Hourly Rounding

These changes are then reinforced to employees by the Charge Nurses in Morning Huddles and in special called Safety Huddles throughout the week. While management is very open to change, implementation of the changes must be carried out by the actual hands-on personnel, and this often times leads to fear of the unknown. As Yoder-Wise (2015) states, “All changes, whether perceived as positive or negative, large-scale or simply, are scary and generate fear” (p. 307). In the short time I have worked in the ED, I have seen both support and resistance among co-workers regarding change processes. While some embrace change, others resist, and are set in their ways viewing change as inconvenient and an addition of time-consuming steps to an already stressful environment. Most whom I work with, when presented with the facts and evidence behind the change, view it positively and have no problem implementing it.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

Change is a hard concept for most, but change in the hospital setting can be beneficial for both staff and patients. According to Mclean (2011), “Every change begins with an ending” (p.79). How people respond to change can make the process easy or hard depending on how the change is presented.

This plan will take 10 weeks to accomplish. Week 1, flyers will be made and distributed, so that all staff is aware of the changes being implemented and can plan to make this change. It will also give staff an opportunity to voice any concerns related to the changes and fill out the initial survey which is in Appendix B. This week will also be used to gather any resource materials needed to help with implementation of skills. Week 2 will be used for coordinating instruction and teaching with unit managers. Weeks 3 & 4 will be used to review the process of shift change report and how communication occurs between nurses, from nurse to patient and from nurse to physician. Staff interdisciplinary interactions will also be reviewed to find weaknesses in communication and teamwork. Week 5 will be used to review incident reports, to determine the gaps and what the staff needs to know to make incident reporting more effective and efficient. Week 6 will be used to arrange teaching times. This week will also be used to find teaching facilitators to teach the rest of the

Rounding allows nurses to gather information in a structured way. It’s proactive, not reactive like call light responses. It’s a great way to get a handle on patient problems before they occur. It’s all about providing the best patient-driven health care… The great thing about hourly rounding is that it doesn’t benefit only the patients. (¶ 4).

A positive force for change centers on the nurse’s strong desire to change current practices. The combination of the turnover rate, low morale, and higher percentage of new nurses, is the driving

The purpose of this paper is to describe quality improvement strategies as they relate to the nurse scheduling process. A process flow map of the six-week schedule process will be reviewed. Strategies surrounding the gap in scheduling will be the focus, as ultimately having sufficient staff affects patient quality of care.

Hourly rounding is something that has been around for a while. One of the first things we learned in nursing school was that you should check on your patient every hour or every 2 hours (depending on nursing aid assistance). I started my research by looking at what hourly rounding entails. From there I found the majority of articles that think hourly rounding really does affect patient care and only a few opinion articles that think the opposite.

The solution to the problem of individual rounding, which is decreasing patient satisfaction and the quality of care, would be to implement interdisciplinary team rounding. Interdisciplinary team rounding would mean that multiple members of the healthcare team would go in together in the morning to assess and evaluate the patient. For example, on the postpartum unit the medical student, resident, and the physician would all go in together at one time in order to eliminate the number of interruptions that the patient would have. This collaboration of care would also be beneficial to the patient and then team because they all would witness the same assessment of the patient and be able to discuss her care with her in the room at that given time.

It is very true that lack of communication and not being honest with your staff can lead to frustration. It will be more appreciative if the manager will come and recognize that some of the new things are new for him/her to instead of just making it mandatory without any preparation. We understand that many times policies and procedures are coming from higher levels, but discussing with the ones which will be affected will have a better outcome in terms of accepting new changes. "The person who has to deliver the often unpleasant news determines whether to call the unit and leave a brief note on the assignment sheet or go to the nurse to talk directly about the change".

Hourly rounding also known as intentional rounding or comfort rounding is an initiative that hospitals nationwide are beginning to implement. Hourly rounding should be purposeful. “Hourly rounding is a systematic proactive nurse-driven evidence based intervention to anticipate and address needs in hospitalized patients” (Deitrick, Baker, Paxton, Flores, & Swavely, 2012, p.13). “Purposeful nurse rounds encompass a practice where nurses attend to and document scheduled patient reviews at pre-determined and regular intervals (hourly or second hourly)” (Lyons, Biunero, & Lamont, 2015, p.31).

I am well acquainted with hourly rounding. My organization has tried numerous times to implement hourly rounding and for many reasons, the effort is never hardwired. Although the implementation of hourly rounding is very effective as proactive way to prevent falls many organization struggles with sustaining rounding. Some of the barriers are lack of staff buy-in, acuity levels, staffing, and poor documentation workflows (Toole, Meluskey, & Hall, 2016). In our post-fall huddles, one of the questions asked is, when was the patient last seen. In many cases, it is more than an hour. If the patient has more contact with the staff, the risk of falling is less. One new technology that we are about to roll out is a new call system that will track

Before implementing the program, PH conducted a mandatory meeting led by the NE to notify the nurses of upcoming changes, and they were asked for suggestions and feedbacks. This fulfills Lewin’s stage of unfreezing (Shirey, 2013). The nurses all agreed on the need for change. The NE presented the newly restructured program (Appendix D) and provided the benefits and incentives that the preceptors would receive, including a paid two-day training. Lewin defined this as the movement phase (Marquis & Huston, 2015). Orientation packets composed of weekly evaluations, care plans (once a week), and skills competency checklists would be completed by the new RNs, and checked by the NE and

In this stage it focusses on sustaining the change over a long period of time. Refreezing is the final stage, once the change has been made and the structure has regained its effectiveness, every effort must be made to remain and make sure the new procedure becomes the standard. The nurse managers or charge nurses during the shift huddles can help in the reinforcement process by praising, rewarding and providing feedback to everyone for their effort to bring the change. When the goals will be met with 100% compliance of the nurses, they will be rewarded with free lunch and snacks and they will receive special appreciation in the staff meeting. The nurse managers must implement systems to ensure that changed behaviors or processes continues, measure the impact of the changes, and provide staff with progress reports and evidence of success such as let the nurses know the current patient satisfaction