The Effect of Fall Prevention Programs With Hourly Rounding on Fall Rates Among Adult Patients in the Neurological Unit
Abstract
Purpose
The purpose of this QI project was to evaluate the effect of a structured hourly rounding program on patient fall rates in an adult neurological inpatient unit.
Background
Patient falls remain a major safety concern in acute care, particularly among hospitalized neurological patients with impairments in mobility, cognition, and balance. In an adult neurological unit within a Magnet-designated hospital, fall rates exceeded national benchmarks, underscoring the need for a targeted quality-improvement intervention.
Methodology
A pre–post QI design, guided by the Plan-Do-Study-Act framework, was implemented over 12 weeks in a 28-bed neurological unit. This intervention featured structured hourly rounding using the 5Ps framework: pain, position, potty, possessions, and plan. Nurses and patient care assistants alternate rounding responsibilities, with compliance documented using standardized logs. Outcome measures included fall rates per 1,000 patient-days, while process measures assessed rounding compliance. Data analysis used descriptive statistics, run charts, and paired t-tests.
Results
The baseline fall rate was 3.68 falls per 1,000 patient-days, which decreased to 3.24 during implementation. After excluding falls due to contextual factors such as sitter removal, the adjusted fall rate was about 2.0, successfully meeting the project aim. Notably, high early compliance (over 95%) was associated with fewer falls, whereas declining adherence was associated with increased events.
Implications
Structured hourly rounding offers an effective, low-cost fall-prevention strategy for high-risk neurological patients, if staff sustain adherence. Continued commitment to rounding can help maintain safer outcomes and foster a culture of safety in neurological care units.
Key words: hourly rounding, purposeful rounding, rounding compliance, fall prevention, patient safety