This document summarizes a quality improvement project aimed at enhancing and sustaining authentic hourly visitation (AHV) to improve patient outcomes and experience. Methodologies used included a SWOT analysis, interviews, questionnaires, literature review, PDSA cycles, and chart reviews. Barriers to consistent AHV identified through staff questionnaires included time constraints, inadequate staffing, patient conditions, and interruptions. The project recommendations are to maintain collaboration between leadership and staff, ongoing data collection and review, and for leadership to address staff needs and challenges.

1. Enhancing and sustaining Authentic
Hourly Visitation to Improve Outcome
and Care Experience
Nneka Christiana Chukwu MSN, RN, CNL
METHODOLOGIES
• Strength, Weaknesses, Opportunities, and Threats (SWOT) analysis
• Informational interview
• Questionnaires
• Literature review
• PDSA
• Chart review
• SWOT ANALYSIS
RECOMMENDATIONS
• Maintain consistent collaboration between the leadership team
and the front-line staff to preserve the AHV process.
• Ongoing collection and review of data to ensure sustainability.
• Need for leadership team to listen and respond to the needs
and challenges identified by staff.
SELECTIVE REFERENCES
Daniels, J.F. (2016). Purposeful and timely nursing rounds: a best
practice implementation project. Joanna Briggs system reviews and
implementation reports. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/26878929
Kaiser Permanente. (n.d.). Authentic hourly visitation for nurses: an
evidence-based practice for performance improvement. Retrieved
from www.kp.org.
Stanford Health Care. (n.d.). Nursing quality and safety: purposeful
rounding. Retrieved from
https://stanfordhealthcare.org/health-care-professionals/nursing/qu
ality- safety/purposeful-rounding.html
ACKNOWLEDGEMENT
My sincere gratitude goes to my Director Josephine Reyes for all her
support.
I offer my heartfelt thanks to my teachers Dr. Cathy Coleman and
Nancy Taquino for their selfless efforts and learning opportunities.
Finally, to my parents and children, my deepest appreciation and
acknowledgment.
ABSTRACT
Authentic hourly visitation (AHV) otherwise known as purposeful
rounding or hourly rounding is an evidence-based process, which
focuses on safety of hospitalized patients using a proactive
approach. Regular and purposeful, proactive rounding promotes
safety, comfort, and responsiveness which has a direct impact on
the care experienced by patients and their satisfaction with service
delivery. The setting for this improvement project was the medical
surgical unit and medical telemetry unit at Kaiser South San
Francisco. This process improvement project aims to enhance and
sustain the frequency and quality of Authentic Hourly Visitation.
Improving the frequency and consistency of this interactive
practice will ensure that patients receive timely and efficient care
with a resultant improvement in their care experience. This goal is
in alignment with that of this integrated delivery health care
organization, which thrives to provide the highest quality of care to
every patient at all, times. The CNL as an outcomes manager, risk
anticipator and educator led this process improvement project in
collaboration with all key players in these microsystems by
administering questionnaires, informational interviews, chart
review and observation.
Keywords: Authentic hourly visitation, barriers, care experience,
patient safety, care experience.
NURSING IMPLICATIONS
Nurses are charged with providing safe and efficient care to
patients. This is critical especially at a time when healthcare is
undergoing reformation (value based purchasing). Healthcare
institutions are no longer reimbursed for hospital acquired
conditions or provision of sub-standard care. Additionally, the
Centers for Medicare and Medicaid Services fine organizations for
never events such as falls and hospital acquired pressure ulcers.
This places financial burden on the organization. Furthermore,
following implementation of Affordable Care Act (ACA) -
Obama-care, patients are no longer limited to one healthcare plan.
The implication is that patients who are not satisfied with their
level of care can transfer care to another provider. Clearly,
identifying and resolving barriers to AHV can impact the ultimate
improvement in outcome of patient care as well as team and
patient engagement.
TIMELINE
OBJECTIVES
To identify and eliminate barriers to Authentic Hourly Visitation.
To increase the overall rating of the hospital from 68.3% to 80% by
December 2016.
To improve the quality and frequency of AHV in order to make it
more meaningful to staff and patients.
SIGNIFICANCE
• Performing the 4PS (presence, pain, position, & potty) during
AHV improves outcome of care and overall HCAHPS scores.
• AHV decreases the use of call light among hospitalized patients,
decreases fall rate, and decreases interruptions in the workflow
of the nurses and patient care technicians
LITERATURE REVIEW
The study of Daniel (2016) on hourly rounding showed a 5%
increase in nurse to patient communication and an 11% increase in
pain management scores. He cited the Institute for Healthcare
Improvement (IHI) who “endorsed hourly rounding as the best way
to reduce call lights and fall injuries, and increase both quality of
care and patient satisfaction” (p.1).
Similarly, Stanford Health Care published the result of a research
conducted in 14 hospitals on hourly rounding which showed that
hourly rounding led to 14% decline in pressure ulcers and 12%
increase in patient satisfaction scores. One of the hospitals
reported a 20% decline in the distance the nurses walk each shift.
5/25 6/3-
6/12
8/95/27 6/13-
6/21
6/23 6/28-
7/11
7/12-
7/19
7/20
8/5
Identify and define project
topic
Aim Statement & Background
Develop Charter and
Questionnaire. Meeting with
professor Coleman for update
Review of literature and
questionnaire
Review and update project
charter and questionnaires
Microsystem assessment with
manager.
Work on charter
Meeting with IT for data
collection
Hand out questionnaires to
staff for data collection
Data analysis and updates
Putting it all together. Review
of project and presentation to
preceptor and other leaders.
Final poster Presentation
• Decrease patient falls and hospital
acquired pressure ulcers
• Improve nurse to patient communication
• Decrease use of call lights
• Improve patient care experience
• Increase HCAHPS scores
• Cost savings for the organization
• Improvement in patient satisfaction
scores.
• Changes in the rounding process
(provide chairs for nurses to sit in the
patients’ rooms) to make it more efficient.
• Staff have received training on AHV
• CNL in the microsystem will lead the
process in collaboration with frontline
staff.
• Addressing barriers to AHV
• Creating a location for staff to
document AHV
Strengths Weaknesses
Opportunities Threats
• Inconsistent rounding by nursing staff.
• Rounding that is not meaningful
• Interruptions during rounding
• Lack of team collaboration and frontline
staff participation in decision making
process
• Lack of follow up
• Inadequate staffing
• Reimbursement
• Loss of clientele to competitors
• Loss of reimbursement dollars
MODEL FOR IMPROVEMENT
FINDINGS
• 70 questionnaires were distributed among registered nurses and
patient care technicians working in medical surgical unit and
medical telemetry unit.
• 60 questionnaires were completed and returned for a return rate of
90%
• The questionnaire contained 11 questions aimed at identifying how
AHV is currently performed and what challenges the staffs
encounter.
Barriers Total Percent
Time Constraint 10 17%
Inadequate Staffing 17 28%
Patient Condition 9 15%
Multiple Interruptions 24 40%
Total Percent
1-5 7 12%
5-10 35 58%
10-15 12 20%
>15 6 10%
Time Spent
on
AHV (mins)
DRIVER DIAGRAM