1. ROUND WITH A PURPOSE: PURPOSEFUL HOURLY
ROUNDING AND THE IMPACT ON THE REDUCTION OF
FALLS IN HOSPITALIZED PATIENTS WITH IMPAIRED
MOBILITY
by
Student Name
Evidence-based Practice Project
Submitted to the Faculty of NUR 49800 Capstone Course in
Nursing
College of Nursing
of Purdue University Northwest,
Hammond, Indiana
in partial fulfillment of course requirements for the degree of
Bachelor of Science
February, 2019
© copyright
bethany galezio
2019
all rights reserved

2. acknowledgments
As I complete this evidence-based practice project proposal,
many thanks go out to Gail D. Wegner, DNP, RN, CNS, Ellen
M. Moore, DNP, RN, FNP, Bridget Shoulders, MS, ACNP-BC,
CCRN-CMC, and my clinical liaison, D. H., MSN, RN,
CMSRN, RN-BC. Their support and scholarly criticism have
helped me accomplish this project which has meant a lot to me
as I pursue excellence in my professional nursing practice.
table of contents
SectionPage
acknowledgments iii
table of contents iv
abstract v
Sections
1. Introduction 1
2. Review of Literature and Synthesis of the Evidence 4
3. Plan for Implementation 16
4. Plan for Evaluation 25
5. Conclusions, Recommendations and Implications 33
references35
List of tables
TablePage
Table 1 Summary of Reviewed Evidence 10
Table 2 Estimated Timetable Blueprint for Implementation 23
Table 3 EBP Evaluation Plan 29
ABSTRACT
Purpose: The purpose of this evidence-based practice project is
to determine if implementing purposeful hourly rounding and

3. standardizing this practice will result in reducing the number of
falls that occur.
PICO Question: “In hospitalized adult patients with impaired
mobility, what is the effectiveness of purposeful hourly
rounding compared to not doing routine purposeful hourly
rounding on reducing the number of falls?”
Significance of the Problem: Falls are a prevalent issue in
healthcare facilities and the community worldwide. Despite the
numerous fall interventions in place to prevent them, falls
continue to occur. Falls are a patient safety and quality of care
issue that are associated with negative outcomes including
extended hospital stay, injury, death, anxiety, and decreased
satisfaction as well as increased financial costs.
Synthesis of the Evidence: A review of research and evidence
suggests that consistent purposeful hourly rounding while
implementing the 4Ps (pain, potty, position, possessions) can
reduce the incidence of falls that occur in hospitals. Purposeful
hourly rounding is a suggested technique to address patient
needs while enhancing their safety and overall healthcare
experience.
Recommended Implementation for Practice Change: Sufficient
research suggests that consistent purposeful hourly rounding
leads to positive patient outcomes including reduction in the
number of falls. Thus, this knowledge should prompt the
development and implementation of an evidence-based
purposeful rounding program by taking a multidisciplinary
approach.
Conclusions/Recommendations for Practice: The
recommendation is to pursue an evidence-based purposeful
rounding program to prevent and reduce the incidence of falls in
hospitalized adult patients. Once developed, the program should
be attempted through a trial run on a unit with a high incidence
rate of falls. The trial run outcomes will determine the
practicability of implementing the program hospital wide.
Key Words: fall prevention, hourly rounding, purposeful
rounding, purposeful hourly rounding, rounding

4. ROUND WITH A PURPOSE ii
section 1
Round with a Purpose: Purposeful Hourly Rounding and the
Impact on the Reduction of Falls in Hospitalized Patients with
Impaired Mobility
Falls continue to be a major safety issue in
healthcare facilities despite all that is done to prevent them and
maximize patient safety. Falls can lead to numerous negative
health outcomes and continue to be a day-to-day challenge in
healthcare facilities worldwide.
Purpose
The purpose
of this evidence-based practice project is to determine if
implementing purposeful hourly rounding and standardizing this
practice will result in reducing the number of falls that occur.
Relevance
A fall is
defined as an unexpected or unintentional descent to the floor,
whether it is with or without injury (Agency for Healthcare
Research and Quality [ARHQ], 2018, p. 1). Falls are a prevalent
issue in healthcare facilities and the community worldwide and
they account for the largest amount of reported adverse events
in hospitals. Falls can cause non-fatal and fatal injuries, most
being non-fatal, but approximately 424,000 people die each year
due to falls worldwide (Avanecean, Calliste, Contreras, Lim, &
Fitzpatrick, 2017, p. 3007). The ARHQ estimates that in the
United States, 700,000 to 1 million falls occur in hospitals each
year (2018, p. 1). When falls occur, patients may develop a fear

5. of falling which can cause them to limit their physical activities
which can lead to decreased mobility, strength, and
independence, only further increasing their risk of falling
(Hicks, 2015, p. 51). Other negative patient outcomes of falls
include extended hospital stay, injury, death, anxiety, and
decreased satisfaction with the care they receive.
Although elderly individuals are the most common
population considered to be vulnerable to falls, any patient of
any age can be at an increased risk for falls due to medications,
medical conditions, and procedures because of an altered
physical or mental state. Nurses are responsible for assessing
the patient’s risk for falling on admission to the hospital unit
and each shift, using a fall risk assessment tool. Fall risk
assessment tool scores show the level of risk which guides the
patient-specific fall prevention interventions implemented.
Despite the numerous fall interventions (bed/chair alarms, non-
slip footwear, gait belts, fall signage, etc.) in place to prevent
them, falls continue to occur which is why change is necessary.
The nursing staff is ultimately responsible for patient safety and
the number of falls that occur can be directly associated with
the quality of care that is provided.
Additionally, falls have substantial financial impacts for
hospitals especially if injury occurs. Fall injuries increase
health care costs because of the increased use of resources and
length of hospital stay. In the United States, it is estimated that
by 2020, the annual cost of fall injuries is anticipated to surpass
$54 billion (Hicks, 2015, p. 51). Roughly $14,000 is the average
cost for an injury sustained fall (The Joint Commission, 2015,
p.1). As mentioned, the length of stay can also increase when a
patient falls. One study found that the length of stay was 6.3
days longer when a fall occurred (Avanecean et al., 2017, p.

6. 3007). Also, the Centers for Medicare & Medicaid Services
recognize a fall as a hospital-acquired condition which means
that hospitals do not receive reimbursement for medical costs
because falls can be prevented when evidence-based practices
are implemented (Hicks, 2015, p. 51). Negative patient
outcomes and increased financial costs associated with falls are
the key reasons why the 4South Orthopedic/Neurology unit of
Hospital A needs to increase their focus on the benefits
purposeful hourly rounding can have, specifically on prevention
and reduction of falls.
Potential Outcomes
The 4South Orthopedic/Neurology unit of Hospital A needs
to evaluate the effectiveness of implementing purposeful hourly
rounding. Standardizing the practice of purposeful hourly
rounding and using it consistently could potentially reduce the
number of falls. Also, patient falls typically mean higher
healthcare costs and increased length of hospital stay. By
anticipating the needs of patients and being more proactive,
rather than reactive, positive outcomes such as decreased fall
rates could occur and thus increasing the safety of patients, and
decreasing the length of hospital stay and healthcare costs.
Overall, these ensure a higher quality of nursing care.
Clinical Question (PICO)
“In hospitalized adult patients with impaired mobility, what is
the effectiveness of purposeful hourly rounding compared to not
doing routine purposeful hourly rounding on reducing the
number of falls?”
Section 2
Review of Literature and Synthesis of Evidence
To address the clinical question
(PICO), “In hospitalized adult patients with impaired mobility,
what is the effectiveness of purposeful hourly rounding
compared to not doing routine purposeful hourly rounding on
reducing the number of falls?”, a literature review was

7. completed using keywords. These keywords included, “fall
prevention”, “hourly rounding”, “purposeful rounding”,
“purposeful hourly rounding”, and “rounding”. The
databases/websites used were The Joanna Briggs Institute,
AHRQ National Guideline Clearinghouse, CINAHL, The Joint
Commission, and Cochrane Library-Cochrane Database of
Systematic Reviews. When using these databases, advanced
search limits were used such as “English language”, “full text”,
“peer-reviewed”, and date range (2014 to present) as well as
Boolean operators (and, or) to narrow the search for the best
available evidence. This search generated sixteen journal
articles, clinical guidelines, or studies that offered pertinent
information relating to answering the clinical question (PICO)
of interest. After appraisal of the evidence using Melnyk’s level
of evidence hierarchy (2011), a total of eight articles were
utilized to address the clinical question (PICO): Level 1- two
sources, Level 3- two sources, Level 4- two sources, Level 5-
one source, and Level 7- one source.
Literature Common Themes
Common themes
found in the literature were the definition of purposeful hourly
rounding, the implementation process of hourly rounding, and
the impact hourly rounding can have on the prevention and
reduction of falls. Other common topics discussed were the
impacts hourly rounding can have on call light usage, patient
and nurse satisfaction, safety, and healthcare costs.
Definition of purposeful hourly
rounding. The literature consistently discusses that purposeful
hourly rounding involves intentionally checking on patients at
systematic and routine intervals to meet their fundamental needs
proactively, rather than reactively (Hicks, 2015, p. 51).
Rounding is considered an intervention that can be applied to

8. all patients regardless of their level of fall risk (Avanecean et
al., 2017, p. 3010). Typically, purposeful rounding also
demands focus on addressing the 4Ps (pain, potty, position,
possessions) or a similar method. Other key components include
assessing the environment for safety concerns and letting the
patient know when staff will return (The Joanna Briggs
Institute, 2016, p. 2). Purposeful hourly rounding, also known
as intentional rounding, is a suggested technique to address
patient needs while enhancing their safety and overall
healthcare experience.
Implementing hourly rounding. Evidence consistently supports
that nursing rounding be performed hourly or at least every two
hours during the evening hours. Additionally, The Joanna
Briggs Institute (2016) is one of numerous other clinical
practice guidelines and studies that recommends implementation
of evidence-based practice protocols such as, the “12 steps” or
“4Ps” to further reduce the number of patient falls (p. 2). The
ARHQ (2018) created a toolkit that includes methods of
assessing the fall risk of a patient, interventions to implement to
prevent falls (with a section focused on hourly rounding), and
ways to evaluate the effectiveness of these interventions. The
toolkit also offers a specific scheduled rounding protocol for
nursing to follow which is consistent with other sources
reviewed regarding implementation of hourly rounding (p. 130).
Inconsistencies involving the
frequency of rounding, who performs the rounding, and
documentation of the rounding were found in the literature
review. While evidence supports rounding being done hourly or
at least every two hours during evening hours, the exact times
varied between studies. Some studies compared hourly rounding
from 0600 to 2200 and then every two-hour rounding from 2200
to 0600, while others did rounding at all hours or just every two
hours (Olrich, Kalman, & Nigolian, 2012, p. 25). Other studies
performed hourly rounding from 0700 to 2200 and then every

9. two-hour rounding from 2200 to 0700 (The Joanna Briggs
Institute, 2016, p. 1). Variances regarding who performed the
rounding were evident as well. Some studies were found to have
only Registered Nurses (RNs) or other nursing staff such as
Certified Nursing Assistants (CNAs) or Patient Care
Technicians (PCTs) do the rounding. In other studies, a
combination of both RNs and CNAs/PCTs with each rounding
on alternating hours was performed (Mitchell, Lavenberg,
Trotta, & Umsheid, 2014, p. 469). There were also few studies
that discussed methods of documenting or recording the hourly
rounding being done. One study mentioned keeping a logbook to
record the rounding (in which elements were found to have been
missing from the logbook), but other methods were not
discussed (Mitchell et al., 2014, p. 470).
Fall prevention and
reduction. Evidence found in the literature consistently supports
the implementation of purposeful hourly rounding in hospitals
to reduce falls. One quasi-experimental study (506-bed U.S.
hospital; two medical-surgical units-one experimental unit, one
control unit), compared data before and after implementation of
hourly rounding and found that there was a 23% decrease in fall
rates (Olrich et al., 2012, p. 25). In another quasi-experimental
study (consisting of 22 hospitals and 27 units), implementation
of hourly rounding, including a 12-step nursing round protocol,
reduced falls (The Joanna Briggs Institute, 2016, p. 1). Another
study discussed in an integrative review (34-bed orthopedic-
medical-surgical unit), found that when purposeful hourly
rounding and the 4Ps (pain, position, potty, possessions) were
used, falls decreased from 5.42 to 3.94 per 1,000 patient days.
In that same integrative review, eleven out of the fourteen
studies had decreased fall rates when some type of nursing
rounding was implemented (Hicks, 2015, p. 52). A systematic
review (involving five randomized control trials-RCTs),
discussed that when patient-centered interventions (including

10. regular rounding) were implemented, decreased fall rates were
found to have occurred in three of the five studies (Avanecean
et al., 2017, p. 3023). Lastly, a mixed method approach
implementation project conducted on a 28-bed hospital unit
found that when purposeful hourly rounding involving the 4Ps
was implemented, patient falls decreased by 50% (Daniels,
2016, p. 249).
In one systematic
review involving sixteen studies, it was found that the evidence
supporting the use of hourly rounding in hospitals was of low to
moderate strength compared to others. According to the review,
this was due to weak research design of the studies and
inconsistent reporting of the quality, quantity, and consistency
of the evidence of hourly rounding. Regardless, it is believed
that additional research and evidence would only support the
practice of hourly rounding to reduce falls (Mitchell et al.,
2014, p. 472).
Existing Knowledge Gaps
When
examining the various sources, there were some gaps in
knowledge and research that were discussed. For example,
several of the studies failed to provide evidence to support that
positive effects of hourly rounding could be sustained over an
extended period of time. More research is needed on how to
sustain hourly rounding over an extended period of time and
convince staff of the benefits of practice changes such as
purposeful hourly rounding. Additionally, many of the studies
were nonrandomized and of small sample sizes so more
randomized control trials and of larger sample sizes are
necessary to obtain improved results. Based on the review of
literature, it is still unclear if there is a more effective method
(i.e., 4Ps vs. 12 steps vs. use of a script or checklist) to hourly

11. rounding compared to others and why. Research involving
accurate documentation of purposeful hourly rounding is
necessary as well. Further research regarding staffing and
budget constraints and the effect they can have on the
implementation of purposeful hourly rounding could be
beneficial too. Lastly, more experimental design studies should
be conducted to enhance the levels of evidence surrounding the
topic of hourly rounding.
Findings
Overall, evidence suggests that consistent purposeful hourly
rounding leads to positive patient outcomes including reduction
in the number of falls. There is sufficient research that supports
purposeful hourly rounding reduces the number of patient falls
when implemented effectively, although additional research
involving specific aspects of hourly rounding could be
beneficial.
ROUND WITH A PURPOSE 2
PICO Question: “In hospitalized adult patients with impaired
mobility, what is the effectiveness of purposeful hourly
rounding compared to not doing routine purposeful hourly
rounding on reducing the number of falls?”
Keywords: fall prevention, hourly rounding, purposeful
rounding, purposeful hourly rounding, rounding
Databases Searched: Joanna Briggs Institute, AHRQ National
Guideline Clearinghouse, CINAHL, Cochrane Library-Cochrane
Database of Systematic Reviews
Table 1
Summary of Reviewed Evidence
Author(s) and Date of Publication ONLY
Sample/Setting/

12. Design
Data Collection Tools
Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)
Agency for Healthcare Research and Quality (2018)
Design:
Clinical practice guideline
Setting:
Quality improvement teams at six medical centers in the U.S.
developed toolkit from various studies
Sample:
N=55 papers
Numerous databases were searched for fall prevention studies.
Studies include: systematic reviews, expert opinion, and
consensus recommendations.
Strategies used by program studies across the U.S. in acute care
hospitals are referenced.
The guideline discusses recommendations of interventions for
preventing falls in the hospital setting. Methods of assessing the
fall risk of a patient, interventions to implement to prevent falls
(with a section focusing on hourly rounding), and ways to
evaluate the effectiveness of these interventions were discussed.
Offers a specific scheduled rounding protocol for nursing to
follow.
Strengths:
The toolkit was created by a team of leaders who are experts in
organizational change and prevention of falls. The six hospitals
tested out the toolkit recommendations and their results are part
of the finalized toolkit. The toolkit was developed through
research and quality improvement initiatives.
Weaknesses:

13. Does not discuss fall incidence data from the six medical
centers that developed the toolkit and applied it to their
practice. Data comparing before and after fall prevention
program implementation could be useful.
Conclusions: This clinical guideline includes valuable
recommendations that should be considered for implementation
of a fall prevention program, specifically highlighting
purposeful hourly rounding.
LOE:
Level 5
Avanecean, D., Calliste, D., Contreras, T., Lim, Y., &
Fitzpatrick, A. (2017)
Design: Systematic review
Setting: Medical/surgical acute care units in four different
countries
Sample: N=5 articles (RCTs)
Studies analyzed in the systematic review included quantitative
data from five randomized control trials (RCTs), cluster RCTs.
JBI-SUMARI tool was used for critical appraisal and
quantitative data extracted by four independent reviewers.
Three of the five RCTs showed significant decreases in fall
rates. In these studies, personalized care plans and patient-
centered education based on patients’ fall risk was
implemented. The other two studies showed no difference in fall
rates.
Strengths: Only RCTs were included in this systematic review.
To ensure methodological validity, the Joanna Briggs Institute
System for the Unified Management, Assessment, and Review
of Information (JBI-SUMARI) tool was used for critical
appraisal of the studies before the systematic review was
developed.
Weaknesses: A meta-analysis is not available. Due to the
studies implemented multiple interventions at a time, no
conclusion can be made as to which interventions are most
effective in preventing falls. Also, not every study mentioned
hourly rounding as an intervention.

14. Conclusions: This indicates that patient-centered interventions
(such as rounding) and education can potentially reduce the
number of falls in acute care settings.
LOE:
Level 1
(systematic review with RCTs)
Daniels, J. (2016)
Design: pre-post design; implementation project
Setting: 28-bed hospital unit in the U.S.
Sample: N=32 observations on day shift and N=12 observations
on night shift for timeliness of rounds. N=44 observations on
combined day and night shifts on the use of the 4Ps protocol
when rounding.
The Joanna Briggs Institute’s Practical Application of Clinical
Evidence System (JBI-PACES) and Getting Research into
Practice (GRiP) audit tool was used. Direct observation of
nurses was done to assess the baseline for when the
interventions (hourly rounding) were established.
Patient falls decreased by 50% when hourly rounding was
executed. Highlights the importance of the “4Ps” protocol (pain,
position, potty, and possessions/placement).
Strengths: The JBI tools (evidence-based) are utilized in this
implementation project. Offers ideas to “hard wire” new
practice and protocol changes with employees.
Weaknesses: The results were not compared to a control unit.
Direct observation could lead to biased nursing behaviors.
Conclusions: The implementation project showed that with the
appropriate approach, practice changes can be successful.
Practice changes (like hourly rounding) can be a challenge to
sustain and further follow up is required to ensure they continue
successfully.
LOE:
Level 4
Hicks, D. (2015)
Design: N/A
Setting: Acute care settings

15. Sample: Fourteen studies (that implemented hourly rounding in
their acute care setting) used rounding as a tool in fall
prevention were reviewed
Data was analyzed in acute care settings. Relevant articles were
read several times to identify patterns, similarities, and
differences between them. Data from each was made into a table
organized by source, purpose, sample, interventions, and
findings pertinent to falls.
Eleven of fourteen studies reviewed had decreased number of
falls when some type of rounding was implemented. One study
had no falls during their time of implementation and two had
unchanged fall rates. Rounding varied between the studies
(rounding times, who was doing the rounding, and the use of a
prepared script/plan) as well as the use of the 3 Ps (pain,
position, and personal needs) or 4 Ps (pain, position, potty, and
possessions) while rounding.
Strengths: Only published articles that discussed research in
acute care settings were reviewed. The search was performed on
credible databases (CINAHL, Healthsource, [email protected]
Ovid, and Proquest Nursing databases).
Weaknesses: The studies that were selected for review have
small sample sizes and nonrandomized samples. In several
studies, the length of time for the studies was brief which does
not show the effects hourly rounding could have if sustained
over time. The use of 4 Ps was not consistent in the sample
studies.
Conclusions: The reviewed studies showed hope for positive
impacts of hourly rounding on reducing falls.
LOE: N/A
Mitchell, M., Lavenburg, J., Trotta, R., & Umscheid, C. (2014)
Design: review ofpre-post studies
Setting: Studies done in hospitals around the world
Sample: N=16 studies
Studies in this were mostly pre-post design and non-
randomized. Each study’s evidence was assessed by using the
GRADE analysis (based on quality, quantity, consistency)

16. This found that there is considerable evidence to support hourly
rounding has benefits principally on the reduction of falls, but
further research is necessary.
Strengths: Supports the idea of purposeful hourly rounding as
an intervention to reduce falls. GRADE analysis tool was
utilized to examine each study’s evidence.
Weaknesses: Most studies were pre-post design and non-
randomized which can lead to bias. Weak research design and
inconsistent interventions (hourly rounding) between the studies
makes it difficult to see precise findings concerning hourly
rounding and the impact on fall rates.
Conclusions: The evidence that supports hourly rounding in
acute care settings is of low to moderate strength (based on the
GRADE analysis of the studies reviewed). More research needs
to be conducted.
LOE:
Level 4
Olrich, T., Kalman, M., & Nigolian, C. (2012)
Design: Replication study (quasi-experimental)
Setting: 506-bed teaching hospital in northeast U.S.
Sample: N=4,418 patients (all patients discharged from the units
during the 1-year study period)
Two medical-surgical units comparable in size were selected for
the study. One unit was the control group and the other was the
experimental group. Data regarding patient falls was collected
for 6 months before hourly rounding was implemented (on the
experimental unit) and then for 6 months during
implementation.
Prior to the study, the fall rate on the experimental unit was
3.37/1,000 patient days. The rate decreased to 2.6/1,000 patient
days with implementation of hourly rounding (not statistically
significant, but it is clinically significant). Fall rates were
reduced by 23% on the experimental unit.
Strengths: Falls decreased on the experimental unit when hourly
rounding was implemented. The study had one unit as the
control and one as the experimental unit. The focus was only on

17. one intervention (just hourly rounding) to reduce falls.
Weaknesses: This experimental study was not original nor was
it randomized. It was also a small sample and not done for an
extended length in time.
Conclusions: The replication study suggests that hourly
rounding can positively impact patient fall rates.
LOE:
Level 3
The Joanna Briggs Institute (2017)
Design: Clinical practice guideline
Setting: Acute in-hospital settings around the world
Sample: N=10 papers (of various levels of evidence)
The guideline’s evidence comes from 3 different clinical
practice guidelines, 3 systematic reviews, an umbrella review
(of 10 meta-analyses of RCTs), a cluster RCT, and an
integrative review.
The guideline discusses evidence-based practice
recommendations for the prevention/reduction of falls in acute
care settings-hospitals. Topics discussed involve a
multifactorial program: fall risk assessment tools (ex: fall risk
due to impaired mobility), patient specific interventions, hourly
rounding, and patient education.
Strengths: Clinical practice guideline is the highest level of
evidence. The best practice recommendations are graded based
on effectiveness.
Weaknesses: Does not include fall incidence data associated
with each type of intervention (specifically hourly rounding).
Conclusions: This guideline consists of recommended evidence-
based interventions (including hourly rounding) that should be
included in fall prevention programs specifically involving
hospitalized patients with impaired mobility.
LOE:
Level 1
The Joanna Briggs Institute (2016)
Design: Clinical practice guideline
Setting: Hospitals/Acute care

18. Sample: N=12 studies/papers (of various levels of evidence)
The guideline’s evidence comes from 5 quasi-experimental
designs, 3 systematic reviews, a mixed method study (survey
and semi-structured interview), and a pre-post test with a
control group.
The guideline discusses evidence-based practice
recommendations to reduce fall rates. Fall rates declined when
hourly rounding and use of the 4Ps protocol was implemented
from 0700-2200 and every 2 hours 2200-0700. A systematic
review cited in the guideline found that hourly rounding showed
moderate strength to improve fall rates.
Strengths: The best practice recommendations are graded based
on effectiveness.
Weaknesses: Does not include fall incidence data and specific
statistics associated with hourly rounding and the 4Ps.
Conclusions: This guideline strongly recommends using the 4Ps
protocol while hourly rounding to decrease fall rates.
LOE:
Level 3
The Joint Commission (2015)
Design: Clinical practice guideline
Setting: U.S. healthcare facilities (hospitals)
Sample: Not applicable
The data from the Joint Commission Sentinel Event database
supplied the statistics pertaining to falls.
The guideline outlines evidence-based best practices for the
prevention/reduction of falls and references several valuable
resources. Provides numerous links to toolkits and resources
that have been developed through quality improvement
initiatives.
Strengths: Offers evidence-based actions and recommendations
that healthcare organizations can utilize and implement to
prevent/reduce falls. Also offers additional resources and tools
developed through quality improvement initiatives (i.e. ARHQ
toolkit)
Weaknesses: The reporting to the Joint Commission is voluntary

19. and only represents a small quantity of actual events that occur.
Conclusions: This guideline consists of recommended evidence-
based interventions that are beneficial to ensure reduced fall
rates and offers valuable statistics to emphasize the current
problem of falls.
LOE:
Level 7
Section 3
Plan for Implementation
The 4South Orthopedic/Neurology unit has repeatedly had the
highest rate of falls in Hospital A. Consistently implementing
an evidence-based practice, such as purposeful hourly rounding,
can improve this quality indicator as well as decrease the length
of hospital stay and healthcare costs. It can also improve patient
and staff satisfaction and ultimately the safety and quality of
the patient care provided.
To implement an evidence-based practice, such as purposeful
hourly rounding, it can be beneficial to utilize a framework for
organizing the change process and promoting action. One
framework that can be helpful is the PARIHS (Promoting
Action on Research Implementation in Health Services)
framework. To ensure successful implementation, the PARIHS
framework consists of three key concepts: evidence, context,
and facilitation (Hopp & Rittenmeyer, 2012, p. 56-57). The first
concept, evidence, involves utilizing knowledge gained through
research, clinical experiences, and patient preferences. As the
aforementioned literature review has shown, there is evidence to
support that reduced fall rates can occur when purposeful hourly
rounding is implemented. The second concept, context, involves
the environment (4South unit) that the practice change will be
implemented in. Context also comprises of considering the
4South unit’s organizational culture, leadership, and evaluation
practices when implementing the project. The last component,
facilitation, is “the process of enabling or making easier the

20. implementation of evidence into practice” (Hopp &
Rittenmeyer, 2012, p. 57). Overall, implementation is more
likely to be successful when the “evidence and context are
strong and expertly facilitated” (Hopp & Rittenmeyer, 2012, p.
57). These key concepts of the PARIHS framework- evidence,
context, and facilitation- will be discussed in depth further and
applied to the implementation process of the evidence-based
practice project.
Stakeholders
The target population for this evidence-based practice project is
all patients admitted to the 4South Orthopedic/Neurology unit.
The stakeholders for this project include all individuals who are
affected by or are involved with the implementation of
purposeful hourly rounding. The active stakeholders are the
individuals who have a substantial role in making the project
successful. The active stakeholders include patients admitted to
the 4South Orthopedic/Neurology unit, registered nurses,
patient care technicians/assistants (PCT/PCA) , professional
staff development specialists, clinical nurse specialists, clinical
advisors, and unit managers. The passive stakeholders are the
individuals who are not actively involved in the project, but can
help it succeed. These individuals include the quality
improvement team, finance department, risk management, and
nursing administration (Chief Nursing Officer).
To ensure the success of the project, a multidisciplinary
purposeful rounding (PR) support team of key individuals will
be developed. This PR support team will consist of a team
leader, a clinical nurse specialist (who specializes in evidence-
based practice regarding fall prevention), a clinical advisor, a
professional staff development specialist, a quality
improvement representative, a risk management representative,
and a group of volunteer PR nurse and PCT/PCA champions
who are enthusiastic and encourage other staff members to
adapt to the practice change.
Various individuals will need to be persuaded for support of
this project. These individuals include: nursing administration,

21. 4South unit manager, clinical nurse specialists, clinical
advisors, professional staff development specialists, the finance
department (financial analysts), quality improvement
management, and risk management. Once approval is attained at
the management level, then a few PR support team members (PR
team lead, clinical nurse specialist, and clinical advisor) can
meet individually with the other indicated areas to explain the
fall rate on 4South, the evidence-based practice project
outcomes, and to pursue their support. After the necessary
project approvals are gained, then information and education
regarding the purposeful rounding project will need to be
provided to the unit staff members through email
communication and unit meetings.
Organizational Fit
The purposeful rounding evidence-based practice project has a
focus on the 4South Orthopedic/Neurology unit to start, but has
the potential for hospital-wide action which is why the project
should align with the Hospital’s A mission, vision, and values.
The mission statement is “to improve the health of our patients
and community through innovation, and excellence in care,
education, research, and service.” One of the project outcomes
involves improving patient outcomes (specifically falls) which
ultimately improves the health of patients and is done through
extensive education and research to find the best evidence to
positively impact our practice. The vision is “the best care,
designed for you” which is shown in the project as patient-
centered care through interventions such as purposeful rounding
to meet the needs of our patients. The hospital organization
values: “purpose, compassion, excellence, and team.” These
values will be incorporated into the project as 4South will show
that they: 1.) have a true purpose in providing quality patient
care by utilizing evidence-based practice, 2.) display an
environment filled with compassion through interventions to
keep patients safe 3.) cultivate excellence by providing patient-
centered care, and 4.) work as a team to improve patient
outcomes.

22. The 4South unit has implemented various other evidence-based
practices in the past and continue to do so to ensure the highest
quality of care possible for patients. One of these is that waffle
mattresses are placed on all beds of patients being admitted for
a hip fracture to prevent skin breakdown/pressure-related
injuries due to immobility. Another intervention is giving
Chlorhexidine Gluconate (CHG) baths to prevent CLABSIs and
CAUTIs to those with central lines and foley catheters as well
as preoperative and isolation patients. These are both evidence-
based interventions that have reduced the number of infections
and pressure-related injuries. Looking at how those
interventions were put into everyday practice and sustained over
time can help gain insight on strategies to successfully
implement the PR project.
B arriers to EBP Implementation
One potential barrier to implementing the EBP project
is the time and resources it takes to educate staff members on
the why and how of purposeful rounding. Educating PRN (as
needed) staff members can be especially challenging because
they are not always as readily available to communicate with
and relay current information to compared to full-time staff.
Also, educating float pool staff is important as 4South gets help
from various float pool staff members and it is key to keep
purposeful rounding consistent even when 4South staff members
are not present on the unit. Additionally, implementing
purposeful rounding and changing the nursing workflow may
have staff members concerned about the amount of time spent
with each patient to address their needs and the additional tasks
at hand.
Another potential barrier is the resistance to change practice

23. based on evidence. Staff members who have been in the nursing
field for several years may be comfortable with the routine they
have and not as receptive to change. PR training will need to
occur to combat this barrier as it will show the need for change
to enhance the quality and safety of our patients through
improving patient outcomes. The professional staff development
specialists and clinical advisors will have a key role in
scheduling PR competencies (teach-back/return demonstration)
for staff members to demonstrate their understanding of the
practice change so that they are capable of and comfortable with
applying PR to their practice.
Facilitation Strategies for EBP Implementation
As previously mentioned, facilitation involves making the
process of project implementation easier. The individuals who
have an impact on the facilitation process, comprise the
purposeful rounding (PR) support team. The PR support team’s
nurse and PCT/PCA champions can help enable others to
become involved in the implementation process and adapt the
practice change to ensure success. Also, the PR support team’s
clinical advisors and clinical nurse specialists possess the
background knowledge that is necessary for successful
implementation of an evidence-based practice project such as
this one.
Another facilitation strategy is to run a trial of the project on
the 4South unit. The trial run will give the PR support team an
opportunity to examine purposeful rounding and the
implementation strategy closely, gain feedback from patients
and staff, review project outcomes (falls, patient/staff
satisfaction, call lights, etc.) and determine if implementing the
practice on 4South and potentially hospital wide is practicable.
Resources Needed
Resources will be essential for successful implementation of the
purposeful rounding project. Financial resources will be needed
to make the project possible and will be used for: 1.) unit
meeting, education, training, and skills competency expenses

24. (e.g. printing expenses) and 2.) printed materials used by staff
during purposeful rounding (e.g. rounding log, 4Ps handout).
Another critical resource is the additional time that staff will
need to dedicate outside of their normal shifts on the unit.
These additional time commitments involve unit meetings,
education/trainings, and skills competencies as well as
responsibilities specific to the PR support team. It will also be
expected that leadership management members dedicate time to
rounding on the unit to verify the performance of the rounding
by staff.
Approval for these necessary resources will first be confirmed
for the trial run of the project. After the trial run occurs and
data is collected, the outcomes (such as fall rate) can be
evaluated further to predict the financial feasibility of the
project continuing on the 4South unit and potentially expanding
to the entire hospital.
Table 2
Estimated Timetable Blueprint for Implementation
Task

25. Estimated Date
of Start
Estimated Date of Completion
Person Responsible
-Gain approval from nursing management for PR project
3/4/19 (2 weeks)
-concurrent task
3/15/19
-Nursing Management
-Student
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Gain approval from finance department (project expenses)
3/4/19 (2 weeks)
-concurrent task
3/15/19
-Finance Department
-Student
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Establish PR support team members (roles and responsibilities)
3/18/19 (2 weeks)
4/5/19
-PR team leader
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Gain support for project from important departments (risk
management, quality improvement, etc.) and encourage
interdisciplinary collaboration by holding a meeting
-Inform them of project at the meeting and encourage open
discussion
4/8/19 (1 week)
4/12/19
-PR team leader
-Clinical advisor

26. -Clinical nurse specialist (EBP expert)
-Risk management
-Quality improvement
-Determine and design education/training materials for
educating nursing staff
4/15/19 (2 weeks)
4/26/19
-PR support team
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Present PR project plan to 4South unit nursing staff through
mandatory meetings to discuss falls, rounding, 4Ps, outcome
measures, expectations, etc.
-At this meeting, provide education/training to nursing staff on
new PR project and when trial run will begin
4/29/19 (3 weeks)
-meetings offered at various times
5/17/19
-PR support team
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Nursing unit staff (nurses, PCTs/PCAs)
-Determine the nurse and PCT/PCA champions (have meetings
for them to attend if they are interested in learning more and
being involved)
5/20/19 (2 weeks)
5/31/19
-PR team leader
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Nursing management
-Volunteer champions
-Skills competency check-offs
6/3/19 (3 weeks)
6/21/19

27. -PR support team
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Nursing unit staff (nurses, PCTs/PCAs)
-Launch/implement 6-month trial run on 4South
Orthopedic/Neurology unit
6/24/19
(24 weeks)
12/6/19
-PR support team
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Nursing unit staff (nurses, PCTs/PCAs)
-Measure/document data and project outcomes (fall rate)
6/24/19
(24 weeks)
-concurrent task
12/6/19
-PR support team (including team leader)
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Present PR project trial run findings and outcomes (fall
incidence rate, number of call lights, and patient satisfaction
survey- Hospital Consumer Assessment of Healthcare Providers
and Systems-HCAHPS scores) to nursing unit staff
12/9/19 (2 weeks)
12/20/19
-PR support team
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Unit manager
-Nursing unit staff (nurses, PCTs/PCAs)
-Prepare presentation (research evidence, outcomes of project-
trial run, and cost benefits) to present to hospital management
to establish practice hospital wide
1/6/20 (2 weeks)

28. -break from 12/20/19- 1/6/20 due to holidays, vacations
1/17/20
-PR support team (including team leader)
-Clinical advisor
-Clinical nurse specialist (EBP expert)
-Nursing management
section 4
Plan for Evaluation
Research supports that the evidence-based practice of
purposeful rounding can result in a reduced rate of falls. This
section will discuss and provide valuable information regarding
the baseline data for the 4South Orthopedic/Neurology unit and
the outcome indicators (Table 3) that will be utilized to evaluate
the success of the proposed purposeful rounding project.
Baseline Data
Collecting baseline data prior to the PR trial run is required to
accurately compare the effects of implementing consistent
purposeful rounding. The baseline data that will be collected
before the trial run will include the fall incidence rate which is
the number of patients who fall during their hospital stay on the
4South Orthopedic/Neurology unit per 1,000 occupied bed days.
Using this method of incidence rates takes into consideration
how empty or full the unit was at any given time when a fall
occurred rather than simply the sheer number of falls. The
outcome data will be measured this same way to stay consistent
and to show the effectiveness of the PR project.
On the 4South unit, the patient fall incidence is currently being
tracked by completing post-fall huddle forms and turning them
into the unit manager as well as completing an incident report.
These forms are reviewed by the unit manager and shared with
the quality improvement team and clinical nurse specialists who
focus on fall prevention. A “call to action” form is developed
which summarizes the post-fall huddle form and is reviewed in
shift change huddle for at least a week after the fall has
occurred to reflect on the fall to prevent future falls. The

29. information from the post-fall huddle forms and incident reports
are logged and used to generate a monthly report of fall
incidence.
The fall incidence data that was collected the last six months
prior to the PR trial run will be used as baseline data for the PR
trial run on the 4South unit. This data will be obtained from the
monthly report of fall incidence that is developed from the post-
fall huddle forms and incidence reports. This same method of
data collection will be used during implementation of the six-
month PR trial run to maintain consistency.
Another outcome indicator that will be tracked for the PR
project is the number of call lights that occur on the 4South
unit. Currently, there is no baseline data available because the
call light system that is used does not have a record that keeps
track of how many times the call light buttons are pushed. With
the call light system that is currently used, the only way to track
the number of call lights that occur is to manually record and
tally them as they occur. This could be done before and after
implementing the PR project to evaluate whether purposeful
rounding can be effective at reducing the number of call lights.
Lastly, patient satisfaction survey scores (HCAHPS) are another
outcome indicator that will be focused on. Currently, the
HCAHPS scores are available for unit managers to review and
share with the nursing staff. The HCAHPS scores are kept track
of so that improvements can be made, and nursing staff are
aware of what they can do to increase the scores and improve
the overall quality of patient care they provide. The HCAHPS
scores can be reviewed and recorded each month for six months
before and after implementing the PR project to evaluate
whether purposeful rounding can be effective at increasing the
patient satisfaction scores (HCAHPS).
Compliance Data
Each week during the PR trial run, the PR team lead will review

30. the data being collected which includes the incidence rate of
falls, number of call lights, and HCAHPS scores. The
purposeful rounding logs will be reviewed and evaluated to
ensure they are being completed correctly and accurately. These
rounding logs will reflect the compliance of the purposeful
rounding that is being done and highlight the 4Ps. If it is found
that the rounding logs are not being completed correctly,
accurately, or if not completed at all, then the PR team lead will
meet determine who the nursing staff member(s) was and
discuss it with them. The PR team lead can then openly discuss
with the individual(s) the barriers to completing the rounding
log and determine if the rounding is getting done at all even if
the log is not being completed. Finding out why the purposeful
rounding was not performed is important so that the areas
needing changes made can be pinpointed.
Interpretation of Data
During the six-month PR trial run, monthly fall
incidence rates will continue to be gathered by completing the
post-fall huddle forms and incident reports with additional help
from the PR support team. After implementation of the PR trial
run on 4South, the baseline pre-implementation fall rates can be
compared to the post-implementation fall rates. With the help of
the Clinical Nurse Specialist (EBP expert) and Quality
Improvement representatives, interpretations of the PR project
data can be made. This comparison of baseline and post-
implementation data will determine if implementing purposeful
rounding is effective at decreasing fall rates in hospitalized
adult patients with impaired mobility. The project outcome
indicators include:
· Within six months of implementing the PR trial run, the fall
incidence rate will decrease by 20% on the 4South
Orthopedic/Neurology unit
· Within six months of implementing the PR trial run, the
number of call lights will decrease by 25% on the 4South
Orthopedic/Neurology unit
· Within six months of implementing the PR trial run, the

31. patient satisfaction survey scores (HCAHPS) will increase by
20% for patients who stayed on the 4South
Orthopedic/Neurology unit
Table 3
EBP Evaluation Plan
Outcome(s)
Measures/Measurement
Data Collection Process/Time of Collection/Person Responsible
1. Fall incidence rate
· Within six months of implementing the PR trial run, the fall
incidence rate will decrease by 20% on the 4South
Orthopedic/Neurology unit

32. Measurement Definition:
Fall incidence rate is the number of patients who fall during
their hospital stay on the 4South Orthopedic/Neurology unit per
1,000 occupied bed days
The calculation is:
Fall incidence rate= (number of patients who fell in a month) /
(number of occupied bed days for a month) x 1,000
-Using this method takes into consideration how empty or full
the 4South unit is at any given time
Baseline Incidence:
A six-month review of fall incidence data will be assessed
(from 4South unit) prior to launching the PR trial run. This
information is currently being documented by completing a
post-fall huddle form and incident report. The unit manager,
quality improvement, and clinical nurse specialists generate a
monthly fall incidence report.
Outcome Data Measurement:
During the PR trial run, a six-month audit of monthly fall
incidence will be compiled based on the monthly fall incidence
report.
The baseline pre-PR project data will be compared to the pre-PR
project data through the creation of a comparison chart. This
will allow analysis to be performed to determine if the fall
incidence rate has decreased as a result of the new purposeful
rounding practice. This information will be presented to
hospital management and will be used to determine if the PR
project should be applied to the entire hospital.
Data Collection Process:

33. The process to determine fall rate data during the 4South unit
PR trial run is as follows:
1.) The unit nurses will complete a post-fall huddle form and an
incident report when a patient fall occurs.
2.) Unit manager will review post-fall huddle form and incident
report.
3.) Quality Improvement (QI) and Clinical Nurse Specialists
(CNS) will review post-fall huddle form and incident report.
They will create a “call to action” form to summarize the fall
and share with unit nurses who will discuss at each shift change
huddle for at least a week after the fall.
4.) QI and CNS will generate a monthly fall incidence report.
Time of Collection:
During the six-month unit PR trial run (June 2019-December
2019), monthly reports will be generated from the collection of
post-fall huddle forms and incident reporting indicating the
patient falls information
Person(s) Responsible:
PR support team members will be responsible for collecting and
monitoring the fall incidence data:
-Nursing staff- will complete post-fall huddle form when a fall
occurs and complete an incident report
-Unit manager/PR team lead- will monitor the PR project and
ensure interventions (4Ps, logging) are being implemented
properly
-Quality improvement team and clinical nurse specialist will
monitor monthly fall rates and produce monthly report
2. Number of call lights
· Within six months of implementing the PR trial run, the
number of call lights will decrease by 25% on the 4South
Orthopedic/Neurology unit
Measurement Definition:

34. Number of call lights is the number of times the call light
button is pushed on the 4South Orthopedic/Neurology unit
Baseline Data Measurement:
The number of call lights that occur on 4South will be recorded
for six months prior to the beginning of the PR trial run. A staff
member will need to accurately record/tally how many call
lights occur during this six-month time frame.
Outcome Data Measurement:
During the PR trial run, a six-month audit of the number of call
lights each month will be compiled based on the tally count
recorded each month.
The baseline pre-PR project data will be compared to the pre-PR
project data through the creation of a comparison chart. This
will allow analysis to be performed to determine if the number
of call lights decreased as a result of the new purposeful
rounding practice. This information will be presented to
hospital management and will be used to determine if the PR
project should be applied to the entire hospital.
Data Collection Process:
The process to determine call light usage rate data during the
4South unit PR trial run includes staff members (PR support
team members, volunteers, champions, etc.). They will
record/tally the number of call lights that occur on the 4South
unit.
Time of Collection:
During the six-month unit PR trial run (June 2019- December
2019), monthly reports will be generated from the tally counts
recorded by staff each month.
Person(s) Responsible:
-PR support team member volunteers, champions- will
record/tally call lights as they occur and compile data for each

35. month for six months
3. Patient satisfaction survey scores (HCAHPS)
· Within six months of implementing the PR trial run, the
patient satisfaction survey scores (HCAHPS) will increase by
20% for patients who stayed on the 4South
Orthopedic/Neurology unit
Measurement Definition:
Patient satisfaction survey scores (HCAHPS) is the percentage
level of overall satisfaction patients rate their hospital stay on
the 4South Orthopedic/Neurology unit
Baseline Data Measurement:
The HCAHPS scores for patients who were on the 4South unit
will be recorded for six months prior to the beginning of the PR
trial run.
Outcome Data Measurement:
During the PR trial run, a six-month audit of the HCAHPS
scores will be compiled and recorded each month.
The baseline pre-PR project data will be compared to the pre-PR
project data through the creation of a comparison chart. This
will allow analysis to be performed to determine if the HCAHPS
score increased as a result of the new purposeful rounding
practice. This information will be presented to hospital
management and will be used to determine if the PR project
should be applied to the entire hospital.
Data Collection Process:
The process to determine patient satisfaction survey scores data
during the 4South unit PR trial run involves obtaining the
HCAHPS scores each month during the trial run.
Time of Collection:

36. During the six-month unit PR trial run (June 2019- December
2019), HCAHPS scores will be viewed and recorded.
Person(s) Responsible:
PR support team members will be responsible for obtaining and
reviewing HCAHPS scores.
-Unit manager/PR team lead/Quality improvement team will
review HCAHPS scores and share with staff
section 5
Conclusions, Recommendations and Implications
The following section will
outline the conclusions, recommendations, and implications for
the evidence-based practice proposal to implement routine
purposeful rounding.
Conclusions
Patient falls continue to be a
patient safety issue in healthcare facilities, such as hospitals,
regardless of the various fall prevention interventions that are
implemented. Falls are associated with several negative patient
outcomes including extended hospital stay, injury, death,
anxiety, and decreased satisfaction as well as increased
financial costs.
A review of research and evidence suggests that consistent
purposeful hourly rounding while implementing the 4Ps (pain,
potty, position, possessions) can reduce the incidence of falls
that occur in hospitals. Purposeful hourly rounding is a
suggested technique to address patient needs while enhancing
their safety and overall healthcare experience.
Recommendations/Implications

37. With the 4South
Orthopedic/Neurology unit having the highest incidence rate of
falls in the entire Hospital, it is appropriate that an increased
focus on fall prevention is initiated. This evidence-based
practice proposal suggests the implementation of a more
consistent and routine purposeful hourly rounding practice to
reduce the incidence rate of falls on the 4South unit. For this to
be successful, it is crucial that a multidisciplinary PR
(purposeful rounding) support team be created. After approval,
development, and organization of the new and improved
purposeful rounding practice by the PR support team, a trial run
will be done on the 4South unit. There will be specific outcome
measures for the 4South unit trial run which include: 1.) a
reduced fall incidence rate, 2.) a decrease in the number of call
lights, and 3.) an increase in the patient satisfaction survey
scores (HCAHPS). Through these outcome measures, the plan is
to increase the overall safety and quality of patient care on the
4South unit and potentially throughout the entire hospital.
Patient falls are a significant patient
safety and quality of patient care indicator that continue to be a
challenge for healthcare facilities. To make a difference in the
lives of patients, change must occur, no matter the barriers that
exist. Through this evidence-based practice proposal involving
implementation of a more routine purposeful rounding program,
Hospital A would be supporting their vision of “the best care,
designed for you”. By creating a project that is evidence-based
and patient-centered, that vision is represented and can offer an
overall better quality of life for patients.

38. References
Agency for Healthcare Research & Quality. (2018). Preventing
falls in hospitals: A toolkit for improving quality of care.
Retrieved from
https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolk
it/index.html
Avanecean, D., Calliste, D., Contreras, T., Lim, Y., &
Fitzpatrick, A. (2017). Effectiveness of patient-centered
interventions on falls in the acute care setting compared to
usual care: a systematic review. JBI Database of Systematic
Reviewed and Implementation Reports, 15(12), 3006-3048.
Retrieved from http://ovidsp.tx.ovid.com.pnw.idm.oclc.org/sp-
3.32.1b/ovidweb.cgi?&S=GMNKFPAGOKDDNLLENCDKNAJC
PPHJAA00&Link+Set=S.sh.18%7c4%7csl_190
Daniels, J. (2016). Purposeful and timely nursing rounds: A best
practice
implementation project. JBI Database of Systematic
Reviewed and
Implementation Reports, 14(1), 248-267.
doi:10.11124/jbisrir-2016-2537
Hicks, D. (2015). Can rounding reduce patient falls in acute
care? An integrative
literature review. MEDSURG Nursing, 24(1), 51–55.

39. Retrieved from
http://pnw.idm.oclc.org/login?url=http://search.ebscohost.com/l
ogin.aspx?direct=true&db=ccm&AN=103755800&site=ehost-
live
Hopp, L. & Rittenmeyer, L. (2012). Introduction to evidence-
based practice: A practical guide for nursing. Philadelphia: F.A.
Davis Company.
Melnyk, B.M. & Fineout-Overholt, E. (2011). Evidence-based
practice in nursing and healthcare: A guide to best
practice. Philadelphia: Lippincott, Williams & Wilkins.
Mitchell, M., Lavenburg, J., Trotta, R., & Umscheid, C. (2014).
Hourly rounding to improve nursing responsiveness: A
systematic review. The Journal of Nursing Administration,
44(9), 464-472. doi:10.1097/NNA.0000000000000101
Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly
rounding: A replication study. MEDSURG Nursing, 21(1), 23-
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dfviewer?vid=7&sid=8d02109b-34c1-46f3-aae7-
0435f8f7cbae%40sdc-v-sessmgr01
The Joanna Briggs Institute. (2017). Falls prevention strategies:
Acute in-hospital setting. Retrieved from Joanna Briggs
Institute EBP Resources website: http://joannabriggslibrary.org/
The Joanna Briggs Institute. (2016). Nursing rounds: Clinician
information. Retrieved from
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3.32.1b/ovidweb.cgi?&S=ICFKFPMCOPDDNLMMNCDKKDO
BJKFIAA00&Link+Set=S.sh.18%7c1%7csl_190
The Joint Commission. (2015). Sentinel event alert 55:
Preventing falls and fall-related injuries in health care facilities.
Retrieved from
https://www.jointcommission.org/assets/1/18/SEA_55.pdf

40. Put Title Here
by
PUt Name Here
Evidence-based Practice Project
Submitted to the Faculty of NUR 49800 Capstone Course in
Nursing
College of Nursing
of Purdue University Northwest,
Hammond, Indiana
in partial fulfillment of course requirements for the degree of
Bachelor of Science
Month, 20xx
© copyright
your name here
20xx
all rights reserved
acknowledgments
Begin optional acknowledgments here.
table of contents
SectionPage
acknowledgments iii

41. table of contents iv
abstract v
Sections
1. Introduction xx
2. Review of Literature and Synthesis of the Evidence xx
3. Plan for Implementation xx
4. Plan for Evaluation xx
5. Conclusions, Recommendations and Implications xx
referencesxx
appendices (If Applicable)
Appendix A – Put Title Here xx
List of tables
TablePage
Table 1 Put Name of Table Here xx
Table 2 Put Name of Table Here xx
Table 3 Put Name of Table Here xx
ABSTRACT
Begin writing abstract here. APA abstracts begin on margin and
do not indent. Please use headings in instructions
PUT YOUR HEADER HERE IN ALL CAPS iv
section 1
Place Title of Project Here
Begin writing here and add pages as needed.
Section 2
Review of Literature and Synthesis of Evidence
Begin writing here.
PUT YOUR HEADER HERE IN ALL CAPS 10
PICO Question:
Keywords:

42. Databases Searched:
Table 1
Summary of Reviewed Evidence
Author(s) and Date of Publication ONLY
Sample/Setting/
Design
Data Collection Tools
Findings/Results
Appraisal of Evidence: Worth to Practice include Strengths,
Weaknesses and Conclusions
Level of Evidence (LOE)

44. Section 3
Plan for Implementation
Begin writing here.
Table 2

45. Estimated Timetable Blueprint for Implementation
Task
Estimated Date
of Start
Estimated Date of Completion
Person Responsible

46. section 4
Plan for Evaluation
Begin writing here.
Table 3

47. EBP Evaluation Plan
Outcome(s)
Measures/Measurement
Time of Collection/Person Responsible
section 5
Conclusions, Recommendations and Implications
Begin writing here.
References
Begin first citation here.

48. APPENDICES
Begin here.