Patient Rounding: An important new nursing initiative to improve the patient experience and patient care OR flavour of the month

Sue Langley, Head of Nursing, Division of Specialist Medical Services

Plan for Workshop

• Background and political context of rounding• My interest• Story so far at CMFT• The science of nursing – what is the evidence?• The art of nursing – care and compassion• Rounding, a theoretical framework• Round up of rounding

What do you think of Rounding?

My opinion next, what is yours?

A few things to think about

Great/Not so Great

Outcomes for patients

Outcomes for nurses

Documentation

Time it takes

Who does rounding?

Discuss in small groups – capture and share main thoughts

Background and political contextConcept of rounding – simplistic level process for regularly checking on patients

2006 Meade / Studer Group 4 P’s

2009 High Impact Interventions Falls Rounding – Ipswich Hospital

Concept of Rounding not new

Florence Nightingale, Ward Rounds, Back Rounds, Night Sister Rounds, Matron Rounds

American literature – Improves patient safety, reduces falls, increases patient satisfaction, reduces call bell usage

Adopted enthusiastically in UK

Political context – Prime Minister called for introduction nursing rounds in all NHS hospitals, part of the recommendations Francis response

Political context

Nurses in England will have to do hourly rounds on hospital wards, make more bedside visits but will have to fill out less paperwork, under plans announced by the Prime Minister.

The changes are being made by David Cameron after a critical report from the Care Quality Commission (CQC) in October.

It found issues with dignity and respect in many hospitals with some patients left to sit in pain or unable to reach food and water.

Newsbeat has been talking to nurses at University College Hospital in central London.

My Interest? - Rounding’s biggest fan

Part of my role – new practice, reducing harm, organisation of nursing work

Nursing and Midwifery Strategy Work – great fit

Personal approach / orientation – back to basics / not keen on theoretical models

Study project – something that would make a difference in day to day practice

High Impact Actions / Interventions work / productive ward NHS Institute

BUT

As more knowledgeable about background/evidence/historical context

? Views changing

Story so far at CMFT

1. Introduced Acute Medicine Division June 2010, HoN ‘Falls Rounding Project’ aim to reduce falls, nothing previously had reduced the falls rate

2. New Approach specific ward Nov 2011 – intentional rounding / patient focus rounding Wider than falls prevention, nutrition/hydration, skin integrity, nurse in charge communication/engagement, improving patient experienceUse of IQP methodology / staff and patient feedback

3. Trust wide adoption April 2012 ‘Patient Focus Rounding’ Linked to ‘Brilliant Basics’ communicationIQP methodologyLaunch, hand book, video, A3 reportsBased for most part on single question ‘Is there anything I can do for you?’ Single document

4. Additional question April 2013 “Worries and Fears”

Trust results

Patient focus rounding tracker data

50.0%60.0%70.0%80.0%90.0%

100.0%

Did you find somebody on the hospital staff to talk to about your worries and fears?

mean avg 2011

Did staff do what you wanted in order to help you?

mean avg 2011

Mean average

improved by 5%

The science of nursing – the evidence base

American Evidence base – quantitative cause and effect

Meade 2006 – seminal work 4 P’s

Studer Group 2007

Sobaski 2008

Tea 2008

Woodward 2009

Beneficial outcomes – improved patient safety through decreased falls, reduced call light usage, increased patient satisfaction, increased staff satisfaction

Diverse clinical settings, RN and HCSW rounding

Some small scale studies qualitative Blakely 2011and Dietrick 2011 process of rounding

UK literature – very poor no quantitative/qualitative studies, discursive

Castledine 2005, Lucas 2010, Bartley 2011, Dix 2012, however descriptions of process similar to American literature

Criticism – return to task orientation / American evidence base

The art of nursing – care and compassionThe bit we need to understand, why rounding is more than a checklist?

Maslow’s Hierarchy of Needs / Fundamentals of Care links to meeting patients’ physiological and safety needs – social needs

Water Personal Belonging

Warmth Health Communication

Toileting Property

Francis – critical of basic nursing care standards

What, as nurses, are we doing to meet patient need?

Rounding is a structured way to deliver communication, care and compassion, however there is complexity within the process; rounding is more than a checklist of tasks devoid of individual patient assessment and professional judgement

Perhaps what we haven’t done is focus on the art

Rounding a theoretical frameworkNot a big fan of theoretical frameworks but may give us a better understanding of the

process to ensure robust implementation and significant outcomes

Trust 4 P’s Studer Spradley Maslow

Anything I can do for you?

How is your pain? Opening words Space Drink

Any worries or fears?

Are you comfortable/position?

Perform scheduled tasks

Actor(s) Food

Help to the bathroom(personal needs)

Address 4 P’s Activity Warmth

Help with drink

(Possessions)

Additional comfort needs

Object(s) Toileting

*? 5 P presence* Environment (assess) Act Personal safety

Closing key words Events Belongings/Property

Explain & return Time/Timings Own health

Goal Belonging

Feelings Communication

Round up of rounding

10 points about rounding

1. Definitely a top agenda item for today’s nursing

2. Potentially seen as politically promoted

3. Adopted across the NHS

4. American evidence base

5. Limited UK evidence base

6. Controversial as seen as a return to task orientation

7. Not new - back to Florence

8. Potential to improve patient care and patient experience

9. Potential to improve staff experience

10. More research required

Questions / your views