nurs 6016 Quality Improvement Initiative Proposal Intentional Rounding
There was an unanimous agreement that the quality initiative should help in handling fall rates. Patient fall rates are normally calculated using the number of fall events per 1000 patient days and the score indicates how a hospital maintains patient safety (Hicks, 2015). The initiative proposed was that the clinical nurse leader establishes an inter-professional team to implement a project that increases the day between patient fall events. The solution forwarded was enhancement of intentional rounding process and addressing the basic needs of the patients. The project is borrowed from the AHRQ guidelines that postulate that intentional rounding is effective when targeting to reduce patient falls within a hospital (AHRQ, 2019). Hourly rounding helps nurses address patient needs like personal belongings, pain, position, and toileting needs. Research also outlines that the use of intentional rounding minimizes the use of call lights among the patients, enhances patient satisfaction and reduces patient falls within the hospital setting (Jenko, Panjwani & Buck, 2019). Additionally, intentional rounding is defined as a structured approach where a nurse assesses patients at specific times to meet their fundamental needs. Intentional rounding follows six steps which are introducing oneself, expectations setting, questioning patient needs, using the 4 P’s which are positioning, placement, pain, and personal needs, offering the patient needs and documenting the care offered. Intentional rounding, therefore, offers patient-centered care which not only decreases patient risk evens but also enhances patient satisfaction.
Implementation Plan
To help in implementation, the project team established the root causes of fall events in the unit. The proactive risk assessment was used to establish the causes of falls within the hospital. The expected areas that may present as problematic are inconsistent intentional rounding, unreliable fall risk assessment, absence of an effective hand-off communication of high-risk patients and poor reports on falls data and event to frontline staff (Jenko, Panjwani & Buck, 2019). From the assessment, the team realized that the hospital had inconsistent intentional rounding.
The team then decided to use the plan-do-study-act (PDSA) cycle to test changes seen in the hospital. The changes were to be assessed by measuring the current state of the fall events, analyzing and discovering fall causes, coming up with targeted solutions and lastly sustaining and spreading improvements. The project team came up with a visual cue laminated poster aimed at reminding the patients to request for assistance before visiting the bathroom or standing up. A daily monitoring tool was set to help in capturing data on the usefulness of the poster and a falls prevention brochure created to educate patients and families about falls.
Standardizing Intentional Rounding
Although the AHRQ guidelines propose a multi-intervention approach, the hospital will adopt only two interventions, which are standardizing the intentional rounding and training patient and family on how to prevent falls (AHRQ, 2019). The project team expects that a standardized intentional rounding will reduce the fall rates to zero and it will handle toileting issues which are the major cause of the falls within the hospital. The unit leaders will have to also do their own rounding to assess how the nurses are communicating with patients and families on fall prevention. The unit leader will use a leader rounding tool to monitor the compliance levels of the unit staff.
Initiative Evaluation
The initiative will be analyzed by taking a baseline and current fall data obtained from the hospital quality database. Every fall event will be recorded and day between falls analyzed and then an analysis executed to monitor the changes in percentages of fall risk (Hicks, 2015). Every unit will have champions mainly a nurse and patient care technician who will be trained on how to fill the data collection form and execute the new work process. The nurse leader rounds will assist in assessing the staff competencies on patient rounding. The data obtained will then be analyzed by the project team and then a decision will be made on whether to maintain the project, make changes or plan another quality initiative.
Inter-professional Perspective
Prevention of hospital falls is crucial because they are linked to liabilities, delayed rehabilitation, increased patient length of stay and greater care costs (Jenko, Panjwani & Buck, 2019). To enhance the effectiveness of any quality initiative, there is a need to have inter-professional collaboration. Interprofessional collaboration offers clarity of professional roles and responsibilities, effective team
Order Now
