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1. Rounding for Outcomes Presented To: Colorado Foundation for Medical CareColorado 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 RoundingEvidence-Based Practice
Share Implementation Strategies for Hourly Clinical RoundingInpatient 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 SafetyNational 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 Model2003
Taking service to the next level
Patient Satisfaction DataPress 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, CNAs, Care Coordinators, Rehab Staff, Dietician
Work Group Decision to Implement
6. Hourly Clinical Rounding: Implementation Plan Define Hourly Rounding
24/7Regular, 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 Ps
PainPhysical and emotional
PottyAssist with elimination needs
PositionPatient 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 EvaluationsParticipation was requiredNOT 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-ImplementationOutcomes 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 unreliableCall 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 EfficiencyTime Saving
Rounding is proactive
Fewer trips back to the patients 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
Its 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