An Enhanced Purposeful Hourly Rounding Program: Impact of Proactive Toileting on Rates of Falls and Injurious Falls

Abstract

Risk factors associated with falls and injurious falls in acute care settings are complex and involve multiple intrinsic and extrinsic aspects. Research indicates 20%–30% of inpatient falls can be prevented by evaluating risk factors and undertaking interventions to mitigate those risks. Registered nurse (RN) and patient care technician (PCT) staff play an essential role in employing fall prevention strategies. One evidence-based best practice is a purposeful hourly rounding (PHR) program. The aim of this quality improvement project was to evaluate how an enhanced PHR program that incorporated proactive toileting on high-fall-risk patients impacted the rate of falls and injurious falls during a two-month practice change period in adult medical-surgical floor patients. RN and PCT staff (N = 102) from two medical-surgical units with the highest rates of toileting-related falls participated in the practice change. Staff who volunteered to become PHR champions received education and training during a live simulation on completing proactive toileting every two hours as part of the PHR process. The remaining unit staff watched a recorded simulation exemplar session and completed a return demonstration with a PHR champion. All RN and PCT staff were trained on the use of a paper proactive toileting log to self-report adherence to the practice change. Fall and injurious fall rates were measured prior to and after staff education on the practice change to determine the significance and impact of proactive toileting on high-fall-risk patients. Findings indicated there was no statistically significant difference in fall and injurious fall rates on either project unit between the baseline and project periods. However, the project did reveal meaningful statistical significance in other areas. During the project period in Unit 2, there was a statistically significant decrease in the rate of falls (z = 2.00, p = .046). Additionally, a greater percentage of proactive toileting logs were completed on days when there were no falls on either project unit (p