PATIENT HOURLY ROUNDING Yale-New Haven Hospital 2010

Objectives Nursing staff will: Verbalize an increased understanding about patient hourly rounding goals. List the 8 specific rounding behaviors.

The Facts Nursing staff devote a lot of time responding to unscheduled patient requests so they have less time for more critical duties. Patient falls and pressure ulcers are concerns to staff , patients and families. How nursing staff respond to call lights plays a major role in how patient perceive the quality of healthcare.

Goals: Reduce call lights Improve patient perceptions of care Increase nursing satisfaction and efficiency Reduce patient falls Reduce skin breakdown The Studer Group (2006). Hourly rounding. Fire Starter Publishing.

Studer group Largest study to show that certain nursing staff behaviors reduce call light and allow nursing staff to respond more efficiently to patient requests. 27 units in 14 hospitals. Call light usage decreased by 38% Patient satisfaction went up from 79.9-88.8% Meade, C.M., Bursell, A.L., Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use, satisfaction and safety. American Journal of Nursing, 106(9), 58-70. Hospitals Baylor univ.< 2750, St eliz.400 Tmple univ, PA 617 sharp memorial hospital San diego 1870

Studer group Success in other areas. Hospitals saw 50% decrease in patient falls. Patient AND employee satisfaction increased. Nurse reported more time to attend to other task because they were answering call lights less often. The Studer Group (2006). Hourly rounding. Fire Starter Publishing.

Studer says: Rounding allows nurses to gather information, it is proactive not reactive. Handle patient problems before they occur. If you need me call me” gives up control of the workflow

Specific Behaviors Use opening words and/actions to introduce yourself, your skill set, your experience. Perform scheduled tasks. Assess and address the: Adult: 4P’s - pain, personal needs, position and placement Pediatrics: P.E.D.I. P=parents/plan/pain E=eating (bottles, meals, etc) D=diapers (supplies, towels, etc) I=interaction/ID bands The Studer Group (2006). Hourly rounding. Fire Starter Publishing. 1 use the word round, explain during rounds you will be checking pain, comfort, position and bathroom, reduces anxiety 2. meds, treatments, procedures, feedings. 3. Prn meds recommended to be given at the earliest fequency so that pt doesn’t need to call. 4. Fluff pillows, straighten sheets, fill water pitchers.

Specific Behaviors Assess comfort needs. Conduct an environmental assessment of the room. Use closing key words or actions. Explain when you or others will return. Document the rounding in Sunrise Clinical Manager The Studer Group (2006). Hourly rounding. Fire Starter Publishing. 5.Other staff can do too. Call light. Telephone light switch and tv, garbage can, bedside table, comfortable and covered. 6.”Is there anything else I can do for you? I have time.” 7.Mrs. J, it looks as if you have everything you need. I or PCA will be back in an hour to round on you again” 8.

Explain Purpose of Hourly Rounding Upon Admission/Transfer/Change in Caregiver “We round every hour on our patients to ensure that you receive “Very Good” care. We will not wake you if you are sleeping unless we need to. If anytime during your stay, you feel you are not receiving “Very Good” care, please let us know immediately so that we can address your concerns.”

Key Words - Adult “Hello Mr/Mrs ____ My name is___ I will be your (Nurse/PCA) today” “What is your pain level right now?” “Can I assist you to the bathroom?” (incontinence care, empty urinal, etc) “Would you like to be repositioned?”

Key Words - Adult “Are you comfortable?” “I want to place these items (call bell, telephone, tissues) in front of you, so that they are within your reach.” “Is there anything else I can do for you before I leave? I have the time.” “I (or other staff member) will be back within the hour to round on you again.”

Key Words - Pediatrics “Hello (patient/parents) ____ My name is___ I will be your (Nurse/PCA) today” Are you aware of the plan for today? “What is your pain level right now?” or “Do you feel that your child is comfortable?” “Can I assist you to the bathroom?” (check diaper, supplies, empty urinal/hats)

Key Words - Pediatrics “Are you comfortable?” (for younger children - comfort items- pacifier, toy, book, etc.) “I want to place these items (call bell, telephone, tissues, trash) in front of you, so that they are within your reach.” (age appropriate) “Is there anything else I can do for you before I leave? I have the time.” “I (or other staff member) will be back within the hour to round on you again.”

SUCCESSFUL ADULT ROUNDING The 4 “Ps”, vital for successful rounding consists of: Pain: asking patients to describe their pain level on scale of zero to 10 Positioning: making sure the patient is comfortable and assessing the risk of pressure ulcers Placement: making sure the items a patient needs are within easy reach (call bell, phone, water) Personal Needs: scheduling patient trips to bathroom to avoid unsafe conditions

SUCCESSFUL PEDIATRIC ROUNDING To help you remember, successful pediatric patient rounding includes: P = parents/plan/pain E = eating (bottles, meals, etc.) D = diapers (supplies, towels, etc.) I = interaction/ID bands

Procedure Responsible Time Frame 1. Use opening key words to introduce yourself and explain your role. Nurse , PCA,BA Initial Introduction 2. Write names and phone numbers of caregiver staff on whiteboard. Nurse and PCA Each Shift 3. Address the 4 Ps for adult areas Hourly Minimum 4. Address the PEDI list for pediatric areas 5. Assess additional comfort needs 6. Conduct an environmental assessment 7. Prior to leaving the room ask “Is there anything else I can do for you? I have the time.” Hourly minimum 8. Tell each patient when you and others will return. Every time you exit the room 9. Nurses will round on the even hours Nurse Even Hours 10. PCAs will round on the odd hours PCA Odd Hours

Procedure- Continued Responsible Time Frame 11. Rounding will be documented at the end of the shift on SCM Flowsheet – Vital Signs: Adult or Pedi (Non-ICU) (See next slide) Nurse and PCA Hourly 12. Rounds will continue throughout the night; patients do not need to be awakened.

Document at end of shift

EVERY PATIENT EVERY TIME EVERY HOUR