Presentation on theme: "Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction Stephanie R. Bruce, BS, RN University of Wisconsin-Milwaukee,"— Presentation transcript:
Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction Stephanie R. Bruce, BS, RN University of Wisconsin-Milwaukee, School of Nursing
Acknowledgments Mary Beth Trentadue, Preceptor Julie Darmody, Faculty Supervisor
Introduction Problem: –Data publicly reported –Medicare Ruling –Limited research Purpose: –To evaluate the effect of hourly nursing rounds on patient call light use, patient falls, and patient satisfaction.
Background Fall Rate falls/1000 patient days –30-48% result in injury (Kalman, 2008) –Cost of Injury: $15-30,000/fall $1.08 billion/year (Landro, 2005) Correlation between staff responsiveness and overall satisfaction (OR 4.1) (Tea, Ellison & Feghali, 2008) Most calls occur at medication and meals times (Meade, Bursell & Ketelsen, 2006)
Literature Review Search terms: –Nursing –Hourly –Rounding Databases used: –CINAHL 11 of 28,289 69(added call light use) –PubMED 3 of 3 plus 6 related articles –MEDLINE 1 of 1051 1(added call light use) –Cochrane 0 of 15 ClinicalTrials.gov 1 of 1
Literature Review Call light use reduced 37.8% Patient falls decreased 50% Patient satisfaction score increased a mean of 8.9 points (on 100-point scale) -Meade, Bursell & Ketelsen, 2006 Nurse called times/day for non-urgent requests Each response takes a minimum of 4 minutes Hourly rounding estimated to save 166 hours/month -Studer Group, 2006
Framework PDSA (Plan Do Study Act) (Institute for Healthcare Improvement, 2004) “Behavioral shaping” (Kazin, 1989)
Methods Setting –45-bed medical-surgical unit in community hospital 14-week study –4-week pre-implementation phase Baseline data –6-week implementation phase Staff education Coaching –4-week post-implementation phase Follow-up data Data collected pre- and post-implementation –Call light use and reason –Patient falls –Patient satisfaction
Intervention Each hour the nursing staff will round on all the patients in the unit. –Nurse (RN) rounds odd hours –Patient care associate (PCA) even hours Round on the hour 6am-10pm, then every 2 hours Upon entering the room, introduce yourself and tell the patient you are there to do your rounds.
Intervention Hourly Rounding Goals –Improve patient safety and satisfaction –Give patients a heightened sense of security –Decrease the number of call lights for non- emergency concerns –Reduce staff stress levels
The following items will be checked and performed for each patient: 1.Assess the patient pain 2.Offer toileting assistance. 3.Change the patient’s position to promote comfort. 4.Make sure the call light (and soft call light when appropriate) is within the patient’s reach. 5.Put the telephone within the patient’s reach. 6.Put the bedside table next to the bed. 7.Put the Kleenex box within the patient’s reach.
The following items will be checked and performed for each patient: 8.Offer sip of fluid to patient and put within patient reach 9.Make sure the garbage bag is on the side of bedside table and empty as needed. 10.Prior to leaving the room, ask, “Is there anything I can do for you before I leave? I have time while I am here in the room.” 11.Tell the patient that a member of the nursing staff (use names on white board) will be back in an hour to round again.
Results Pre-Implementation: –Call Lights 4.2 calls per patient –Falls One –Patient Satisfaction Promptness response to call (n=42) –Mean 79.2 Overall rate of care given (n=41) –Mean 87.8
Results Post-Implementation: –Call Lights 2.7 calls per patient –Falls Zero –Patient Satisfaction Promptness response to call (n=12) –Mean 85.4 Overall rate of care given (n=16) –Mean 92.2
Results 36% Reduction in call light use Reason for call light use did not vary 100% Decrease in falls* Satisfaction increased 6.2 points (on 100- point scale)
Discussion of Barriers Gaining “buy-in” from staff Staff completion of accountability tool – dissatisfaction/non-compliance with rounding logs Consistency in staff using protocol Staffing, acuity, admits and discharges
Limitations Conclusions about influence on falls cannot be determined due to small sample Satisfaction data is still coming in
Implications Rounding was shown to be an effective intervention to –Decrease call light use –Increase patient satisfaction Based on these results, hospital-wide adaptation of this protocol is recommended.
Recommendations: Future Study Training –Create unit leaders/Rounding champions –Follow each staff member as they round –Use pre- and post-tests with staff education Need for: –Randomized control study –Cost benefit analysis Use of call light system that can collect data
References Kalman, M. (2008). Getting back to basics: hourly rounds to decrease patient falls and call light usage and increase patient satisfaction. Retrieved on April 14, 2008 from Kazin, A. (1989). Behavioral modification in applied settings. 4 th ed. Pacific Grove, CA: Brooks Cole. Landro L. (2005). The informed patient: hospitals aim to curb injuries from falling. Wall Street Journal, D1. Institute for Healthcare Improvement. (2004). Project planning form. Boston: Institute for Healthcare Improvement, 1-9. Meade, C.M., Bursell, A.L. & Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use, satisfaction, and safety. AJN, 106, Studer Group (2006). AHC Research Call Light Study. Retrieved on March 35, 2008 from Tea, C., Ellison, M. & Feghali, F. (2008). Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit. Orthopaedic Nursing, 27,