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Rounding for Outcomes

Presentation Objectives:. Provide the

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Rounding for Outcomes

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    1. “Rounding for Outcomes” Presented To: Colorado Foundation for Medical Care—Colorado IHI Node Presented By: Michele Kelly, RN, MSN Buena Vista Regional Medical Center Storm Lake, Iowa

    2. Presentation Objectives: Provide the “Case for Change” to Hourly Clinical Rounding—Evidence-Based Practice Share Implementation Strategies for Hourly Clinical Rounding—Inpatient Setting Provide Outcome Measurement data for Hourly Clinical Rounding Patient Satisfaction, Patient Safety, Employee Satisfaction

    3. Hourly Clinical Rounding: “Case for Change” What does the data/evidence show us? Patient Safety—National Focus Public Reporting of Data Quality & Safety Patient Perception of Care More Public Reporting (HCAHPS) “Satisfaction = Quality” in the eyes of the Customer Patient Satisfaction & Employee Satisfaction are closely linked “Alliance for Healthcare Research”=Studer Group Research Project IHI/AONE TCAB Research Project Transforming Care at the Bedside

    4. Hourly Clinical Rounding: “Case for Change”--BVRMC Implementation of Studer Model—2003 Taking service to the next level Patient Satisfaction Data—Press Ganey “Good” but not “Great” Employee Satisfaction Inpatient Satisfaction work group in place Strong Leadership on the Inpatient Unit Buy-In from staff for service initiatives Employee Satisfaction Scores Excellent (IHS Benchmark)

    5. Hourly Clinical Rounding: Plan for Change Reviewed Evidence in the Literature Studer Research IHI/AONE TCAB Project Nurse Manager presented the “Challenge” to Inpatient Customer Satisfaction Work Group Nurse Manager, Staff Nurses, CNA’s, Care Coordinators, Rehab Staff, Dietician Work Group Decision to Implement

    6. Hourly Clinical Rounding: Implementation Plan Define “Hourly Rounding” 24/7—Regular, Consistent Alternate hours RN=Even CNA=Odd Do NOT wake sleeping patients “Key Words” Developed “Is there anything else I can do for you while I am here?” “A member of our staff will return in one hour.” “Do you have any questions or concerns?”

    7. Hourly Clinical Rounding: Implementation Plan We developed a “Theme” “Round Around the Clock” (Refer to Picture) Educational Tool Determine Outcome Measures: Patient Satisfaction Scores (PG) Fall Rate Data (IHA Benchmarking) Frequency of Patient Call Lights (Jeron System) Employee Satisfaction (Survey Data + Anecdotes)

    8. Hourly Clinical Rounding: Implementation Plan Define the Expectations: Focused, Purposeful Rounding The “Three P’s” Pain—Physical and emotional Potty—Assist with elimination needs Position—Patient positioning & Environmental positioning (call light, water pitcher, Kleenex, etc.) Documentation Requirements—(see log)

    9. Hourly Clinical Rounding: Implementation Plan “Hardwiring” the Change Education of Staff (RN + CNA) Staff meetings11/06 Job Descriptions & Annual Evaluations—Participation was required—NOT optional Documentation of Rounding (see Rounding Log) Nurse Manager & House Supervisor follow up (compliance monitoring, coaching) We are “Ready to Roll” Implementation of Hourly Rounding 12/06

    10. Hourly Clinical Rounding: Pre- & Post-Implementation Outcomes Measurement Patient Safety: Fall Rate: Falls/1000 pt. days (Calendar Years) 2006 (pre) 2007 (post) 2008 (post) 2009 (YTD) Fall Rate: 2.45 1.16 1.81 1.09 Number/year: 14 7 8 1 Range/month: 0-3 0-2 0-2 0-1 # of Months with 2 7 6 1 Zero Falls Anecdotal reports from staff related to catching “near-falls” when making rounds

    11. Hourly Clinical Rounding: Outcomes Measurement Patient Satisfaction: Press Ganey Data (Percentile Scores All PG Data Base) 2006(pre) 2007 (post) 2008 (post) Nursing Section 90% 95% 94% Personal Issues Section 83% 91% 87% Attention to Spec. Needs 90% 96% 96% Pain Control 79% 87% 92% Promptness Response to 90% 94% 93% Call Light

    12. Hourly Clinical Rounding: Outcomes Measurement Daily Patient Call Lights 2006 (pre) 2007 (post) 2008 Avg # Calls/Day 106.2 99.3 100.3 Calls/Patient Day ( * ) 9.34 8.77 ( * ) Data not available Note: We determined this data to be somewhat unreliable—Call light data includes calls made by staff in the room requesting help & may reflect patient calls from “shared” rooms (swing between OB and Med-Surg)

    13. Hourly Clinical Rounding: Outcomes Measurement Employee Satisfaction Anecdotal Reports: Increased Efficiency—Time Saving Rounding is proactive Fewer trips back to the patient’s room Greater sense of “control” for Staff Less interruptions Immediate gratification when patient needs are met Promotes Positive Work Environment— “Purpose, worthwhile work and making a difference” IHS Survey Data Satisfaction on the Med-Surg Unit remains excellent

    14. Hourly Clinical Rounding: Outcomes Measurement Employee Satisfaction--Composite Score BVRMC (19 standard questions) *Significant change at 95% confidence

    15. Hourly Clinical Rounding: Summary The Evidence supports Hourly Rounding National Data BVRMC Data Supports National Patient Safety Initiatives: IHI 5 Million Lives Campaign Enhances Patient Perception Care It’s the right thing to do!

    16. Questions ?

    17. Questions? Contact Information: Michele Kelly, RN, MSN Director of Quality Buena Vista Regional Medical Center Storm Lake, IA 50588 712-213-8604 Kelly.michele@bvrmc.org

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