Hourly Rounding with purpose: Evidence Based Practice Project

1. 3ed International Nursing Conference-2010 Jordanian Nursing Council JNC Hourly Rounding with purpose: Evidence Based Practice Project Mohammad R. Al-Qudimat, RN, MSN Nursing Research & Evidence Based Practice Program Supervisor King Hussein Cancer Center - Department of Nursing

2. Outline • Background • Aims • Methodology • PICO Question • Searching Key Words • Search Data Base • Result and discussion • Recommendation • Acknowledgments • Conclusion

3. Background What is hourly round project? It is the deliberate action of nursing staff visiting patient on a pre-determined time schedule to ensure that care needs are met through proactive nursing intervention. Hourly rounds are systematic nursing bedside rounds that incorporate specific actions, done at specific intervals (McCartney, 2009)

4. Background Reason for change Research shows that hourly patient rounding: Increases patient satisfaction. Decrease call light usage Increase patient safety  hospital-acquired pressure ulcers, and falls Support our goal  nursing care Standard for customer services Reactive response  Proactive response

5. Background • Many nurses revealed that they are already performing routine rounding on their patients, responding to call light, and tried their best to improve patient safety. • Frequent responses to call lights interrupt continuity of care and actually may decrease patient satisfaction (Gurney, 2006).

6. Purpose The purposes of this project • To investigate best practice interventions to increase patient safety, patient Satisfaction and decrease call light at King Hussein Cancer Center. • To report the best evidences and implementation of the hourly rounding practice.

7. Methodology – Task force team • Task force team was assigned • Nursing research and EBP supervisor • Magnet project supervisor • 4 clinical supervisor • Evidence Based-Resource Unit Nurses  take care of the application in units

8. Methodology - PICO Question • Among oncology patient, is the nursing hourly rounding with purpose improve the patient safety and satisfaction in comparison to the current routine practice at KHCC?

9. Methodology – Data Base • A literature search was conducted using • PubMed • Ovid • Science Direct • EBSCOhost Databases

10. hourly round nursing round 24hourly round call light falling down patient satisfaction effect of round nursing round and EBP call light quit fall prevention improve patient safety patient safety Methodology – Key word

11. Methodology – Review of literatures • The literature found was published between 1994-2009 • A total of 50 articles containing original research, and expert opinion, were included in the review. • 23 articles that related specifically to hourly rounding were found. • All evidences revealed that hourly rounding decreased patients' fall, bed-sore, and increase patients' satisfaction.

12. Methodology – Review of literatures • EB-RUN program preprinted Summary table was used for research critiques • The level of evidences was between III-VII. • Level of evidence from Research studies or other sources**

13. Methodology – Result and Discussion • All relevant literatures concluded that the rounding with purpose: • Decrease falling down events (references) • Decrease pressure ulcer (references) • Improve patients satisfaction (references) • Organize nurses time  hourly rounding can save hospital nurses an estimated 166 hours a month (studer group, 2006 & Trinsey, 2006)

14. What did we do? Form the team Literature review Data collection Presentation to nursing leaders Preparation phase: Kick-in day Hands on practice for all involved KHCC nurses Implementation phase Data collection after the implementation

15. Our team • Task force team was assigned • Nursing research and EBP supervisor • Magnet project supervisor • 4 clinical supervisor • Evidence Based-Resource Unit Nurses  take care of the application in units

16. What did we do? Form the team Literature review Data collection Presentation to nursing leaders Preparation phase: Kick-in day Hands on practice for all involved KHCC nurses Roll up Implementation phase Data collection after the implementation

17. Kick-in day two days • Photo

18. What did we do? Form the team Literature review Data collection Presentation to nursing leaders Preparation phase: Kick-in day Hands on practice for all involved KHCC nurses Roll up Implementation phase Data collection after the implementation

19. Roll up • Photo

20. Our Slogan “Its not how much time you spend…it’s how you spend the time” Author unknown

21. What did we do? Rounding charter Assigned RNs are responsible for rounding on their patients, they could be partner with PN/LPN to ensure round effectiveness Rounds will be done every hour from 6:00-22:00 and every 2 hour 22:00-6:00 A 24 hour rounding sheet shall be posted in a prominent place at the bedside for each patient document rounding/action on the 24 hour rounding sheet immediately after the round

22. What did we do? Rounding charter The 5 Ps will be addressed on each round: P: Pain  pain level + pain management P: Potty offer toileting assistance + empty urine P: Position  assess comfort position P: Personal equipment; i.e. Call light, Telephone, TV remote control, Water, Trash can, empty urinal, and Tissue box. P: Promise to return back; some one will be back in one hour to round on you again.

23. What did we do? Rounding charter “I am here to do my round because I care!”

24. What did we do? Rounding charter "Is there any thing that I can do for you before I leave? I have the time."

25. Peer supporter Nursing leaders Magnet and EBP Educator

27. Conclusion • We believe that changing practice based on best evidences will be reflected significantly on direct patient care. • The evidences recommend using the hourly nursing round to enhance patient safety, satisfaction, and decrease the workload on nurses. • Despite challenges to initiate change into the work flow, the best evidences recommend the hourly rounding as standard of care.

28. ACKNOWLEDGMENT • Bedside Nurses • Nursing Leaders

29. Thank You