HOURLY ROUNDS APRIL 13, 2015
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Hourly rounding was implemented in a long term care facility to reduce falls among residents. The pilot program involved education of staff on hourly rounding and use of a checklist to document rounds. Initial results showed a 43% reduction in falls during the 30 day pilot period compared to the previous year. However, compliance with hourly rounding decreased due to staffing shortages. Continuous education and supervision are recommended to sustain fall reductions through consistent hourly rounding. Direct observation of staff also improved adherence to the rounding protocol.
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Hourly rounding involves nurses proactively checking on patients on an hourly basis to address any needs related to pain, bathroom use, positioning, and proximity of items. Studies have shown that hourly rounding can reduce call light usage by 38%, falls by 50-60%, pressure ulcers by 14%, and improve patient satisfaction scores. Hospitals that implemented hourly rounding also saw increased nursing satisfaction and efficiency due to answering fewer call lights and having more time for other tasks.
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Utilize the 8 "Vital Behaviors" to integrate Purposeful Hourly Rounding into our daily clinical practice. Anticipated to improve our current practice of hourly rounding to be more purposeful with intention.
Nursing rounds,manual,protocols
Nursing rounds involve a head nurse or teacher leading rounds with staff or students to understand patient conditions and the effects of nursing care. The purposes of rounds include observing patients' physical and mental states, staff work, introducing patients to personnel, carrying out care plans, evaluating treatment results, and teaching students. Rounds are conducted by discussing objectives outside patients' rooms first, then briefly visiting patients. Advantages are testing students' knowledge, benefiting informed students, orienting new nurses, and evaluating nursing activities and challenges. Disadvantages can include hampering confidentiality and distractions reducing attention. Standing orders provide emergency treatment guidance for areas without doctors by promoting temporary care until a doctor can be seen.
Community h centers theories
This document discusses various quality improvement theories and models that can be used for infection control, including FADE, PDSA cycles, and total quality management (TQM). It provides examples of how PDSA cycles and TQM principles have been applied in healthcare settings. References are included from literature discussing quality improvement methods for improving care and the use of behavioral theories in infection control. The document also describes the search strategies and collaboration challenges experienced by a group working on applying these quality improvement models.
Beginning an improvement journey ii introduction to improvement models
This document discusses various improvement models and approaches that can be used to enhance processes and quality, including Lean, Six Sigma, Toyota Production System, Theory of Constraints, and PDSA cycles. It explains that the most appropriate model depends on the goals of the improvement, the organization's maturity level, and available resources. Key aspects covered include using small tests of change to reduce risk, empowering teams, and focusing on incremental daily improvements in addition to discrete projects and events. The overall message is that multiple models can be effective and it's important to match the approach to the specific situation.
Improvement of Hospital Project Cost and Schedule Mgmt Final Rpt
Of pressing concern to the CFO of our client hospital were the spending issues and schedule
slippages of internal implementation projects--issues that he felt contributed to the
current cash flow problem of the hospital that would grow to an even greater problem if
EMR capabilities weren’t fully implemented and operational by 2015. The CFO solicited
external help to 1) validate why there has existed such a level of overspending and
schedule slippage on projects, 2) propose a recommendation for solutions, and 3) change
the existing process to ensure better project budget and schedule control in the long run.
Successful Projects For Leaders (SP4L) had been hired as a consultant to assess what
went wrong with that implementation and to improve how projects in general would be
conducted so that it could move forward with the EMR project successfully. By using a systematic approach, we identified several areas in the project Initiation-Planning-Execution-Control-Closing process that needed modification. The net result is
better project cost and schedule performance, leading to better cash flow budgeting and
planning, with an expected savings of more than $350,000 annually as well as improved
acceptance and ownership by the end-users. Based on the proactive response to their
issues, the CFO, CNO, and PCCs are satisfied and are serving as excellent centers of
influence for the rest of Senior Management and the nursing staff, respectively.
Profile
Preston Robinson is a director and manager of sales operations with over 20 years of progressive experience in sales, operations, finance, and people leadership. He has consistently exceeded profit goals by 5% annually and driven $7.5M in incremental profit. Robinson has experience transitioning between finance and sales roles, engaging teams, and fitting within diverse cultures. He focuses on employee growth, performance management, and developing talent.
A3 Management (Part 1 of 2)
The document provides an overview of a webinar on A3 Management. It introduces Karen Martin as the instructor and discusses the agenda, which focuses on using the A3 problem-solving method. This includes exploring the key components of an A3 report such as defining the problem theme, analyzing the current and target conditions, identifying the root cause, and developing countermeasures. The goal is to teach a structured approach to problem-solving using the PDSA cycle and visual A3 format.
Operating Systems - File Management
The document discusses how operating systems manage files and memory allocation. It explains that from the computer's perspective, there are no actual files, only blocks of allocated and unallocated memory. The file manager in the operating system creates the illusion of files and folders by tracking memory locations and implementing file allocation policies. Files can be stored contiguously, non-contiguously, or through indexed allocation with pointers. Access controls determine which users can access which files.
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Beginning an improvement journey ii introduction to improvement models
Beginning an improvement journey ii introduction to improvement models
Improvement of Hospital Project Cost and Schedule Mgmt Final Rpt
Improvement of Hospital Project Cost and Schedule Mgmt Final Rpt
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Lean thinking in EMERGENCY Department
Lean thinking principles were implemented in the emergency department of The Mission Hospital in Durgapur, India to improve patient flow and reduce waste. Key aspects of lean thinking used included value stream mapping to identify non-value adding activities, applying the 5S methodology to organize the workspace, and conducting gemba walks to observe processes firsthand. This led to reductions in patient length of stay, wait times, and overcrowding in the emergency department. Bottlenecks like long wait times for radiology, inpatient teams, and available beds were identified and addressed through lean problem solving techniques. Implementing lean thinking also helped prevent physician burnout by streamlining workflows and reducing clerical burdens.
Capstone Project Change Proposal Presentation for Faculty Review a.docx
Capstone Project Change Proposal Presentation for Faculty Review and Feedback
Assessment Description
Create a 10-15 slide Power Point presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in the digital classroom for feedback from the instructor.
PICOT Question (See other file uploaded)
Interventions
Falling incidences can cause several complications, including health care costs, severe health issues, immobility, etc. With the severity of this issue, appropriate interventions should take place. In this context, proper monitoring is one of the significant interventions to prevent this incidence (Huang et al., 2020). Hence, incorporating educated and efficient technicians while providing patient care can be an essential step. Yet, due to decreased mobility or functionality, older people often require help in doing basic activities, in this aspect, providing help to the patients while changing to hospital-approved gowns (Liu-Ambrose et al., 2019). In addition, one significant and effective intervention is providing quick education to the patient regarding fall prevention strategies (Radecki, Reynolds & Kara, 2018). Another critical aspect is providing a safe environment for clinical care. Outpatient clinics should improve their workflow and environmental condition, such as removing hazardous materials, and keeping the floor clean and dry, so that the clinic can provide a safe area for older patients. These interventions can help prevent falls (Guirguis-Blake et al., 2018).
Benchmark - Capstone Change Project Objectives
1. Prevent elderly falls in an outpatient radiology clinic.
Rationale: Falls occur as age advances due to individual risk factors or environmental factors. For example, gait or balance deficits, chronic conditions, medications, and footwear the patient is wearing. Assisting these patient populations can prevent falls in the department.
2. Educate patients and people in the community on how to prevent falls.
Rationale: Educate patients regarding physical changes and chronic health conditions that cause or probability of falls.
3. Provide a safe environment for clinical care in the outpatient clinical setting.
Rationale: Design the clinical area accessible to patients in wheelchairs, with assistive devices, and with mobility deficits. Have handrails on walls and hallways for support, clean, non-skid floors, and lighted pathways in hallways, rooms, and bathrooms.
4. A patient care technician (PCT) is available in the outpatient clinical area for patients.
Rationale: Having a PCT in the clinical area, especially around the dressing rooms, would benefit the patients needing help when changing to hospital-approved gowns and monitoring patients for risk.
Identifying Problems
The document discusses identifying problems in healthcare quality and reducing waste. It begins by outlining the six aims of quality healthcare: safe, timely, effective, efficient, equitable, and patient-centered. It then discusses various sources of waste in the healthcare system, including overtreatment, failures of care coordination, failures to execute best practices, excessive administrative complexity, pricing failures, and fraud/abuse. Specific estimates are given for the amount of waste from each category, totaling hundreds of billions of dollars annually. The document emphasizes the opportunity for improvement that exists and stresses the importance of focusing on problems we can directly address and fix.
Hospital Harm Measure: Can It Really Be Used For Improvement?
This document summarizes a webinar about using hospital harm data and resources to inform quality improvement plans. It includes an agenda with presentations on the patient perspective, an organization's experience in Fraser Health, and tips for using the Hospital Harm Improvement Resource. It discusses why reducing hospital harms is important to patients, and Fraser Health's journey to reduce common harms like UTIs, pneumonia, and sepsis. It promotes engaging patients and provides links to resources on including the patient experience and engaging patients as partners in safety. Attendees are invited to learn more about the Hospital Harm project through listed websites and contacts.
Falls collaborative case studies
We held an improvement collaborative with 19 NHS providers earlier this year to help improve the management of falls in an inpatient setting.
This resource shows case studies of the providers involved in the collaborative.
Prevention of patient falls - A case study
This document discusses a case study on preventing patient falls at a hospital. It found that falls decreased after implementing a fall prevention program that included a fall risk assessment tool, staff training, patient education, and safety interventions. Initially there were 7 falls reported in 6 months, which increased to 14 falls in the next 6 months as incident reporting improved. After the prevention program, falls decreased to 4 in the next 6 months. The program analyzed causes of falls and found major reasons were falls from beds, to bathrooms at night without assistance, and due to patients' medical conditions.
Blog
Hourly rounding has been shown to reduce patient fall rates in hospital settings compared to using tab or bed alarms alone. Study 1 found that implementing hourly rounding on inpatient units resulted in a 23% reduction in falls, though it was not statistically significant. Study 2 was a systematic review finding that most studies reported hourly rounding as an effective way to reduce fall rates in hospitals. Together these studies indicate that hourly rounding may help prevent falls more than other interventions alone and has been associated with reductions in fall rates in various hospital settings.
Fall Prevention (1)
This document outlines an evidence-based fall prevention project conducted by nursing students at Alvernia University. It includes background information on the problem of falls in hospitals, learning objectives, a PICO question, and a literature review. The literature review found that multicomponent fall prevention programs utilizing multiple nursing interventions tailored to individual patient needs are most effective at reducing inpatient falls compared to single interventions alone. Continuous re-evaluation of interventions is important to assess effectiveness and improve outcomes. Current practices at Good Samaritan Hospital for fall prevention are also described.
January-February 2016 • Vol. 25No. 1 17CPT (R) Gwendolyn .docx
January-February 2016 • Vol. 25/No. 1 17
CPT (R) Gwendolyn Godlock, MS-PSL, BSN, RN, AN, CPHQ, is Field Representative Nurse
Surveyor, The Joint Commission, Oakbrook, Terrace, IL.
CPT Mollie Christiansen, BSN, RN, AN, CMSRN, is Clinical Nurse Officer in Charge, Burn
Progressive Care Unit, United States Army Institute of Surgical Research, Joint Base San
Antonio Fort Sam Houston, TX.
COL Laura Feider, PhD, RN, is Dean, School of Nursing Science and Chief, Department of
Nursing Science, Army Medical Department Center and School, Health Readiness Center of
Excellence, Joint Base San Antonio Fort Sam Houston, TX.
Acknowledgments: The team would like to thank nursing leaders COL (R) Sheri Howell, for-
mer Deputy Commander of Nursing and Chief of Staff; and COL Richard Evans, Assistant
Deputy Chief Army Nurse Corps, for their support. A special acknowledgment for the former
Chief, Medical Nursing Section, COL Vivian Harris, who remained a staunch supporter, advo-
cate, and cheerleader, the Medical Section nursing staff, and the Center for Nursing Science
and Clinical Inquiry.
Note: The view(s) expressed herein are those of the authors and do not reflect the official policy
or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army
Office of the Surgeon General, the Department of the Army, Department of Defense, or the U.S.
Government.
Implementation of an Evidence-Based
Patient Safety Team to Prevent Falls
in Inpatient Medical Units
T
he Centers for Medicare &
Medicaid Services identified
falls as a preventable health
care acquired condition (DuPree,
Fritz-Campiz, & Musheno, 2014). A
large portion of the medical-surgical
inpatient population is aging, and
therefore at high risk for falls (Boltz,
Capezuti, Wagner, Rosen berg, &
Secic, 2013). Falls have physical and
emotional implications for patients,
as well as increased financial costs for
facilities. Nationally, medical units
have the highest rates of falls
(Bouldin et al., 2013). Most notably,
falls can cause significant injuries
resulting in increased length of stay,
unexpected surgeries, and even death
(Williams, Szekendi, & Thomas,
2014). Historically medical-surgical
nurses care for a mix of complex
patients with an array of comorbidi-
ties and patient needs (Carter &
Burnette, 2011).
Literature Review
The literature search was limited
to keyword searches on falls, team-
work, patient safety, nursing, hourly
rounding, and communication. Data -
bases included PubMed, EBSCO,
Agency for Healthcare Research and
Quality, CINAHL, and The Joint
Commission for years 2008-2014.
Use of fall prevention teams was an
emerging evidence-based practice
(EBP) intervention to decrease the
incidence of inpatient falls (Graham,
2012). Consistently, the evidence
demonstrated ineffective communi-
cation, situation awareness, team-
work, assessment, hourly rounding,
and environmental challenges as key
factors related to preventable inpa-
tient falls.
Collectively, research.
Time Out Project, Woodhull Hospital
This document summarizes a study conducted at Woodhull Medical Center on improving patient safety through implementing surgical checklists called "Time Outs". The study found that adopting checklists to confirm key patient and procedure details before surgeries significantly reduced complications and deaths, cutting rates nearly in half. Over multiple years, the Woodhull study expanded Time Outs to other medical areas and evaluated staff attitudes. The researchers aim to determine how training impacts Time Out quality and whether improvements correlate with safety perceptions. Proper use of checklists was found to shift staff perspective from seeing Time Out as an extra task to recognizing its ability to help ensure safer care.
The rise and fall of your patient
Presented by: Angela Greetham, Bay of Plenty DHB
at OHSIG 2014, Thursday 11/9/14, Limelight Room 1, 11.15am
Video URLs:
HQSC on fall prevention: www.youtube.com/watch?v=NdO7JCXJBO4
Amy rwakihembo task sharing uganda final
This presentation discusses enabling clinical officers in Uganda to provide tubal ligations to address workforce shortages. There is a shortage of healthcare workers in Uganda, with only 1 worker per 625 people compared to the WHO recommendation of 1 per 435. Currently 62% of doctor positions are vacant. The presentation outlines the rationale for task sharing based on shortages and uneven distribution. It also describes a study that assessed complications and client satisfaction for tubal ligations performed by clinical officers, finding low complication rates and over 99% of clients rating the procedure as good or very good. The conclusions recommend allowing clinical officers to specialize in family planning services including tubal ligations or adding tubal ligations to their national curriculum.
A safety champion program engagement and empowerment of frontline staff to pr...
The document describes a Safety Champion Program established at Henry Ford Health System (HFHS) to promote a culture of safety through engaging and empowering frontline staff. The program trains multidisciplinary employees as Safety Champions to act as voices and faces of safety on their units. Safety Champions complete core training courses and then work to identify safety issues, improve communication and processes, and share best practices. Evaluation found units with Safety Champions showed significantly greater improvements in safety culture survey scores than those without. A variety of unit-based projects initiated by Safety Champions helped reduce safety issues like injuries. The program has been successful, with over 350 Safety Champions participating, and is credited with positively impacting HFHS' culture of safety.
The Effect of Protocol of Nursing Intervention on Quality of Care in Minor In...
IOSR Journal of Nursing and health Science is ambitious to disseminate information and experience in education, practice and investigation between medicine, nursing and all the sciences involved in health care.
Nursing & Health Sciences focuses on the international exchange of knowledge in nursing and health sciences. The journal publishes peer-reviewed papers on original research, education and clinical practice.
By encouraging scholars from around the world to share their knowledge and expertise, the journal aims to provide the reader with a deeper understanding of the lived experience of nursing and health sciences and the opportunity to enrich their own area of practice
Prevention of Patient Falls - A Case Study
Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. According to researcher Janice Morse, approximately 14% of all falls in hospitals are accidental, another 8% are unanticipated and 78% are anticipated falls. Guideline to prevent falls in the hospital has helped to bring down the numbers and improve patient safety.
TCAB_AM
This document discusses the Transforming Care at the Bedside (TCAB) initiative launched by the Institute for Healthcare Improvement to redesign care on medical/surgical units. TCAB aims to improve safety, patient-centeredness, team vitality, and value through engaging frontline staff in testing changes. The framework focuses on high leverage changes like leadership, teamwork, patient-centered care, value-added processes, and safety. Metrics include adverse events, falls, pressure ulcers, satisfaction, and time spent on direct care.
Effective Falls and Fracture Management within Primary Care: a qualitative ge...
Effective Falls and Fracture Management within Primary Care: a qualitative ge...UKFacultyPublicHealth
This document summarizes a study that explored general practitioners' perspectives on managing falls and fractures in older patients. Through interviews with 17 GPs, the study identified several key themes: falls prevention is a high priority but GPs face barriers like a lack of integration between primary and secondary care, incomplete awareness of available services, and complex referral pathways that consume valuable time. Opportunities exist at both the population and individual levels through public health initiatives, risk stratification, and targeting interventions to high-risk groups. Overall, the study highlights the ongoing challenge of falls management within primary care given its time constraints and role as the frontline of the overstretched NHS.CAPSTONE-FINAL-5-11-15
This document presents a program evaluation of the Stepping On falls prevention program. The evaluation analyzed four outcomes of the program: self-efficacy, participant valuation, lower body strength, and reduction of fall risk. Data was collected through questionnaires given to participants at the beginning, end, and 3-month follow up of the program. Results showed a significant increase in lower body strength and decrease in fall risk, but no significant change in self-efficacy. Participants reported high perceived value of the program. The evaluation suggests Stepping On is effective in fall prevention based on improvements in strength, risk reduction, and valuation, though program measurements and follow up could be improved.
1 QUALITY IMPROVEMENT STUDENT PROJECT PROPOSAL IMPR.docx
This summary provides an overview of a quality improvement proposal to improve patient handoffs in the emergency department at San Francisco General Hospital. The proposal aims to address issues with the current non-uniform verbal handoff process. The intervention involves implementing the SBAR communication technique using rapid PDSA cycles. Early adopters will test the new handoff method during shifts and evaluate satisfaction and compliance. Opinion leaders will then help convince more physicians to adopt the standardized SBAR protocol. The goal is to achieve 100% compliance within 18 months to improve patient safety and provider satisfaction during handoffs. Barriers to changing the existing process include resistance from physicians comfortable with the status quo and perceptions that a new method may take more time.
DPM Project Work.pdf
In this case study, we delve into the crucial role of Business Process Management (BPM) in optimizing the efficiency and responsiveness of a Hospital's Emergency Department. We uncover how process modeling and automation, coupled with performance metrics, enhance patient care and throughput. We also discuss our unique KPI formula, designed to quantitatively evaluate improvements and steer towards evidence-based decision making. Join us as we explore the transformational power of BPM in the healthcare sector.
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Capstone Project Change Proposal Presentation for Faculty Review a.docx
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January-February 2016 • Vol. 25No. 1 17CPT (R) Gwendolyn .docx
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HOURLY ROUNDS APRIL 13, 2015
- 1. INTRODUCTION DONNAARIS RN AURORA UNIVERSITY PROBLEM METHODS OUTCOMES & IMPLICATIONS 1 2 3 4 6 Figure 1. Sample Hourly Round Checklist Table 1: Phases of Pilot Program Methods/Approach Figure 2. Fall rates pre & post hourly rounds pilot program RESULTS OF INTERVENTION FINDINGS & RECOMMENDATIONS . IMPLICATIONS REFERENCES In 2011, 22,900 older adults died from falls.1 Injury from falls cost $30 billion in 2012, and is expected to increase to $68 billion in 2020. 1 Medicare & Medicaid are no longer paying facilities for treatment of in- facility fall.2 ... Most falls are caused by multiple factors, both intrinsic (patient related) and extrinsic (environmentally related).3 Multifactorial interventions; two or more interventions linked to each faller risks profile, there was a reduction in falls.5 Patient-centered proactive hourly rounding, where front-line staff actively participates in the design of the pilot phase, record significant fall reduction rates.4 EXPLORATORY FEB 01-15 Audits of care/ CNA’S work flow Review fall protocol Chart review/fall hx. N=6 Met multidisciplinary teams Review of literature EDUCATION FEB 02-06 Education sessions/ 1N Hourly Round 4P’s Poster board Hourly rounds & Hourly Round Checklist Observational Audits/daily Review falls data weekly IMPLEMENTATION FEB 16- MAR16 Suggestion Box Hourly Round Forms Staff Teach back on Hourly Rounds Hourly Round Support & Audit checklist for compliance Staff feedback EVALUATION FEB 16 WEEKLY THRU MAR 16 Staff teach back Observational Audits/Weekly & Daily Daily & Weekly Q & A Analyze data & final meeting with team Findings reviewed/DON; to begin pilot program on other units 2014 NO - INTERVENTION FALLS = 37 PRE - INTERVENTION FALLS=14 43% FALL REDUCTION IN 30 DAYS POST- INTERVENTION FALLS=6 FALL RATES PRE- AND POST HOURLY ROUNDS 2014 2015 2015 Rounding completed on at risk residents. Star Team to participate as assigned. Date: 7am 8am 9am 10am 11am Noon 1pm 2pm 3pm Purposeful rounds completed by: (place initials in box indicating time of rounds, check all items below that apply for that time) 4 Ps Position Of Resident? Potty - Toileting schedule? Incontinent? Position of Bed Call light within residents reach? Position of Alarms - Bed & Chair? ENVIRONMENTAL SCAN Fall risk hazards: bed in low position, mats on ground. ***Pt. is able to "return demonstrate" the use of call light or light within reach *** Personal alarms bed & chair alarms activated. PATIENT CENTERED Ask, "Is there anything else I can do for you?" FINDINGS: Hourly rounds was not consistently done due to staffing shortages, staff could not round hourly in the rooms. Most falls occurred while residents were in their room. RECOMMENDATIONS: Continuous education about rounding and supervision is strongly recommended. This project demonstrates implementation of evidence based strategies can reduce falls in nursing homes. Commitment by the facility to reduce falls by engaging staff is vital to success of new initiatives. Quarterly reports on compliance with rounds and recognition of reduced fall rates, maintains staff motivation for the program. 1. Cost of Falls. (2014) Center for Disease Control and Prevention www.cdc.gov. 2. Jorgensen, J. (2012) Reducing Patient Falls: a call to action. American Nurse Today, 7 (1) 10-20. 3. Stevens, J.A., Finklestein, E.A., Miller, T. R., (2006) The cost of non-fatal falls among older adults. Injury Prevention, 12 (3) 290-295 4. Tea,C., Ellison M., Feghali, F. (2008) Proactive Patient Rounding to increase customer service and satisfaction on an Orthopedic Unit. Orthopedic Nursing, 27 (4),233-240 5. Udell,J.E. (2015). Interviews for preventing falls in older people: an overview of Cochrane Reviews. Cochrane Database Of Systematic Reviews, (1), doi:10.1002/14651858.CD009074.pub2 Continuous education on hourly rounds needed to sustain fall reduction. CNA’s complained staff shortage affected hourly rounds. Low compliance with completing hourly rounds checklist/computer integration suggested. Direct observation audits increased compliance with rounds. OUTCOMES Reduction in use of call light. Reduction in falls by 43%. Reduction in CNA’s workload. Increased patient safety. Falls are the cause of an estimated1,800 deaths of residents in Long Term Care Facilities annualy.1 How does patient-centered proactive hourly rounds for residents in the LTCF, along with the use of multifactorial fall prevention interventions, e.g. bed & chair alarms, reduce fall occurrence and promote patient safety.