Document Type

Open Access Capstone

Publication Date

Spring 2022


Description of the Problem: Falls sustained by patients in the hospital environment are a major concern in today’s healthcare setting. Falls are costly for both patients and hospitals in terms of excess morbidity and mortality as well as financial constraints given that falls are no longer eligible for insurance reimbursement. B3 is a 24-bed medical and oncology unit at a Boston-area community hospital. Over the past three years, B3 has had one of the highest total fall and fall with injury rates in the hospital. Available Knowledge: An exhaustive review of literature was conducted which revealed intentional rounding on patients by nursing staff as an evidence-based intervention with the potential to reduce falls in the project setting. Aims and Objectives: The overall aim of this Neuman’s Systems Model-guided quality improvement project was to reduce the monthly unit fall rate to below 0.358% and to reduce the monthly fall with injury rate to below 0.096%. Other objectives included improving the unit’s culture of safety, staff knowledge about falls reduction and patient satisfaction. Intervention: B3 piloted an intentional rounding protocol for this quality improvement project in an effort to decrease patient falls and falls with injury. All patients admitted to B3 were assessed for risk of falling using the Morse Fall Score upon admission and were placed on the intentional rounding protocol. Nursing staff had a checklist addressing common patient needs to guide these intentional rounds. Evaluation of the Intervention: The intentional rounding intervention was evaluated over a threemonth trial period by comparing pre and post intervention fall and fall with injury rates. Additionally, surveys were conducted to determine the extent of unit safety, knowledge of evidence-based falls prevention as well as post intervention patient satisfaction scores. The implementation of intentional rounding on B3 reduced both the fall and fall with injury rates among patients during the three-month intervention period. The fall rate was reduced to 0.1258% and the fall with injury rate was 0%. Additionally, patient satisfaction scores were also improved during the intervention period. Staff knowledge of falls increased and staff reported that intentional rounding made B3 a safer unit. Intentional rounding was determined to be an easy-to-implement, cost effective tool to reduce patient falls that was well received by both staff and patients.