Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls.

Morgan, Lauren, Flynn, Lorna, Robertson, Eleanor R., New, Steve, Forde-Johnston, Carol and McCulloch, Peter Intentional Rounding: a staff‐led quality improvement intervention in the prevention of patient falls. Journal of Clinical Nursing, 26 (1-2). pp. 115-124.

Abstract

Aims and objectives
This study designed and evaluated the use of a specific implementation strategy to deliver a nursing staff‐led Intentional Rounding intervention to reduce inpatient falls.

Background
Patient falls are a common cause of harm during hospital treatment. Intentional Rounding has been proposed as a potential strategy for prevention, but has not received much objective evaluation. Previous work has suggested that logical interventions to improve patient care require an integrated implementation strategy, using teamwork training and systems improvement training, to instigate positive change and improvement.

Methods
Customised Intentional Rounding was implemented and evaluated as part of a staff‐led quality improvement intervention to reduce falls on a neuroscience ward. Intentional Rounding was instigated using a pre-specified implementation strategy, which comprised of: (1) engagement and communication activities, (2) teamwork and systems improvement training, (3) support and coaching and (4) iterative Plan‐Do‐Check‐Act cycles. Process (compliance with hourly visiting to patients by staff) and outcome (incidence of falls) measures were recorded pre‐ and post-intervention. Falls measured on the active ward were compared with incidence of falls in 50 wards across the rest of the same Trust.

Results
There was a 50% reduction in patient falls on the active ward vs. a minimal increase across the rest of the Trust (3·48%). Customised Intentional Rounding, designed by staff specifically for the context, appeared to be effective in reducing patient falls.

Conclusions
Improvement programmes based on integrating teamwork training and staff‐led systems redesign, together with a preplanned implementation strategy, can deliver effective change and improvement.

Relevance to clinical practice
This study demonstrates, through the implementation of a specific strategy, an effective improvement intervention to reduce patient falls. It provides insight into the effective design and practical implementation of integrated improvement programmes to reduce risk to patients at the frontline.

What does this paper contribute to the wider global clinical community?
This study shows that through a specific implementation strategy based on integrated training, staff‐led improvement, coaching and support and iterative design, effective change and improvements to patient care can be delivered at the frontline. Intentional Rounding has had mixed evidence to date. Within this study, analysis of the existing systems helped inform the design of Intentional Rounding. Frontline nursing staff were supported by the research team to create a system of Intentional Rounding, which was designed iteratively to suit the context in which it was being implemented. These factors, alongside senior nursing support, appeared key in successful implementation of the intervention.

Item Type: Article
Date Deposited: 30 Nov 2018 11:54
Last Modified: 30 Nov 2018 11:54
URI: http://eureka.sbs.ox.ac.uk/id/eprint/7159

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