Responding to Our Patients Signature Healthcare Brockton Hospital

Patient Surveys Names of all our patients are sent to Press Ganey and randomly they send our patients surveys They send a regular survey to some and a HCAHPS survey to others

HCAHPS Surveys “HCAHPS” stands for Healthcare Consumer Assessment of Hospital Providers and Systems” First national survey of patients’ perspectives of hospital care Developed by CMS and the Department of Health and Human Services

HCAHPS Surveys What areas are measured? Global Communication with Nurses Response of Staff Communication with Doctors Pain Management Communication about Medications Discharge Information

HCAHPS Surveys Established in 2006 HCAHPS participation was voluntary for first two years Data started to be required and publicly reported in 2008

Healthcare Reform Results of HCAHPS surveys publicly reported on www.hospitalcompare.hhs.org In 2010, Healthcare Reform (Patient Protection and Affordable Care Act) changed hospital reimbursement to a Value Based Purchasing system Value Based Purchasing is a system where the hospital is paid for the quality of care delivered

Value Based Purchasing Quality of care is determined by our patients through the HCAHPS survey results and our core measure results

Communication with Nurses

Response of Staff

So What Do We Do? Review of the literature Studer Group

What Does the Literature Say? Quality and patient satisfaction are connected Nursing communication is highly correlated with patient satisfaction If we want to do well on HCAHPS, we need a consistent culture of excellence

What Does Studer Say? To be truly responsive to a patient, the patient must believe their care is important to us The patient must believe they and their care are a priority to us A proven method to accomplish this is “Hourly Rounding” on patients.

Hourly Rounding Powerful tactic proven to: Improve clinical outcomes Decrease risk Reduce call lights Increase patient satisfaction Improve employee satisfaction

Rounding Results Data shows rounding: Decreases call lights by 38% Decreases falls by 50% Decreases hospital acquired decubiti by 14% Improves patient perception by 12 mean points

Hourly Rounding Defined Nurses and nursing assistants going to the patient room and “rounding” on patients hourly while demonstrating specific behaviors. 6 AM to 10 PM- hourly 10 PM to 6 AM- every 2 hours

Rounding Specific Behaviors Address patient’s most frequent requests based on research Keeps nursing in control of workflow instead of the patient controlling it Address patient needs in advance instead of waiting for the patient to ask

Rounding Specific Behaviors Not just “checking in” but completing specific behaviors Staff are tempted to modify rounds but it has been shown that this will decrease impact

Specific Behaviors Use opening key words Let the patient know your name and role Tell them you are here to do the “hourly round” Explain that you are here to check on their needs.

Specific Behaviors Complete scheduled tasks Perform tasks that are scheduled such as medication administration, treatments, procedures, etc.

Specific Behaviors Assess and address Pain Privy Positioning

Specific Behaviors Personal comfort needs Fluff pillow, straighten sheets, fill water pitchers, offer something to drink, etc.

Specific Behaviors Prevention by checking environmental needs Call light within reach? Telephone within reach? Light switch and TV control within reach? Bedside table within reach? Trash can within reach? Does the patient appear comfortable? Path to BR free of clutter?

Specific Behaviors Use closing key words Ask if there is anything else you can do for them before you leave Tell them you will return in the next hour (two hours from 10 PM to 6 AM)

Specific Behaviors Document on the Rounding Log Rounds logged every hour (or two on nights) Able to track compliance Assures patient you will be returning

Rounding Log Sample ROUNDING LOG Unit _____ Room ________ Date: __________ Name: _________________________________ PLEASE INITIAL AND CHECK EACH HOUR WHEN BEHAVIORS COMPLETED TIME INITIALS PAIN POSITION PRIVY PERSONAL PREVENTION PERIOD   Notify nurse or medicate as appropriate Reposition and observe for pressure/ friction Offer toileting, check for incontinence Personal needs such as water, other drink, blanket, tissues are met Call light, TV remote, bedside table, light control, path to BR clear 12 - 2 AM 2 - 4 AM 4 - 6 AM 6 - 7 AM 7 - 8 AM

Rounding Wrap-up Opening- name, role and rounding to see if they have any needs Medications, treatments, procedures Pain Privy- bathroom Position- reposition, chair, etc. Personal needs- water, tissues, etc. Prevention of injury- table, call light, clear path Closing- is there anything else?, return in next hour Document- on log