Implementing Purposeful Hourly Rounding on Medical Surgical Unit to Decrease Call Light Usage and Increase Staff Responsiveness HCAHP Scores

Background Information:

Nursing can influence patient satisfaction by how well the nurse delivers the care and the ability to anticipate patient needs proactively. Staff responsiveness and patient satisfaction may be correlated; when patients rate staff high on responsiveness, they are more likely to be satisfied with their care. After reviewing the literature on improved staff responsiveness and patient satisfaction, the recommendation was to implement hourly rounding.  Through purposeful rounding, nurses develop relationships with patients, allowing them to assess and provide nursing interventions to patients proactively which may lead to patient satisfaction. For successful implementation of this process, staff education, training, and accountability are required. 

Aims: The purpose of this evidence-based project change was to increase staff compliance to purposeful hourly rounding.  The goals for this project were to 1) increase staff compliance to the protocol by 30%, 2) decrease patient call light usage by 15%, and 3) increase HCAHPs score that measure staff responsiveness by 15%.

Description of method: Quasi-experimental design was utilized. This project consisted of a series of audits, both pre and post interventions, on staff compliance by utilizing the purposeful hourly rounding protocol and tracking patient call light data, and staff responsiveness. Interventions consisted of staff education about the importance of utilizing the purposeful rounding protocol and dissemination of reminder cards that scripted 5Ps (pain, position, potty, possession, prior to leaving room).

Outcomes/data: Fifty staff were audited.  During Phase 1 pre-intervention period, 23% of staff addressed all 5Ps during their patient rounds. Compliance rate for Phase 2 was a 40% increase. Call light usage was measured: prior to the project initiation, during phase 1 period, period between phase 1 and phase 2, and post-intervention phase 2.  Prior to audit, the unit received 800-2300 calls during the two week period.  The call light usage decreased from 718 in phase 1 and 788 in phase 2 (p= 0.44), a 48% reduction. Hospital staff responsiveness increased from 40.1 % to 65%, a 24.9% increase between pre- and post-implementation   

Recommendations: Because staff audits impacted call light volume, it is important to select unit champions from various shifts to help promote and maintain the process.  To establish the purposeful rounding process as a unit expectation, it is essential to continue periodic audits of the purposeful rounding process. Audits should be performed without staff knowledge to prevent Hawthorne effect and obtain reliable data.  Replicating this study on another unit for a longer duration may help verify significance of project findings.  Future studies should include investigating variables that impact staff resistance to rounding and strategies to change unit culture to consistently meet patient needs.