Capella University NHS-FPX8040
NURS-FPX9100: Defining the Nursing Doctoral Project
Prof.
June 5, 2023
Project Charter-Secondary Review
| Part 1 | ||||||||
| General Project Information | ||||||||
| Project Name | Preventing patient falls in the medical-surgical department using scheduled rounding protocols. | |||||||
| Executive Sponsors | · One of the main sponsors is the Chief Nursing Officer. The other is the Chief Executive Officer.
· The CEO is the highest officeholder and plays a crucial role in setting organizational standards. The focus is on consistently improving the quality and safety of care to optimize care outcomes. For this project, the CEO has a say in making informed conclusions on scheduled rounding protocols and compliance. Hourly rounding is an excellent option for White Plains Hospital to enhance fall precautions (Anu, 2021). For instance, the CEO is likely to acknowledge the need for hourly visits during the day and visits every two hours during night shifts. Further, scheduling rounding would require the executive sponsors to support the need for adequate staffing and care coordination between nurses, nurse assistants, and patient care technicians to optimize outcomes. · The Chief Nursing Officer is a crucial executive sponsor in this project. The CNO understands challenges experienced throughout the care continuum and the need for proactive and sustainable measures to improve the situation. In this project, the CNO plays the crucial role of being among the leaders that effectively support patient falls reduction initiatives. Thus, the CNO will examine the effectiveness of nurse education practices, set expectations for reducing patient falls, demonstrate responsibility and accountability, and establish the right culture for reporting patient falls without blames. The CNO’s role in providing ongoing and meaningful feedback on hourly rounds and ensuring that nurses have adequate resources also make the executive a key player in promoting project success. |
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| Department Sponsors | The departmental sponsors include the nurse manager responsible for operations in the medical-surgical unit. The manager understands operational gaps and opportunities available to scheduled rounding protocols. Her experience in the profession and over ten years working at the facility means that she understands events in the care environment, including the rate of falls and progress made. R.Q is the nurse manager with over 20 years of experience delivering care in a high demanding care environment. A primary role is to identify weaknesses in the system and integrate ideas on the best way forward. | |||||||
| Project Aim | This project aims to reduce patient falls in the emergency care setting at White Plains Hospital using scheduled rounding protocols. The unit requires a QI intervention that involves checking on the patient to ensure that their possessions, such as support tools are within reach. Hourly rounding is a viable option for day and night shifts (Østervang, et al., 2019). However, compliance from nurses and nursing assistants is vital to have a robust approach to preventing patient falls. Notably, this QI project promotes adherence to standards and protocols that enable practitioners to assess a patient’s pain level, offer help that could minimize movement, and ensure that patients are comfortable and have their essential resources within reach (Hudson-Covolo et al., 2018; Grillo et al., 2019; Heng et al., 2020).
The project’s overarching aim is to decrease falls with major injury in a long-term care facility within 4 months. By implementing the AHRQ Fall Prevention toolkit, the intended goals are to improve fall rates to benchmark standard of 0.4 per 1000 patient days as set by AHRQ. The system impact expected is a decrease in injury resulting in decrease in length of stay and decrease in lost revenue as the average cost of fall with injury ranges around 14,000 per patient. Additionally, the implementation of the QI is expected to raise patient satisfaction by over 10 percentage points in the department from the current 60%.
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| Focus | The focus of the QI is implementing more proactive scheduling rounding protocols. Patients would no longer over-depend on call lights to ask for help. Equally, the intervention reduces the frequency of unscheduled call lights due to coordinated regular rounds. Thus, staff have better ways to help patients meet needs, such as toileting and access to drinking water and essentials. It is vital to identify new and better ways of interacting with patients. For instance, the nurse or nursing assistants may clarify the need for a patient to use the call bell or contact a practitioner using contact details on a whiteboard. The QI project also incorporates the P’s of rounding, including pain, position, possessions, and a peaceful environment required to address vulnerable patients’ needs proactively. Further, documenting hourly rounding sessions and conducting flexible rounds every two hours in night shifts and one hour during day shifts is vital to strengthen the project’s focus.
To achieve the project aim, the following AHRQ’s Fall Management Program will be implemented. The Falls Management team will implement an interdisciplinary quality improvement initiative based on scheduled rounding protocols. The intervention is designed to assist nursing facilities in providing individualized, person-centered care, and improving their fall care processes and outcomes through scheduling tools. The protocols will include assessing the patients’ pain levels using an established scale, offering toilet assistance, ensuring that the bed is in a locked position, ensuring that the telephone is within the patients reach, and putting the tissue box and switches close to the bed. The literature has shown that reducing the distance a patient has to reach for an essential item such as a remote controller or telephone reduces that patient’s likelihood of falling (Ganz & Latham, 2020). Literature also shows that offering toilet assistance can help reduce patient falls significantly (Goldsborough, 2019). The Plan-Do-Study-Act (PDSA) model provides insights into the best ways to contextualize the issue and respond appropriately (Coury et al., 2017). The approach makes the project team familiar with the issue and the anticipated outcomes. In this sense, the team can collaborate to identify the best strategies for accomplishing hourly rounding protocols. The PDSA also allows the team to exhaust the various issues associated with patient falls and the efforts required to record zero patient falls in the medical-surgical unit. |
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| Project Team | ||||||||
| Title | Department | Credentials | Role | |||||
| Project Manager | Project manager | Nursing | Doctoral student | D.M: Project manager in charge of monitoring and controlling the scope and deliverables.
· Seeks to use the QI project to introduce meaningful changes in scheduled rounding protocols. The contributions in quality improvement initiatives benefit D.M since it is part of the professional commitment to making an impact in patients’ lives and the practicum site. |
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| Team Members
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The Nurse manager | Medical-Surgical unit | Doctor of Nursing Practice | M.N: Nurse manager
· Over ten years of experience makes her a pivotal addition to the project team. M.N understands operational gaps that cause patient falls and can actively play a crucial role in identifying sustainable solutions. · The roles in the medical-surgical unit and advanced care settings make her familiar with patients’ needs in the area and the need for proactive efforts to maximize patient satisfaction. · As a nurse manager, M.N will benefit from this project regarding increased care coordination and a safe environment that enhances nurse credibility and reduces operational challenges. |
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| Nurse 2 | Advanced care nurse | Nursing | Advanced Practice Nurse and Doctor of Nursing Practice | R.S: Nurse working in the advanced care setting.
· The nurse has worked at the facility for over five years. · She has over 15 years in the field, having worked in other hospitals before. As such, she understands the complexities in the care environment. · R.S also understands the relevance of quality improvement initiatives in improving patient safety across the care continuum. · The nurse will benefit from this project through flexible rounding protocols and well-coordinated functions that safeguard her from burnout and compassionate fatigue. |
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| Educator | Nursing educator | Nursing | Doctorate in nursing administration | D.P: The nurse educator
· In charge of designing and implementing training programs. Being part of the healthcare team means she understands events in the care environment. · D.P is among the parties to share evidence-based ideas on the best ways to prevent patient falls. · The project is an opportunity for D.P to contribute toward creating a safe care environment by engaging the nursing team about the need for scheduled rounding and the best ways to achieve the intended outcomes. |
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| A member of the nursing team | Nurse Assistant | Nursing | Advanced Practice Nurse | V.R: The nursing assistant
· Responsible for monitoring patients’ conditions and the effectiveness of the treatment plan. · The professional understands the high standards of care required to maximize patient satisfaction and enhance brand credibility. · The QI project enhances V.R’s awareness about complexities associated with patient falls prevention and the best ways to optimize scheduled rounding protocols. |
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| Stakeholders | ||||||||
| The Board of Directors | · The board plays a vital role in maintaining a highly functional facility.
· One of the responsibilities is approving long-term plans and efforts to deliver the best care. The directors also seek clarification on operational deviations as they strive to ensure that everything matches the company’s future aspirations. · Scheduled rounding protocols help improve the quality and safety of care. The board can benefit from associating with a firm with a high brand reputation and credibility based on significantly reduced patient falls (Kim et al., 2021). |
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| The project team | · The project team is responsible for producing the intended outcomes.
· The team includes individuals with experiences, knowledge, and skills that enable them to share ideas on the best ways to address physical and environmental risks associated with patient falls. · The team will use the QI project as an opportunity to strengthen the professional commitment to delivering quality and safe care. |
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| Patients | · Patients are the primary beneficiaries of the project.
· It is essential to incorporate their experiences and feedback on the risk factors that could expose them to falls. · Specifically, patients will be expected to share evidence of their experiences at the facility, including near falls and operational weaknesses that jeopardize the quality of care. · Patients benefit from the project in terms of reduced risks of readmissions, prolonged hospitalization, and increased cost of care. |
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| Part 2 | ||||||||
| Project Overview | ||||||||
| Project Description | ||||||||
| Gap in Practice
The current data shows that the hospital has 3 falls for 1000 patients. That is significantly above the recommended rate of less than 0.4 patient falls per 1000 patients. The gap between the desirable rate and the current rate can be explained partially by the lack of a deliberate fall’s reduction intervention in the hospital. While there has been staff education on the importance of patient safety, there is a lack of a direct program to address the falls problem.
Intervention Practice Change Interventions Intervention one: Toilet assistance program Recommendations and progression from literature. As show by Goldsborough (2019), assisting patients with their toilet duties can reduce patient falls significantly. Toilet usage is an activity performed daily. Were patients have mobility issues, for example, getting to the toilet can be a difficult tasks. Additionally, toiles have wet areas and can pose an elevated risk level for patients. Intervention operational logistics. The toilet assistance protocol will be implemented through a request system. Patients will be able to request for toilet assistance. The awareness that a patient can ask for toilet assistance is the significant step; currently, patients do not seem to know that they are allowed to ask to be assisted into and out of the toilets.
Intervention two: Access to items and tools protocol Recommendations and progression from literatureAs noted by Grillo et al. (2019), reaching out for items such as remote controllers, the telephone, and even items on the bedside table can lead to falls among patents. It follows that rounding protocols that ensure that items are close and within reach for every patient will reduce the incidence of falls (Walsh et al., 2018). Intervention operational logistics: The protocol aims to customize the position of the items, using a ranked list that allows patients to prioritize what they would want closest to them. DNP Learner Role as Project Manager
The project involves adopting the scheduled rounding protocols to prevent patient falls at White Plains Hospital. As the proposer, the focus is on the medical-surgical unit to demonstrate the need for a proactive approach that reduces the need for patients to use call lights to request help (Manges et al., 2020). The intervention adopted for this project is the ‘Patient Falls Hourly Rounding Checklist’ to enhance consistency in fall prevention practices and meet organizational goals for patients’ and their families’ satisfaction. The checklist evaluates nursing compliance with falls prevention regulations in the medical-surgical unit (Anu, 2021). In this case, the patient falls hourly rounding checklist seeks to ascertain nurses’ adherence to standards associated with environmental measures such as bed position and accessibility of personal items, documentation of incidents, response to bed alarms, and supervision while performing basic needs such as bathing. |
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| Evidence to Support Need | ||||||||
| Patient falls, and the resulting injuries and deaths jeopardize a hospital’s brand credibility. An upward trend of incidents in the medical-surgical unit could be disastrous for White Plains Hospital. An hourly rounding checklist is among the options available for the facility to enhance patient safety (Cuttler et al., 2017). As shown by Walsh et al. (2018), there is merit in addressing patient falls within medical facilities. Reducing patient falls impacts the overall safety score associated with a hospital. Safety scores are improvement because they affect how a hospital is perceived by the target population. Hospitals that have a reputation of patient falls will more often than not be viewed as risky facilities. Considering that recommendations are an important part of any institution’s image in the age of online ratings, it would be beneficial to the brand to have a reputation of few to no falls. The safety issue also affects the economics for patients and the hospital. Patients who suffer falls are likely to have extend admission periods. That has economic impacts because of lost productivity hours and the money paid for extended hospitalization (Haddad et al., 2019). Additionally, a patient who suffers a fall might require additional interventions like physiotherapy. Hospitals are less likely to spend money settling and contesting law suits if patient falls are reduced or eliminated (Haddad et al., 2019). Evidence by Sun et al. (2020) and Riddell (2020) shows that the implementation of a rounding protocol can help augment staff efforts to reduce patient falls. The rounding protocol not only guides staff members on what actions to take but also inculcates a culture of attention to the patient within the staff body (Riddell, 2020).
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| Project Purpose/Business Case
The business case relates to the need for a safe environment characterized by consistent improvement in falls prevention. White Plains Hospital can benefit from effective hourly rounds protocols that match specific patients’ circumstances. The collaborative nature of the QI makes it ideal for nurses, nursing assistants, and nurse managers to ensure that there are proper fall precautions. |
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| Project Goals
Organizational Benefits · Reduction of resources spent in managing patients who have fallen. · Reduction in legal suits due to negligence. · Positive brand reputation Organization Support · The protocol needs to be adopted at the policy level. That way, the implementation is guided and facilitated by top management. Sustainability · The adoption as a policy item will support sustainability. · Continued staff education will also support sustainability Potential Risks · Resistance from a section of the nursing team unwilling to embrace new systems such as alarms that may be associated with additional responsibilities. · Reluctance to embrace the project. · A section of the nursing team may seek additional incentives such as performance bonuses to participate in inpatient falls reduction programs proactively. The project excludes financial gains associated with decisions to boost the workforce’s commitment to the initiative. The primary goal is to elicit collective efforts required to safeguard patients from the adverse impacts of falls. |
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| SMART Objectives (Specific, Measurable, Attainable, Relevant, Time-Bound) | ||||||||
| · To improve compliance with falls prevention standards by 10% by the second week of the implementation period.
· To improve compliance with falls prevention standards by 40 % by the sixth week of the implementation period. · To improve compliance with falls prevention standards by 90 % by the end of the implementation period. |
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| Deliverables | ||||||||
| The gains from the project include;
· Improved nurse and patient safety outcomes · Enhanced policy guidelines on the prevention of falls · Improved falls risk assessment in the medical-surgical unit. · Enhanced adherence to protocols, environmental concerns, and resource requirements for patient fall prevention. The assumptions are that everyone in the nursing team will understand the project’s relevance from a personal and organizational perspective. The deliverables are also achievable within the first six months after project implementation. The anticipated achievements demonstrate the need for the facility to enhance compliance with hourly rounding protocols to prevent patient falls. The project is achievable by establishing a new roadmap that allows nurses, nurse assistants, patients, and affiliates to review the hourly rounding protocols and adapt them to specific patients’ circumstances. For this project, the CNO and CEO will play active roles in monitoring strategies and their effectiveness in preventing falls. On uncertainties, a section of the nursing team may seek incentives such as performance-related bonuses to reduce patient falls actively. |
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| Project Scope | ||||||||
| The project team will work on a roadmap for implementing and complying with hourly ounding protocols to prevent patient falls. The aim is to capture all risk factors associated with patient falls by reviewing nursing rounds and adapting them to specific operational circumstances. A comprehensive review of hourly rounding protocols provides evidence of human and technical gaps that undermine the organization’s resilience in reducing patient falls. Thus, the project team will evaluate several alternatives, such as the need for bed alarms, education, and physical designs required to reduce patient falls. | ||||||||
| Project Milestones | ||||||||
| The review and implementation of the hourly rounding protocols will happen in three weeks. The duration is enough for the project team to share insights into the best ways to implement hourly rounding protocols for day and night shifts. Approval in May will provide opportunities for further discussions on the situation. Evaluation surveys conducted within two weeks are vital to contextualize the issue and ensure that everyone understands the urgency of adopting hourly rounding protocols and their roles in preventing falls. Other stages of the project include integrating the evidence and compiling a report within one month to describe the project’s relevance in reducing patient falls. The goal is to have accurate and complete evidence on organizational, patient, and physicians’ related characteristics that influence the rate of patient falls. | ||||||||
| Part 3 | ||||||||
| SWOT Analysis | ||||||||
| Strengths | ||||||||
| · The White Plains Hospital has a culture of quick response to chnges with strategic value
· The protocol does not demand a significant financial investment · The protocol is intuitive and can easily be adopted with minimal resistance · White Plains Hospital has advanced communication structures that make it easy for everyone to stay up-to-date with organizational changes. |
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| Weaknesses | ||||||||
| · The dynamic nature of healthcare professionals may force many to withdraw from the QI project. In this case, the project leader may be forced to rely on volunteer nurses to complete the hourly rounding checklist.
· The complex nature of practices in the medical-surgical unit may undermine efforts to acquire insights from patients’ experiences. In this case, the total number of patients eligible for the project may not match the anticipated sample required to provide insights into the effectiveness of the hourly rounding checklists. · It may be challenging to include speciality practitioners in the project due to the demanding nature of their work. |
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| Opportunities | ||||||||
| · White Plains Hospital already has the staff numbers needed to implement the QI
· Since White Plains Hospital operates as a non-profit organization, employees are likely to accept changes with low levels of resistance · White Plains is a general medical and surgical facility, which means that reduced patient falls increase consumers’ confidence and could attract more patients to the facility (Parnell, 2018). |
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| Threats | ||||||||
| · The demanding nature of the surgical department makes nurses, physicians, and nurse assistants vulnerable to turnover intentions.
· White Plains Hospital may incur additional staffing costs by recruiting more nurses and nurse assistants to implement the hourly rounding successfully. · Hourly rounding requires staff to focus on additional tasks such as addressing the patients’ pain, toileting, and repositioning, which increase staff workload (Francis et al., 2019). |
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| Known Major Risks | ||||||||
| Rank the SWOT weaknesses and threats listed above here. Identify at least one high risk and discuss how it might be mitigated. | ||||||||
| Risk Level (Low, Medium, High) | Risk | |||||||
| Medium | Participants in the survey may hold back vital information | |||||||
| Medium | Some nurses may resist the changes due to the demanding nature of their work. | |||||||
| Medium | The complex nature of the care environment in the medical-surgical unit may undermine efforts to acquire insights from patients’ experiences. | |||||||
| High | · High staff turnover in the medical-surgical unit could create complexities in implementing the project. Reducing nurse turnover at the unit is vital to achieving the intended results.
· Transition programs for new nurses are vital to make the group aware of the complexities of the care environment and their obligations towards optimizing care outcomes. · The nursing manager should utilize the transformational leadership approach to encourage employee dedication to their roles (Yodang & Nuridah, 2020). · Long-term employee engagement in the unit also calls for supportive incentives such as work-life balance and financial motivations to enhance staff resilience. |
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| Medium | · Time and cost overruns as the project team move to ensure that everyone understands and appreciates the impact of the study on the organization. | |||||||
| Medium | · The complexities of patients’ conditions and needs in the medical-surgical needs mean that the organization has to allocate additional resources to acquire experienced professionals and provide motivational incentives. | |||||||
| Ethical Considerations | ||||||||
| · The proposal will be submitted to Capella University for non-human subject research. The Institutional Review Board will review the proposal. The White Plains Hospital examined the viability and relevance of the project in addressing patient falls at the facility.
· The project leader got the approval to proceed. It was vital to safeguard participants’ information during the implementation when using the checklist to make observations and collect data. Notably, letters were used anonymously to identify high-risk patients (Priyadarshini, 2020). Further, the project leader avoided including the names of nurse participants conducting the hourly rounding audits. |
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| Constraints | ||||||||
| · Achieving the patient and nurse education goals within the intended period considering the dynamic nature of the medical-surgical unit and complications in delivering the best care to patients.
· Resistance to change from a section of the nursing team means spending time explaining the purpose and the contributions toward streamlining nurses’ functions. · The multiple interventions available could create challenges in making mutual decisions based on different nurse and patient preferences of the proposed solutions. · Being a non-profit means that the facility will require additional funding from external sources to accomplish the project. Uncertain funding may undermine the implementation of the initiative. |
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| External Dependencies | ||||||||
| · Dependencies include parties that can contribute to the project’s success. The facility is a non-profit organization. The status means that external funding from donors and well-wishers is necessary to implement the project and produce the intended outcome.
· The project team may also require a consultant to provide insights into the successful strategies that help reduce patient falls. The consultant will have the knowledge and experiences drawn from other organizations to provide insights into the best and sustainable ways to protect patients from falls. |
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| Communication Strategy | ||||||||
| · The success of this project depends on the effectiveness of interactions among stakeholders, the project team, and the board of directors through multimdia channels.
· A pre-set meeting schedule through face-to-face interactions will allow the project manager to engage the Chief Nursing Officer and the Chief Executive Officer about the need for the project and its implications on the organization. · Communication with the project team will be through group sessions and e-mail conversations. The meetings and messages will provide insights into the progress and measures required to accomplish the intended outcomes on time. · Scheduled Zoom meetings with the nurse educator, nurse manager, and nurses. The meetings will happen during the participants’ convenient time to avoid interrupting them while at work. The focus is gaining insights into the situation and reactions toward the impact of hourly rounding on patient fall. · The project also involves engaging patients. Face-to-face sessions with physically, emotionally, and psychologically stable patients will help acquire details about the gaps in falls prevention and the role of hourly rounds in responding to their needs on time. |
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| Proposed Outcomes | ||||||||
| Metric | Outcome Measure | Process Measure | Countermeasure (optional) | |||||
| Robustness of the fallsisk assessment | 90% improvement of patient fall risk assessment within three weeks of the implementation period. | The checklist provides insights into the duration and completeness of risk assessments done by nurses. | N/A | |||||
| Documentation of patient fall prevention | A 60% improvement of compliance with documentation standards within six weeks during the implementation period. | The checklist reveal nurses’ effectiveness in documenting fall prevention and care management plan. | N/A | |||||
| Consistency in environmental awareness | 97% consistency in applying environmental safety measures such as access as patients’ access to call bells and safe positioning of the bed within four months of the implementation period. | Checklists confirm the frequent application of environmental safety measures to ensure that the bed position, tables, personal items, call bells and other essentials match the characteristics of a safe care environment. | N/A | |||||
| Data Collection Plan | ||||||||
| · The ‘Hourly Rounds Checklist’ will be used to collect data on nurses’ compliance with falls prevention measures. High fall patients will be coded using alphabetical letters. The completed checklist will be collected at the end of a shift. The project leader will complete the checklist and generated a report summarizing the data gathered throughout the project. Then, data will be entered in the Microsoft Excel software and analyzed with descriptive statistics.
· For the analysis, percentages will provide insights into nurse compliance with patient fall standards. Additionally, counts are vital to establishing the number of high fall risk patients in the medical-surgical unit. The project leader will share the findings with the executive sponsors responsible for approving the results and communicating them to departmental leaders in the medical-surgical unit. The final report will be provided to the CEO and CNO |
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References
Anu, J. (2021). Hourly rounding and fall prevention among the elderly in long term care: A change process. Journal of Geriatric Medicine, 3(1), 1-5. https://ojs.bilpublishing.com/index.php/jgm/article/download/2614/2742
Coury, J., Schneider, J., & Rivelli, J. (2017). Applying the Plan-Do-Study-Act (PDSA) approach to a large pragmatic study involving safety net clinics. BMC Health Services Research, 17(411), 1-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477281/pdf/12913_2017_Article_2364.pdf
Cuttler, S., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons, and alarms. BMJ Open Quality, 6, 1-8. https://pubmed.ncbi.nlm.nih.gov/29450285/
Francis, K., Kurtsev, A., Walter, D., Steele, C., & Staines, C. (2019). Nurses’ experiences and perceptions of hourly rounding: A private Australian Catholic hospital single case study. International Archives of Nursing and Health Care, 5(2), 1-6. https://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-5-125.pdf
Ganz, D. A., & Latham, N. K. (2020). Prevention of falls in community-dwelling older adults. New England journal of medicine, 382(8), 734-743.
Goldsborough, Kimberly A., “Implementation of Safe Patient Toileting to Decrease Patient Falls on Medical-Surgical Unit” (2019). DNP Scholarly Projects. 30.
https://scholars.unh.edu/scholarly_projects/30
Grillo, D. M., Firth, K. H., & Hatchel, K. (2019). Implementation of purposeful hourly rounds in addition to a fall bundle to prevent inpatient falls on a medical-surgical acute hospital unit. Medsurg Nursing, 28(4), 243-250.
Haddad, Y. K., Bergen, G., & Florence, C. (2019). Estimating the economic burden related to older adult falls by state. Journal of public health management and practice: JPHMP, 25(2), E17.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(140), 1-12. https://bmcgeriatr.biomedcentral.com/track/pdf/10.1186/s12877-020-01515-w.pdf
Hudson-Covolo, J. L., Rivers, R., & Irwin, B. (2018). Daily intentional nurse leader rounding on patients. Journal of Perianesthesia Nursing, 33(1), 90-95.
Kim, E., Kim, G., & Lim, J. (2021). A systematic review and meta-analysis of fall prevention programs for pediatric inpatients. International Journal of Environmental Research and Public Health, 18(5853), 1-12. https://www.mdpi.com/1660-4601/18/11/5853/pdf
Manges, M., Zaver, M., Mack, K., & Abraham, S. (2020). Hourly rounding and medical-surgical patient falls: A review of the literature. International Journal of Scientific Research and Management, 17(2), 85-95. https://www.researchgate.net/publication/348390368_Hourly_Rounding_and_Medical-Surgical_Patient_Falls_A_Review_of_the_Literature/link/5ffc5c8392851c13fe0576b0/download
Østervang, C., Vestergaard, L. V., Dieperink, K. B., & Danbjørg, D. B. (2019). Patient rounds with video-consulted relatives: qualitative study on possibilities and barriers from the perspective of healthcare providers. Journal of Medical Internet Research, 21(3), e12584.
Parnell, T. (2018). White Plains Hospital spine services: Fostering excellent outcomes through evidence-based, collaborative care. MD News. https://lowerhudsonbronx.mdnews.com/white-plains-hospital-spine-services-fostering-excellent-outcomes-through-evidence-based
Priyadarshini, P. (2020). Ethics in nursing research. European Journal of Molecular & Clinical Medicine, 7(7), 6080-6086. https://ejmcm.com/article_6005_21f5f1614485918666042bdb6cc01468.pdf
Riddell, S. F. (2020). Hourly Rounding Implementation to Decrease the Incidence of Patient Falls (Doctoral dissertation, Grand Canyon University).
Sun, C., Fu, C. J., O’Brien, J., Cato, K. D., Stoerger, L., & Levin, A. (2020). Exploring Practices of Bedside Shift Report and Hourly Rounding. Is There an Impact on Patient Falls?. JONA: The Journal of Nursing Administration, 50(6), 355-362.
Walsh, C. M., Liang, L. J., Grogan, T., Coles, C., McNair, N., & Nuckols, T. K. (2018). Temporal trends in fall rates with the implementation of a multifaceted fall prevention program: persistence pays off. The Joint Commission Journal on Quality and Patient Safety, 44(2), 75-83.
Yodang, Y., & Nuridah, N. (2020). Nursing leadership models in promoting and improving patient’s safety culture in healthcare facilities: A systematic review. Evidence-Based Health Policy, Management & Economics, 4(4), 263-274. https://jebhpme.ssu.ac.ir/article-1-302-en.pdf