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Intentional One Hour Rounding In the nursing profession patient safety and satisfaction is greatly stressed and very important, thus I chose to do my leadership change project on intentional one hour rounding and how it affects patient safety, specifically falls, and patient satisfaction. To bring this vision to a reality it was important to understand the problems and to set measurable goals for achieving them. It was also important to gain knowledge from other leaders in the community and health care field to have a better understanding of the pitfalls that I could come into contact with while working toward a solution.
My practicum experience has broadened my horizons and allowed me to understand what leadership qualities are and how a leader could impact a proposed cause. My practicum took place at Gulf Coast Medical Center (GCMC), which houses 349 newly designed private rooms and opened to the public on March 8, 2009. Within this hospital there are a number of specialized units such as: Cardiac Med, SPCU, MPCU, MedSurg, General Surgery, Neuro, ICU, open heart ICU, Cath lab, ER, OR, and Obgyn and they could all benefit from one hour intentional rounding.
According to “Gulf Coast Medical Center” (2011), “Services include: emergency department – 43 beds, comprehensive cardiovascular care, including cardiology, cardiac surgery, angioplasty, cardiac catheterization, kidney transplantation, orthopedic surgery, neurosurgery & spine surgery, neurology, Joint Commission Certified Primary Stroke Center, obstetrics and gynecological care, general and vascular surgery, general medicine, intensive care units, diagnostic imaging, and outpatient rehabilitation services. ” The population served is adult beginning from 18 years of age; there are also newborns from the Obstetrics unit.
I worked closely with the administrative supervisor, Judy Landas and we came to the agreement that the best change project is one that benefits patient safety and increases patient satisfaction. The problem within the organization is patient falls and below average patient satisfaction scores. The area in which we reside and work has a growing amount of elderly people. According to “Statistics Related to Falls in United States” (2007), the leading cause of death related to injury is falls in individuals over the age of 65. “One out of three adults age 65 and older gets injured from falls very year” (“Speak Up: Reduce your risk of falling”, 2011). The other issue is low patient satisfaction scores. This was evident when analyzing the survey by the “U. S. Department of Health & Human Services” (2011), when patients were asked if they would give GCMC a 9/10 rating 60% wrote yes but compared to the state average of 63% and national average of 67% GCMC is below average. Another question that was asked is if you as the patient would report “yes” that you would defiantly recommend this hospital; the results were 64% for GCMC, 67% for the state, and 69% nationally.
In both questions GCMC is below state and national averages. Leaders within in the organization are constantly striving for better HCAHP scores especially in these economic times because Medicare/Medicaid reimbursement falls solely on these results. My goal and vision are similar and they are that with close nursing observation and frequent rounding patient falls will be decreased and patient satisfaction scores will increase over the next year. The goal is to get patient satisfaction above national and state averages and to decrease patient falls to 100% reduction over a 3 month period of time.
The proposed change involves nurses and nursing assistants making rounds on opposite hours. For example, nurses will round on all odd hours and nursing assistants on even hours. They would come into the room and tell the patient that they are making their hourly rounds and follow this with the 4 P’s, pain, position, potty (elimination needs), proximity of personal items (Halm, 2009). This would make patients aware that someone would always be in every hour to attend to their needs. After collaborating with leaders at GCMC I have gained some knowledge on how to track and audit this intervention.
Inside of each room will be a checklist (Figures 1 & 2) for a nurse, nursing assistant, and supervisor’s initials by each hour. The nurse manager/supervisor must make rounds in the beginning and end of each shift. For the patient, it may be a good idea to write the next time someone will be in the room on a dry erase board so they are always aware and their expectations are met. SPCU at Gulf Coast Medical Center is currently initiating this plan but decided to change the name from intentional one hour rounding to patient safety and comfort ounding which is a great idea because it specifically explains the reasons for the rounding to the patients. According to Halm (2009), “Another innovative solution is to view hourly rounds as an interdisciplinary practice. Other team members may make rounds while with the patient, intervening on the basis of each member’s scope of practice. Perhaps a physical therapist can assess the 4 P’s and assist the patient to the bathroom while assessing their transfer ability and gait. Patients’ needs outside the caregiver’s scope would then be communicated to a suitable staff member for follow-up. This would be a great idea because to make a positive change all health care providers need to work as a team. How will this positively impact patient safety and specifically decrease patient fall rates? Intentional one hour rounding will reduce the necessity for patients to try to get out of bed independently for toileting purposes or to get a personal item. The Moffitt Cancer center conducted a study on intentional one hour rounding and how it affected falls in their facility. The study was conducted on the unit with the highest rate of falls, it was tracked for a 3 month period of time and the results were amazing.
Three months prior to the implementation of intentional rounding there were 3 falls with injury recorded (Ferrall, 2009). During the three month period of the study there were no falls recorded, meaning that there was 100% reduction in falls and even more impressive is that at the end of the year there was a 67. 8% reduction in falls on this unit (Ferrall, 2009). According to Halm (2009), fall reduction was analyzed in 9 different studies and the results showed that 7 out of 9 (77%), studies presented a reduction in falls during intentional one hour rounding. How could we ignore such improvements in patient safety?
It is important to acknowledge that small changes can make significant differences. Patient satisfaction scores are an integral part in boosting nursing moral and compensation. Nursing as a profession is critiqued highly upon good quality care but I would like to stress that good quality care is not always impeccable knowledge base and intervention, rather than it is about treating the patient as a whole and this includes their psychosocial needs. According to Ford (2010), patient satisfaction relies greatly on nurse-patient relationship, continuity of care, trust, compassion, respect, safety, understandable instructions, and service quality.
Patients also appreciate reliability, responsiveness, and effective communication. Meade’s national study showed that 92-98% of patients were satisfied with intentional one hour rounding (Ford, 2010). Intentional one hour rounding or patient safety and comfort rounding allows for nurses to build that nurse-patient relationship, gain respect and trust, provide safety and education, and over simply give good quality care. According to Duffin (2010), “Patient satisfaction scores increased on average by 8. 9 points on a 100-point scale, to 88. 8 in Croydon Health Services NHS Trust and Whipps Cross University Hospital NHS Trust. Unfortunately, there is not enough time to implement this intervention and record findings within this courses span of time and GCMC has just started implementing patient and comfort rounding recently so it is difficult to say what the results are on a local level. To conclude, the main intentions of one hour rounding is to ensure patients receive the highest level in care, thus reducing the overall liability of Gulf Coast Medical Center. In turn, this process will help improve overall satisfaction ratings and meet or achieve national percentages in these specific categories.