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Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction






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Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction . Stephanie R. Bruce, BS, RN University of Wisconsin-Milwaukee, School of Nursing. Acknowledgments. Mary Beth Trentadue , Preceptor Julie Darmody , Faculty Supervisor. Introduction. Problem:
Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction

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Slide 1

Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction

Stephanie R. Bruce, BS, RNUniversity of Wisconsin-Milwaukee, School of Nursing

Slide 2

Acknowledgments

  • Mary Beth Trentadue, Preceptor

  • Julie Darmody, Faculty Supervisor

Slide 3

Introduction

  • Problem:

    • Data publicly reported

    • Medicare Ruling

    • Limited research

  • Purpose:

    • To evaluate the effect of hourly nursing rounds on patient call light use, patient falls, and patient satisfaction.

Slide 4

Background

  • Fall Rate 3.3-7.0 falls/1000 patient days

    • 30-48% result in injury (Kalman, 2008)

    • Cost of Injury: $15-30,000/fall

      • $1.08 billion/year (Landro, 2005)

  • Correlation between staff responsiveness and overall satisfaction (OR 4.1) (Tea, Ellison & Feghali, 2008)

  • Most calls occur at medication and meals times

    (Meade, Bursell & Ketelsen, 2006)

Slide 5

Literature Review

  • Search terms:

    • Nursing

    • Hourly

    • Rounding

  • Databases used:

    • CINAHL 11 of 28,28969(added call light use)

    • PubMED 3 of 3 plus 6 related articles

    • MEDLINE 1 of 10511(added call light use)

    • Cochrane 0 of 15

  • ClinicalTrials.gov 1 of 1

Slide 6

LiteratureReview

  • Call light use reduced 37.8%

  • Patient falls decreased 50%

  • Patient satisfaction score increased a mean of 8.9 points (on 100-point scale)

    -Meade, Bursell & Ketelsen, 2006

  • Nurse called 12-15 times/day for non-urgent requests

  • Each response takes a minimum of 4 minutes

  • Hourly rounding estimated to save 166 hours/month -Studer Group, 2006

Slide 7

Framework

  • PDSA (Plan Do Study Act)

    (Institute for Healthcare Improvement, 2004)

  • “Behavioral shaping” (Kazin, 1989)

Slide 8

Methods

  • Setting

    • 45-bed medical-surgical unit in community hospital

  • 14-week study

    • 4-week pre-implementation phase

      • Baseline data

    • 6-week implementation phase

      • Staff education

      • Coaching

    • 4-week post-implementation phase

      • Follow-up data

  • Data collected pre- and post-implementation

    • Call light use and reason

    • Patient falls

    • Patient satisfaction

Slide 9

Intervention

  • Each hour the nursing staff will round on all the patients in the unit.

    • Nurse (RN) rounds odd hours

    • Patient care associate (PCA) even hours

  • Round on the hour 6am-10pm, then every 2 hours

  • Upon entering the room, introduce yourself and tell the patient you are there to do your rounds.

Slide 10

Intervention

  • Hourly Rounding Goals

    • Improve patient safety and satisfaction

    • Give patients a heightened sense of security

    • Decrease the number of call lights for non-emergency concerns

    • Reduce staff stress levels

Slide 11

The following items will be checked and performed for each patient:

  • Assess the patient pain

  • Offer toileting assistance.

  • Change the patient’s position to promote comfort.

  • Make sure the call light (and soft call light when appropriate) is within the patient’s reach.

  • Put the telephone within the patient’s reach.

  • Put the bedside table next to the bed.

  • Put the Kleenex box within the patient’s reach.

Slide 12

The following items will be checked and performed for each patient:

  • Offer sip of fluid to patient and put within patient reach

  • Make sure the garbage bag is on the side of bedside table and empty as needed.

  • Prior to leaving the room, 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 (use names on white board) will be back in an hour to round again.

Slide 13

Results

  • Pre-Implementation:

    • Call Lights

      • 4.2 calls per patient

    • Falls

      • One

    • Patient Satisfaction

      • Promptness response to call (n=42)

        • Mean 79.2

      • Overall rate of care given (n=41)

        • Mean 87.8

Slide 14

Results

  • Post-Implementation:

    • Call Lights

      • 2.7 calls per patient

    • Falls

      • Zero

    • Patient Satisfaction

      • Promptness response to call (n=12)

        • Mean 85.4

      • Overall rate of care given (n=16)

        • Mean 92.2

Slide 22

Results

  • 36% Reduction in call light use

  • Reason for call light use did not vary

  • 100% Decrease in falls*

  • Satisfaction increased 6.2 points (on 100-point scale)

Slide 23

Discussion of Barriers

  • Gaining “buy-in” from staff

  • Staff completion of accountability tool –dissatisfaction/non-compliance with rounding logs

  • Consistency in staff using protocol

  • Staffing, acuity, admits and discharges

Slide 24

Limitations

  • Conclusions about influence on falls cannot be determined due to small sample

  • Satisfaction data is still coming in

Slide 25

Implications

  • Rounding was shown to be an effective intervention to

    • Decrease call light use

    • Increase patient satisfaction

  • Based on these results, hospital-wide adaptation of this protocol is recommended.

Slide 26

Recommendations: Future Study

  • Training

    • Create unit leaders/Rounding champions

    • Follow each staff member as they round

    • Use pre- and post-tests with staff education

  • Need for:

    • Randomized control study

    • Cost benefit analysis

  • Use of call light system that can collect data

Slide 27

References

Kalman, M. (2008). Getting back to basics: hourly rounds to decrease patient falls and call light usage and increase patient satisfaction. Retrieved on April 14, 2008 from http://stti.confex.xom/stti/congrs08/techprogram/paper_37872.htm

Kazin, A. (1989). Behavioral modification in applied settings. 4th ed. Pacific Grove, CA: Brooks Cole.

Landro L. (2005). The informed patient: hospitals aim to curb injuries from falling. Wall Street Journal, D1.

Institute for Healthcare Improvement. (2004). Project planning form. Boston: Institute for Healthcare Improvement, 1-9.

Meade, C.M., Bursell, A.L. & Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use, satisfaction, and safety. AJN, 106, 58-70.

Studer Group (2006). AHC Research Call Light Study. Retrieved on March 35, 2008 from www.studergroup.com

Tea, C., Ellison, M. & Feghali, F. (2008). Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit. Orthopaedic Nursing, 27, 233-40.

Slide 28

Questions/Comments

Thank you.


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