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

Effect of Hourly Nursing Rounds on Call Light Use, Patient Falls, and Patient Satisfaction . Stephanie R. Bruce, BS, RN University of Wisconsin-Milwaukee, School of Nursing. Acknowledgments. Mary Beth Trentadue , Preceptor Julie Darmody , Faculty Supervisor. Introduction. Problem:

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

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  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

  15. 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)

  16. 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

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

  18. 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.

  19. 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

  20. 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.

  21. Questions/Comments Thank you.

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