Hourly Rounding - The 4 P's - Maryland Patient …

1 MPSC 2010 Annual Conference Solution Submission Organization Name: Peninsula Regional Type: Acute Care Hospital Medical Center Contact Person: Janet Mercer & Cherita Fagan Title: Clinical Manager- 5WB/5EB E-Mail: Phone: IDENTIFICATION: What was the problem to be solved? Increase Patient satisfaction scores Decrease falls Decrease skin breakdowns Increase staff satisfaction How was the problem identified? Patient satisfaction survey (NRC Picker) results Hospital survey identified opportunity to increase Patient satisfaction Skin breakdown rates Fall rates What baseline data existed? NRC Picker Overall Rating of Care score- (April 09) Average Skin rate per one thousand (1000) pt. days (January thru April 09) Average Fall rate per one thousand (1000) pt. days (January thru April 09) PROCESS: Evidence-based research indicated implementation of Hourly Rounding would increase pt. satisfaction, decrease fall rates, decrease skin breakdown rates, and increase staff satisfaction.

2 All Patient care staff in clinical areas was educated utilizing the Studer Group Hourly Rounding Module. A one-hour class was developed introducing staff to the concepts of Hourly Rounding . Peninsula Regional s decision was to focus Hourly Rounding on the 4 P s: Pain, Potty, Positioning, and Possessions (see attachment #1). Several vignettes were shown during the class to reinforce the Rounding behaviors. Each staff member left the class with a competency (see attachment #2) to take back to their area and practice/ role-play with another staff member. Once comfortable they had to complete the competency with a Clinical Resource Nurse. Hourly Rounding was rolled out hospital wide on April 15, 2009. To ensure successful implementation, it was critical for nurse managers to validate with each Patient the performance of Hourly Rounding . Hourly Rounding The 4 P s MPSC 2010 Annual Conference Solution Submission SOLUTION: What solution was developed?

3 Competency based (return demonstration) education for all employees on clinical areas. Management Rounding to verify performance of Hourly Rounding by staff. Rounding Log for documentation (Attachment #3) How was this solution implemented? Classroom setting for one hour. Return demonstration of competence. What are the results of this implementation? Patient satisfaction scores trending upward for overall rating of care. Fall rate trending down Skin breakdown trending down What measures are being taken to assure the results are sustained over time? Hourly Rounding logs are monitored for completion and to ensure documentation of Rounding is being performed. During the managers daily Rounding process verification of Hourly Rounding is verified with the Patient . If inconsistencies are noted between the patients experience and the Rounding log documentation, coaching and mentoring is provided to each individual staff. OUTCOMES: NRC Picker Patient satisfaction scores- (September 09) (Attachment #4) Average Fall per 1000 pt days (May-December 09) (Attachment #5) Average Skin per 1000 pt days (May-December 09) (Attachment #6) MPSC 2010 Annual Conference Solution Submission HHoouurrllyy RRoouunnddiinngg TThhee FFoouurr PPss Introduce Yourself For example: Mrs.

4 Smith, my name is Sarah, and I will be your nurse today. I will take excellent care of you. I have discussed your care with your nurse from the last shift and I have the plan for the day. Describe Hourly Rounding Because we want you to receive excellent care, we are going to round every hour from 6 to 10 and every 2 hours from 10 to 6 We will not wake you if you are sleeping, unless your physician has asked us to do so. During this time, we will check on your pain, your comfort and if you need to use the bathroom. We will also be asking if you need anything moved within easier reach, or have any questions about your care. Use White Boards Write today s date, the Patient s nurse s name and his/her assistant/PCT. Also write the charge nurse s name and extension. ossessions otty ain P osition P P P Address the Four Ps Pain How is your pain? Medicate Patient or schedule during upcoming rounds. Position Are you comfortable? Move the Patient up in bad.

5 Rearrange pillows. Offer extra blankets. Turn patients who are at high-risk for skin breakdown. Potty Do you need to use the bathroom? Assist the Patient to the bathroom. Possessions Do you need me to move the phone, call light, trash can, water or your bedside table within reach? Arrange bedside table. Refill water pitcher. In addition: Perform scheduled tasks: - MD ordered procedures - Give scheduled treatment and/or medication Closing Communicate when you will return. I, or someone from my team, will be back in about an hour. Close with Key Words. Is there anything else that I can do for you? I have time. Document your round on the Rounding Log in the Patient s room. MPSC 2010 Annual Conference Solution Submission Name:_____ Badge #:_____ Unit:_____ Hourly Rounding Competency Skills Checklist Directions: Use this tool as a competency checklist to document the demonstration of Hourly Rounding competencies and behaviors.

6 There are two parts to this competency the learner s self evaluation and the manager/supervisor/or designee s evaluation of the learner which must both be signed-off to complete this competency. All information reviewed/skills assessed are based on the 2006 StuderGroup, Patient Care Strategies: Achieving Nursing & Patient Care Excellence ( Hourly Rounding ). Successful completion of this competency will be documented in NetLearning, ECH. Competence Statements Successfully Demonstrated Self Evaluation (learner s initials) Successfully Demonstrated (initialed by evaluator) Introductions Knocks on Patient s door prior to entering, asks permission Uses good eye contact Explains the purpose of Hourly Rounding (initial visit) Uses key words excellent care Describes Rounding schedule (7am-10pm q 1 hour; midnight-6am q 2 hours) Update White Boards Places name on white board Updates information as per unit practice. Addresses 4P s Pain.

7 Position .. Potty .. Possessions. Asks: How is your pain? Are you comfortable? Do you need to go to the bathroom? Is everything you need within your reach? (move items as needed table, call bell, phone, tissues, water) Performs and Explains Scheduled Tasks, Treatments, Care and Medication Use Completes MD ordered treatments, procedures Completes nursing care as needed Administers scheduled medications Closing Explains to Patient , We will be Rounding again in about an hour. Asks Is there anything else that I can do for you? I have the time. Documents Rounding on the Rounding log in the Patient s room MPSC 2010 Annual Conference Solution Submission My signature below indicates that the above information/skills have been reviewed and that I have successfully demonstrated understanding/competence. _____ _____ Employee Signature Date Initials Validation of evaluator: _____ _____ _____ Initials Signature Date MPSC 2010 Annual Conference Solution Submission Hourly Rounding Log This log is to be completed every hour from 7 am to 10 pm and every 2 hours from midnight to 6 am.

8 I have assessed my Patient for all of the above comfort measures as indicated by my signature below: Time Period Initials of Person Rounding Comments (*note if pt. sleeping) 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM 8:00 PM 9:00 PM 10:00 PM 12:00 AM 2:00 AM 4:00 AM MPSC 2010 Annual Conference Solution Submission 6:00 AM Rounding includes: Asking about pain, voiding/elimination, positioning, ensuring everything within reach, asking if there is anything else you can do, and telling the Patient when someone will be back. MPSC 2010 Annual Conference Solution Submission MPSC 2010 Annual Conference Solution Submission MPSC 2010 Annual Conference Solution Submission