1. Effect of Structured Frequent Nursing Rounds on Patient Satisfaction, Safety, and Call Light Usage Aimee Cloyd, ASN,RN Nurse Supervisor Leisa Kelly, MS, APRN, CEN Clinical Nurse Specialist

2. Objective To relate the effects of a structured rounding program to patient outcomes.

3. Evidence Based Practice Support for the Project A research study was published in AJN in 2006 describing the results of a multi-facility research study to measure the effectiveness of frequent nursing rounds This research study supported the EBP we implemented at our institution

4. Background Information Press Ganey measures patient satisfaction on a random group of patients discharged from our facility Patient satisfaction within the medical division consistently ranged below the 90 th percentile Patient falls were higher than the national benchmark Staff viewed call light usage as an ongoing interruption into our day The Medicine Division saw this research study as a potential solution to improve outcomes

5. EBP Team The divisional director, nurse managers, and members of the unit based council worked together with the CNS to develop the model for the project Processes discussed in the original study design were replicated

6. Development of the Call Light Log Call light log had been used previous to this project; however, the purpose of the call was changed from a write in box to a check box to provide categorical data Included patient room number Call back time Whether the need was met Purpose of the call

7. Development of the Rounding Log A rounding log was developed to act as a visual reminder to staff Staff was to initial each time they entered the room Log was duplicated, and later laminated for durability

8. Development of the Rounds Request Form A rounds request form was develop to communicate patient needs to the nurse when the CNA or CSR rounded Non-licensed personnel documented the patient need on a form Communicated to the nurse at the end of their rounding session

9. Development of the Scripting and the Process Nurses rounded on the odd hour (Assessments at 7AM/PM; meds 9 AM/PM) Non-licensed personnel rounded on the even hour Rounds scheduled hourly from 7AM-10PM Every other hour from 12MN to 6AM Scripts and observations for rounding developed

10. Actions to be Taken by Nursing Staff Members During Rounding Determine patient’s pain level Put medication as needed on the nurses scheduled list Offer toileting assistance Determine the patient’s position and position comfort Make sure the call light is within the patient’s reach Place the telephone within the patient’s reach Place the TV remote/bed light switch within the patient’s reach Place the bedside table next to the bed Place the Kleenex box and water within the patient’s reach Place the garbage can next to the bed Ask: “Is there anything I can do for you before I leave? I have time while I am here in the room.” Tell the patient that a member of the nursing staff will be back in the room in one hour to round and check on them again.

11. Implementation of the Pilot Initially the process was implemented on the North Tower A ceremony highlighting the Lake’s nurse theorist, Jean Watson, kicked off the rounding project Hospital administration, service line administrators, managers and staff nurses attended the ceremony For the first month all was well

12. Effect of Hourly Rounding on Clinical Outcomes No effect on call light usage No effect on patient falls Improvement in patient satisfaction measures Pain Management: Pain controlled Loyalty: Recommend the facility to others Care and Concern Personal Needs

13. Call Light Usage Manual Log Executone

14. Call Light Data An attempt to obtain objective call light data was explored Data from the Executone System was obtained, but staff did not concur to its accuracy Call lights used for non-patient requests System changed from 2006 to 2007 After several months, call light data was no longer considered as an outcome

15. Falls Per 1000 Patient Days

16. Patient Satisfaction Nursing Core Indicators: Attention to Personal Needs

17. Patient Satisfaction Nursing Core Indicators: Response to Concerns

18. Patient Satisfaction Nursing Core Indicators: Loyalty

19. Patient Satisfaction Nursing Core Indicators: Pain Management

20. Pre-Post Comparisons: Pilot Unit Year 1 to year 2 OutcometN 06-07N 07-08p Loyalty.182287346.859 Personal Needs.692294349.504 Pain.328260324.749 Care and Concern.072264313.944

21. Effects of the Pilot There was initial buy-in, however staff soon began to question “When was the pilot going away?” Initial gains realized were not held Consistent outcome measures were difficult to obtain Falls are only as accurate as reported Call light usage was only as accurate as documented

22. Other Units Believed it Would Work The medical unit on the south tower wanted to give the process a try They were challenged to maintain consistent patient satisfaction scores and saw the process as an opportunity The unit was eager to show that teamwork can improve patient satisfaction scores Several of the nurses were in school, had read the article, and wanted to implement it

23. Patient Satisfaction Nursing Core Indicators: Attention to Personal Needs

24. Patient Satisfaction Nursing Core Indicators: Response to Concerns

25. Patient Satisfaction Nursing Core Indicators: Loyalty

26. Patient Satisfaction Nursing Core Indicators: Pain Management

27. Pre-Post Comparisons OutcometN 06-07N 07-08p Loyalty1.819280277.046* Personal Needs 2.464273277.031* Pain1.523238246.156 Care and Concern 2.212247234.049*

28. Comparative Analysis Between the Groups OutcomeFNp Personal Needs- Pre.272567.607 Personal Needs- Post 4.524626.045* Pain-Pre.192498.665 Pain-Post 1.226570.280 Care and Concern- Pre 1.057511.315 Care and Concern- Post 4.032547.047* Loyalty-Pre 1.048567.317 Loyalty-Post 17.921623<.001**

29. What was the difference? We have stars in our team – CNA’s, PCA’s, and CSR’s – were all important factors in the success of this project We believed that it would work We personalized the process and wanted it to be a success Our scores have stayed consistent, it is how we provide care now The paradigm shift occurred Our CNA Star

30. What Were Our Challenges? Initial buy-in was tough, but the patient satisfaction scores increased, our staff was sold on the project. Staff was hesitant to say “We’ll be back in an hour,” worried that no one would return. We like to succeed and we incorporated hourly rounding into our daily routine. We were pushed to take down the papers, but our manager felt that they were visual reminders.

31. Questions????