Document Type



Doctor of Nursing Practice



Date of Defense


Graduate Advisor

Dr. Susan Dean-Baar


Dr. Susan Dean-Baar

Dr. Reid Roxanne

Mr. Leonard Rhine


Falls and fall-related injuries are common and significant health issues among older adult patients living in Long-Term Care (LTC) facilities, especially those with memory impairment. The current quality improvement (QI) project aimed to educate staff members and implement a structured 4 Ps hourly rounding (HR) protocol on an LTC facility pilot unit in Missouri. The project was implemented in a memory care unit housing older military veterans patients in a large metropolitan area of Missouri. The project question that guided the intervention was: In older residents living in a memory care unit of an LTC facility, what is the impact of implementing hourly rounding using the 4 Ps approach on decreasing falls within eight weeks? The reason for implementing the project was that the memory care unit was experiencing a high fall rates with adverse effects compared to the other two skilled units of the facility. The intervention consisted of staff education and implementation of an HR protocol based on the 4 Ps approach. During the 4 Ps HR, staff members checked on veterans for Pain, Position, Potty, and Proximity of personal belongings. The project was a descriptive, observational and a comparative intervention using a purposeful and a convenience sampling methods. The “Plan, Do, Study, Act” (PDSA) model was used as a quality improvement approach to test for change. In the two months prior to implementing the 4 Ps HR, monthly fall rates were 8.571 and 10.141 falls per 1000 occupied-bed days. As results of the QI project, the fall rates decreased to 7.936 and 7.824 falls per 1000 occupied-bed days during the two months of implementing the 4 Ps HR. The staff knowledge survey showed an improvement in knowledge with mean scores of 57.774% on the pretest and 91.665% on the posttest, representing a 33.39% increase in staff knowledge.

The p-value was 0.008, which is less than 0.05, and the null hypothesis was rejected. A conclusion was that the education sessions had a statistical difference in improving staff members knowledge. Therefore, the education session was successful. The level of completion in documenting and implementing the HR protocol was 95.85%. The current QI project improved the quality of care in the memory unit through the structured fall prevention interventions of HR. It also revived staff members' awareness about fall prevention precautions through education sessions.