10. Analysis of results is complete and sound.
11. Study limitations are acknowledged and described.
12. Conclusions are supported by analysis of findings.
Each criterion receives 1 point and evaluated from total points as:
Level 3 (High quality):
9 – 12
Level 2 (Moderate quality):
5–8
Level 1 (Low quality):
0–4
23