Journal Club article critique/Fishbone

The article chosen reflects a study on the effects of purposeful hourly rounding and preventable falls completed in a 112 bed Medical/Surgical unit, with 26 of those beds dedicated to patients identified as having co-morbidities that are associated with higher fall risks, with an average daily census of 108 patients. In a sample size of 2295 patients, the number of falls on the unit were examined. The unit then began implementation of purposeful hourly rounding addressing the 5 Ps, potty, position, pain, possessions and plan of care and collected that data on numbers of falls. Before implementation, there were 5.31 falls per 1000 patient days and after implementation there were 2.58 falls per 1000 patient days, then down to 2.4 and 1.45 in the subsequent months. Additionally, the Press Ganey patient satisfaction scores in the areas of patient perception of nurse courtesy and call light response times increased. Although the study did not reflect a statistically significant correlation, it did show a significant clinical reduction in the number of falls. This study is important because it reflects that purposeful hourly rounding can positively affect patient care and reduce the number of falls, thus reducing patient injury and unnecessarily prolonged hospitalizations which are costly to the patient and facility.


Grillo, D. M., Firth, K. H., & Hatchel, K. (2019). Implementation of purposeful hourly rounds in addition to a fall bundle to prevent inpatient falls on a medical-surgical acute hospital unit. Medsurg Nursing, 28(4), 243-246,261.

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10 Responses

  1. cmsare at |

    Great job, this is such an important topic. It it truly amazing to me how many falls happen in the hospital. An article that I read talks about 3 % of hospitalized Americans fall each year, one third of those falls results in injury and the article states that according to the Joint Commision a fall with injury comes with a cost of about $14,000.00 (Pittman, 2019). According to Pittman (2019), the best way to prevent falls is purposeful hourly rounding.

    Pittman, M. (2019, November 21). 4 ways hospitals can prevent patient falls. CHSH.

  2. ardavis8 at |

    Hourly rounding is a wonderful topic. This is something I have always taken upon myself to do with my patients. I have found they ended up being less “needy” if I just checked in on them every hour and they were happier with their care. Even if they were sleeping, I could tell them later, “I peeked in, but didn’t want to wake you” and they would know that I had been there. I also found that by doing this, I had less interruption when I was able to do my charting, because I had already been in checking on everyone. In an article I found, it also was discussing how the overall patient satisfaction scores were actually improved with hourly rounding and using AIDET. It also reduced the patients fear and anxiety and would build a good relationship between the nurse and the patient as well. There’s an improvement with safety, less chance of skin breakdown, less risk of falls, less need for stronger pain medication because you are staying on top of the pain better with positioning and other methods besides just medication.

    Allen, T., Rieck, T., Salsbury, S. (2016). Patient Perceptions of an AIDET and Hourly Rounding Program in a Community Hospital: Results of Qualitative Study. Patient Experience Journal. Vol 3, 1:7.

  3. cdelorenzo at |

    Preventing falls among patients in healthcare settings require a multifaceted approach. The recognition, evaluation and prevention of patient falls can pose significant challenges. Intentional Rounding (IR) has many advantages. IR gives nurses allocated time to check on their patients and make sure they are comfortable and their needs are being met.It improves communication between staff, patients and family members and provides a opportunities for a positive nurse-patient relationship. It increases the presence of nurses at the bedside and enables staff to get to know their patients and their needs. This allows nurses to detect subtle/ significant changes in behaviors and appearances. All this improves patient care and safety.

    Sims, S., Leamy, M., Davies, N., Schnitzler, K., Levenson, R., Mayer, F., Grant, R., Brearley, S., Gourlay, S., Ross, F., & Harris, R. (2018). Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why. BMJ quality & safety, 27(9), 743–757.

  4. oofakolujo at |

    One of the major performance improvement initiatives to prevent falls is the implementation of hourly rounding. Research indicates that patients fall in the hospitals because they are attempting to get up and use the restroom, needing positioning or pain medications and trying to reach for their personal items. Hourly rounding helps in decreasing patient’s anxiety, addressing the 4 P’s (pain, potty, position, and possessions), assessing for a safe environment, and setting expectations when staff will be returning. Taking care of patient’s comfort, safety and environmental needs helps to prevent falls and increase patient’s satisfaction (Brown, 2016).

    Brown, C. H. (2016). The effect of purposeful hourly rounding on the incidence of patient falls. Nursing Theses and Capstone Projects. Retrieved July 8, 2020, from

  5. mmoore8 at |

    This is an area that our unit is currently working to improve – fall prevention. I absolutely agree with the importance of hourly rounding in preventing falls. Even though hourly rounding is an expectation at our facility, the reality of it happening consistently does vary. This has to do with staffing and other issues. During med pass time, the RN could be in one patient’s room for 15-20 minutes. With 7-8 patients, there is always the possibility that someone will not get seen within an hour– and of course if there is an emergency, hourly-rounding can fall through the cracks. Therefore, the goal is to have nursing assistants also be part of the hourly rounding protocol. That way someone on the nursing staff is attending to the patient’s needs every hour. Again, staffing plays a HUGE role in this! Most of the falls on our unit occurred during times when staff was short. There is also a problem with exit alarms not being re-set after taking patients to the restroom. I like to walk by the fall risk rooms and just look for exit alarm lights, even if not my patient. The bed alarms really make a difference with confused or impulsive patients at risk for falls.

    Agency for Health Care Research and Quality. (2013). 3. Which fall prevention practices do you want to use? AHRQ.

  6. vfndifon at |

    Hourly rounding is definitely very important in fall prevention. I try to round on my patients who are at risk for falls at least hourly if possible. I also encourage nurse techs to round as well because sometimes, nurses get very busy and can not make it to every patient hourly. I have realized that some falls happen because the patient is unable to reach a call light or personal items. I make sure to leave call lights and bedside table within reach and remind patients to call for help. Hourly rounding is known as a nurse-led proactive strategy to anticipate patient needs while utilizing evidence-based interventions (Deitrick, Baker, Paxton, Flores, & Swavely, 2012).

    Deitrick, L. M., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly
    rounding: Challenges with the implementation of an evidence-based process. Journal
    of Nursing Care Quality, 27(1), 13-19.

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