Hourly Rounding: A replication study
Tintu Sebastian
South University Online
NSG3036-Intorduction to Nursing Research
Week 2, Assignment 2
Donyale Childs
July 7, 2015 Hourly Rounding: A Replication Study Patient satisfaction is an important phenomenon that affects hospital ratings and reimbursements. Hospitals across nation are seeking measures to improve patient satisfaction, decrease patient falls and call light usage. A medical surgical clinical nurse specialist (CNS) at a northeast hospital collected data on the rate of patient falls, patient satisfaction for a period of 15 months and usage of call light for 4 weeks, which showed that this is a crucial problem that the hospital is facing and there is a lot of opportunity for improvement. The CNS assembled a team to identify measures to improve the current situation and decided to replicate the study on rounding conducted by Meade and colleagues (2006). The purpose of the study was to identify the effect of regular nurse rounding on patient fall rate, call light usage and patient satisfaction in a medical surgical unit. A literature review using three studies from Medline and
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Call light retrieval system tracked call light usage for 2 weeks before and 4 weeks during the study. Data analysis of patient falls, satisfaction scores and call light usage was done using Chi-square and rank sum tests. Results showed that there was 23% reduction in falls in the experimental unit whereas the number of falls increased in the control unit. The call light usage fluctuated throughout the study and so there were no statistically significant results. Discharge surveys did not show any change in patient satisfaction scores, but unscientific evidence from leadership rounds show increase in patient satisfaction
A change I would recommend for this department is for the staff to become more aware of how rounding and pain management affects the patient experience. Another suggestion based on the objective of improving patient experience would be to continue educating staff on how patient experience plays a crucial role in the reimbursement and how it impacts not only the hospital but them as well. I also recommend that the staff should continue performing rounding and pain management as if they were still being measured so that eventually these two areas will occur automatically without even having to think about it. By doing so, it will turn into a habit and will hopefully lead to a more consistent score in these two areas. New staff should also be trained that both monitoring for pain management and rounding is standard practice for the unit. As it is a lot easier to train someone new to get into this habit earlier than it is to try and implement it later after he/she has already established a routine. Staff members that have a higher role in the department must also continue to lead by example as well, in order to instill the importance of these two areas. Lastly, I recommend that the department needs to find a way to motivate and encourage staff to do rounding and pain management effectively with more internal rewards such as staff members seeing the positive impact focusing on these two areas have on patient lives.
Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).
The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.
This paper will describe current quality outcome measures and the significance for improving medical care. Organizational accountability and transparency has improved with the emergence of Hospital Inpatient Quality Reporting (IQR) programs and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPs). This article will review the role of the nurse manager in creating a culture for quality care as well as the nurse for meeting organizational and patient expectations. Organizations like The Joint Commission (JC), Agency for Healthcare Research and Quality (AHRQ), Centers for Medicare and Medicaid Services (CMS), and The American Nurses Association (ANA) have been critical in establishing standards for quality. This paper will also report on the most recent hospital statistics and steps taken to improve HCAHP scores and reduce readmission rates at the University of Tennessee Medical Center in Knoxville (UTMCK). Statistics at UTMCK will also be compared to the Tennessee and National averages found on the Medicare website Hospital Compare. The aim of this paper is to explore if healthcare system initiatives are improving quality and enhancing patient outcomes.
Prior to the hourly rounding implementation, all the clinical staff (staff involved in patient care) will attend an hour workshop, which will cover the advantages and significance of hourly rounding to patient safety, reduction of falls, increase patient satisfaction, improved health outcomes, and financial impact to the organization. A video on how to do the hourly rounding properly and what behavior to avoid will be shown. After the workshop, the staff will do return demonstration, playing the role of the staff, while being checked off to ensure that the expectations during hourly rounding are met. This includes how to properly introduce oneself to the patients, informing the patients that the staff will be rounding every hour till 2200 then every two hours till 0600, to address their pain, possession, position, and potty needs. By performing return demonstrations, the validators (nurse managers, educators) will be able to ascertain that the staff understood and will
Answering the call light (also called call bell a handheld like that is attached to the patient room wall, above the headboard of the bed) in a timely manner by the nursing staff in hospital setting is necessary to prevent falls that can harm, prolonged stays, and unnecessarily increase the cost of healthcare. However, researches concerning call light uses as it relates to patient safety, patient-care management and patient satisfaction are limited (Meade et al. 2006). Patients and their families emphasize that nurses should monitor patients constantly and provide assistance and answer a call light in a timely manner (Yoder, 2011). Note that the falls may be caused by several factors such as
The results of the study showed that significant increase in patient satisfaction scores, decreased call light usage, and reduction in patients fall rates. One-hour rounding shows higher satisfaction than two hour- rounding. Hypothesis supported the study because the research shows rounding can reduce patient call light usage (Meade, Bursell, Ketelsen , 2006). The theoretical framework that forms the basis of the research is that consistent nursing rounds can meet the basic needs of patient and ultimately reduce call light use and [pic]improve management of patient care while also[pic] increasing [pic]patient satisfaction and[pic] safety.
Patients depend on healthcare professionals through the use of call lights. Many different factors can affect a patient’s ability to function independently such as “cognitive impairments, visual loss, and decreased mobility” patients turn to call lights for assistance (Huey-Ming, 2010). Unfortunately, if a nurse or certified nursing assistant is occupied risks occur and can ultimately lead to injuries of patients due to help not received at that given moment. In the journal titled Perspectives of Patients and Families About the Nature of and Reasons for Call Light Use and Staff Call Light Response Time written by Huey- Ming Tzeng, patients felt “staff responsiveness to call lights often affect nurse-patient communication, patient
A manager should make sure that the resources that are provided to the staff are useful, effective, and helpful. The manager should ensure that they have the adequate amount of resources and tools in order to complete there work and job. When it comes to the issue of nurse staffing ratios, the manager has the responsibility of making sure that the unit is staffed to meet the demands of the patients and there level of care, or acuity (GCU, 2011). Utilizing there skills in leadership, quality care, people and communication can all be of benefit. Leadership skills, such as leading by example, are necessary for nurse managers. Quality care skills can be beneficial to gather the necessary data and provide adequate staffing to promote and improve overall performance. People skills are used to interview new employees and hopefully increase staffing
Hourly rounding is a strategy involving nurses and other health care staff to regularly “check in” on patients every hour. Because nursing staff is not reacting to call lights, patients are more content and happy; therefore nurses feel they are doing a better job helping their patients (Studer, 2007). Research has shown that rounding every hour lowers patient’s use of call lights and resultantly decreases the workload of the nurse (Leighty, 2007; Meade, Bursell, & Ketelsen, 2006; & Tipton, 2008). Performing hourly rounds has contributed to 20% less walking per shift
Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.
In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer
Tzeng and Yin (2009) identified the main reasons for call light use and the impact that hourly rounds have in decreasing the call light use rate and patient falls. This study was done in a community hospital located in Michigan and used archived hospital data for analyses. The archives involved were from four adult acute care units during February 2007- June 2008: one surgical unit with 53 beds, two medical units with both totaling 87 beds and one medical-surgical combined unit with 58 beds (Tzeng, & Yin, 2009).
Hourly rounding contributes in several key areas to achievement of high levels of patient satisfaction, including quality of care and patient safety. This puts patients at the center of care by building on the fundamental aspects of care, which are so important. Thus by checking in on patients in wards regularly to see whether they are comfortable and have everything they need can produce a number of positive results. Nurses
One of the many goals of the nursing profession is to provide high-quality, safe patient care. There are many responsibilities that come with a nursing career and when the nurse to patient ratio increases, there is a possibility that it may hinder the safe care that patients deserve, and this may result in negative patient outcomes and level of satisfaction. Staffing is one of the many issues that healthcare facilities face. In many facilities, there never seems to be enough nurses per shift to provide high quality, thorough patient care which often leads to burnt out staff, and frustrated patients and families. This review discusses the findings of quantitative studies and one systematic review that involves patient outcomes in relation to nurse staffing.