title: Intentional Rounding: a staff-led quality improvement intervention in the prevention of patient falls.
abstract: OBJECTIVE
  This study designed and evaluated the use of a specific implementation strategy to deliver a nursing staff-led Intentional Rounding intervention to reduce inpatient falls.
  
  
  BACKGROUND
  Patient falls are a common cause of harm during hospital treatment. Intentional Rounding has been proposed as a potential strategy for prevention, but has not received much objective evaluation. Previous work has suggested that logical interventions to improve patient care require an integrated implementation strategy, using teamwork training and systems improvement training, to instigate positive change and improvement.
  
  
  METHODS
  Customised Intentional Rounding was implemented and evaluated as part of a staff-led quality improvement intervention to reduce falls on a neuroscience ward. Intentional Rounding was instigated using a prespecified implementation strategy, which comprised of: (1) engagement and communication activities, (2) teamwork and systems improvement training, (3) support and coaching and (4) iterative Plan-Do-Check-Act cycles. Process (compliance with hourly visiting to patients by staff) and outcome (incidence of falls) measures were recorded pre- and postintervention. Falls measured on the active ward were compared with incidence of falls in 50 wards across the rest of the same Trust.
  
  
  RESULTS
  There was a 50% reduction in patient falls on the active ward vs. a minimal increase across the rest of the Trust (3·48%). Customised Intentional Rounding, designed by staff specifically for the context, appeared to be effective in reducing patient falls.
  
  
  CONCLUSIONS
  Improvement programmes based on integrating teamwork training and staff-led systems redesign, together with a preplanned implementation strategy, can deliver effective change and improvement.
  
  
  CONCLUSIONS
  This study demonstrates, through the implementation of a specific strategy, an effective improvement intervention to reduce patient falls. It provides insight into the effective design and practical implementation of integrated improvement programmes to reduce risk to patients at the frontline.
authors.affiliation: Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Lauren
authors.identifier: http://orcid.org/0000-0001-8395-9492
authors.initials: L
authors.lastname: Morgan
authors.affiliation: Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Lorna
authors.initials: L
authors.lastname: Flynn
authors.affiliation: Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Robertson
authors.affiliation: Saïd Business School, University of Oxford, Oxford, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: New
authors.affiliation: Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Forde-Johnston
authors.affiliation: Quality, Reliability, Safety and Teamwork Unit, Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: McCulloch
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D006801:Humans; D061214:Patient Safety; D058996:Quality Improvement
keywords: Intentional Rounding; human factors; patient falls; patient safety; quality improvement; staff-led improvement