Hourly Rounding Implementation Karen Cook, RN 1 Hour Rounding/29 beds 37.8% reduction Call Light Rings

Hourly Rounding ImplementationKaren Cook, RN

13,21614,201

9,316

12,450

8,315

11,507

0

3,000

6,000

9,000

12,000

15,000

Pre-Rounding Weeks 1-2 Weeks 3-4

One Hour Two Hour

1 Hour Rounding/29 beds 37.8% reduction

Call L

igh

t R

ing

s

Copyright © Studer Group. Please do not quote, cite, or disseminate without Studer Group authorization.

Objectives

Outline a plan for implementation of hourly rounding

Share Atlanta Medical Center’s story


Healthcare FlywheelSM

Hourly Rounding

More time for proactive nursing creates passion

Increased pt. sat

Increased nurse sat

Fewer falls and skin breakdown reduce costs and increase capacity


Implementation Steps: Hourly Rounds

1. Select nursing units2. Collect baseline data and establish goals3. Conduct staff training4. Skills lab and coaching5. Communicate results6. Hardwire and sustain results


Implementation Steps: Select Nursing Unit

Select nursing units1. Start with the units used in the study

(medical, surgical, oncology, orthopedics)2. Engaged nursing leadership3. Ensure stable staffing – < 5% registry use4. Right timing – no other big initiatives5. Commit to at least 45 days of follow-up after

implementation to ensure behaviors are a habit


Implementation Steps: Collect Baseline Data

Collect Baseline Data1. Collect call light frequency for 2 weeks prior to

beginning hourly rounding, one month after implementation and quarterly thereafter

2. Collect reasons for call light – will demonstrate behaviors have impact

3. Fall rates4. Pressure Ulcers5. Patient perception of quality

(responsiveness, pain control, nurse communication)


Implementation Steps: Collect Baseline Data

1. Staff satisfaction survey data

2. Teamwork results3. Staff perception

• Collect the staff perception of hourly rounding

• Standardize key words for leaders

• Address barriers proactively in training

What could keep employees from doing a good job at reducing call lights?______________________________________

What objections will they have to rounding? ________________________________________

How are you going to deal with these objections? ________________________________________

What could keep employees from doing a good job at reducing call lights?______________________________________

What objections will they have to rounding? ________________________________________

How are you going to deal with these objections? ________________________________________


Establish a Baseline – Call Light Log

How many call lights ring in your unit?


Don’t Forget Call Lights Associated with Alarms

#1 = alarm fatigue

To combat alarm fatigue, ECRI recommends that hospitals and device manufacturers:

Minimize the number of clinically insignificant or avoidable alarms; and

Optimize alarm response protocols (MedCity News, 11/4).


Set Goals

Set your goals for reductionsStudy ranged from 13%-75%Larger reductions had strong nurse managers leading

Set realistic 90 day improvement goals

Define implementation date, percent of staff to be through skills labs and 100% compliance with validation dates


Define Parameters

Standardize the timing

One hour rounds from 6 am-10 pm

From 10 pm-6 am two hour rounds to respect patients’ sleeping patterns

The “P’s” to ask about on rounds

Will there be a “policy?”

What will success look like?


Define Documentation

Non- negotiable if you want to achieve desirable results

Is a visible representation to patient/family of excellent, safe, quality care

During rounds, nurse leaders ensure logs represent hourly rounding behaviors are completed (R/R top performers)

Sustained results – can consider taking logs down but remember this if for the patients


Define Setting Expectations

When will it be introduced

How will it be described to patient and family

Who will be responsible

All of this should involve an hourly rounding champion and unit-based councils

“On this unit, one of our care team members will be coming in to see you every hour during the day. You will see either me or Jackie, our certified nurse assistant. I have worked with Jackie for two years and she is excellent. We will be checking on your comfort such as we will make sure we are helping manage any pain you might have, help you change position, help you to the bathroom and make sure you have everything you need.” We call this hourly rounding and we do it to make sure you are safe and we are always meeting your needs.”


Implementation Steps: Conduct Staff Training

Conduct Staff Training1. Connect to purpose and WIFFM2. Provide quality data3. Explain the process4. Solicit feedback5. Provide timeline and next steps6. Set expectations for nurse leader rounding

questions7. Address barriers/issues8. Thank them!


Implementation Steps: Skills Lab

Conduct Skills Lab and Coaching

Skill labs can be used for training a skill or validation of a skill.

You have to know the difference because the feedback is framed differently

In Training skill labs, educators, content experts and others can be used to give feedback.

In Validation skill labs, leaders are present to give feedback and competency is checked.


Hourly Rounding: Education for Med 2/MPCU Mandatory for all PCA’s, LPN,s and RN’s

Training will occur in two steps: First watch the short video set up in the

locker room and sign the roster. Attend one 10 minute session during

the times below to complete the simulation/coaching training. Room for the simulation will be announced each day

Both may be completed during your scheduled shifts or you may come in early /stay after your shift to complete (clock into education).

Hourly rounding training schedule:10/18/11 0730-1030 Room _________10/19/11 0900-1300 Room _________10/24/11 1000-1200 Room _________10/26/11 0730-0930 Room _________10/27/11 1400-1600 Room _________11/1/11 0730-0930 Room _________11/2/11 1700-2000 Room _________11/3/11 1400-1600 Room _________11/9/11 1000-1200 Room _________11/10/11 1700-2000 Room _________11/15/11 1000-1200 Room _________11/16/11 1400-1600 Room _________11/21/11 1000-1200 Room _________11/22/11 1700-2000 Room _________

Hourly rounding is proven to:Decrease fallsDecrease skin integrity problemsDecrease call light useIncrease Patient SatisfactionIncrease Nurse SatisfactionImprove overall efficiency


Implementation Steps: Skills Lab

Define mandatory – consequences for lack of participation

Define consequences for failure to document, participate or support plan

Clearly define how you will gather stories, barriers and what is working well


Must Validate to Reduce Variance

Inspect what you Expect!

Managers will verify staff are doing hourly rounds on their individual units

All caregivers should be validated annually


Implementation Steps: Communicate Results

Communicate Results1. Nurse leader rounds2. Daily huddles3. Displays on department bulletin board4. Staff meetings5. Management meetings6. Physician staff meetings


Implementation Steps: Hardwire and Sustain

Hardwire and Sustain1. Reward and recognize2. Annual validation with test3. Plan for new hires 4. Plan for quick orientation for registry staff5. Include in all forms of rounding6. Results!


Lessons Learned

Hardwire nurse leader rounding first

Train all nursing leaders (anyone in person of authority) together first

Include wins from hourly rounding in daily huddles

Soft validation = soft results

If union is present, engage them early

Coaching helps!


Atlanta Medical Center

Documents

Hourly Rounding Implementation Karen Cook, RN 1 Hour Rounding/29 beds 37.8% reduction Call Light Rings