Introduction and Problem Statement

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Falls, injuries, and nosocomial infections are some of the most common unsafe incidents that are common in the long-term care environment such as medical-surgical health departments. The nurses working in long-term care are such as the medical-surgical healthcare units are facing demanding tasks of ensuring that the patient population is kept safer from injuries caused by preventable falls on the daily basis. The majority of the patients in long-term care are older than 65 years and are usually exposed to lengthy hospital stays. These populations are exposed to several comorbidities, they take multiple medications, and are therefore having a decline in their functional ability (Brosely & March 2015). Elderly individuals are also exposed to nosocomial infections as a result of their weakened immune systems. Nursing home residents might be presenting a combination of the above-mentioned features and this implies that they are highly exposed to the risks of falls and are sustaining major injuries.

The prevention of falls and injuries to the patients requires multifactorial strategies and is important in dealing with the functional, physical, psychological, and educational components. It is also important for the Medical-surgical healthcare departments to ensure that the nurses are working as a team to ensure that there is an effective utilization of the collaborative interdisciplinary prevention measures that are helpful in the reduction of the risks of falls and injuries caused by the falls (Goldsack et al., 2015).

One of the most important strategies that have been considered to be helpful in the improvement of the patients’ safety through the reduction of injuries and falls is the hourly nursing rounding. Hourly rounding is defined as a nurse-led proactive strategy utilized in the anticipation of the patients’ needs while using evidence-based interventions. This strategy requires nurses to ensure that patients are checked based on a specific set time frame. The nursing hourly rounding strategy also requires nurses to perform critical evaluations of the environment and taking necessary steps to ensure that there is the promotion of patient safety, improvement in the quality of healthcare, and improvement of team communication.

Problem Statement

Patient safety is a major area of focus among healthcare providers and healthcare organizations. The healthcare providers are playing a crucial role in ensuring that the patient population is protected from the fall episodes as a result of the longer lengths of stay, multiple comorbidities, polypharmacology, and reduction in their function ability, and advanced age. The issue of falls is common among aging individuals and their injuries are considered to be the causes of deaths caused by unintentional injuries. Due to the international impacts of falls in the aging population, there is a need to ensure that there is the existence of strategies or programs aimed at reducing falls and injuries that are associated with the falls (Hill & Fauerbauch, 2014).

Based on the consideration of the number of residents that are being cared for by the nurses, it is evident that the implementation of the effective measures are necessary to ensure that there is a reduction in the rates of falls and the needs of the individuals are cared for and the safety of the patients is promoted. The major area of focus on the safety of the patients especially the elderly patients is on the rate of falls. Falls is considered a major health concern for elderly patients. The World Health Organization (WHO) (2016) reports that about 20 to 30 percent of the aging population are experiencing moderate to major injuries from falls and greater risk of mortality caused by the fall-associated injuries (World Health Organization, 2016).

Neily et al (2015) report that approximately 3 to 20 percent of the inpatients are falling at a rate not less than once after being admitted to the healthcare facilities. This study further reveals that patients in the acute and the rehabilitation centers are experiencing about 30 to 51 percent of injurious falls. The falls and injuries are affecting the quality of life of the patients and this is causing an increase in healthcare costs. The healthcare cost associated with falls and fall-associated injuries is costly. Neily et al (2015) state that patient with two falls or more with no severe injury incurs approximated yearly healthcare cost of $ 16,000 while the individuals with severe injury is costing up to $ 27,000 (Neily et al., 2015).

The patients in the medical-surgical healthcare departments are also experiencing the risk of being exposed to the healthcare-acquired pressure ulcers and the low nurse patients’ ratios and this interferes with the level of their safety. The strategies or available solutions towards addressing these problems are not fully implemented. The failure in the implementation of the solutions such as hourly nursing rounding is associated with the numerous factors that can be considered as the barriers. Some of the barriers that interfere with the process of achieving full implementation of the hourly nurse rounding are the resistance from the nurses. The resistance is associated with the lower number of healthcare providers to offer services to a large number of the growing population of the patients (Brosely & March 2015).

The low nurse-patient ratio makes it hard for the healthcare facilities to ensure that there is an effective shifting process in the hourly rounding intervention. The implementation of hourly nursing rounding requires an adequate number of healthcare providers and this implies that the low number of these professionals makes it hard to ensure that the hourly nursing rounding procedure is implemented effectively to ensure that patients in the medical-surgical healthcare units are protected from unsafe incidences.

Therefore, these data are showing the need to ensure that efforts are made to help in the reduction of injuries, healthcare costs, and the promotion of a safer environment. It is therefore important for the healthcare facilities to ensure that there is an implementation of the evidence-based fall reduction approaches that are supported by the present literature (Hill & Fauerbauch, 2014).


Falls, injuries, and nosocomial infections are common healthcare issues that expose patients to severe infections and a longer stay in healthcare facilities. Purposeful hourly rounding has been confirmed to be a proactive method that can be adopted by the healthcare providers such as nurses to ensure that the needs of the healthcare providers are identified. It also helps in the demonstration of positive fall prevention outcomes. The utilization of the evidence-based hourly nurse rounding approach has been on the rise, nevertheless, its implementation is not fully achieved. It is, therefore, necessary for the nurse leaders to ensure that the rounding programs are evidence-based and clearly defined within the organization’s policies.



Brosely, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 30(2), 153-159. doi:15505065. Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly Rounding and Patient Falls: What Factors Boost Success? Nursing, 45(2), 25-30. doi:107770823 Hill, E., & Fauerbauch, L. A. (2014). Falls and fall prevention in older adults. Journal of. Falls and fall prevention in older adults. Journal of Legal Nurse Counseling, 25(2), 24-29. Neily, J., Quigley, P. A., & Essen, K. (2015). Implementation Guide for Fall Injury Reduction: VA National Center for Patient Safety Reducing Preventable Falls and Fall-Related Injuries. 1-10. World Health Organization. (2016). Fact sheet.


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