Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction

1. Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction Stephanie R. Bruce, BS, RNUniversity of Wisconsin-Milwaukee, School of Nursing

2. Acknowledgments • Mary Beth Trentadue, Preceptor • Julie Darmody, Faculty Supervisor

3. 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.

4. Background • Fall Rate 3.3-7.0 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)

5. 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

6. LiteratureReview • 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 12-15 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

7. Framework • PDSA (Plan Do Study Act) (Institute for Healthcare Improvement, 2004) • “Behavioral shaping” (Kazin, 1989)

8. 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

9. 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.

10. 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

11. The following items will be checked and performed for each patient: • Assess the patient pain • Offer toileting assistance. • Change the patient’s position to promote comfort. • Make sure the call light (and soft call light when appropriate) is within the patient’s reach. • Put the telephone within the patient’s reach. • Put the bedside table next to the bed. • Put the Kleenex box within the patient’s reach.

12. The following items will be checked and performed for each patient: • Offer sip of fluid to patient and put within patient reach • Make sure the garbage bag is on the side of bedside table and empty as needed. • 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.” • Tell the patient that a member of the nursing staff (use names on white board) will be back in an hour to round again.

13. 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

14. 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

22. 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)

23. 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

24. Limitations • Conclusions about influence on falls cannot be determined due to small sample • Satisfaction data is still coming in

25. 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.

26. 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

27. 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 http://stti.confex.xom/stti/congrs08/techprogram/paper_37872.htm Kazin, A. (1989). Behavioral modification in applied settings. 4th 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, 58-70. Studer Group (2006). AHC Research Call Light Study. Retrieved on March 35, 2008 from www.studergroup.com Tea, C., Ellison, M. & Feghali, F. (2008). Proactive patient rounding to increase customer service and satisfaction on an orthopaedic unit. Orthopaedic Nursing, 27, 233-40.

28. Questions/Comments Thank you.