Hourly Rounding vs. Bed Alarms: Reducing Falls in Acute Care

Introduction: Falls as a Nursing Practice Problem

The research question guiding this paper is: among acute patients on medical-surgical units, does hourly rounding — as opposed to only setting the bed alarm — help decrease patient falls by 75%?

Falls are a major problem among acute patients, particularly among the 65 and older population, and can lead to a wide range of related complications — occasionally with fatal results. For this reason, falls represent a crucial topic for nurses and caregivers to investigate. Nurses have at least two primary options for controlling and preventing falls. The first is hourly rounding, which refers to either a nurse or a nurse technician checking on the patient every hour to determine whether the patient requires anything. The second is setting bed alarms on patients who are at high fall risk, so that the alarm notifies the nurse if the patient attempts to get up unassisted. This paper investigates both methods as potential strategies for preventing falls among acute patients on hospital wards.

Consequences and Scope of Patient Falls

The fall event itself is traumatic, and its consequences can include post-fall anxiety, fractures, head injuries, and loss of independence — each of which carries broader ramifications affecting the physical, social, mental, emotional, and behavioral dimensions of the patient's life. The impact of falling on a patient is therefore wide-reaching and touches virtually every segment of his or her daily existence.

Oliver et al. (2004) report that approximately 2.9 to 13 falls per 1,000 bed days have been documented, and that up to 30% of such falls may result in injury — including fracture, head trauma, and soft tissue trauma — all of which may in turn lead to impaired rehabilitation and co-morbidity.

Falls are also associated with higher anxiety and depression scores, loss of confidence, and post-fall syndrome. Beyond the patient, falls are costly in that they extend the length of hospital stays and complicate institutional care. Patient falls may also cause guilt among nursing staff or prompt litigation from patients' families.

Preliminary Research Questions and Feasibility

The following five preliminary research questions were generated to guide a literature review on this topic, along with an analysis of each question's feasibility:

Rationale for the questions: The goal is to make the research as specific as possible while ensuring that every angle is considered and all possibilities are accounted for. An overview of the effectiveness of each method is needed, as is an investigation into the demographics of studies conducted in connection with each method. The results may point to the need for further investigation of one method before a determination about its feasibility can be made. The results may also reveal that hourly rounding or bed alarm use has been studied only in connection with a particular population and may be less relevant to the present case, or may require further testing to establish its relevance.

This study focuses on only two intervention options. However, sound evidence-based practice requires consideration of all possible options. For this reason, the study is grounded in a general evaluation of recommendations for fall monitoring before placing the two specific options within the broader context of established recommendations.