Inpatient falls is one of the most costly type of adverse patient event in acute care hospitals in the United States (Guillaume, Crawford, & Quigley, 2016). Inpatient falls have been well documented in elderly patients but are also common in patients under the age of 65. Patient falls are common events, however, they are also preventable. This paper will discuss the implementation of hourly rounding to improve inpatient fall rates. Using Lewin’s change model to hardwire the rounding process as a new behavior, the steps will be discussed. System leadership approach is also key in implementing a successful new process to reduce inpatient falls and gain staff buy-in.
The system leadership approach is based on the thought that leadership is a group effort (Shao, Feng, & Hu, 2016). Systems leaders develop or identify a vision for an organization, then plan a strategy, and gather a group to carry it out (Shao, Feng, & Hu, 2016). In order for a change to be successful, leaders know they need the support of those affected by the change. Systems leaders gain the buy-in of the front-line staff in order to ensure a smooth transition from old habits to new ones. In order to get the buy-in and cooperation, the front-line staff need to understand exactly why change is needed and what impact their efforts will have on patient safety, meaning a reduction in falls.
Before, during, and after the change process, information about the patient falls such as time, date and location of fall should be monitored to show just how the change impacted the facility in positive way. For example, information about patient falls before hourly rounding should be communicated as well as information during the process to highlight any wins or opportunities. Leadership needs to inform front-line staff of the outcome and why and how they are making a difference.
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The change model that will be used to implement the hourly rounding program is Lewin’s Change Model. This change model involves three basic steps, unfreezing, moving, and refreezing (Carroll, & Carrigan, 2016). The first step involves assessing the issue at hand, which is the high fall rates and how to reduce them through hourly rounding, as well as potential for change. Moving is involving the front-line staff and those affected by the change to get involved. This step is actually getting front-line staff buy-in. The last step is implementing permanent changes, setting expectations, and goals. This step sets forth the new way of doing business and rewards those who comply or positive reinforcement (Carroll, & Carrigan, 2016).
This change model is appropriate for a successful hourly rounding program because it will get the employees on board and help them to lose bad habits that may have contributed to higher fall rates (Goldsack, Bergey, Mascioli, & Cunningham, 2015). This change model will also provide the staff some control or empowerment over improving their working situation and whether fall rates improve. If employees feel like they have a voice, their feeling of frustration may decrease making them more receptive to the change.
In the beginning, staff members should be educated about the expense of patient falls, the current fall rates for the organization, and contributing factors (Goldsack, Bergey, Mascioli, & Cunningham, 2015). Leaders should be in tune with the state of their unit and should be able to speak to this subject. The next step is educating leadership of expectations of leader rounding as well as staff hourly rounding. Until everyone is educated, they cannot be expected to perform rounding correctly. Education may consist of videos, demonstrations with skills check off, and reinforcement by regular education from nursing leadership. Leadership involvement consists of daily environmental rounds for safety issues and rounding on employees to ensure compliance and to deal with any obstacles that may impede staff rounding (Carroll, & Carrigan, 2016).
For a planned change to be successful, the leader has to plan ahead, create a vision of where they see the facility in the future, and draft a plan to get there (Silva, 2017). This first step in implementing Lewin’s change model is difficult because it breaks old habits and utilizes new methods of completing tasks, unfreezing. Once the unfreezing begins, the leader must be on-hand and observe and participate in the positive behaviors. The next step is moving. In this step, leading by example is a way to show how to perform a process or a step, versus just telling. This lets the employees know that the change is here to stay and everyone is in support. The leader must also be willing to correct those who refuse to make the effort to round for fall prevention. This step takes time and patience.
As the ideal behaviors and outcomes become the normal, the step of refreezing begins. In the refreezing, the new behaviors are again reinforced. The leader at this point, should make it a priority to regularly involve the front-line staff in reviewing the fall rates and preventable risks. As the scores rise or fall, the employees need to feel like they have control over this. Their actions or lack of action, such as purposefully rounding on patients or falling back on old habits is within the control of the front-line staff (Silva, 2017).
Conclusion
Implementing change takes a team. As the team forms, what keeps them working as a team is the desire to improve the patient safety. As leaders develop a vision for the organization they support, the vision should be shared with the front-line staff. Efforts to gain support from those who interact with the patients is crucial to improving falls as well as for other quality measures. A successful rounding program involves leadership from the top down to the front-line staff. If everyone is actively involved in preventing falls, there is a bigger chance for patient fall rates to decrease.
