Purposeful Rounding
Presented by
April Fairey
Why?
We rely on all of our team members to be mission
critical in creating patient centered excellence…
But… how do we validate that they meet patient
and internal customer expectations on their terms?
Four Types of Rounding
Hourly Rounding for
Patient Centered Excellence
Patient Centered Communication
Leaders Rounding on Patients
HCAHPS Key Drivers
Willingness to Recommend
Communication With Nurses
Pain Management
Responsiveness of Hospital Staff
Communication about Medicines
Communication with Doctors
Cleanliness of Hospital Environment
Quietness of Hospital Environment
Discharge Information
.73
.60
.52
.49
.47
.44
.39
.30
.30
This analysis comes from the 2011 HealthStream Database, which consists of discharges from 10/01/07 – 10/31/10.
Hourly Rounding
Evidence Based Practice that Can:
Reduce call lights
Reduce patient falls
Reduce skin breakdown
Improve patient perception of care
Improve patient satisfaction and
HCAHPS scores
• Increase time spent with patients
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•
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Outcomes of Hourly Rounding
The 5 P’s of Hourly Rounding
Hourly Rounding
Pain
Potty
Positioning
Personal
Items
Privacy
Effective Hourly Rounding
Words and actions that
help us partner with our
patients and families for
the best outcomes and
care.
Patient Communication Board
Pain
Leaders Rounding on Patients
Leaders Rounding on Patients
Traditional
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•
•
•
•
Admissions/Discharges
Physician Rounding
Complaint Visit
Interdepartmental Rounding
Problem Patient
BLG Focused
VS.
• Staff Driven
• Uses staff action plans
• Validate staff actions and
behaviors
• Set patient’s expectations
• Service recovery
• Staff recognition
Rounding Steps
On admission advise what hourly rounding is
and managing pain is a priority for this unit
Whiteboard has names and last pain score
Example alignments to HCAHPS and Patient Centered
Excellence:
• Script commitment to being the best possible hospital, quiet at night
• Validate if staff have been responsive to call lights
• Ensure patient communication board is updated with nurse, doctor, plan
of care and pain goals
Sample Leader Interaction with Patient
I’m _____, the Director of ______.
Our goal is that you receive Very Good care
while you are a patient here.
Do you feel well enough to answer a
few questions for me?
Discovery and Service Recovery
• In the last 24 hours have you needed to use your call
light? If so what for? Were we timely in our response?
• Describe your experience
• Tell me more
• Is there anyone I can recognize for providing you with
“excellent ” care? What exactly did they do?
• I apologize for the delay in answering your call light. Tell
me how I can make this better for you?
Focus on Positives
• Manage up staff and organization
• Identify and recognize by name staff who
consistently follow the action plan; send thank
you notes to their home
• Involve employees in the decision making
process
Action Plan
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•
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Educate all staff on actions; share rounding date
Share agreed actions in common area for high visibility
Document agreed actions on Patient Rounding Log
Select patient population for rounding
Begin rounding with focused questions
Document outcomes on rounding log
Share findings with staff and senior leaders
Outcomes of Leaders Rounding on
Patients
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Build Relationships
Reward and Recognize
Patient Safety
Deliver High Quality Services
Identify OFI’s
Create a “WOW” experience
Outcomes of Leaders Rounding on
Patients
• Patients rounded on by Nurse Leaders reported
satisfaction levels on average 59 percentile
points higher than patients not rounded on by
nurse leaders
• Decrease patient complaints by 66%
• Reduce Emergency Department LWOT from
4.5% to 2%
Rounding Queen
Interdepartmental Rounding
Interdepartmental Rounding
Traditional
BLG Focused
• Problem Focused
• Reactive
• As Needed
VS.
• Scheduled
• Customer Knows the Question
being asked
• Focus is what is working well
and staff recognition
• Mutual OFI identified and plans
agreed to
• Information Harvested
documented and shared with
staff and senior leaders
Example Alignments to Patient Centered Excellence:
• Pharmacy: Who can I recognize that has helped you communicate
medication side effects?
• Environmental Services: What can our team do to help you keep
rooms “always” clean?
Ancillary Departments:
Environmental Assessment
Meet patient needs and reduce call lights:
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•
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Manage up experience; share your role
Use key words and phrases
Conduct an environmental assessment; are important
items in reach?
It’s Not Just About “Nursing” or “IP”
• Everyone is an owner of HCAHPS success
• 60% of inpatients start their experience in the ED
• HCAHPS survey is expanding across the house
Annual Goal Results
290 Bed Hospital
Location: Waterbury, CT
Month
Nov 2011
Sep 2011
Jul 2011
May 2011
Mar 2011
Jan 2011
Nov 2010
Sep 2010
Jul 2010
May 2010
Mar 2010
Jan 2010
Nov 2009
Sep 2009
Jul 2009
May 2009
Mar 2009
Jan 2009
Nov 2008
Sep 2008
Jul 2008
May 2008
Mar 2008
Jan 2008
Nov 2007
Sep 2007
Jul 2007
May 2007
Mar 2007
Jan 2007
Number of Infections
Number of Hospital Acquired Infections by Month
40
35
30
25
20
FY Monthly Average
FY 2010 Goal
15
FY 2011 Goal
10
5
FY 2012 Goal
0
290 Bed Hospital
Location: Waterbury, CT
Likely Barriers to Effective Rounding
1. Not prioritized as part of daily schedule
2. Distractions and called to fight “fires”
3. Accountability Gaps
4. Overall lack of belief in patient focused
rounding as a critical management tool
5. Failure to act on the information
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