Transcript Slide 1
Evaluating the Impact of
Nurses’ Rounding on
Patient Satisfaction and
Clinical Outcomes
Margaret Redmond,BSN, OCN
Rene Lavoie, RN-BC
Renee DiGiovanni, BSN, RN-BC, CCTN
Ochsner Medical Center, New Orleans
Miro Sarac, PhD, LSUHSC School of Nursing
Background – Nursing Rounds
Purpose
Described as
To assess patient needs
Task oriented
Unstructured without a
consistent set of
standards – “a peak in
the door”
Current practice
Reactive vs. proactive
Literature Review
Structured rounding protocol focusing
on Pain, Potty, & Positioning supported
positive impact on outcomes
Reduced call light usage
Improved patient satisfaction
Decreased in fall rate
Mead, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing rounds
on patient call light use, satisfaction, and safety. AJN, 106(9),59-69.
Purpose for Study
Investigate the
impact of a patient
rounding protocol on
outcomes associated
with
Pain
Potty
Positioning
Study Methods
Research Design
Prospective
Descriptive Study
IRB expedited review with waiver of
documentation of informed consent
Convenience Sample
Patients
admitted to five medical surgical units
Procedure
Rounding
protocol over 12 weeks
Rounding Protocol
Focus on “ 3 P’s”
Hourly during the
day (6am-10pm)
Every 2 hrs at
night (10pm-6am
“Is there anything
else you need?”
Data Collection –
Pre- & Post-Protocol
Call light use
Pain
Potty
Position
Pain management
satisfaction
Press
Ganey
Patient satisfaction
Press Ganey
Falls
NDNQI
Falls 1000/patient
days
Hospital acquired
pressure ulcers
NDNQI
HAPU/1000 patient
days
Data Analysis
Frequency distribution
for each variable
Tests for differences
between & among
groups
Chi- square
Paired t-test
ANOVA
All tests 2-tailed, α = 0.05
Distribution of Pre- & Post-Calls
total number of postcalls
2500
2000
1500
UNIT 7
UNIT 8
1000
UNIT 11
UNIT 3
500
UNIT 9
0
0
2
4
6
8
10
12
time (week)
precalls
postcalls
UNIT 9
UNIT 8
UNIT 3
UNIT 11
UNIT 7
percentage of total number of pre/postcalls
Distribution of Patient Call
Lights Pre- & Post-Protocol
35
30
prepain
prepotty
prepositioning
postpain
postpotty
postpositioning
25
*
20
15
10
5
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
0
UNIT 3
UNIT 11
UNIT 7
UNIT 8
UNIT 9
Significant differences, Anova, *p < .05. ** p < .005, p < .0001
100
90
80
70
60
50
40
30
20
10
0
mean score
mean score
Quality Indicators by Unit
CICU
TSU
9th
CICU
11th
TSU
IMTA
PrePain
PostSat
9th
11th
PostPain
25
10
9
8
7
6
5
4
3
2
1
0
# per 1000 pt days
# per 1000 pt days
PreSat
IMTA
100
90
80
70
60
50
40
30
20
10
0
20
15
10
5
0
CICU
TSU
PrePU
IMTA
PostPU
9th
11th
CICU
TSU
IMTA
PreFalls
9th
PostFalls
11th
Incidental Finding
IV pump alarming
Beep
Beep
Beep
Beep
Limitations
Generalizability of
findings
Convenience sample at
one site
Limited to 3-month
study period
Unable to verify the
accuracy of rounding
logs
Appropriate time?
Addressed all 3
variables?
Summary
Decreased patient call
light volume overall
Improved outcomes on
some units
Pain management
HAPU and falls
Uncertain why some
units did not
demonstrate
improvement
Relevance to Nursing
Frequent structured
rounds should
Improve clinical
outcomes
Reduce nurses’ burden
Additional research
should address
Other foci for rounding
should be studied (ie. IV
pump)
Obstacles to nurses’
rounding
References
Castledine, G. (2002). Patient comfort rounds: A
new initiative in nursing. British Journal of
Nursing, 11 (6), 407.
Halm, M. et al. (2003). Interdisciplinary rounds:
Impact on patients, families and staff.
Clinical Nurse Specialist, 17(3), 133-142.
Mead, C., Bursell, A., & Ketelsen, L. (2006).
Effects of nursing rounds on patient call light
use, satisfaction, and safety. AJN, 106(9),
59-69.
Van Handel, K. & Krug, B. (1994). Prevalence and
nature of call light request on an orthopedic
unit. Orthopedic Nursing, 13(1), 13-18.