By Nancy E. Oates

When nature calls, you have to answer, even if you’re woozy from surgery or light-headed from new medications. Yet even a few steps to a bedside commode can put a patient at risk for a fall, says Ann Brandley-Loner, a nurse in Duke Raleigh Hospital’s telemetry unit.

“Any patient in the hospital is at risk to fall because they’re in an environment different from what they’re used to,” Brandley-Loner says. Patients in the telemetry unit are particularly vulnerable.

The unit cares for patients with heart issues that include dizziness and shortness of breath; those with stroke symptoms that include muscle weakness or balance difficulties; post-surgical patients emerging from anesthesia; and patients starting new medication regimes.

“You don’t know how the patient will react to a medication until after it’s given,” she says. “That puts them at risk for a fall.”

While looking for a project to take on as she advanced up the clinical ladder, Brandley-Loner came across an article that touted the benefits of hourly patient rounds. Not only did patient satisfaction rise, but the number of times a patient used a call light decreased because the nursing staff was proactively meeting patient needs.

Brandley-Loner, a charge nurse, decided to institute the practice in her unit in September 2009.

In the new procedure, nursing staff make hourly visits to a patient’s room to see whether the patient needs to use the toilet. While there, the nurse can take care of any other needs the patient may have.

At night, the rounds are spaced every two hours. Patients don’t have to get up during the rounds, and nurses still answer calls as needed. If a patient is sleeping, the nurse leaves a note on the bedside table, letting the patient know someone was in and to call if the patient needs anything upon waking.

“The majority of the patients appreciate us popping in to check on them every hour to make sure they don’t need anything,” Brandley-Loner says.

With taking vital signs, doing assessments, giving medicine, and helping with morning care and meal trays, a nurse or nursing assistant is in the patient’s room frequently anyway. The new system helps staff make a concerted effort to conduct hourly checks even during the busiest times.

But adding one more thing for nursing staff to chart took time. Brandley-Loner tapped into a wireless locator system. Nurses and nursing assistants wear a small, black diamond-shaped device that acts like a global positioning system.

The system creates a computer record of when a nurse or nursing assistant enters a room, when a bathroom call is made, and when a call light is turned off. The system eliminated the need to write on charts.

Brandley-Loner began her career at Duke in 1999 as a secretary and nursing assistant. She completed her nursing degree in 2004 and has been a charge nurse since 2005.

Patient safety is Duke’s top priority, she says. Patient falls can result in a variety of injuries ranging from a bruise or skin tear to an intracranial bleed.

“The hourly rounds are one more way we can improve patient care,” Brandley-Loner says.