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Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study.

ABSTRACT: The aim of the study was to explore the effects of Intentional Rounding, a regular-based proactive patient monitoring, on falls and pressure ulcers in internal medicine units. This is a cluster-randomised controlled study, where units were assigned (1:1) to Intentional Rounding (intervention group) or Standard of Care (control group). The primary outcome was the cumulative incidence of falls and new pressure ulcers. These events were considered separately as secondary endpoints, together with the number of bell calls and the evaluation of patient satisfaction. Primary analyses were carried out on the modified intention-to-treat population (hospitalisation of at least 10 days). Recruitment occurred between October 2019 and March 2020, at which time the study was prematurely closed due to the COVID-19 pandemic. Enrolment totalled 1822 patients at 26 sites; 779 patients were included in the modified intention-to-treat analysis. The intervention group had a lower risk of falls (adjusted incidence rate ratio 0.14; 95% confidence interval, 0.02-0.78; p = 0.03). There were no statistical differences in new pressure ulcers or the cumulative incidence of both adverse events. Mean bell calls for each patient were 15.4 ± 24.1 in the intervention group and 13.7 ± 20.5 in the control group (p = 0.38). Additionally, patient satisfaction in the intervention group was almost at the maximum level. Our study supports the usefulness of Intentional Rounding in a complex and vulnerable population such as that hospitalised in internal medicine units.

SUBMITTER: Di Massimo DS

PROVIDER: S-EPMC9320400 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study.

Di Massimo Dino Stefano DS Catania Gianluca G Crespi Annachiara A Fontanella Andrea A Manfellotto Dario D La Regina Micaela M De Carli Stefano S Rasero Laura L Gatta Claudia C Pentella Giovanna G Bordin Gabriella G Croso Antonella A Bagnasco Annamaria A Gussoni Gualberto G Campani Daiana D Busca Erica E Azzolina Danila D Dal Molin Alberto A On Behalf Of The Intento Study Group

Journal of clinical medicine 20220708 14

The aim of the study was to explore the effects of Intentional Rounding, a regular-based proactive patient monitoring, on falls and pressure ulcers in internal medicine units. This is a cluster-randomised controlled study, where units were assigned (1:1) to Intentional Rounding (intervention group) or Standard of Care (control group). The primary outcome was the cumulative incidence of falls and new pressure ulcers. These events were considered separately as secondary endpoints, together with th ...[more]

PMID: 35887739

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Project description:BackgroundIn response to concerns about high hospital mortality rates, patient and carer complaints, a Mid Staffordshire NHS Foundation Trust public inquiry was conducted at the request of the UK government. This inquiry found serious failures in the quality of basic care provided and as a consequence, recommended that patients should have more regular visits, organised at predictable times from nursing staff. Intentional rounding, also known as nursing ward rounds, was widely adopted to meet this need.ObjectiveTo test, refine or refute eight programme theories to understand what works, for whom, and in what circumstances.SettingSix wards (older people and acute wards) in three NHS trusts in England.ParticipantsBoard level and senior nursing managers (N = 17), nursing ward staff (N = 33), allied health and medical professionals (N = 26), patients (N = 34) and relatives (N = 28) participated in an individual, in-depth interview using the realist method. In addition, ward-based nurses (N = 39) were shadowed whilst they conduced intentional rounds (240 rounds in total) and the direct care of patients (188 h of patient care in total) was observed.MethodsThe mixed methods design included: Phase (1) Theory development - A realist synthesis was undertaken to identify any programme theories which were tested, refined and/or refuted, using data from phases 2 and 3; Phase (2) A survey of all English NHS acute Trusts; Phase (3) Six case studies of wards involving realist interviews, shadowing and non-participant observations, analysis of ward outcome and cost data; and Phase (4) Synthesis of findings from phases 1, 2 and 3.ResultsThe realist synthesis identified eight programme theories of intentional rounding: 'Consistency and comprehensiveness', 'Accountability', 'Visibility of nurses', 'Anticipation', 'Allocated time to care', 'Nurse-patient relationships', 'Multi-disciplinary teamwork and communication' and 'Patient empowerment'. Key findings showed that of the original eight programme theories of intentional rounding, only two partially explained how the intervention worked ('Consistency and comprehensiveness' and 'Accountability'). Of the remaining six programme theories, the evidence for two was inconclusive ('Visibility of nurses' and 'Anticipation') and there was no evidence for four ('Allocated time to care'; 'Nurse-patient relationships'; 'Multi-disciplinary teamwork and communication'; and 'Patient empowerment').ConclusionsThis first theory-informed evaluation of intentional rounding, demonstrates that the effectiveness of intentional rounding in the English healthcare context is very weak. Furthermore, the evidence collected in this study has challenged and refuted some of the underlying assumptions about how intentional rounding works. This study has demonstrated the crucial role context plays in determining the effectiveness of an intervention and how caution is needed when implementing interventions developed for the health system of one country into another.

Project description:ObjectivesThe study aimed to assess the relationship between the Fit fOR The Aged (FORTA) score - a classification system designed to evaluate medication appropriateness in older adults - and several negative outcomes, including impaired cognitive performance, functional status, adverse clinical events, and all-cause mortality at 3, 6, and 12 months after hospital discharge.MethodsThis retrospective study utilized data from the ELICADHE cohort, a cluster-randomized trial conducted across 20 Italian internal medicine and geriatric wards. The study included patients aged 75 and older with complete FORTA score assessments. Demographics, medication history, and comorbidities were collected. The FORTA classification system assessed medication appropriateness. FORTA scores were calculated and FORTA score cut-offs (3 and 5) were applied. Statistical analyses included descriptive statistics, survival analysis with Cox regression, logistic regression, and negative-binomial regression using SAS 9.4 and RStudio 12.1. Ethical approval was obtained.ResultsOf the 506 patients included, 171 (33.8%) were fully assessable with complete FORTA scores. The study found no significant association between higher FORTA scores and impaired cognitive performance, functional status, or mortality. Additionally, no clear relationship was observed between FORTA scores and adverse clinical events or mortality. The analysis indicated that age was a significant factor associated with mortality and adverse clinical events.ConclusionThe study did not find a significant relationship between the FORTA score and negative outcomes in older patients discharged from internal medicine and geriatric wards. Further research is needed to define specific FORTA score cut-off values and expand the criteria to improve medication assessment in this population.ObjectivesThe study aimed to assess the relationship between the Fit fOR The Aged (FORTA) score - a classification system designed to evaluate medication appropriateness in older adults - and several negative outcomes, including impaired cognitive performance, functional status, adverse clinical events, and all-cause mortality at 3, 6, and 12 months after hospital discharge.MethodsThis retrospective study utilized data from the ELICADHE cohort, a cluster-randomized trial conducted across 20 Italian internal medicine and geriatric wards. The study included patients aged 75 and older with complete FORTA score assessments. Demographics, medication history, and comorbidities were collected. The FORTA classification system assessed medication appropriateness. FORTA scores were calculated and FORTA score cut-offs (3 and 5) were applied. Statistical analyses included descriptive statistics, survival analysis with Cox regression, logistic regression, and negative-binomial regression using SAS 9.4 and RStudio 12.1. Ethical approval was obtained.ResultsOf the 506 patients included, 171 (33.8%) were fully assessable with complete FORTA scores. The study found no significant association between higher FORTA scores and impaired cognitive performance, functional status, or mortality. Additionally, no clear relationship was observed between FORTA scores and adverse clinical events or mortality. The analysis indicated that age was a significant factor associated with mortality and adverse clinical events.ConclusionThe study did not find a significant relationship between the FORTA score and negative outcomes in older patients discharged from internal medicine and geriatric wards. Further research is needed to define specific FORTA score cut-off values and expand the criteria to improve medication assessment in this population.

Project description:BackgroundMedication reconciliation (MedRec) is a widely accepted tool for the identification and resolution of unintended medication discrepancies (UMD).ObjectiveThis study aimed at assessing the magnitude and associated factors of UMD identified through medication reconciliation upon patient admission to the internal medicine wards.MethodsProspective cross-sectional study was conducted at the internal medicine wards of Felege Hiwot and Tibebe Ghion comprehensive specialized hospitals in Bahir Dar city, Northwest Ethiopia, from May 01 to July 30, 2021. Data were collected by using a data abstraction format prepared based on standard MedRec tools and previous studies on medication discrepancy. Pharmacists-led MedRec was made by following the WHO High5s "retroactive medication reconciliation model". SPSS® (IBM Corporation) version 25.0 was used to analyze the data with descriptive and inferential statistics. A binary logistic regression analysis was used to identify factors associated with UMD. A statistical significance was declared at a p-value < 0.05.ResultsAmong 635 adult patients, 248 (39.1%) of them had at least one UMD. The most frequent types of UMDs were omission (41.75%) and wrong dose (21.9%). The majority (75.3%) of pharmacists' interventions were accepted. Polypharmacy at admission (p-value < 0.001), age ≥ 65 (p-value = 0.001), a unit increase on the number of comorbidities (p-value = 0.008) and information sources used for MedRec (p-value < 0.001), and medium (p-value = 0.019) and low adherence (p-value < 0.001) were significantly associated with UMD.ConclusionThe magnitude of UMD upon patient admission to the internal medicine wards was considerably high. Omission and the wrong dose of medication were common. Older age, polypharmacy, low and medium adherence, and an increase in the number of comorbidities and information sources used for MedRec are significantly associated with UMDs. Pharmacists' interventions were mostly acceptable. Thus, the implementation of pharmacists-led MedRec in the two hospitals is indispensable for patient safety.

Dataset Information

Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study.

Publications

Intentional Rounding versus Standard of Care for Patients Hospitalised in Internal Medicine Wards: Results from a Cluster-Randomised Nation-Based Study.

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