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Effect of Structured Frequent Nursing Rounds on Patient
Satisfaction, Safety, and Call Light Usage
Aimee Cloyd, ASN,RN Nurse Supervisor
Leisa Kelly, MS, APRN, CENClinical Nurse Specialist
Objective
• To relate the effects of a structured rounding program to patient outcomes.
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
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 90th 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
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
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
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
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
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
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.
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
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
Call Light Usage
533 519
621
419
10461128
920969
0
200
400
600
800
1000
1200
March April May June
2006
2007
Manual Log
Executone
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
Falls Per 1000 Patient Days
2.2
4.3 4.5
2.2
4.4
2.3
9.1
2.26
6.6
4.16
01
23
4
56
7
89
10
Mar April May June July
2006
2007
Patient Satisfaction Nursing Core Indicators: Attention to Personal Needs
87.590.6
81.375
78.6
70.675
91.7
73.1
85.3
76.880 8081.8
83.377.1
87.587.5
80
92.9
0
10
20
30
40
50
60
70
80
90
100
March May July September November
2006
2007
Patient Satisfaction Nursing Core Indicators: Response to Concerns
88.983.3
7570.8 73.171.7
76.9
83.979.376.8
65
76.6 79.2
90
81.781.885.7
89.7
67.9
85.7
0
10
20
30
40
50
60
70
80
90
100
March May July September November
2006
2007
Patient Satisfaction Nursing Core Indicators: Loyalty
85.484.481.379.2
85.7
66.7
8588.3
85.189.1
82.180.3 80
9083.9
89.692.5
89.7
78.3
85.7
0
10
20
30
40
50
60
70
80
90
100
March May July September November
2006
2007
Patient Satisfaction Nursing Core Indicators: Pain Management
86.187.582.1
75 72.568.3
84.1
91.1
80.985.9
82.783.3
95.5
82.587.5
81.8 83.386.8
70
91.7
0
10
20
30
40
50
60
70
80
90
100
March May July September November
20062007
Pre-Post Comparisons: Pilot Unit Year 1 to year 2
Outcome t N 06-07 N 07-08 p
Loyalty .182 287 346 .859
Personal Needs
.692 294 349 .504
Pain .328 260 324 .749
Care and Concern
.072 264 313 .944
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
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
Patient Satisfaction Nursing Core Indicators: Attention to Personal Needs
81.8
91.3
72.5
84.6 84.485.5 83.388 85.9
89.1
80.6
90.7
83.380
0
10
20
30
40
50
60
70
80
90
100
June August October December
2006
2007
Patient Satisfaction Nursing Core Indicators: Response to Concerns
80.482.9
66.9
90 87.582.4 80.9
85.2 86.483.980.8
86.5
72.4
86.4
0
10
20
30
40
50
60
70
80
90
100
June August October December
2006
2007
Patient Satisfaction Nursing Core Indicators: Loyalty
79.6
88.5
70.2
92.387.5
83.889.5
81.3
89.193.3
84.7
93.5
80.385
0
10
20
30
40
50
60
70
80
90
100
June August October December
2006
2007
Patient Satisfaction Nursing Core Indicators: Pain Management
82.986.8
63.5
93.2
84.182.4 81.785.9 84.8
88.584.485
76.4
85.7
0
10
20
30
40
50
60
70
80
90
100
June August October December
20062007
Pre-Post Comparisons
Outcome t N 06-07 N 07-08 p
Loyalty 1.819 280 277 .046*
Personal Needs
2.464 273 277 .031*
Pain 1.523 238 246 .156
Care and Concern
2.212 247 234 .049*
Comparative Analysis Between the Groups
Outcome F N pPersonal Needs-Pre .272 567 .607
Personal Needs-Post 4.524 626 .045*
Pain-Pre .192 498 .665
Pain-Post 1.226 570 .280
Care and Concern-Pre
1.057 511 .315
Care and Concern-Post
4.032 547 .047*
Loyalty-Pre 1.048 567 .317
Loyalty-Post 17.921 623 <.001**
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
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.
Questions????
