Quality Improvement Project; Hourly Rounding



Quality Improvement Project: Hourly RoundingCristina MardisBon Secours Memorial College of NursingQuality and Safety in Nursing IINUR 3207Professor Barbara FitzgeraldNovember 26, 2016 “I pledge” Quality Improvement Project; Hourly RoundingHourly rounding and the impact on patient care will be discussed throughout this paper. The Birthplace at Memorial Regional Medical Center will also be mentioned in this paper. Literature has suggested that hourly rounding is an effective plan for improving patients’ outcome. When a patient is admitted to the hospital, they anticipate they will be provided with good care. The nursing staff have the greatest impact on patient outcomes. Plus, they are the ones carrying out the patient rounding. Therefore, it is pertinent nurses understand the importance and expectation of the hourly rounding. Hourly rounding “is defined as a consistent nurse-patient interaction involving an assessment of patient needs and the provision of effective responses to those needs (Bragg et al., 2016, para. 1). Based on multiple research and studies, hourly rounding has improved patient satisfaction scores. “Patients tend to correlate satisfaction and quality care with the nursing staff‘s availability, visibility, and proficiency to meet their needs in a timely and efficient manner (Fabry, 2014, p. 201). At Memorial Regional Medical Center at The Birthplace, hourly rounding was recently discussed in the last meeting. Patients were expressing that once they were turned over to post-partum, they did not see their nurse nearly as much as when they were considered labor patients. This was enough to raise concern and initiate discussion on ways to improve the issue. The nurse to patient ratio for both post-partum and labor are different. In order for a patient to be turned over to post-partum, they have to be stable. While a patient is laboring, the nurse is more than likely in their room multiple times during the hour for various reasons. These reasons include but are not limited to the following; turning and repositioning, adjusting the monitors, allowing bathroom use, changing pads, increasing the Pitocin, and changing out medication bags. If a fetal strip is non-reassuring, multiple staff may be at the bedside for an extensive period of time. Hourly rounding is important on every unit. Other studies for different units have shown that hourly rounding decreased the rates of falls, the use of call bells, and overall patient satisfaction (Olrich, Kalman, & Nigolian, 2012). Hospital acquired pressure ulcers have also reduced with hourly rounding. Pressure ulcers is not much of a concern for The Birthplace as it is for other floors such as Medical/Surgical units. Patients may become frustrated if they have not seen their nurse for a while. They may try to get out of bed on their own and fall. Patients who need assistance with repositioning may become uncomfortable and irritated that they are unable to change positions because their nurse has not been in the room. This also places them at a risk for pressure ulcers. When call bells go off, this can cause a disruption in the flow of things. The nurse may forget what he or she was doing before the call bell went off. Some nurses on units have zone phones, so other staff members can call that nurse. The secretary will call the nurse if their patient called out. If that nurse is in another patient’s room, this can be disruptive for that patient if the phone rings. Any type of noise is disturbing while in the hospital, especially at night. “Decreased call light volume has been shown to decrease disruptions in care and give nursing staff more time to complete other tasks” (Fabry, 2014, p. 207). All of these issues stated above are reasons patients are dissatisfied with their hospital stay. The Birthplace has newly implemented a plan to emphasize on hourly rounding for better patient satisfaction. Dry erasable clocks have been placed outside of the room and on the white boards in the room. Every hour needs to be marked off on both clocks when the nurse performs her hourly round. The focus is mainly for post-partum and antepartum patients. Like stated previously, labor patients are rounded on more often. There have been instances where patients have verbalized they do not prefer the hourly rounding. One doctor actually wrote an order that stated vital signs could be every twelve hours. The sound of the door opening is just enough to wake the patient if they are sleeping. During hourly rounds nurses should check to see if the water pitcher is filled with fresh water. The call bell, telephone, and other items should be placed within the patient’s reach. The nurse should also perform environmental checks (Kessler, Claude-Gutekunst, Donchez, Dries, & Snyder, 2012). There is also a place in Connect Care where hourly rounds are documented. Several nurses have expressed how helpful this is as a reminder to go into the patient’s room as well as assess pain.The whiteboard in the rooms give nurses the opportunity to provide important information to patients and family. The current date and staff should be written on the board. There is space to write goals for the day which include rest, breast-feeding every two to three hours, decrease blood pressure, increased time out of bed, etc. The Birthplace does a technique called M in the box. The M stands for medication. The letter M is written on the board with a box around it. Underneath the M in the box is a list of medications the patient is receiving while in the hospital. By doing this, it offers a learning opportunity for the patient and family as well as feeling involved in their own care. Either the managers from both units or the clinical care leaders take turns rounding on patients daily. This allows the patients and/or family to give any feedback they desire. Hourly rounding has always been the practice. However, recently there have been new ways to help implement hourly rounding to better help patient satisfaction scores. So far, The Birthplace has received some positive feedback. Patients that stated their nurse performed hourly rounding gave a high satisfaction score. Patients have been more pleased when the nurses offer to do tasks, versus the patients having to ask. They do not feel like they are a burden to the nurses. Feedings for the babies are more routine and the mothers appear more relaxed. Patients are less likely to fall asleep with the babies in their arms, which decreases the risk for a newborn fall. Medications are given at the scheduled time for both mom and baby. The patient is less likely to use the call bell or phone their nurse, which helps decrease interruptions. Rounding should include a set of questions, which are referred to as the four P’s. The four P’s include pain, potty, position, and possessions. The nurse needs to assess pain, offer toileting and repositioning, and place the patient’s belongings within arm’s reach (Hodgson, 2012).Both patients and the nursing staff have found major benefits with hourly rounding and other interventions that have increased patient satisfaction scores. Other hospitals in the country have implemented changes similar to The Birthplace. Whiteboards have been installed and they are also used to inform patients of the hourly rounding times. Various comfort needs are assessed during the rounds such as environmental checks, the need for pain medication, position changes, and the need for the bathroom (Krepper et al., 2012). Patients are more at ease with hourly rounding because they trust the process and the fact that their needs will be met (Hodgson, 2012).right35242500ReferencesBragg, L., Bugajski, A., Marchese, M., Caldwell, R., Houle, L., Thompson, R., ... Lengerich, A. (2016). How do patients perceive hourly rounding. Nursing Management, 11-13.Fabry, D. (2014). Hourly rounding: perspectives and perceptions of the frontline nursing staff. Journal of Nursing Management, 23, 200-210. , L. L. (2012, October 24, 2012). Hourly rounding in a high dependency unit. Nursing Standard/RCN Publishing, 27(8), 35-41.Kessler, B., Claude-Gutekunst, M., Donchez, A. M., Dries, R. F., & Snyder, M. M. (2012). The Merry-Go-Round of Patient Rounding: Assure Your Patients Get The Brass Ring. MedSurg Nursing, 21(4), 240-245.Krepper, R., Vallejo, B., Smith, C., Fullmer, C., Messimer, S., Xing, Y., & Myers, K. (2012). Evaluation of a Standaridized Hourly Rounding Process (SHaRP). Journal for Healthcare Quality, 36(2), 62-69.Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly Rounding: A Replication Study. Medsurg Nursing, 21(1), 23-36. ................
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