Patient Hourly Rounding - Term Paper Example

? Patient Hourly Rounding Introduction Patient safety and patient satisfaction are at the heart of nursing practice, and vital to the sustenance of any health care institution. This importance of patient safety and patient satisfaction means that innovative approaches to deliver these patient oriented factors should be the objective of nursing care and the health care institutions, which deliver patient care services. Such an approach is mutually beneficial to the patients, nursing professionals, and health care institutions (Ford, 2010). The reputation of nursing care and health care institutions are dependent on the record of patient safety and patient satisfaction. It would not be too harsh to say that the very existence and sustenance of nursing care and health care institutions is dependent on these two vital factors, particularly in the modern trend of rising demand for excellence in the delivery of health care services. This understanding only reinforces the need for changes in the delivery of nursing care and health care services, towards excellence in ensuring patient safety and patient satisfaction. To satisfy this objective, however, the best means to changes that provide it have to be uncovered (Grove, 2008). Patient Hourly Rounding The concept of patient hourly rounding originated in England, where it was termed patient comfort rounds. Patient hourly rounding is built on predetermined definite protocols. The norm for protocols in patient hourly rounding is founded on four P’s, which stand for pain, personal needs, positioning, and placement. Other issues that could be a part of the protocol for hourly rounding include changing of dressings, administration of medications, and patient education. The concept of hourly rounding is based on compassionate care, and the strengthening of interpersonal relationship between the patient and the nurse, with the essential ingredient of anticipation of the needs of patients and meeting these needs (Charmel, Frameton, & Plantree, 2009). Patient hourly rounding are, thus a systematic nursing function that consists of nurses undertaking bedside rounds of patients, with a specific set of actions, and conducted over specific intervals. Thought the ultimate goal in patient hourly rounding is patient safety and patient satisfaction, the immediate objective is prevention of potential patient problems or to inhibit exacerbation of actual problems (McCartney, 2009). Recommended Change Patient hourly rounding is the recommended change in nursing care practice. The specific actions included in the patient hourly rounding are: Greet the patient Inquire if the patient needs toileting, pain control, repositioning, and blanket Place call light, telephone, tissue box, bed table, and TV control within convenient reach of the patient Provide mouth care, if required Give oral fluid, if required Provide any clarifications sought by the patient Inquire if the patient requires any other assistance Inform the patient when the next round will be performed (Adapted from Gardner et al, 2009, & Olrich, Kalman & Nigolian, 2012). The specific time interval will be hourly rounding. Evidence suggests that hourly rounding is superior to bi-hourly rounding in delivering patient safety and patient satisfaction (Meade, Bursell & Ketelsen, 2006). Theoretical Framework Lewin’s Change Model is an early model for planned change. The concept in this model is that a static state of behaviors in an organization occurs when the forces pushing for change and the forces striving to maintain status quo are almost equal. In other words, change is possible only when the forces pushing for change is increased, and the forces striving to maintain status quo is decreased. Lewin’s change model recommends a three step process towards attaining this objective in planned change. The first step is unfreezing, which consists of reducing the forces striving to maintain status quo. In this case, the first step is reducing the support among nurses for opposition to patient hourly rounding. The second step is termed as moving, which consists of implementing interventions that develop new behaviors, values, and attitudes. In this case, it means implementing the patient hourly rounding that brings about the behavioral change among nurses of being at the side of their patients on an hourly basis, with an attitude that enhances patient safety, and founded on the values for patient satisfaction. The final step is termed refreezing, wherein the new behavior among nurses is frozen by support mechanisms that involves involve awareness, appreciation, and rewards. In this case, support mechanisms will involve creating awareness of the reduction in falls of patients and increase in patient satisfaction on an individual basis, posting of notices on high performers, and the rewards system altered to incorporate efficiency in patient rounding as an important factor (Cummings & Worley, 2008). Evidence in Support of Patient Hourly Rounding Changes in nursing practice are based on evidence. There is a sufficient body of literature that can be used to provide evidence that supports the use of patient hourly rounding, from the perspective of patients in terms of their safety and satisfaction; from the perspective of nurses in terms of reduced call light usage, reduced interruptions in their task schedules and nursing satisfaction; and from the perspective of health care institution, through enhanced efficiency in the delivery of patient care services, thus covering all the stakeholders. Ford 2010 demonstrates that by finding out patient needs and accomplishing tasks in hourly rounding, there is improvement in the safety of patients and quality of care delivered to patients, which enhances patient satisfaction. In addition, there is reduced use of call lights. The Meade, Bursell & Ketelsen, 2006, study which compared hourly nurse rounding, bi-hourly nurse rounding, and no rounding, found that hourly rounding of nurses was by far the best in enhancing patient safety, patient satisfaction, and reducing call light usage (Melnyk, 2007). The same theme of enhanced patient safety through reduced fall rates, patient satisfaction, and reduction in call light usage is echoed by the Olrich, Kalman and Nigolian, 2012 study. Patient satisfaction is highly influenced by the assistance they receive in simple basic-self care needs, like use of the commode, ambulation, and taking of meals. Even bi-hourly rounding that incorporates these basic care needs is capable of enhancing patient satisfaction in medical and surgical units (Blakely, Kroth & Gregson, 2011). In the opinion of nurses, where nurse rounding has been implemented, patient satisfaction has enhanced enormously (McCartney, 2009). A comparison within a unit with nursing staff divided into hourly rounding and no rounding, clearly demonstrated reduced call light usage and enhanced satisfaction, with patients expressing their satisfaction to the managers. The highlight of this study was that nurses in the no rounding sample noticed the positive outcomes with hourly rounding, and initiated hourly rounding on their own (Orr, Tranum, & Kupperschmidt, 2007). Moving on from patient satisfaction to nurse satisfaction, nurses are less stressed when hourly rounding is implemented, as the reduced frequency of call light usage gives more time for nurses for carrying out their other tasks, reducing the stress experienced. Hourly rounding thus offers health care institutions a possible solution for reducing stress in the workplace for nurses, particularly at this time of shortage of nurses (Ford, 2010). The only cautionary note comes from Tzeng and Yin, 2009, who found that reduced call light usage could have an impact on patient safety in terms of increased fall rates. Summing up from the perspectives of patient safety and satisfaction, and satisfaction of nurses, and efficiency of care delivery in health care institutions, hourly rounding is a change required in nursing practice. Challenges to Implementation of Patient Hourly Rounding No change process is implemented without resistance. Resistance can be expected from nurses, who will have to change their patient care practice routine, through the implementation of hourly rounding. Resistance to patient rounding from nurses will be in the form of stating that they already do make rounds, though not on a hourly basis, or that it will be one more thing that they have to do, for which they do not have time (McCartney, 2009). Summing up the barriers that will be encountered in implementing hourly rounding are educating the staff of the change process and getting their acceptance; maintaining the charting requirements; consistency in performing the checks; disparate patient population, diagnoses, and co-morbidities; and staffing levels, and, admission and discharge numbers (Orr, Tranum, & Kupperschmidt, 2007). Characteristics of Change Leaders Nurse Managers are expected to lead the change. The Nurse Managers must believe in the benefits of the intervention of hourly rounding to enhanced patient safety and patient satisfaction. The Nurse Managers will have to be knowledgeable on how these benefits are derived, and the protocol and systems required for efficient hourly patient rounding. Nurse Managers will need to be willing to put in the extra effort required to communicate about the change process, educate the nurses on hourly rounding of patients, and even demonstrate on the effective way to conduct patient hourly rounding. Nurse Mangers will also need to encourage and motivate the nursing staff towards acceptance of hourly rounding, in terms of patient satisfaction and nurse satisfaction (Roach, 2001). Implementing Patient Hourly Rounding Nurse Managers will lead and develop the hourly rounding protocol and timings. The health care institution will provide time and facilities for educating nurses on hourly rounding and evidence of benefits derived from patient rounding. Once the education process is complete, the nurses in the unit will be divided into two groups. The first group will consist of nurses who support patient hourly rounding and the second group of those who resist the change, and prefer to go about in the usual manner. Records of the nurses caring for patients will be maintained on boards. Unit secretaries will record the number of calls made by patients on each day and daily fall rates. Nurses in the patient hourly rounding group will maintain a record of the time of rounds for each patient (Orr, Tranum, & Kupperschmidt, 2007). Monitoring Patient Hourly Rounding Nurse Managers will check the maintenance of records and the due processes of the patient rounding. Nurse Managers will personally assess patient satisfaction and amend the patient rounding protocol, if necessary. Nurse Managers will assess nurse satisfaction in the patient rounding group. Patient call records of all the nurses will be posted for all to see. Success of the program will be measured by the drop in patient fall rates, patient call rates, increase in patient satisfaction, and increase in nurse satisfaction among the patient hourly rounding group. The crowning success will occur, when the group of nurses going about patient care in the usual way volunteer to participate in the patient rounding program (Orr, Tranum, & Kupperschmidt, 2007). Conclusion There is a growing demand for enhanced patient safety and patient satisfaction in the delivery of patient care services that is important to nurses and health care institutions. Evidence shows that hourly patient rounding offers a solution for the demands for patient safety and patient satisfaction, and a means to reduce the stress experienced by nurses. Resistance can be expected to the changes in nursing routine that will result through the introduction of patient hourly rounding. This will have to be factored in the implementation and monitoring of patient hourly rounding. Success of the implementation of hourly rounding will be a measure of reduction in patient fall rates, increase in patient and nursing satisfaction, and the willingness of all nurses for patient hourly rounding. Literary References Blakely, D., Kroth, M. & Gregson, J. (2011). The Impact of Nurse Rounding on Patient Satisfaction in a Medical-Surgical Hospital Unit. Medsurg Nursing, 20(6), 327-332. Charmel, P. A., Frameton, S. B. & Plantree, P. C. (2009). Putting Patients First: Best Practices in Patient-Centered Care. Second Edition. New Jersey: John Wiley & Sons Inc. Cummings, T. G. & Worley, C. G. (2008). Organizational Development & Change, Ninth Edition. Mason, Ohio: South-Western Cengage. Learning. Ford, B. M. (2010). ‘Hourly Rounding: A Strategy to Improve Patient Satisfaction Scores.’ MEDSURG Nursing, 19(3): 188-192. Gardner, G., Woollett, K., Daly, N. & Richardson, B. (2009). Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study. International Journal of Nursing Practice, 15, 287-293. Grove, J. C. (2008). Staff Interventions to Improve Patient Satisfaction. Ann Arbor, MI: ProQuest LLC. McCartney, P. R. (2009). Hourly Rounds: An Evidence-based Practice. MCN, September/October 2009, p.327. Meade, M. C. Bursell, L. A& Ketelsen, L. (2006). ‘Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety.’ American Journal of Nursing, 106(9), 58-70. Melnyk, B. M. (2007). The Latest Evidence on Hourly Rounding and Rapid Response Teams in Decreasing Adverse Events in Hospitals. Evidence Digest, Fourth Quarter, 2007, p. 220-223. Olrich, T., Kalman, M. & Nigolian, C. (2012). Hourly Rounding: A Replication Study. Medsurg Nursing, 21(1), 23-26. Orr, N., Tranum, K. & Kupperschmidt, B (2007). Hourly Rounding for Positive Patient and Staff Outcomes: Fairy Tale or Success Story. The Oklahoma Nurse, p.11. Roach, S. S. (2001). Introductory Gerontological Nursing. Philadelphia, PA: Lippincott, Williams & Wilkins. Tzeng, H. M. & Yin, C. Y. (2009). Relationship between call light use and response time and patient falls in acute care settings. Journal of Clinical Nursing, 18, 3333-3341. Read More