Transcript Effect of Hourly Nursing Rounds on Call Light Use, Patient

Effect of Hourly Nursing Rounds on
Call Light Use, Patient Falls, and
Patient Satisfaction
Stephanie R. Bruce, BS, RN
University of Wisconsin-Milwaukee,
School of Nursing
Acknowledgments
• Mary Beth Trentadue,
Preceptor
• Julie Darmody,
Faculty Supervisor
Introduction
• Problem:
– Data publicly reported
– Medicare Ruling
– Limited research
• Purpose:
– To evaluate the effect of hourly nursing rounds on
patient call light use, patient falls, and patient
satisfaction.
Background
• Fall Rate 3.3-7.0 falls/1000 patient days
– 30-48% result in injury
– Cost of Injury: $15-30,000/fall
• $1.08 billion/year
(Kalman, 2008)
(Landro, 2005)
• Correlation between staff responsiveness and
overall satisfaction (OR 4.1) (Tea, Ellison & Feghali, 2008)
• Most calls occur at medication and meals times
(Meade, Bursell & Ketelsen, 2006)
Literature Review
• Search terms:
– Nursing
– Hourly
– Rounding
• Databases used:
–
–
–
–
CINAHL 11 of 28,28969(added call light use)
PubMED 3 of 3 plus 6 related articles
MEDLINE 1 of 10511(added call light use)
Cochrane 0 of 15
• ClinicalTrials.gov 1 of 1
Literature Review
• Call light use reduced 37.8%
• Patient falls decreased 50%
• Patient satisfaction score increased a mean of 8.9
points (on 100-point scale)
-Meade, Bursell & Ketelsen, 2006
• Nurse called 12-15 times/day for non-urgent requests
• Each response takes a minimum of 4 minutes
• Hourly rounding estimated to save 166 hours/month
-Studer Group, 2006
Framework
• PDSA (Plan Do Study Act)
(Institute for Healthcare Improvement, 2004)
• “Behavioral shaping”
(Kazin, 1989)
Methods
• Setting
– 45-bed medical-surgical unit in community hospital
• 14-week study
– 4-week pre-implementation phase
• Baseline data
– 6-week implementation phase
• Staff education
• Coaching
– 4-week post-implementation phase
• Follow-up data
• Data collected pre- and post-implementation
– Call light use and reason
– Patient falls
– Patient satisfaction
Intervention
• Each hour the nursing staff will round on all the
patients in the unit.
– Nurse (RN) rounds odd hours
– Patient care associate (PCA) even hours
• Round on the hour 6am-10pm, then every 2 hours
• Upon entering the room, introduce yourself and tell the
patient you are there to do your rounds.
Intervention
• Hourly Rounding Goals
– Improve patient safety and satisfaction
– Give patients a heightened sense of security
– Decrease the number of call lights for nonemergency concerns
– Reduce staff stress levels
The following items will be checked and
performed for each patient:
1.
2.
3.
4.
5.
6.
7.
Assess the patient pain
Offer toileting assistance.
Change the patient’s position to promote comfort.
Make sure the call light (and soft call light when
appropriate) is within the patient’s reach.
Put the telephone within the patient’s reach.
Put the bedside table next to the bed.
Put the Kleenex box within the patient’s reach.
The following items will be checked and
performed for each patient:
8.
Offer sip of fluid to patient and put within patient
reach
9. Make sure the garbage bag is on the side of bedside
table and empty as needed.
10. Prior to leaving the room, ask, “Is there anything I can do
for you before I leave? I have time while I am here in the
room.”
11. Tell the patient that a member of the nursing staff
(use names on white board) will be back in an hour to
round again.
Results
• Pre-Implementation:
– Call Lights
• 4.2 calls per patient
– Falls
• One
– Patient Satisfaction
• Promptness response to call (n=42)
– Mean 79.2
• Overall rate of care given (n=41)
– Mean 87.8
Results
• Post-Implementation:
– Call Lights
• 2.7 calls per patient
– Falls
• Zero
– Patient Satisfaction
• Promptness response to call (n=12)
– Mean 85.4
• Overall rate of care given (n=16)
– Mean 92.2
5:
00
6: AM
00
7: AM
00
8: AM
00
9: AM
00
10 AM
:00
11 AM
:00
12 AM
:00
1: PM
00
2: PM
00
3: PM
00
4: PM
00
5: PM
00
6: PM
00
7: PM
00
8: PM
00
9: PM
00
10 PM
:00
11 PM
:00
12 PM
:00
AM
Number of Calls
Variation In Frequency of Call Light Use by Time
Pre-Implementation
Post-Implementation
50
40
30
20
10
0
Hour That Call Came In
Reason for Call Light Pre-Implementation
Bathroom/bedpan assistance (25%)
Repositioning/mobility assist (16%)
IV problem/Pump alarm (9%)
Room amenities (9%)
Pain (6%)
Accidental (11%)
PCA (12%)
RN (12%)
Both RN and aide (0%)
Other (0%)
Reason for Call Light Post-Implementation
Bathroom/bedpan assistance (27%)
Repositioning/mobility assist (12%)
IV problem/Pump alarm (11%)
Room amenities (11%)
Pain (6%)
Accidental (11%)
PCA (11%)
RN (11%)
Both RN and aide (0%)
Other (0%)
Variation in Reason for Call Light Use
Number
of Calls
Number of Calls
120
100
Variation in Reason for Call Light Use
80
20060
10040
20
0
0
Pre-Implementation (Baseline) vs. Post-Implementation (Rounding)
Pre-Implementation (Baseline) vs. Post-Implementation (Rounding)
Bathroom/bedpan assistance
Repositioning/mobility assist
IV problem/Pump alarm
Room amenities
Pain
Accidental
PCA
RN
Both RN and aide (vomited)
Other
Mean
Patient Satisfaction
Promptness Response to Call
90
88
86
84
82
80
78
76
74
87.4
84.8
83.6
85.4 84.8
83.5
79.2
Pre-Implementation
Unit
87.3
All Press Ganey Database
Post-Implementation
150-299 Bed Group
WI Peer Group
Mean
Patient Satisfaction
Overall Rating of Care Given
93
92
91
90
89
88
87
86
85
92.2
90.8
88.7
87.8
88.8
88
Pre-Implementation
Unit
90.8
All Press Ganey Database
88
Post-Implementation
150-299 Bed Group
WI Peer Group
Rank
Promptness Response to Call
70
60
50
40
30
20
10
0
65
54
30
13
10
1
All Press Ganey
Database
150-299 Bed Group
Pre-Implementation
WI Peer Group
Post-Implementation
Overall Rating of Care Given
100
94
86
70
Rank
80
60
40
40
34
13
20
0
All Press Ganey
Database
150-299 Bed Group
Pre-Implementation
WI Peer Group
Post-Implementation
Results
•
•
•
•
36% Reduction in call light use
Reason for call light use did not vary
100% Decrease in falls*
Satisfaction increased 6.2 points (on 100point scale)
Discussion of Barriers
• Gaining “buy-in” from staff
• Staff completion of accountability tool –
dissatisfaction/non-compliance with rounding
logs
• Consistency in staff using protocol
• Staffing, acuity, admits and discharges
Limitations
• Conclusions about influence on falls cannot be
determined due to small sample
• Satisfaction data is still coming in
Implications
• Rounding was shown to be an effective
intervention to
– Decrease call light use
– Increase patient satisfaction
• Based on these results, hospital-wide adaptation
of this protocol is recommended.
Recommendations: Future Study
• Training
– Create unit leaders/Rounding champions
– Follow each staff member as they round
– Use pre- and post-tests with staff education
• Need for:
– Randomized control study
– Cost benefit analysis
• Use of call light system that can collect data
References
Kalman, M. (2008). Getting back to basics: hourly rounds to decrease
patient falls and call light usage and increase patient satisfaction.
Retrieved on April 14, 2008 from
http://stti.confex.xom/stti/congrs08/techprogram/paper_37872.htm
Kazin, A. (1989). Behavioral modification in applied settings. 4th ed.
Pacific Grove, CA: Brooks Cole.
Landro L. (2005). The informed patient: hospitals aim to curb injuries
from falling. Wall Street Journal, D1.
Institute for Healthcare Improvement. (2004). Project planning form.
Boston: Institute for Healthcare Improvement, 1-9.
Meade, C.M., Bursell, A.L. & Ketelsen, L. (2006). Effects of nursing
rounds on patients’ call light use, satisfaction, and safety. AJN, 106,
58-70.
Studer Group (2006). AHC Research Call Light Study. Retrieved on
March 35, 2008 from www.studergroup.com
Tea, C., Ellison, M. & Feghali, F. (2008). Proactive patient rounding to
increase customer service and satisfaction on an orthopaedic unit.
Orthopaedic Nursing, 27, 233-40.
Questions/Comments
Thank you.