Implementing Purposeful Hourly Rounding on Medical

Surgical Unit to Decrease Call Light Usage and Increase

HCAHPs Staff Responsiveness Score

Tru Byrnes, MSN, CNL, RN, CMSRN

MSN Capstone Project

Disclosure Information

Presenter Name Tru Byrnes, MSN, RN, CNL, CMSRN

Conflict of Interest None

Employer Carolinas Medical Center-Main

Sponsorship / Commercial

Support

None

Learning Objectives

Session Goal

- Increase the clinician’s knowledge on how to improve HCAHPs

Staff Responsive Score.

Session Objectives

– Describe the importance of purposeful hourly rounding in clinical

practice.

– Develop strategies to increase staff compliance to the protocol.

– Evaluate outcomes based upon HCAHPs Staff Responsive

Score

Carolinas Medical Center- Charlotte NC

874 licensed beds

Setting

• 5T Medical Surgical Unit

• 36 Beds

• Patient Population

• Nurse-Patient Ratio

Purpose & Goals

Purpose

• Increase compliance with purposeful rounding by holding

staff accountable to the protocol

Goals

• Increase staff compliance to the protocol by 30%

• Increase staff responsiveness score by 15%.

• Decrease patient call light usage by 15%

Problem Identification

Staff Responsiveness

2013

Percentile

1st quarter 92.8

2nd - 3rd quarters 68

Benchmark 85

Theoretical Framework

• Lewin’s Change Theory

– Unfreezing

– Movement

– Refreezing

Review of LiteratureAuthors Call Light Usage Reduction

Culley (2008). • 77 on the step-down unit

• 31% on the surgical unit

• 56% on medical unit

Ford (2010). • 52% after three weeks of hourly rounds

Patient Satisfaction

Bourgault, A., King, M., Hart, P.,

Campbell, M., & Swartz, S. Lou, M.,

2008.

HCAPHs Scores:

• Overall quality of care (p<0.04)

• Hospital recommendation (p<0.03)

Murray, T., Spence, J., Bena, J.,

Morrison, S., & Albert, N., 2010.

• 34.6% increased on hospital experience rating from

20.4% to 55%

Barriers

Deitrick, Baker, Paxton, Flores, &

Swaverly., 2012.

• Lack of education and training on the rounding

process, and accountability.

Methodology

• Quasi-experimental Design

– A series of audits:

• Pre and post intervention on staff compliance of

purposeful hourly rounding

– Monitored call light data and staff responsiveness

HCAPHS score

• Sample

– N=70

Methodology

• Interventions

• Staff education on 5Ps of rounding

• Disseminated reminder cards with scripted 5Ps

• Project Duration

• 9 weeks

– 4 weeks pre- post intervention data collection

and 1 week staff education

)• 2010 – 31 CLABSIs - $1,420,234

• 2011 – 20 CLABSIs - $916,280

• 2012 – 24 CLABSIs - $1,099,536

• 2013 – 16 CLABSIs - $733,024

Steps Are steps followed?

Y/N

(comments)

1 Knock on door gently and announce entry indicating that you are there to

check on the patient. If the patient is awake:

Pain: Assess/Ask about pain. If not RN, call RN if pain is present

2 Potty-Ask whether patient needs bedpan or if ambulatory, assistance to

the bathroom

3 Position- Turn Patient every 2 hours if at risk for developing pressure

ulcer. If not, offer to reposition patient/ ask if patient is comfortable

4 Possessions-Ensure that call light, phone, Kleenex, water, trash can, and

patient’s belongings are all within reach of patient.

5 If patient awake, check if they need anything else while you are in the

room

6 If patient awake, tell patient someone from team will be back in 1 hour to

check on if patient asleep check again in 1 hour

5Ps Purposeful Rounding Protocol Audit Tool

5T Staff Patient Rounding (RN/ NA) 7Aam to midnight

Date of Audit

Outcomes

Compliance rate on staff addressed all 5Ps during their

patient rounds

• Audited n=50 staff out of 70 (RNs and CNAs)

• Pre-intervention: 23%

• Post-Intervention: 63%

Outcomes

1800

718

2300

778

0

500

1000

1500

2000

2500

Baseline data prior tothe project

implementation

Phase 1 pre-intervention (audit)

Times between phase1 and phase 2 without

audit

Phase 2 post-intervention (audit)

Nu

mb

er

of C

alls

Total Call Light Usage in Two Weeks

Outcomes

40.1%35.7%

44.4%

65.0%

50.0%

80.0%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

Reponsiveness of hospitalstaff

Call button help soon aswanted it

Help toileting as soon as youwanted

HCAHPS Survey Results

Pre-Implmentation (April 1-June 7) Post-Implementation ( June 8-August 8)

Recommendations

• Establish purposeful rounding as a process, it is

essential to continue periodic audits.

• Select champions from various shift to help promote and

maintain the process.

• Audits should be performed without staff knowledge to

prevent Hawthorne Effect and obtain reliable data.

Recommendations

• Replicating this study on another unit for a longer

duration may help verify significant of project findings.

• Investigating variables that impact staff resistance to this

concept of rounding.

• Change unit culture to consistently meet patient needs

proactively.

References

• Bourgault, A., King, M., Hart, P., Campbell, M., & Swartz, S. Lou, M. (2008). Nursing

Management, 39 (11), 18-24.

• Culley, T. (2008). Reduce call light frequency with hourly rounds. Nursing

Management, 39 (3), 50-52.

• Deitrick, L., Baker, K., Paxton, H., Flores, M., & Swavely, B. (2012). Hourly Rounding:

Challenges with implementation of an evidence based-process. Journal of Nursing

Care Quality, 27 (1), 13-19.

• Ford, B. (2010). Hourly rounding: A strategy to improve patient satisfaction scores.

MEDSURG Nursing, 19 (3), 188-191.

• Grove, S., Burns, N., & Gray J. (2013). The practice of nursing research: Appraisal,

synthesis, and generation of evidence (2nd Ed). St. Louise: MO: Elsevier

• Kaminski, J (2011). Theory applied for informatics: Lewin’s change theory. Canadian

Journal of Nursing Informatics, 6(1), Editorial http://cjni.net/journal/?p=1210.

• Murray, T., Spence, J., Bena, J., Morrison, S., & Albert, N. (2010). Journal of Nursing

Care Quality, 25 (4), 366-372.

Acknowledgment

• Dr. Janie Best, DNP, RN, CNL, ACNS-BC, Faculty

Advisor at Queens University of Charlotte

Tru.Byrnes@carolinashealthcare.org