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Research project 3 for Kristen Brame
- 1. Kristen Brame RN BSN The University of Texas College of Nursing
- 2. • Bedside Report • Hourly Rounding • Team Huddles
- 3. • Should these topics be initiated? • Bedside Report • Develop a standardized process • Hourly Rounding • Focus on the four P’s • Team Huddles • Fast, highly focused • Scheduled regularly • Called by anyone
- 4. • Caruso, E. (2007). The evolution of nurse-to-nurse bedside report on a medical- surgical cardiology unit. MEDSURG Nursing, 16(1), 17-22. • Cooper, R., & Meara, M. (2002). The organizational huddle process- optimum results through collaboration. Health Care Manager, 21(2), 12-16. • Donald, A. (2002). How to practice evidence-based medicine. Medscape General Medicine, 5(1). • Ford, B. (2010). Hourly rounding: a strategy to improve patient satisfaction scores. MEDSURG Nursing, 19(3), 188-191. • Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: a pilot study. International Journal of Nursing Practice, 15, 287-293. • Haneberg, L. (2006). To improve teamwork, huddle up! Leader to Leader, Fall, 16-19. • Kleiber, C., Davenport, T., & Freyenberger, B. (2006). Open bedside rounds for families with children in pediatric intensive care units. American Association of Critical Care Nurses, 15(5), 492-496. • Orr, N., Tranum, K., & Kupperschmidt, B. (2007). Hourly rounding for positive patient and staff outcomes: fairy tale or success story? The Oklahoma Nurse Page, 11. • Trossman, S. (2009). Shifting to the bedside for report. The American Nurse, March/April, 7. • Weisgram, B., & Raymond, S. (2008). Using evidence-based nursing rounds to improve patient outcomes. MEDSURG Nursing, 17(6), 429-430.
Editor's Notes
- The effect of hourly rounding, bedside report and report huddles on the care of preterm infants is being researched in my facility. Evidence-based decision frameworks utilize four major steps: 1) eliciting, describing, defining and refining a structured question, 2) systematic and comprehensive overview of the literature, 3) evaluation of the data, 4) analysis of the data (Donald, 2002). During my participation in this research project my time has been spent in the systematic and comprehensive overview of literature, as well as the evaluation and analysis of the collected data. I have spent many hours assisting in the research of these three topics and their effects on preterm infant care. Because of the limited amount of research on these topics, I was instructed to slowly widen my search to include the general effect of these topics on patient care. I have utilized the libraries at the University of Texas at Arlington, the University of the Permian Basin, the Texas Tech Health Science Center and the World Wide Web. Throughout my research I have collected and examined numerous articles that have been helpful in the progress of this evidenced based project.
- After performing a comprehensive overview of the collected literature, I assisted in the evaluation and analysis of the collected data. During this process I discovered valuable information on the research topics that will assist Medical Center Hospital in deciding if they want to initiate bedside report, hourly rounding and team huddles in their facility. Research studies showed parents of children in IntensiveCare Units place great importance on receiving information about their children’s condition, having their questions answered, and talking with the physicians in charge of their children’s care (Kleiber, Davenport and Freyenberger, 2006). Opening the NICU to patient’s families during bedside rounding is a simple intervention that has beneficial effects for parents, children and the healthcare team (Trossman, 2009). While analyzing the research studies on hourly rounding I discovered that nurses are called to each patient’s room 12-15 times a day for non-urgent requests with each call taking at least 4 minutes of the nurses time (Gardner, Woollett, Daly & Richardson, 2009). These interruptions in the cognitive work of nursing can cause omissions in care and potentiate medical errors (Orr, Tranum &Kupperschmidt, 2007). The purpose of hourly rounding is to anticipate and meet patient needs routinely, and ensure patient safety (Ford, 2010). Rounding allows information to be gathered in a structured way, addressing problems before they occur. - Practice improvement literature emphasizes using team huddles in health care to improve the quality and depth of primary health care. Communication is a key element of team function, and has been recommended by the US institute for Healthcare Improvement as a key strategy to reduce medical errors and improve health care outcomes (Haneberg, 2006). A team huddle is a quick gathering of patient care team members to discuss and decide on a plan of action for the day. Participants develop an enhanced appreciation for face-to-face communication accountability, trust, support and mutual respect. Like the best football teams, participants learn to discuss the game plan, make quick adjustments to changing conditions and support each other toward the accomplishments of a common goal (Cooper &Meara, 2002).
- While this research project is still in progress, I feel I have furthered the anticipated outcome of initiating bedside report, hourly rounding and team huddles at Medical Center Hospital. After a significant amount of research and evaluation, I have developed several suggestions I feel would assist our administration in the initiation process. To assist in the transition to bedside reporting, a standard process should be developed. The following process would be my suggestion for a standardized bedside report. Nursing staff would receive their assignment for the day and locate the off-going nurse for their patient. Both nurses would go to the patient for an introduction and would discuss pertinent information and the plan of care for the day with each other and the patient. An assessment of IV lines, wounds and patient status would be performed jointly, so any concerns could be resolved by both nurses. According to Caruso (2007), nurses using this process reported great satisfaction in having seen and briefly assessed the patient prior to initiating the shift. According to Ford (2010), hourly rounding is a new proactive approach to organizing nursing care that has garnered positive results; its focus on patient-centered care has led to notably improved patient satisfaction scores. To assist in the initiation of hourly rounding at Medical Center Hospital, I would suggest coaching staff to evaluate the four P’s: Pain, Personal needs, Positioning and Placement (Ford, 2010). By assessing patient pain, need to void, need to be repositioned and ensuring all items are in reach, nursing staff can decrease the number of calls received to return to patient rooms and increase patient satisfaction (Weisgram & Raymond, 2008). As a result of my time spent researching and evaluating team huddles, I have developed multiple suggestions to facilitate their use at Medical Center Hospital. First, huddles should be fast and highly focused. I would suggest staff remain standing in a circle to encourage speed and a sense of camaraderie. Secondly, team huddles should be scheduled regularly, 2-3 times a week, and should not be canceled. Finally, all team members should be encouraged to call additional team huddles when a challenge is encountered. Upon completion of this study, Medical Center Hospital will decide whether or not to initiate these research topics in their facility. I feel the data I have collected, evaluated and analyzed, in addition to my suggestions will assist Medical Center Hospital in making a knowledgeable decision.