Paper
Monday, November 5, 2007
383
Patient Rounding: A Prescription for Satisfaction
Dana Kocsis, MSN, Nursing, Akron General Medical Center, Akron, OH, USA and Caroline Miksch, Nursing, Kent State University College of Nursing, Kent, OH, USA.
| Learning Objective #1: Discuss evidence-based practice as the method for problem identification, intervention and evaluation as related to patient satisfaction scores in an acute care setting. |
| Learning Objective #2: Describe Patient Rounding as an Intervention in Providing Quality Patient Care. |
The strategic plan for nursing at a mid-size community hospital has as one of its major goals the provision of quality patient care within the context of evidence-based practice. This goal is aimed directly at unit level involvement. The measure of success of this goal is to be reflected in increased patient satisfaction scores as measured by the Press Ganey Satisfaction scale. The Senior Vice-President & CNO for Nursing Services provides the support and direction for initiatives aimed at meeting the goals in the strategic plan.
The Director for Nursing/Patient Services of a cardiovascular telemetry unit within the health care facility provided direction to her staff in meeting the goals of nursing’s strategic plan through the use of an evidence-based practice model to identify factors and initiatives for increasing patient satisfaction scores.
The Director reviewed patient satisfaction scores and identified a need to increase unit scores (EBP Problem Statement). Through discussion with staff and colleagues within and outside of the institution, it was identified that increased contact with patients by those providing nursing care may serve to increase satisfaction. Means to achieve this with finite patient staffing on a complex and busy unit were considered. Sources of evidence were explored including the literature, the patients, and the clinical experts. ‘Patient Rounding’ was identified as a possible strategy. A search for written evidence revealed a paucity of literature regarding the direct use of rounding as a strategy. However, an occasional article related to ‘patient rounding’ for safety and decreasing patient use for call lights served as encouragement to its use. The absence of literature on ‘patient rounding’ as it related to patient satisfaction only served to heighten interest in the topic.
Patient scores related to a sense of safety, security, and caring were considered as possible factors in contributing to the satisfaction or dissatisfaction of patients while hospitalized. The Director, while interested in the satisfaction scores, was more concerned about the quality of care as expressed in patients feeling that they are ‘safe’ and ‘cared for’ by the nurses. The Director collaborated with her staff and other clinical experts outside of the agency including the previous director of the unit.
Plans were made for implementation of the strategy. A protocol that incorporates specific actions into nursing rounds was developed as well as a protocol regarding who would round each hour or two. Nurse aids and/or licensed practical nurses rounded one hour and registered nurses the next. It was determined that all staff would be included. Built into the protocol were designated time frames for the rounding. Between the hours of 7:00a.m.-10p.m. hourly rounding was conducted while between 10:00p.m. and 7:00a.m rounding was set at every two hours. Four target areas were incorporated as part of the protocol for the content of the rounding. These areas included: 1) Pain, 2) Positioning and Comfort, 3) Toileting Needs, and 4) the question, “Is there anything else I can do for you”.
The strategy was implemented under the direction of the Director of the unit with the assistance of a Nurse Extern enrolled in upper level nursing in a baccalaureate nursing program. The Director set the expectations, processed with staff, integrated all facets of the strategy during staff meetings, provided guidance to the initiation of the strategy on the unit, and managed barriers to implementation. She and the Nurse Extern championed implementation on behalf of quality patient care and coached staff on all shifts. The underlying philosophy was that the strategy needed to become a part of the culture of the unit and reflective of the caring core of nursing. Rounding logs were posted on the doorways of all patient rooms.
80% completion of rounds was set as the success level for staff. Evaluation was based on patient satisfaction scores as reflected in the Press Ganey Satisfaction scale. It was expected that scores would increase over time. Scores are reported in percentile rankings comparing similar health care institutions. Data was obtained over three quarters with significant rating increases from the first to the second quarter. The third quarter scores in patient and nurse satisfaction and on standard personal issues increased to the 90th percentile rank. The Nurse Extern prepared data for presentation and gave a formal paper presentation to nurses throughout the institution. Outcomes were also disseminated through a poster on the unit and written materials within the institution.
The lessons learned relate to the necessity of the strategy becoming a part of the culture of the unit and integrated into all aspects of patient care. This strategy derives from the caring core of nursing and aims at the care and concern needed by each patient. The caring core of nursing is applicable to all nurses globally. While additional research needs to be conducted on outcomes in a variety of settings, the effects of the human, one to one, contact provided by rounding in this study provides rationale for its continued use. Role modeling by those in management is essential as is mentoring of all personnel, including new professionals. The unit will continue to collect data on other outcomes that may be related to implementation of the strategy such as nurse retention on the unit, patient falls, and time efficiency contributing to increased productiveness.