Evidence based practice hourly rounds power point better


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  • 1 use the word round, explain during rounds you will be checking pain, comfort, position and bathroom, reduces anxiety2. meds, treatments, procedures, feedings. • Pain - Evaluate pain level.3. Prn meds recommended to be given at the earliest fequency so that pt doesn’t need to call.4. Fluff pillows, straighten sheets, fill water pitchers, call light, remote in reach, Telephone light switch, garbage can, bedside table, comfortable and covered. 5.Respond to questions. Ask if there anything else the patient needs.6.Reassure - Express care and concern. Let the patient the next rounding time.7.”Is there anything else I can do for you? I have time.” 8.Mrs. H, it looks as if you have everything you need. I or CNA will be back in an hour to round on you again”
  • • Please say to each patient: "I am here to do my rounds to check on your comfort because I care."• Check PAIN-ask level, and if medication is needed.• Offer TOILETING assistance, empty urinal/bedpan• Assess COMFORT/POSITIONING-is any help needed, is it time to turn the patient.• ENVIRONMENTAL check (peace of mind):• Check that call light, telephone, TV control and bed light switch are in reach.• Bedside table, Kleenex and water are in reach.• Garbage can is next to bed, not full, with bag.• Does patient need refreshment?• Prior to Leaving Room:– "Is there anything else I can do for you before I leave? I have time while I am here.– I will be back in one hour to round on you again".• Document the rounds.
  • Often, nurses make rounds on even hours and support staff make rounds on odd hours. While making rounds, staff engage patients by checking on the “4 P’s”: pain, positioning, potty (elimination), and proximity of personal items. Patients are told that staff will check on them frequently, so hourly rounds help manage patients’ expectations. Patients become less anxious about getting their needs met as they learn to trust the process of hourly rounds. Attending to patients’ comfort, safety, and environmental needs may also prevent adverse events like falls, pressure ulcers, or unrelieved pain; and contribute to patients’ satisfaction with nursing care. Proponents also attest that hourly rounds organize work flow, offering efficiencies by giving nurses time back as they proactively (rather than reactively) anticipate and attend to patients’ needs.
  • To help you remember, successful pediatric patient rounding , use pneumonic PEDI
  • Success TipsEnsure buy-in of nursesEnlist others to roundHold nurses accountableModify and utilize in additional areas (ED, OB)Present and promote as evidence-basedRecognize and reward those that do it well 
  • Hospitals Baylor univ.< 2750, St eliz.400 Tmple univ, PA 617 sharp memorial hospital San diego 1870
  • To communicate the results of the project solution and allow workplace feedback a multi-approach should be taken, to include group e-mails, staff meetings and nursing surveys. Each of these approaches allows for staff members to receive critique, ask questions and submit suggestions or comments anonymous. By publishing success and failures within the hospital other individuals awareness of the need for increasing patient satisfaction is increased and similar or alternative initiatives can be developed in different care settings.
  • Evidence based practice hourly rounds power point better

    1. 1. Hourly Rounding: Obtaining Results Evidence-Based Practice 1
    2. 2. Objectives Why hourly rounding is effective and powerful Results from two facilities of implemented hourly rounding and results Motivate nursing staff to become hourly rounding advocates Staff involvement and accountability for patient satisfaction. 2
    3. 3. The Facts Proactively address patient needs Improve staff workflow and satisfaction Improve service quality and patient-centered care Decrease risk for pressure ulcers, falls, etc. Safety and clinical quality 3
    4. 4. Goals: Reduce call lights Improve patient perceptions of care Increase nursing satisfaction and efficiency Reduce patient falls Reduce skin breakdown 4
    5. 5. 4 P’s PainPottyPositionProximity 5
    6. 6. Scripted Rounding "I am here to do my rounds to check on your comfort because I care.“  4P’s "Is there anything else I can do for you before I leave? I have time while I am here. I will be back in one hour to round on you again".  Document the rounds. 6
    7. 7. Explain Goals of Hourly Rounding“We round every hour on our patients to ensure that you receive ‘QUALITY’ care. We will not wake you if you are sleeping unless we need to. If anytime during your stay, you feel you are not receiving ‘QUALITY’ care, please let us know immediately so that we can address your concerns.” 7
    8. 8. PEDIATRIC ROUNDINGP = parents/plan/painE = eating (bottles, meals, etc.)D = diapers (supplies, towels, etc.)I = interaction/ID bands 8
    9. 9. Rounding Behaviors that Reduce Call Lights Use opening key words to reduce anxiety. Perform scheduled tasks Address the 4 P’s of pain, position and potty, proximity Assess additional comfort needs (to decrease call lights & increase patient satisfaction) Conduct an environmental assessment to assure safety Prior to leaving the room ask, “Is there anything else I can do for you?” Tell each patient when you will be back (to decrease call lights and decrease anxiety) Document the round 9
    10. 10. Studer group Largest study to show that certain nursing staff behaviors reduce call light and allow nursing staff to respond more efficiently to patient requests. 27 units in 14 hospitals. Call light usage decreased by 38% Patient satisfaction went up from 79.9-88.8% Meade, C.M., Bursell, A.L., Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use, satisfaction and safety. American Journal of Nursing, 106(9), 58-70. 10
    11. 11. Studer group 50% decrease in patient falls. Patient AND employee satisfaction increased. Nurse reported more time to attend to other task because they were answering call lights less often. 11
    12. 12. Findings One Year After the Study 85.7% of the units continued the rounding. 92.8% of the hospitals expanded the rounding. Patient Satisfaction scores maintained a strong increase over the early results. Falls continued to decrease over the year. Resource: Studer Group 2007 12
    13. 13. Findings One Year After the StudyQuantitative Measures Before One Year Rounding Patient satisfaction 79.9 88.8 38.2%Percentage of “excellent” 80.1% ratings Reduction in falls* — 60% Resource: Studer Group 2007 13
    14. 14. Top Five Changes In Patient Requests Rounding affected the 4 P’s: 3000 Pain (-35%) 2,379 Potty (-40%) 2500 Position (-29%) 2000 Proximity 1,628 1,424 1,420 1500 1,142 984 868 1000 744 507 361 500 0 Bathroom Pain Positioning IV/Alarms Misc Pre-Round End Round Resource: Studer Group 2007 14
    15. 15. North Mississippi Medical Center Tupelo, Mississippi Tupelo, MS 650 beds – largest hospital in Mississippi Serves 650,000 people in 22 counties 40 medical specialties Level II Trauma Center Hospitalist program 3,900 employees Malcolm Baldrige Quality Award in 2006 15
    16. 16. North Mississippi Medical Center Tupelo, Mississippi1008060 Pre-One Hour Rounding One Hour Rounding4020 0 Patient Satisfaction 16
    17. 17. FREQUENCIES OF PATIENT FALLS ON EXPERIMENTAL AND CONTROL UNITS Number of falls Number of falls Group in the four weeks during the four weeks prior to rounding of roundingOne-hour rounding 25 12 groupTwo-hour rounding 19 13 group 17
    18. 18. Skin Breakdown Reduced One Hour Rounding 14% reduction 7 6 5 4 3 2 1 0 Pre-One Hour Rounding During One Hour Rounding 18
    19. 19. King’s Daughter’s Hospital Yazoo City, Mississippi Yazoo City, Mississippi since 1930. 25-bed acute and swing bed unit 10-bed geriatric psychiatric unit Twenty-four hour Emergency Department. Outpatient Services: Wound Care Clinic , Foot Specialist Clinic, Diability, Urology, Ophthalmology , Otolaryngology, Cardiology, Orthopedic Surgery, Gastroenterologist, General Surgery 19
    20. 20. King’s Daughter’s Hospital Yazoo City, MississippiGoals of implementation: Educating Staff: Decrease hospital acquired  Explained WHY we were pressure ulcers implementing Decrease falls  Reviewed evidence-based data Improve pain control  Defined actual process Improve patient satisfaction  Scripting: Decrease call lights  4 P’s – Positioning, Potty, Implementation timeline: Pain, and Proximity  Education  “Is there anything else I can  Go-Live do for you while I’m in the room?” 20
    21. 21. King’s Daughter’s Hospital Yazoo City, MississippiResults: Patients perception of nurses checking on them more frequently Heightened awareness of repositioning to decrease pressure ulcers, of assisting to the bathroom to decrease falls, and assessing pain to achieve better control Decrease in call lights 21
    22. 22. Benefits of Hourly Patient Rounds Leads to better care: Builds trust between patients and caregivers. Reduces patient anxiety by more frequent encounters Reduces call lights which minimizes interruptions and other distractions faced by the nursing staff Improves the patient’s perception of staff communication, staff responsiveness, pain management and a safe environment Increases overall patient and employee satisfaction Mead, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing rounds on patient call light use, satisfaction, and safety. AJN, 106(9),59-69. 22
    23. 23. Conclusion The implications of these findings for nurses would certainly be a more organized workflow, less burnout and fatigue and greater job satisfaction as well as improved patient care and comfort. 23
    24. 24. Conclusion Available evidence indicates hourly rounds are appropriate, safe, and useful for practice 24
    25. 25. References Assi M, Wilson P, Bodino J, et al. (2008). Why making the rounds makes sense. Am Nurse Today. 2008;3(2):12. Bulechek G, Butcher H, Dochterman J. (2008). Nursing Intervention Classification. St Louis, MO: Mosby; 2008. Coombs, M. A. (2004). Power & Conflict between Doctors and Nurses: Breaking through the Inner Circle in Clinical Care. New York: Routledge. Culley T. (2008). Reduce call light frequency with hourly rounds. Nurs Manag. 39(3):50-52. Galanti, G. (1997). Caring for Patients from Different Cultures: Case Studies from American Hospitals (2nd ed.). Philadelphia: University of Pennsylvania Press. Haack W. (2007). Care rounding: a process to improve patient satisfaction, pain management and safety. Proceedings of American Nurses Credentialing Center (Virginia Henderson Library), 2007. http://www.nursinglibrary.org/Portal/main .aspx?pageid=4024&pid=19623. Hourly rounding decreases call light frequency, may ultimately improve care quality. (2006). Nurse Executive Watch. www.advisory.com. 2006. Johnson L, Topham D. (2007). Reducing falls through RN rounding. Clin Nurs Spec. 2007;21(2):114. Kalman M. (2008). Getting back to basics: hourly nursing rounds to decrease patient falls and call light usage and increase patient satisfaction. Proc Sigma Theta Tau Int (Virginia Henderson Library), 2008. http://www.nursinglibrary.org/Portal/main.aspx?pageid=4024&pid=20449. 25
    26. 26. References Kennedy, J. and Frick, B. (2008). Boot Camp: Develop Nurse Leadership Skills in a Supportive Group Environment. What’s Right in Health Care: Evidence to Outcomes. www.studergroup.com. Leighty J.(2006). Hourly rounding dims call lights. http://www.studergroup.com/dotCMS/knowledgeAssetDetail?inode=319742 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. Schroder, Jack. (2003) Identifying medical malpractice. (2nd Ed.) Oakland, CA: Catalpa Press. Studer Group (2006). AHC Research Call Light Study. Hourly Rounding, developed by Studer Group, the largest study ever focused on the impact of rounding. www.studergroup.com. Weisgram B, Raymond S.(2008). Using evidence-based nursing rounds to improve patient outcomes. Medsurg Nurs.2008;17(6):429-430. Woodard J. (2009). Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Clin Nurs Spec.2009;23(4):200-206. 26