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
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Purpose
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Described as
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

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
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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
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IV pump alarming
Beep
Beep
Beep
Beep
Limitations

Generalizability of
findings
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Convenience sample at
one site
Limited to 3-month
study period
Unable to verify the
accuracy of rounding
logs

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Appropriate time?
Addressed all 3
variables?
Summary
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Decreased patient call
light volume overall
Improved outcomes on
some units
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
Pain management
HAPU and falls
Uncertain why some
units did not
demonstrate
improvement
Relevance to Nursing

Frequent structured
rounds should
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
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.