Implementing Purposeful Hourly Rounding on Medical ...
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Implementing Purposeful Hourly Rounding on Medical
Surgical Unit to Decrease Call Light Usage and Increase
HCAHPs Staff Responsiveness Score
Tru Byrnes, MSN, CNL, RN, CMSRN
MSN Capstone Project
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Disclosure Information
Presenter Name Tru Byrnes, MSN, RN, CNL, CMSRN
Conflict of Interest None
Employer Carolinas Medical Center-Main
Sponsorship / Commercial
Support
None
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Learning Objectives
Session Goal
- Increase the clinician’s knowledge on how to improve HCAHPs
Staff Responsive Score.
Session Objectives
– Describe the importance of purposeful hourly rounding in clinical
practice.
– Develop strategies to increase staff compliance to the protocol.
– Evaluate outcomes based upon HCAHPs Staff Responsive
Score
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Carolinas Medical Center- Charlotte NC
874 licensed beds
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Setting
• 5T Medical Surgical Unit
• 36 Beds
• Patient Population
• Nurse-Patient Ratio
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Purpose & Goals
Purpose
• Increase compliance with purposeful rounding by holding
staff accountable to the protocol
Goals
• Increase staff compliance to the protocol by 30%
• Increase staff responsiveness score by 15%.
• Decrease patient call light usage by 15%
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Problem Identification
Staff Responsiveness
2013
Percentile
1st quarter 92.8
2nd - 3rd quarters 68
Benchmark 85
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Theoretical Framework
• Lewin’s Change Theory
– Unfreezing
– Movement
– Refreezing
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Review of LiteratureAuthors Call Light Usage Reduction
Culley (2008). • 77 on the step-down unit
• 31% on the surgical unit
• 56% on medical unit
Ford (2010). • 52% after three weeks of hourly rounds
Patient Satisfaction
Bourgault, A., King, M., Hart, P.,
Campbell, M., & Swartz, S. Lou, M.,
2008.
HCAPHs Scores:
• Overall quality of care (p<0.04)
• Hospital recommendation (p<0.03)
Murray, T., Spence, J., Bena, J.,
Morrison, S., & Albert, N., 2010.
• 34.6% increased on hospital experience rating from
20.4% to 55%
Barriers
Deitrick, Baker, Paxton, Flores, &
Swaverly., 2012.
• Lack of education and training on the rounding
process, and accountability.
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Methodology
• Quasi-experimental Design
– A series of audits:
• Pre and post intervention on staff compliance of
purposeful hourly rounding
– Monitored call light data and staff responsiveness
HCAPHS score
• Sample
– N=70
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Methodology
• Interventions
• Staff education on 5Ps of rounding
• Disseminated reminder cards with scripted 5Ps
• Project Duration
• 9 weeks
– 4 weeks pre- post intervention data collection
and 1 week staff education
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)• 2010 – 31 CLABSIs - $1,420,234
• 2011 – 20 CLABSIs - $916,280
• 2012 – 24 CLABSIs - $1,099,536
• 2013 – 16 CLABSIs - $733,024
Steps Are steps followed?
Y/N
(comments)
1 Knock on door gently and announce entry indicating that you are there to
check on the patient. If the patient is awake:
Pain: Assess/Ask about pain. If not RN, call RN if pain is present
2 Potty-Ask whether patient needs bedpan or if ambulatory, assistance to
the bathroom
3 Position- Turn Patient every 2 hours if at risk for developing pressure
ulcer. If not, offer to reposition patient/ ask if patient is comfortable
4 Possessions-Ensure that call light, phone, Kleenex, water, trash can, and
patient’s belongings are all within reach of patient.
5 If patient awake, check if they need anything else while you are in the
room
6 If patient awake, tell patient someone from team will be back in 1 hour to
check on if patient asleep check again in 1 hour
5Ps Purposeful Rounding Protocol Audit Tool
5T Staff Patient Rounding (RN/ NA) 7Aam to midnight
Date of Audit
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Outcomes
Compliance rate on staff addressed all 5Ps during their
patient rounds
• Audited n=50 staff out of 70 (RNs and CNAs)
• Pre-intervention: 23%
• Post-Intervention: 63%
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Outcomes
1800
718
2300
778
0
500
1000
1500
2000
2500
Baseline data prior tothe project
implementation
Phase 1 pre-intervention (audit)
Times between phase1 and phase 2 without
audit
Phase 2 post-intervention (audit)
Nu
mb
er
of C
alls
Total Call Light Usage in Two Weeks
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Outcomes
40.1%35.7%
44.4%
65.0%
50.0%
80.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Reponsiveness of hospitalstaff
Call button help soon aswanted it
Help toileting as soon as youwanted
HCAHPS Survey Results
Pre-Implmentation (April 1-June 7) Post-Implementation ( June 8-August 8)
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Recommendations
• Establish purposeful rounding as a process, it is
essential to continue periodic audits.
• Select champions from various shift to help promote and
maintain the process.
• Audits should be performed without staff knowledge to
prevent Hawthorne Effect and obtain reliable data.
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Recommendations
• Replicating this study on another unit for a longer
duration may help verify significant of project findings.
• Investigating variables that impact staff resistance to this
concept of rounding.
• Change unit culture to consistently meet patient needs
proactively.
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References
• Bourgault, A., King, M., Hart, P., Campbell, M., & Swartz, S. Lou, M. (2008). Nursing
Management, 39 (11), 18-24.
• Culley, T. (2008). Reduce call light frequency with hourly rounds. Nursing
Management, 39 (3), 50-52.
• Deitrick, L., Baker, K., Paxton, H., Flores, M., & Swavely, B. (2012). Hourly Rounding:
Challenges with implementation of an evidence based-process. Journal of Nursing
Care Quality, 27 (1), 13-19.
• Ford, B. (2010). Hourly rounding: A strategy to improve patient satisfaction scores.
MEDSURG Nursing, 19 (3), 188-191.
• Grove, S., Burns, N., & Gray J. (2013). The practice of nursing research: Appraisal,
synthesis, and generation of evidence (2nd Ed). St. Louise: MO: Elsevier
• Kaminski, J (2011). Theory applied for informatics: Lewin’s change theory. Canadian
Journal of Nursing Informatics, 6(1), Editorial http://cjni.net/journal/?p=1210.
• Murray, T., Spence, J., Bena, J., Morrison, S., & Albert, N. (2010). Journal of Nursing
Care Quality, 25 (4), 366-372.
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Acknowledgment
• Dr. Janie Best, DNP, RN, CNL, ACNS-BC, Faculty
Advisor at Queens University of Charlotte
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