Rounding for Outcomes

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-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 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