Evaluating the Impact of Nurses’ Rounding on Patient Satisfaction and Clinical OutcomesMargaret Redmond,BSN, OCNRene Lavoie, RN-BCRenee DiGiovanni, BSN, RN-BC, CCTNOchsner Medical Center, New OrleansMiro Sarac, PhD, LSUHSC School of Nursing

Background – Nursing Rounds Purpose

To assess patient needs

Described as Task oriented Unstructured without

a consistent set of standards – “a peak in the door”

Current practice Reactive vs. proactive

Literature Review

Structured rounding protocol Structured rounding protocol focusing on Pain, Potty, & focusing on Pain, Potty, & Positioning supported positive Positioning supported positive impact on outcomesimpact on outcomes Reduced call light usageReduced call light usage Improved patient satisfactionImproved patient satisfaction Decreased in fall rateDecreased in fall rate

Mead, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing roundsMead, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing roundson patient call light use, satisfaction, and safety. on patient call light use, satisfaction, and safety. AJN, 106AJN, 106(9),59-69.(9),59-69.

Purpose for Study

Investigate theInvestigate the impact of a impact of a patientpatient rounding rounding protocol on protocol on outcomes outcomes associated with associated with PainPainPottyPottyPositioningPositioning

Study Methods

Research Design Prospective Descriptive Study IRB expedited review with waiver of

documentation of informed consent Convenience Sample

Patients admitted to five medical surgical units

Procedure Rounding protocol over 12 weeks

Focus on “ 3 P’s” Hourly during the

day (6am-10pm) Every 2 hrs at

night (10pm-6am “Is there

anything else you need?”

Rounding Protocol

Data Collection – Pre- & Post-Protocol Call light use

Pain Potty Position

Pain management satisfaction Press Ganey

Patient satisfaction Press Ganey

Falls NDNQI

Falls 1000/patient days

Hospital acquired pressure ulcers NDNQI

HAPU/1000 patient days

Data Analysis

Frequency distribution for each variable

Tests for differences between & among groups Chi- square Paired t-test ANOVA

All tests 2-tailed, α = 0.05

Distribution of Pre- & Post-Calls

0 2 4 6 8 10 120

500

1000

1500

2000

2500

UNIT 3

UNIT 7

UNIT 11

UNIT 8UNIT 9

UNIT 3

UNIT 11

UNIT 7UNIT 8

UNIT 9

precalls postcalls

time (week)

tota

l num

ber

of p

ostc

alls

Distribution of Patient Call Lights Pre- & Post-Protocol

0

5

10

15

20

25

30

35

prepain prepositioning

postpain

prepotty

postpotty postpositioning

UNIT 3 UNIT 11 UNIT 7 UNIT 8 UNIT 9

per

cen

tag

e o

f to

tal n

um

ber

of

pre

/po

stca

lls

***

**

**

*

*

****

**

Significant differences, Anova, *p < .05. ** p < .005, p < .0001

**

*

Quality Indicators by Quality Indicators by UnitUnit

0102030405060708090

100

mea

n s

core

CICU TSU IMTA 9th 11th

PreSat PostSat

0102030405060708090

100

mea

n s

core

CICU TSU IMTA 9th 11th

PrePain PostPain

0123456789

10

# p

er 1

000

pt

day

s

CICU TSU IMTA 9th 11th

PrePU PostPU

0

5

10

15

20

25

# p

er 1

000

pt

day

s

CICU TSU IMTA 9th 11th

PreFalls PostFalls

Incidental Finding

IV pump alarming

Beep

Beep

Beep

Beep

Limitations

Generalizability of findings Convenience sample

at one site Limited to 3-month

study period Unable to verify the

accuracy of rounding logs Appropriate time? Addressed all 3

variables?

Summary

Decreased patient call light volume overall

Improved outcomes on some units Pain management HAPU and falls

Uncertain why some units did not demonstrate improvement

Relevance to Nursing

Frequent structured rounds should Improve clinical

outcomes Reduce nurses’ burden

Additional research should address Other foci for rounding

should be studied (ie. IV pump)

Obstacles to nurses’ rounding

References Castledine, G. (2002). Patient comfort Castledine, G. (2002). Patient comfort rounds: A rounds: A new initiative in nursing. new initiative in nursing. British British Journal of Journal of Nursing, 11 Nursing, 11 (6), 407.(6), 407.Halm, M. et al. (2003). Interdisciplinary Halm, M. et al. (2003). Interdisciplinary rounds: rounds: Impact on patients, families and Impact on patients, families and staff. staff. Clinical Nurse Specialist, 17Clinical Nurse Specialist, 17(3), (3), 133-142.133-142.Mead, C., Bursell, A., & Ketelsen, L. (2006). Mead, C., Bursell, A., & Ketelsen, L. (2006).

Effects of nursing rounds on patient Effects of nursing rounds on patient call light call light use, satisfaction, and safety. use, satisfaction, and safety. AJN, AJN, 106106(9), (9), 59-69.59-69.Van Handel, K. & Krug, B. (1994). Prevalence Van Handel, K. & Krug, B. (1994). Prevalence and and nature of call light request on an nature of call light request on an orthopedic orthopedic unit. unit. Orthopedic Nursing, Orthopedic Nursing, 1313(1), 13-18.(1), 13-18.