implementing purposeful hourly rounding on medical surgical unit
TRANSCRIPT
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Item type Presentation
Format Text-based Document
Title Implementing Purposeful Hourly Rounding on MedicalSurgical Unit to Decrease Call Light Usage and IncreaseStaff Responsiveness HCAHP Scores
Authors Brynes, Tru
Downloaded 29-Jan-2018 23:37:57
Link to item http://hdl.handle.net/10755/601749
Implementing Purposeful Hourly Rounding on Medical
Surgical Unit to Decrease Call Light Usage and Increase
HCAHPs Staff Responsiveness Score
Tru Byrnes, MSN, CNL, RN, CMSRN
MSN Capstone Project
Disclosure Information
Presenter Name Tru Byrnes, MSN, RN, CNL, CMSRN
Conflict of Interest None
Employer Carolinas Medical Center-Main
Sponsorship / Commercial
Support
None
Learning Objectives
Session Goal
- Increase the clinician’s knowledge on how to improve HCAHPs
Staff Responsive Score.
Session Objectives
– Describe the importance of purposeful hourly rounding in clinical
practice.
– Develop strategies to increase staff compliance to the protocol.
– Evaluate outcomes based upon HCAHPs Staff Responsive
Score
Purpose & Goals
Purpose
• Increase compliance with purposeful rounding by holding
staff accountable to the protocol
Goals
• Increase staff compliance to the protocol by 30%
• Increase staff responsiveness score by 15%.
• Decrease patient call light usage by 15%
Problem Identification
Staff Responsiveness
2013
Percentile
1st quarter 92.8
2nd - 3rd quarters 68
Benchmark 85
Review of LiteratureAuthors Call Light Usage Reduction
Culley (2008). • 77 on the step-down unit
• 31% on the surgical unit
• 56% on medical unit
Ford (2010). • 52% after three weeks of hourly rounds
Patient Satisfaction
Bourgault, A., King, M., Hart, P.,
Campbell, M., & Swartz, S. Lou, M.,
2008.
HCAPHs Scores:
• Overall quality of care (p<0.04)
• Hospital recommendation (p<0.03)
Murray, T., Spence, J., Bena, J.,
Morrison, S., & Albert, N., 2010.
• 34.6% increased on hospital experience rating from
20.4% to 55%
Barriers
Deitrick, Baker, Paxton, Flores, &
Swaverly., 2012.
• Lack of education and training on the rounding
process, and accountability.
Methodology
• Quasi-experimental Design
– A series of audits:
• Pre and post intervention on staff compliance of
purposeful hourly rounding
– Monitored call light data and staff responsiveness
HCAPHS score
• Sample
– N=70
Methodology
• Interventions
• Staff education on 5Ps of rounding
• Disseminated reminder cards with scripted 5Ps
• Project Duration
• 9 weeks
– 4 weeks pre- post intervention data collection
and 1 week staff education
)• 2010 – 31 CLABSIs - $1,420,234
• 2011 – 20 CLABSIs - $916,280
• 2012 – 24 CLABSIs - $1,099,536
• 2013 – 16 CLABSIs - $733,024
Steps Are steps followed?
Y/N
(comments)
1 Knock on door gently and announce entry indicating that you are there to
check on the patient. If the patient is awake:
Pain: Assess/Ask about pain. If not RN, call RN if pain is present
2 Potty-Ask whether patient needs bedpan or if ambulatory, assistance to
the bathroom
3 Position- Turn Patient every 2 hours if at risk for developing pressure
ulcer. If not, offer to reposition patient/ ask if patient is comfortable
4 Possessions-Ensure that call light, phone, Kleenex, water, trash can, and
patient’s belongings are all within reach of patient.
5 If patient awake, check if they need anything else while you are in the
room
6 If patient awake, tell patient someone from team will be back in 1 hour to
check on if patient asleep check again in 1 hour
5Ps Purposeful Rounding Protocol Audit Tool
5T Staff Patient Rounding (RN/ NA) 7Aam to midnight
Date of Audit
Outcomes
Compliance rate on staff addressed all 5Ps during their
patient rounds
• Audited n=50 staff out of 70 (RNs and CNAs)
• Pre-intervention: 23%
• Post-Intervention: 63%
Outcomes
1800
718
2300
778
0
500
1000
1500
2000
2500
Baseline data prior tothe project
implementation
Phase 1 pre-intervention (audit)
Times between phase1 and phase 2 without
audit
Phase 2 post-intervention (audit)
Nu
mb
er
of C
alls
Total Call Light Usage in Two Weeks
Outcomes
40.1%35.7%
44.4%
65.0%
50.0%
80.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Reponsiveness of hospitalstaff
Call button help soon aswanted it
Help toileting as soon as youwanted
HCAHPS Survey Results
Pre-Implmentation (April 1-June 7) Post-Implementation ( June 8-August 8)
Recommendations
• Establish purposeful rounding as a process, it is
essential to continue periodic audits.
• Select champions from various shift to help promote and
maintain the process.
• Audits should be performed without staff knowledge to
prevent Hawthorne Effect and obtain reliable data.
Recommendations
• Replicating this study on another unit for a longer
duration may help verify significant of project findings.
• Investigating variables that impact staff resistance to this
concept of rounding.
• Change unit culture to consistently meet patient needs
proactively.
References
• Bourgault, A., King, M., Hart, P., Campbell, M., & Swartz, S. Lou, M. (2008). Nursing
Management, 39 (11), 18-24.
• Culley, T. (2008). Reduce call light frequency with hourly rounds. Nursing
Management, 39 (3), 50-52.
• Deitrick, L., Baker, K., Paxton, H., Flores, M., & Swavely, B. (2012). Hourly Rounding:
Challenges with implementation of an evidence based-process. Journal of Nursing
Care Quality, 27 (1), 13-19.
• Ford, B. (2010). Hourly rounding: A strategy to improve patient satisfaction scores.
MEDSURG Nursing, 19 (3), 188-191.
• Grove, S., Burns, N., & Gray J. (2013). The practice of nursing research: Appraisal,
synthesis, and generation of evidence (2nd Ed). St. Louise: MO: Elsevier
• Kaminski, J (2011). Theory applied for informatics: Lewin’s change theory. Canadian
Journal of Nursing Informatics, 6(1), Editorial http://cjni.net/journal/?p=1210.
• Murray, T., Spence, J., Bena, J., Morrison, S., & Albert, N. (2010). Journal of Nursing
Care Quality, 25 (4), 366-372.
Acknowledgment
• Dr. Janie Best, DNP, RN, CNL, ACNS-BC, Faculty
Advisor at Queens University of Charlotte