Will Hourly Rounds Decrease Patient Falls - Research Paper Example

?Hourly Rounds will Decrease Patient Falls Affiliation with more information about affiliation, research grants, conflict of interest and how to contact Hourly Rounds will Decrease Patient Falls This section of the paper focuses on the implementation of a proper system of hourly rounds by nurses for reducing patient falls. It has attempted to over all the key elements of the assignment in a substantive way with accuracy and persuasiveness. The paper has used Lewin Theory as an implementation guide. Plan for implementing the proposed solution: The main focus of the plan is to incorporate a system of regular hourly rounds by nurses, as a solution to decrease patient falls in the hospital. For this, the first step is careful planning for which it is necessary to ascertain the following: 1. The number of patients visiting the hospital on an average. 2. The number of nurses in the hospital. 3. The number of physicians in a hospital. 4. The number of nurses as assistant to the physicians. 5. The average period a patient visits the hospital. Developing a plan involves careful evaluation and organizing. Appropriate staffing procedures also need to be adopted for getting the plan executed. Such a plan is highly crucial in implementing the proposed solution. The main aim of a nurse is to decrease patient falls in the hospital and to provide proper assistance and care to them for their recovery from illness. The goals of nurses also include helping individuals “to maintain their health so they can function in their roles” (Imogene King’s Theory of Goal Attainment, 2011, para. 13). Once the hospital ascertains the requirements of nurses for hourly rounds, it is necessary to staff the hospital appropriately so that adequate human resources are available for executing the tasks as per the plan devised for reducing patient falls. Assuming: 1. The number of patients visiting the hospital on an average who require hospitalization are 50 [ ulcer prevalence – 15, injury prevalence – 25, ICU – 10] 2. The present number of nurses in the hospital - 20 3. The number of physicians in a hospital - 5 4. The number of nurses as assistant to the physicians – 4. 5. The average period a patient visits the hospital – inconsistent , 2 weeks (approx) The plan envisages the arrangement of nurses for hourly visits on rotation basis. 10 nurses should be able to handle 25 patients. The plan is to implement a rotation basis system so that 20 nurses cater to 50 patients and administer them on the basis of the guidance and supported provided by physicians. Plan for monitoring the implementation of the solution: In order to implement the solution of a rotational arrangement of nurses so as to extend each patient the advantage of the hourly round system it is very important to monitor the situation that exists in the hospital and to plan the visits accordingly. “An important part of plan implementation is monitoring, which is taking periodic looks at “how it's going” in Implementing the plan” (Training Course on Decentralized Education Planning in the Context Public Sector Reform, 2007, p. 2). Proper staffing pattern activities are essential to develop productive human asset in the hospital so that the hospital can provide utmost care and security to its patients. Each nurse’s on job commitment is assessed through the number of patient falls under her tenure. Month-wise assessment should be made in order to assess the efficiency of nurses. In the months where both the fall prevalence and the nursing hours are the same, it implies that the nursing care in these months is not enough. In the months where occurrence of falls is more than average these needs to be balanced with appropriate nursing care hours. When there is a wide difference between the falls prevalence and the nursing hours per day and there is less falls it implies that nursing care hours are higher than the prevalence of falls. Such a plan needs to be implemented for the purpose of monitoring of the implementation of the solution. How a theory of planned change is used to develop the implementation plan: Nursing staff consists of registered nurse, licensed practical nurses and other nursing personnel. Licensed nurses practice under registered nurses. The nurse managers are directly reporting to the directors. The hospital aims to provide complete security to its patients and, therefore, the number of nurses in each department needs to be strengthened. Contractual basis of recruitment of nursing staff can prove beneficial to the hospital as during the contract period if the nurse is appropriate in nursing care and is able to decrease the number of falls then the nurse can be appointed on a permanent basis. “Kurt Lewin theorized a three-stage model of change that is known as the unfreezing-change-refreeze model that requires prior learning to be rejected and replaced” (Lewin, 2011, para. 2). Change management should be adopted and staff should be assed on the basis of their performance and their results in terms of the reduction in patient falls under their tenure. The nurses under whom there is increased patient falls should be replaced with new nurses. Feasibility of the implementation plan: The implementation plan is practically feasible as it envisages a system of hourly rounds in the hospital with nurses who are already available. Only if their performance falls below the desired level, there is a need to recruit additional nurses or replacing the existing ones who are inefficient. Monitoring of the plan will also help in eliminating inefficiency as the nurses will become more conscious of the need for improving their performance and make concerted efforts to reduce patient falls. Since the nurses will designated for the rounds on a rotation basis, it will not be a problem for them to attend their rounds on predetermined schedules. Thus, the implementation of the plan can be feasible. Validity, reliability and sensitivity of the outcome and the measures (instruments) that are being proposed: The process being implemented is reliable and valid as it stipulates the generation of monthly reports. These will facilitate the measurement of the effectiveness of the plan as well as indicate how hourly visits by nurses reduce patient falls. Besides, it will also increase the efficiency of the nurses as they will be apprehensive of punitive measures where performance falls short of expectation. The system will also minimize their work as this will eliminate the wastage of “time and energy by reducing call light use” (Clinical Rounds: Hourly Rounds Keep Call Lights Quiet, 2006, para. 1). Rationale for choosing the proposed outcome measures: The hourly schedules and measurement of its outcome are tangible. Monthly reports on patient falls will provide a clear and specific data about the outcomes. It will also enable the hospital to determine which nurse worked on a specific schedule when falls occurred. The process of fixing responsibility, thus, becomes easy. As stated earlier, this will also increase the efficiency of the nurses in particular and the hospital in general. This, in turn, will result in better patient care and bring more good will to the hospital. Feasibility of the evaluation plan: The evaluation process is simple as it involves only the generation of monthly reports, indicating the number of patient falls in each department and the details of the nurses on duty. This is a simple process and does not involve any additional overheads to the hospital. Once the report is generated, clear data will be available as to who the best performing nurse is and who falls short of expected outcomes. This will make it easy for the hospital to take remedial action and eliminate inefficiency. Description of the design for the evaluation. Formative evaluation can be in the form of learner assessments, communication with the patients and the relatives. Periodic evaluations can be taken from nurses in order to assert they are doing their job appropriately. Summative evaluations can also be performed which includes formative assessments examination of patients, surveys and interviews conducted with patients. The outcome is fewer patients’ falls with the incorporation of the hourly round system. The outcome will be evaluated through formative and summative evlautions. • Description of the methods to be used to evaluate the innovation is presented including:  site for the study, sampling process, inclusion/exclusion criteria, description of the instruments *(A copy of the measure should be included as an Appendix), methods for collecting outcome data, resources needed for evaluation. Site of the study is VA hospital. The random sampling technique was employs to gather data. A sample plan is an accurate plan for getting the sample from cluster. The total sample taken for the study was 100. The cluster consists of patients and their relatives from the hospital. Feedback from the patients is vital to offer the information on the subject of satisfaction of service after the incorporation of such a plan. The methods used to implement the proposed solution are: 1) careful planning 2) organizing 3) setting up of resources 4) fixing a budget 5) fixing a time frame 6) review of the implementation of the project by surveys and interviews 7) measuring the survey and the interview results Timeframe with Steps: Timeframe for completion of each step –It is intended to operate the project in 4 months and 1 month after the implementation of the project is for discussion on the matter. The following are the steps along with the time plan. 1st month – identification of the core issue of patient falls, 2nd month – investigating number of plans appropriate for the project. 3rd month – recruiting staff and making office arrangements. 4th month – seeking grants from various agencies After implementing the project analysis of the project 1 month analysis is needed to review the plan that has been put into practice. 1 month – interviews with patients and their relatives on how satisfactory the measure of implementing the hourly rounds system has been effective in reducing patient falls in the hospital. Budget and Budget Narrative: For the preparation of the budget two major expense heads has been taken into consideration. They are the operational expenses and the human resource expense. The operating expenses are mainly related to the costs for better providing of services with Information technology to regulate the rotational jobs of nurses, the setting up of the equipments for the recreation and the yoga facilities for the nurses while on hourly duty. Also, the human resource expense has been taken into consideration while preparing the budgets. Allocations have been made for the extra payments of nurses, a warden and the yoga and the computer instructor. Operational Expenses: Expense Heads Amount (in dollars) Setting up of recreation and yoga facilities $ 5000 Setting up IT services $ 3000 Total $ 8000   Manpower Expenses: Expense Heads Amount (in dollars) Extra income to nurses $ 10,000 Arrangement of Yoga instructor $ 5,000 Arrangement of Warden $ 2,000 Total $ 17,000 Total expense - 17000 + 8000 = $ 25000 Revenue: Membership income $ 4000 Total revenue $ 4000 The budgeted revenue is $ 4000 while the budgeted expense is $ 25000 The methods for monitoring after the implementation of the plan include collecting sample survey results and results of interviews. Conclusion: Though patient fall is a major concern in hospitals, many studies have proved that a proper system of hourly rounds by nurses can be quite effective in overcoming this problem. In order to achieve this, hospitals need to incorporate a proper plan and strictly implement it as a routine exercise in their system. They also need to monitor it properly to ensure that the plan is being practically implemented as per predetermined schedules. Generation of monthly reports will be an efficient method to measure the outcome of the plan implementation as the data so facilitated will give specific results and the details of the nurses on duty when falls have occurred. This will not only help the hospital to fix responsibility but will also help in eliminating inefficiency as well as enhancing performance as the nurses will be apprehensive of punitive measures wherever shortfalls are noticed. Thus, hospitals will be able to enhance the efficiency of their staff and provide better patient care to their customers, which, in turn, will boost their business. Appendix A Site – VA Hospital Sample size – 100 Cluster consists of patients, their relatives. % who conveyed satisfaction after the incorporation of the hourly round system – 100 % who were against the system – 0 % of nurses who agreed to the hourly round system – 90 Reference List Clinical Rounds: Hourly Rounds Keep Call Lights Quiet, (2006). Lippincott’s Nursing Center.com. Retrieved Sep. 02, 2011, from http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=627645 Imogene King’s Theory of Goal Attainment, (2011). Nursing Theories: A Companion to Nursing Theories and Models. Retrieved Sep. 02, 2011, from http://currentnursing.com/nursing_theory/goal_attainment_theory.html Lewin, K. (2011). Change Theory. Nursing Theories: A Companion to Nursing Theories and Models. Retrieved Sep. 02, 2011, from http://currentnursing.com/nursing_theory/change_theory.html Training Course on Decentralized Education Planning in the Context Public Sector Reform, (2007). Mekong Institute – UNESCO Bangkok. Retrieved Sep. 02, 2011, from http://www2.unescobkk.org/elib/UNESCO-MI-Course-Material/Session-16/PPP%2016.Monitoring%20Plan%20Implementation.pdf Read More