Hospital Pathways programme - Intentional Rounding


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Hospital Pathways programme - Intentional Rounding

  1. 1. Theory Burst Intentional Nurse Rounding Annette Bartley Faculty member The Hospital Pathways Programme A partnership between The King’s Fund Point of Care and The Health Foundation
  2. 2. Session Objectives <ul><li>To discuss the fundamental aspects of care </li></ul><ul><li>To communicate the purpose of inpatient hourly( intentional) rounding </li></ul><ul><li>To describe key steps in the process </li></ul><ul><li>To identify key factors that will help to determine success </li></ul>
  3. 3. Understanding the context of bedside care <ul><li>What’s good about it? </li></ul><ul><li>What’s not? And why? </li></ul><ul><li>What could be improved? </li></ul>
  4. 4. Intentional Rounding – What is it? <ul><li>Structured process where frontline staff regularly round on patients and reliably perform scheduled/required tasks </li></ul><ul><li>8 key behaviors </li></ul><ul><ul><li>Opening key words – managing up </li></ul></ul><ul><ul><li>Perform scheduled tasks </li></ul></ul><ul><ul><li>Address the 3 p’s of pain, potty? (toileting), and position </li></ul></ul><ul><ul><li>Assess comfort needs </li></ul></ul><ul><ul><li>Environmental assessment </li></ul></ul><ul><ul><li>Closing key words </li></ul></ul><ul><ul><li>Explain when you or others will return </li></ul></ul><ul><ul><li>Document the round on the log </li></ul></ul>
  5. 5. The “Case for Change” <ul><li>What does the data/evidence show us? </li></ul><ul><ul><li>Patient Safety—National Focus </li></ul></ul><ul><ul><li>Patient Perception of Care </li></ul></ul><ul><ul><ul><li>More Public Reporting </li></ul></ul></ul><ul><ul><ul><li>“ Satisfaction = Quality” in the eyes of the Customer </li></ul></ul></ul><ul><ul><li>Patient Satisfaction & Employee Satisfaction are closely linked </li></ul></ul><ul><ul><li>“ Alliance for Healthcare Research”= Studer Group Research Project </li></ul></ul><ul><ul><li>IHI/AONE TCAB Research Project </li></ul></ul><ul><ul><ul><li>Transforming Care at the Bedside </li></ul></ul></ul>
  6. 6. The Research <ul><li>Alliance for Health Care Research </li></ul><ul><ul><li>38% Reduction in Call Lights </li></ul></ul><ul><ul><li>12 point mean increase in Pt Satisfaction </li></ul></ul><ul><ul><li>50% reduction in patient falls </li></ul></ul><ul><ul><li>14% reduction in pressure ulcers </li></ul></ul>
  7. 8. Intentional rounding triaL Falls Reduction
  8. 9. Round the UK <ul><li>Wales/South West/South Central/UCLH/Northern Ireland/Scotland </li></ul><ul><li>Falls reduction/pressure ulcer reduction/less call bells </li></ul><ul><li>Help social isolation </li></ul><ul><li>Patient and staff satisfaction increase </li></ul><ul><li>Less ‘chaotic’ care </li></ul><ul><li>But message is to test it and then implement it systematically </li></ul>
  9. 10. Tools – Rounding Log
  10. 11. Tools – Badge Card
  11. 12. Tools – Accountability Tool
  12. 13. OMHS Intentional Rounding - wins <ul><li>59 % reduction in Pressure ulcers FY08: 7.82 FY09: = 4.83 </li></ul><ul><li>54% reduction in call lights – (2878 fewer calls after rounding) </li></ul><ul><li>Patient feedback – ‘I know someone will be back to check on me, and they come…’ </li></ul><ul><li>Improved employee satisfaction – 5.67 on a 7 point scale compared to national norm of 4.66 (Baird and Borling) </li></ul><ul><li>Reduction in cost </li></ul><ul><ul><li>$3.02/pt 6 month avg. prior </li></ul></ul><ul><ul><li>$2.39/pt 8 months avg. following </li></ul></ul>
  13. 14. Benefits of rounding (1) <ul><li>Reduced the number of call lights </li></ul><ul><li>• Reduced number of complaints related to pain </li></ul><ul><li>• Increased employee satisfaction </li></ul><ul><li>• Increased staff productivity </li></ul><ul><li>• Increased nursing staff satisfaction and gave </li></ul><ul><li>them control over patient care. </li></ul>
  14. 15. Benefits of rounding ( 2) <ul><li>Increased Patient Satisfaction </li></ul><ul><li>Patients are happier and feel staff are always accessible </li></ul><ul><li>Families were happier with the care </li></ul><ul><li>Reduced patient and family complaints </li></ul><ul><li>Issues can be resolved immediately </li></ul>
  15. 16. Initial feedback <ul><li>I’m in with patients more than one time an hour </li></ul><ul><ul><li>already … </li></ul></ul><ul><li>I am answering the call lights already </li></ul><ul><li>I do not have the time to document anymore </li></ul><ul><ul><li>Information </li></ul></ul><ul><li>This is just another “flash in the pan” idea </li></ul><ul><li>This will not help me – it will only cause me </li></ul><ul><li>more work </li></ul>
  16. 17. Staff Quotes <ul><li>“ I have seen hourly rounding increase patient satisfaction as well as employee satisfaction. When we started, our patient satisfaction was running in the 50 th percentile. Now we are in the 90 th percentile and above. Our employee satisfaction is now above the Gallup 75th percentile while previously it was only at the 50th percentile.” </li></ul><ul><li>Jean H. Price, R.N.,BC. Director </li></ul>
  17. 18. The art of the possible… <ul><li>Centred on patients </li></ul><ul><li>Catches all </li></ul><ul><li>Provides a quality assurance framework for care </li></ul><ul><li>Evidences what nurses do </li></ul><ul><li>Demonstrates the impact of care intervention </li></ul>
  18. 19. Factors for success <ul><li>Link to a specific aim ( falls reduction/social isolation) </li></ul><ul><li>Measures that relate to the aims </li></ul><ul><li>Be flexible allow nurses to be creative and co-design the process with patients </li></ul><ul><li>Get results before spreading </li></ul><ul><li>Hardwire into wider system </li></ul><ul><li>Monitoring process/managers </li></ul><ul><li>Celebrate successes </li></ul>
  19. 20. Think critically
  20. 21. In summary <ul><li>&quot;Facts are stubborn things, but statistics are more pliable&quot; </li></ul><ul><li>&quot;Always do right. This will gratify some people and astonish the rest.&quot; ~Mark Twain </li></ul>
  21. 22. Thank You! Questions?