Evidence-based Approach ToImproving Patient SafetyElena D. Memoracion, RN, MSN, NE-BC, NEA-BCMary E. Bayer, RN, BSN, MPA
Purpose At Long Island Jewish Medical Center, clinicalexcellence and patient experience have becomea top priority. Our goal is to excel in all areas ofpatient satisfaction and patient care. Utilizing a collaborative team approach, NursingLeadership, frontline Registered Nurses and PatientCare Associates from various service lines identifiedan evidence-based approach to reduce falls andimprove patient satisfaction.
SignificanceResearch shows that proactive nursing hourlyrounding increases patient satisfaction, reduces fallsand call lights usage when performed instandardized and consistent manner. Regularpatient rounding creates an opportunity toanticipate and meet the basic patient care needsthrough a proactive nursing intervention. Hourlyrounding has shown to decrease hospital acquiredpressure ulcers and improve staff satisfaction.
Strategy and Implementation Nursing leadership and frontline staff workedcollaboratively and developed the Proactive NursingHourly program based on the 4Ps model. InSeptember 2011, the program was implementedafter 60 educational sessions incorporating casestudies were provided to frontline RNs and PCAs Rounding script was developed and roundingbehaviors were incorporated into the hourly roundingcompetency. Unit ownership and accountability were establishedby having the Nurse Manager and Assistant NurseManager speak with patients/family daily to assesstheir perspective of the hourly rounding experience
Strategy and Implementation Audit and feedback by nursing leadership toascertain compliance Ongoing leadership support and staff willingness tochange practice were key in the successfulimplementation
Hourly Rounding ProcessThe physical presence of direct care provider in thepatient’s room hourly from 6am – 10pm and every 2hours from 10pm - 6am and engaging the patient byaddressing the 4Ps: Personal needs (toileting) Position Pain PossessionsUpon patient admission RN educates patients/family: 4Ps proactive nursing hourly rounding Rounding sheet
Hourly Rounding Process RN and PCA share and alternate roundingresponsibilities Staff documents hourly or every 2 hours on roundingsheet Nurse Manager / Assistant Nurse Manager reviewsrounding sheet during daily rounds
Inpatient Falls - Hourly Rounding2.502.252.1828% 0Jan 2011 - Sept 2011Pre-Hourly RoundingOct 2011 - Sept 2012Post-Hourly Rounding
Hourly Rounding - Likelihood to Recommend5% ng83.0Jan 2011 - Sept 2011Oct 2011 - Sept 2012
Hourly Rounding – Overall Nursing6% Improvement100.090.080.082.787.670.0Pre-Hourly Rounding60.0Post-Hourly Rounding50.040.030.020.010.00.0Jan 2011 - Sept 2011Oct 2011 - Sept 2012
Hourly Rounding – PromptnessResponse to Call Bell8% .020.010.00.0Jan 2011 - Sept 2011Pre-Hourly RoundingOct 2011 - Sept 2012Post-Hourly Rounding
Hourly Rounding – How Well Your Pain wasControlled100.090.04% 00.0Jan 2011 - Sept 2011Pre-Hourly RoundingOct 2011 - Sept 2012Post-Hourly Rounding
Implications for Practice4Ps Proactive Nursing Hourly Rounding: Evidence-based practice to improve patient safetyand satisfaction Basic nursing practice can be done utilizing acollaborative team approach Ongoing leadership support, staff education, auditand feedback are key factors in the success A mechanism to ensure staff ownership andaccountability is critical in sustaining the gain
Hourly Rounding - How Well Your Pain was Controlled 82.1 85.7 0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0 Jan 2011 - Sept 2011 Oct 2011 - Sept 2012 Pre-Hourly Rounding Post-Hourly Rounding 4% Improvement