Transcript Effect of Structured Frequent Nursing Rounds on Patient Satisfaction

Effect of Structured Frequent Nursing
Rounds on Patient Satisfaction,
Safety, and Call Light Usage
Aimee Cloyd, ASN,RN
Nurse Supervisor
Leisa Kelly, MS, APRN, CEN
Clinical Nurse Specialist
Objective
• To relate the effects of a
structured rounding program to
patient outcomes.
Evidence Based Practice
Support for the Project
• A research study was published
in AJN in 2006 describing the
results of a multi-facility research
study to measure the
effectiveness of frequent nursing
rounds
• This research study supported
the EBP we implemented at our
institution
Background Information
• Press Ganey measures patient
satisfaction on a random group of
patients discharged from our facility
• Patient satisfaction within the medical
division consistently ranged below the
90th percentile
• Patient falls were higher than the
national benchmark
• Staff viewed call light usage as an
ongoing interruption into our day
• The Medicine Division saw this
research study as a potential solution
to improve outcomes
EBP Team
• The divisional director, nurse
managers, and members of the unit
based council worked together with
the CNS to develop the model for the
project
• Processes discussed in the original
study design were replicated
Development of the Call
Light Log
• Call light log had been used
previous to this project; however,
the purpose of the call was
changed from a write in box to a
check box to provide categorical
data
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Included patient room number
Call back time
Whether the need was met
Purpose of the call
Development of the
Rounding Log
• A rounding log was developed to
act as a visual reminder to staff
• Staff was to initial each time they
entered the room
• Log was duplicated, and later
laminated for durability
Development of the
Rounds Request Form
• A rounds request form was
develop to communicate patient
needs to the nurse when the CNA
or CSR rounded
• Non-licensed personnel documented
the patient need on a form
• Communicated to the nurse at the
end of their rounding session
Development of the
Scripting and the Process
• Nurses rounded on the odd hour
(Assessments at 7AM/PM; meds 9
AM/PM)
• Non-licensed personnel rounded on
the even hour
• Rounds scheduled hourly from
7AM-10PM
• Every other hour from 12MN to 6AM
• Scripts and observations for
rounding developed
Actions to be Taken by Nursing
Staff Members During Rounding
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Determine patient’s pain level
Put medication as needed on the nurses scheduled list
Offer toileting assistance
Determine the patient’s position and position comfort
Make sure the call light is within the patient’s reach
Place the telephone within the patient’s reach
Place the TV remote/bed light switch within the
patient’s reach
Place the bedside table next to the bed
Place the Kleenex box and water within the patient’s
reach
Place the garbage can next to the bed
Ask: “Is there anything I can do for you before I leave? I
have time while I am here in the room.”
Tell the patient that a member of the nursing staff will
be back in the room in one hour to round and check on
them again.
Implementation of the
Pilot
• Initially the process was
implemented on the North Tower
• A ceremony highlighting the Lake’s
nurse theorist, Jean Watson, kicked
off the rounding project
• Hospital administration, service line
administrators, managers and staff
nurses attended the ceremony
• For the first month all was well
Effect of Hourly Rounding
on Clinical Outcomes
• No effect on call light usage
• No effect on patient falls
• Improvement in patient satisfaction
measures
• Pain Management: Pain controlled
• Loyalty: Recommend the facility to
others
• Care and Concern
• Personal Needs
Call Light Usage
1200
1000
1128
1046
Manual Log
Executone
920
969
800
600
621
2006
2007
533 519
419
400
200
0
March
April
May
June
Call Light Data
• An attempt to obtain objective call
light data was explored
• Data from the Executone System was
obtained, but staff did not concur to its
accuracy
• Call lights used for non-patient requests
• System changed from 2006 to 2007
• After several months, call light data
was no longer considered as an
outcome
Falls Per 1000 Patient Days
10
9
8
7
6
5
4
3
2
1
0
9.1
6.6
4.3
2.2
Mar
4.5
2.2
April
4.4
2.3
May
4.16
2.26
June
July
2006
2007
Patient Satisfaction Nursing Core
Indicators: Attention to Personal
Needs
100
81.3
75
80
70
92.9
91.7
90.6
90 87.5
85.3
78.6
70.6
75
73.1
80
76.8
83.3
8081.8
77.1
87.5
87.5
80
60
50
2006
2007
40
30
20
10
0
March
May
July
September
November
Patient Satisfaction Nursing Core
Indicators: Response to Concerns
100
90 88.9
83.3
80
70
90
83.9
75
71.7
70.8 73.1
76.9
79.3
76.8
76.6
79.2
81.7
81.8
89.7
85.7
85.7
67.9
65
60
2006
50
2007
40
30
20
10
0
March
May
July
September
November
Patient Satisfaction Nursing Core
Indicators: Loyalty
100
90
85.4
84.4
80
70
81.3
79.2
85.7
88.3 89.1
85
85.1
90
82.1
80.3 80
89.6
83.9
92.5
89.7
85.7
78.3
66.7
60
2006
2007
50
40
30
20
10
0
March
May
July
September
November
Patient Satisfaction Nursing Core
Indicators: Pain Management
100
90
87.5
86.1
80
91.1
82.1
75
70
84.1
95.5
85.9
83.3
80.9 82.7
91.7
87.5
86.8
82.5 81.8 83.3
72.5
68.3
70
60
50
2006
2007
40
30
20
10
0
March
May
July
September
November
Pre-Post Comparisons:
Pilot Unit Year 1 to year 2
Outcome
t
Loyalty
.182
287
346
.859
Personal
Needs
.692
294
349
.504
Pain
.328
260
324
.749
Care and
Concern
.072
264
313
.944
N 06-07 N 07-08
p
Effects of the Pilot
• There was initial buy-in, however staff
soon began to question “When was the
pilot going away?”
• Initial gains realized were not held
• Consistent outcome measures were
difficult to obtain
• Falls are only as accurate as reported
• Call light usage was only as accurate as
documented
Other Units Believed it
Would Work
• The medical unit on the south tower
wanted to give the process a try
• They were challenged to maintain
consistent patient satisfaction scores and
saw the process as an opportunity
• The unit was eager to show that teamwork
can improve patient satisfaction scores
• Several of the nurses were in school, had
read the article, and wanted to implement
it
Patient Satisfaction Nursing Core
Indicators: Attention to Personal
Needs
100
90
80
91.3
81.8
84.6
84.485.5
88
83.3
89.1
85.9
90.7
80.6
83.3
80
72.5
70
60
2006
50
2007
40
30
20
10
0
June
August
October
December
Patient Satisfaction Nursing Core
Indicators: Response to Concerns
100
90
80
90
82.9
80.4
87.5
82.4
85.2
80.9
86.4
83.9
86.5
80.8
86.4
72.4
70
66.9
60
2006
50
2007
40
30
20
10
0
June
August
October
December
Patient Satisfaction Nursing Core
Indicators: Loyalty
100
90
80
88.5
92.3
79.6
87.5
83.8
89.5
93.3
89.1
81.3
93.5
84.7
85
80.3
70.2
70
60
2006
2007
50
40
30
20
10
0
June
August
October
December
Patient Satisfaction Nursing Core
Indicators: Pain Management
100
90
80
93.2
86.8
82.9
84.182.4
85.9
81.7
88.5
84.8
84.485
85.7
76.4
70
63.5
60
2006
2007
50
40
30
20
10
0
June
August
October
December
Pre-Post Comparisons
Outcome
t
Loyalty
1.819
280
277
.046*
Personal
Needs
2.464
273
277
.031*
Pain
1.523
238
246
.156
Care and 2.212
Concern
247
234
.049*
N 06-07 N 07-08
p
Comparative Analysis Between
the Groups
Outcome
F
N
p
Personal NeedsPre
.272
567
.607
Personal NeedsPost
4.524
626
.045*
Pain-Pre
.192
498
.665
Pain-Post
1.226
570
.280
Care and ConcernPre
1.057
511
.315
Care and ConcernPost
4.032
547
.047*
Loyalty-Pre
1.048
567
.317
Loyalty-Post
17.921
623
<.001**
What was the
difference?
Our CNA Star
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We have stars in our team – CNA’s,
PCA’s, and CSR’s – were all important
factors in the success of this project
We believed that it would work
We personalized the process and
wanted it to be a success
Our scores have stayed consistent, it
is how we provide care now
The paradigm shift occurred
What Were Our
Challenges?
• Initial buy-in was tough, but the patient
satisfaction scores increased, our staff was
sold on the project.
• Staff was hesitant to say “We’ll be back in
an hour,” worried that no one would return.
• We like to succeed and we incorporated
hourly rounding into our daily routine.
• We were pushed to take down the papers,
but our manager felt that they were visual
reminders.
Questions????