Using evidence-based nursing rounds to improve patient outcomes.

MEDSURG Nursing—December 2008—Vol. 17/No. 6 429 clinical nurse specialist led to the development of an evidenced-based approach to reduce falls. A review of the literature was performed, and one study was found that validated the use of frequent nursing rounds as a strategy to decrease falls and call light use (Meade, Bursell, & Ketelsen, 2006). The interventions proposed in this study seemed to provide a feasible solution to the problem of falls. Hourly nurse rounding is an example of a protective strategy to reduce accidental and anticipated falls (Morse, 2002). The Madigan Nursing Research Department was consulted to help design and implement the program. The decision was made to replicate the study interventions from Meade and colleagues (2006) with a pilot project on the telemetry ward. A timeline was created to guide program implementation with goal dates for specific interventions. Data collection of nurse call bell usage was initiated first using a convenient check sheet placed adjacent to the call monitor. The staff annotated the time a call was received and the nature of the call by checking one of six categories, such as assistance getting to the bathroom, need for medication, need for a nurse, and other care issues. This report was tabulated daily and entered into a database to capture the number, type, and time of nurse calls in a 24-hour period to provide a sense of the demand the call bell system placed on the nursing staff. demonstrate that Army hospitals meet the same standards by which civilian facilities are judged. Within MAMC, this is demonstrated by an intense focus on graduate medical education and registered nurse advanced skills training courses as noted by 19 residency programs, 8 fellowship programs, one of four 16week Army critical care nursing programs, a clinical site for nurse anesthetist training, and a 16-week operating room nursing course. In continued efforts to maintain high standards of patient care at MAMC, the Joint Commission’s 2008 National Patient Safety Goals were reviewed formally. This review was part of the systematic approach to improving health care in the critical care arena and the continued pursuit of an evidence-based health care methodology. Reducing the risk of harm resulting from falls (Goal #9) became the focus of the Critical Care Section for the stepdown telemetry unit. This unit was identified to have greater than 75% patient movement and a high turnover rate of nursing staff. The number of patient falls in the last year was the impetus for selecting this goal. Also, potential implementation of measures to decrease the fall rate were examined.