NR702 Project and Practicum I

Guided Study: DNP Project Proposal Development

Week 1: Introduction, Problem Statement, Objectives and Aims, and Significance of
Practice Problem sections

For patients at Fort Myers Rehab and Nursing Center, will the implementation of an EBP
purposeful rounding process compared to no rounding lead to decreased fall rates in 8-10 weeks?

Purposeful rounding refers to a systematic intervention that is critical in anticipating as

well as addressing the needs of the patient. The term “purposeful” is often interchanged with

hourly rounding. However, the visits do not necessarily take place at hourly intervals. Purposeful

rounding is vital in order to ensure that patients are safe. The practice is also critical in promoting

preventive care (Daniels, 2016). Nurses and other healthcare providers have the ability to

improve both patient safety and satisfaction through nursing round interventions. Moreover, staff

responsiveness and patient communication are improved significantly following the practice.

Falls represent a major problem in all healthcare settings. According to Goldsack (2015), the

rates of fall in acute care hospitals can go as high as 9 in about 1,000 days in the hospital. Out of

these cases, approximately 30% of them result in serious injury.

The following study examines the impact of purposeful rounding on the incidents of

patients falls among the residents in a long-term care nursing home. Past studies done on the

subject indicate that purposeful hourly rounding can significantly reduce incidents of patient

falls, improving quality, safety and the perceptions of the care (Goldsack, 2015). The paper is

divided into five chapters including an introduction, theoretical framework, project design and

methods, results and discussion of the DNP project and finally the implications in practice and

conclusion.
 Problem Statement

Falls significantly contribute to the incidents of nonfatal injuries especially for

individuals who are above the age of 65 (Cummings, Bridgman, & Brown, 2016). They present

the biggest challenge in care provision. Among this age group, women tend to have higher rates

of falls compared to men. Moreover, falls present a common cause of death among this age

group leading to approximately 42 deaths related to falls in every 100,000 people annually (Gu,

Balcaen, Ni, Ampe, & Goffin, 2016). Statistics also indicate that the rates of the fall are

increasing in the United States. Fall-related deaths increased by two-fold between 1999 and 2004

(Gilasi, Soori, Yazdani, & Tenjani, 2015). Apart from injuries, falls lead to further adverse

effects especially in relation to cost. Out of all causes of rehospitalization, 15% of them are due

to fall-related injuries especially in the first month after the discharge from the hospital (King,

Pecanac, Krupp, Liebzeit, & Mahoney, 2018). The approximate costs for nonfatal fall as per

2000 data were $18 billion ND $170 million dollars for fall-related deaths (King, Pecanac,

Krupp, Liebzeit, & Mahoney, 2018). Part of nursing care for the last six decades has been the

establishment of key strategies to reduce inpatient falls. Despite purposeful hourly rounding

being one of the most commonly used strategies to reduce the incidence of patient fall, there are

significant challenges especially in the implementation phase of the initiative including lack of

coordination and full participation of both educators and health managers. Therefore, the paper

seeks to answer the research question: For patients at Fort Myers Rehab and Nursing Center, will

the implementation of an EBP purposeful rounding process compared to no rounding lead to

decreased fall rates in 8-10 weeks?

 Objectives and Aims

The aim of the proposed DNP project is to implement purposeful hourly rounding as an

evidence-based practice to reduce the rate of patient falls in healthcare settings. In order to

achieve this, the following objectives have been identified and they will serve as a guide for the

DNP scholar throughout the project:

 To implement hourly rounding as an EBP in various units and assess its effectiveness in

reducing the rate of patient falls therein.

 To provide service users with patient-centered care by using hourly rounding as a

strategy to provide patients with healthcare that is responsive to their needs, preferences

and values especially physical comfort and emotional well-being (Barry & Levitan,

2012).

 To implement hourly rounding as a strategy to reduce the extra costs associated with

patient care as a result of the injuries and high mortality rates caused by falls. The extra

costs lead to an increase in the cost of care for both individual service users and for the

federal and global healthcare system.

 To create awareness amongst patients of all regions, genders and age groups on the high

prevalence of patient falls and how it adversely affects health outcomes to ensure that

they participate in the hourly rounding strategy by adequately communicating about their

needs to the nurses (American Nurse Today, 2010).

 To educate the nurses about their role in reducing the high rate of patient falls and

helping them understand that through the hourly rounding strategy, they can play a

crucial role in improving the nursing care provided to patients.

 To improve the overall quality of healthcare provided to patients by using hourly

rounding as an EBP to reduce accidental injuries and deaths that occur as a result of

patient falls.
 Significance of the Practice Problem

Reports from the WHO indicate that fall presents one of the main causes of accidental

injury deaths globally (Lam, Kang, Lin, Huang, Wu, & Chen, 2016). On average, 645,000

people die from falls annually all over the world (Francis, Steele, Noonan, Ryan, Walter, &

Kurtsev, 2016). Out of these deaths, 80% are in both the low and middle-income countries (Lam,

Kang, Lin, Huang, Wu, & Chen, 2016). The health burden has increased significantly as a result

of the high prevalence of the problem. Every year, more than 37 million falls that require

medical attention are reported (Hernandez, 2015). Despite the fact that falls are more common

among the older people aged above 65, children are also at a higher risk of falls with 40% of the

total DALYs lost due to falls globally occurring in children (Hernandez, 2015). Furthermore, the

individuals who suffer a disability as a result of falls are usually at higher risk for

institutionalization and long-term care.

Another significance of the practice problem is to examine the financial impact of falls in

the global healthcare system. Apart from the high prevalence and mortality rates, falls are also

associated with higher financial costs especially due to the fall injuries. In Australia and the

Republic of Finland, the average health system cost per fall injury is US$1049 and $3611

respectively (Gu, Balcaen, Ni, Ampe, & Goffin, 2016). Therefore any form of intervention put in

place to minimize the fall incidence significantly reduced the healthcare expenditure. For

instance, Canada has invested in systems to reduce fall rates. In Canada, any strategy to reduce

the fall incidence by 20% especially among children below 10 saves more than $120 million

annually (Gu, Balcaen, Ni, Ampe, & Goffin, 2016).

Falls are prevalent across regions, genders and age groups. However, studies suggest that

females commonly suffer from non-fatal falls. On the other hand, men are more likely to die

from falls due to the level of risk-taking behaviors. Other risk factors include unsafe
environment, occupations, underlying medical conditions, substance abuse, side effects of

medication among others (Lam, Kang, Lin, Huang, Wu, & Chen, 2016). In this regard, apart

from the purposeful hourly rounding, other strategies including the creation of safer

environments, emphasizing on education, training among others should be explored as

alternatives.

Patient falls do not only harm the patient but also impacts on nursing care, health

organizations and family and society in general (King, Pecanac, Krupp, Liebzeit, & Mahoney,

2018). For patients, fall is associated with functional impairment, disability, longstanding pain,

mortality, increased the length of hospital stays as well as a premature nursing home admission

(King, Pecanac, Krupp, Liebzeit, & Mahoney, 2018). According to the Center for Medicare and

Medicaid Services, falls are among the eight ‘never events’ due to their high cost, as well as high

volume events that are potentially preventable through evidence-based guidelines (King,

Pecanac, Krupp, Liebzeit, & Mahoney, 2018). Hospital fall rates are categorized into

physiological unanticipated falls such as fainting and environmental falls resulting from

equipment failure or any other form of external hazards. Furthermore, falls as a result of current

risks of fall, gait instability and medical history of fall can be categorized as physiological

anticipated in nature. These factors are further aggravated by other facility factors such as the

staffing ratio, type of patients in the facility, equipment availability and mode of care. Therefore,

fall incidents tend to affect the way the facility is run especially on the rotation of the staff nurses

to ensure consistent contact with the patients. Fall result not only increased treatment costs but

also reduced economic productivity due to long periods of being bedridden.

 References

American Nurse Today. (2010, December). Hourly rounding benefits patients and staff.

Retrieved from [Link]

benefits-patients-and-staff/

Barry, M., & Levitan, S. (2012). Shared decision making -the pinnacle of patient-centered care.

New England Journal of Medicine, 366(9), 780-781.

Cummings, S., Bridgman, T., & Brown, K. (2016). Unfreezing change as three steps: Rethinking
Kurt Lewin’s legacy for change management. Human relations, 33-60.

Daniels, J. (2016). Purposeful and timely nursing rounds: a best practice implementation project.

JBI Database System Rev Implement Rep, 48(1), 248-267.

Francis, K., Steele, C., Noonan, M., Ryan, M., Walter, D., & Kurtsev, A. (2016). Piloting,

evaluating and modifying ‘purposeful rounding' an evidenced-based approach to nursing

care: A private Catholic Health services approach to embedding evidence into practice.

International Journal of Evidence-Based Healthcare.

Gilasi, H., Soori, H., Yazdani, S., & Tenjani, P. (2015). Fall-Related Injuries in Community-

Dwelling Older Adults in Qom Province, Iran, 2010-2012. Arch Trauma Res, 4(1).

Goldsack, J. (2015). Hourly rounding and patient falls: what factors boost success? Nursing.

Gu, Y.-Y., Balcaen, K., Ni, Y., Ampe, J., & Goffin, J. (2016). Review on prevention of falls in

hospital settings. Chinese Nursing Research, 7-10.

Hernandez, M. (2015). Impacting patient care experiences: Hourly Rounding. Capstones and

Projects.

King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of Fall Prevention

on Nurses and Care of Fall Risk Patients. The Gerontologist, 58(2), 331-340.
Lam, C., Kang, J., Lin, H., Huang, H., Wu, C., & Chen, P. (2016). First Fall-Related Injuries

Requiring Hospitalization Increase the Risk of Recurrent Injurious Falls: A Nationwide

Cohort Study in Taiwan. PLOS One.