PATIENT CARE EXCELLENCEHOURLY ROUNDING, BEDSIDE SHIFT REPORT,INDIVIDUALIZED PATIENT CARE AND DISCHARGETELEPHONE CALLS AT ST.VINCENT’S EASTThe Patient Care Excellence Model includes 4 tactics, that when implementedsuccessfully, improves quality, ensures excellence, and increases patient satisfaction tIndividualizedSatisfactionWith NursingPatient CenteredCareDischargePhone CallsHow will we achieve this? By using the Studer Group Model of Patient Care thatemphasizes behaviors that drive nursing quality and ensure nursing excellence in caringfor patients.What is the Studer Group: The Studer Group is an organization that “continuouslyshares best practices, discusses challenges, and creates solutions to make health care abetter place for employees to work, patients to receive care, and physicians to practicemedicine. With this as our focus, Studer Group has developed a model of patient care toemphasize behaviors that drive nursing quality and ensure nursing excellence in caringfor patients.”Key words at key times:o Are things said and done to help patients, families and visitors better understandwhat we are doing?o They align our words with our actions to give a consistent experience andmessage.o They are intended to show patients and families that we care about them as aperson.

Benefits of key words at key times:o Provides a consistent experience to patients, families and visitorso Builds relationships and trusto Increases patient confidence in careo Aligns the care of the staff to the needs of the patientso Rewarding for staffExamples of Hospital Key Wordso Do you need assistance?o Can I take you where you are going?o Is there anything else I can do for you?Examples of Unit Key Wordso Key words are individualized by unito Based on Priority Indexo Communicated in Unit Meetingso Used with every patient every dayo Examples based on Press Ganey Survey questionso I am closing your door for your privacy.o Has anyone explained your procedure? It is important that we keep youinformed.o It is important for us to manage your pain.o Is there anything else I can do for you? I have time. (Shows concern)Body language needs to match the message you are giving.Non-verbal communication is just as important as verbal communication.Sometimes it is all about what you should not say. Think about the message thesecomments might send to a patient.o We’re short staffedo No one told me you were here.o We can’t get good help on this unit.o It’s not my job.The Patient Care Excellence Model ImplementationIndividualized Patient Care – Ongoing.Joint Commission NPSG 15 – The organization encourages patients’ activeinvolvement in their own care as a patient safety strategy.Discharge Telephone Calls – October 2006Joint Commission NPSG 15 – The organization identifies safety risks inherent inits patient population.Hourly Rounding – March 2008Joint Commission NPSG 9 – The organization reduces the risk of patient harmresulting from falls.Bedside Shift Report – March 2008

Joint Commission NPSG 2E – The organization implements a standardizedapproach to “hand off” communications, including an opportunity to ask andrespond to questions.Reasons for Call LightsSt. Luke’s Medical Center, Milwaukee WIPublished by Karen Van Handel, Barbara KrugOrthopedic Nursing, Jan/ Feb 1994 Vol 13/No getphysicalchangeotso hem rethinghelpliftingmedpainequipmentpositionin foog/dtransfericequestionstoiletingassist0.0Call light implications – To accomplish arriving at the patient’s room, fulfilling thepatient’s request and returning to another task equates to four minutes. If interruptionscan be minimized, time saved means hours available for other tasks. For example, 4minutes x 25 call bells/shift 1.66 hours which could be used to complete routine tasks ifcalls could have been prevented.How can we reduce call light interruptions? By completing hourly rounding,consistently demonstrating particular behaviors, using key words and accomplishingspecific tasks during hourly rounds.What is hourly rounding? Hourly rounding is a proactive assessment by nurses andpatient care assistants on an hourly basis (every 2 hours at night) focused on why patientsuse their call light (pain, potty, positioning, personal belongings, and pumps).Recent research of the effects of hourly rounding (Article from AJN September 2006:Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety – StuderGroup):o Reduces call lights by 38%o Reduces falls by 50%o Reduces pressure ulcers by 14%o Increases patient satisfaction by 12%Benefits of Hourly Rounding:o Anticipates needs of the patiento Keeps patients and families informed

ooooIncreases trust with patient and familyIncreases presence of the nurseEnhances communicationBetter work flowSpecific Behaviors and Tasks of Hourly Rounding:1. Use opening key words and/or actions to introduce yourself, your skill set, yourexperience and others.o Key words let the patient know who you are and what your role is.o Using the word “round” is a familiar term with patients, and they will soonbegin to associate a “round” as a consistent action on the part of the staffto assess their pain, comfort, and position.o Body language needs to match the message. Non-verbal communication isimportant.2. Perform scheduled tasks. Complete any scheduled tasks that are needed for thatpatient during the round.o Medications scheduled for that houro Treatmentso Procedureso Feedingso Check pumps and fluids3. Assess and address the 4 P’s of pain, potty, possessions and position.o Offer PRN medications at the earliest frequency during the course ofregularly scheduled rounds.o If necessary, write the next available time the pain medication can beadministered on the patient’s white board.o Assess potty, possessions and position needs.4. Assess additional comfort needs.o Straighten sheetso Offer something to drink, if not contraindicatedo Open or close curtainso Adjust lighting/temperature5. Conduct an environmental assessment of the room (possessions).o Is the call light within reach?o Is the telephone within reach?o Is the light switch and TV control accessible?o Is there a trash can next to the bed?o Is the bedside table within reach?o Does the patient look comfortable and is the patient covered to protectpersonal privacy?6. Use closing key words and/or actions.o Use the phrase, “Is there anything else I can do for you? I have time.”7. Explain when you or others will return.

o Before leaving the room, use key words and actions that tell the patientwhen you will return. “Mrs. Johnson, it looks as if you have everythingyou need. I will be back in an hour to round on you again.”o When you tell patients when you will return, they will begin to clustertheir requests in the context of your rounds, rather than relying on the calllight system, as long as they trust you will come back that next hour.o DO NOT SAY “Call me if you need me.”8. Document the round on the log.o Shows accountabilityo Ensures rounds are being doneWhat Hourly Rounding Is Not!o Hourly rounding is NOT just checking on patients!o Hi, Ms. Smith – you doing OK? Good – I’ll see you in a little while.o Why don’t we just check on patients?o It does not live up to our word.o It does not produce results for patients and staff.o There are no efficiencies gained. No decrease in call lights No decrease in falls No decrease in pressure ulcers No increase in patient satisfaction No increase in pain managementT ools : T he Welcome C ard

Using the Welcome Card: Upon meeting the patient the first time, use the Welcome Cardto set clear expectations with the patient and family. Tell the patient that “If at any timeduring your stay you have any questions or concerns, please call me immediately. If I amnot available, please call my charge nurse.” This is the only time we should tell thepatient to “Call me.” When making hourly rounds, we will tell the patient that we will“be back in about an hour”.T he 4 P ’s P ocket C ardThe Pocket Card is available for associates to keep with them as a reminder of thecomponents of hourly rounding. If you would like to have one, contact your manager.T he S orry I Missed Y ou C ard

The Sorry I Missed You card should be left on the patient’s bed if the patient has left theunit for a test or procedure. Only one card should be left. If the patient is out of the roomfor more than an hour, additional times should be added to the card so that the patient willknow that we are continuing hourly rounding even if the patient is not there.T he Hourly R ounding L ogThe Hourly Rounding Log is posted in every patient room every day. As hourly roundsare completed, the nurse or PCA should initial the log to communicate to the patient andfamily that hourly rounds have been done. This log is not a part of the patient’s chart anddoes not replace any required documentation. It is not required that the log be initialedevery time that someone enters the room if multiple visits occur during the hour.Hourly Rounding Exampleo Hi, Ms. Smith. I’m here to do my hourly rounds.o PAIN – How is your pain?o POSITION – Are you comfortable?o POTTY – Do you need assistance to the bathroom?o POSSESIONS – Do you have your call light, etc.?o Check pumps to make sure no action is required.o Update the plan of care on the white board.o Is there anything else I can do for you? I have time.o I will be back in about an hour.Do not say – Call me if you need me. If we tell patients to call us, they will. If they trustus to come back in an hour as we have told them we will, they will cluster their requestsaround the next visit and only call when absolutely necessary.

Comments from Nurses:o “Initially I was uncertain but then I saw how it saved steps. I got better atrounding every day.”o “I had more time to do my work because call lights were not going off all thetime.”o “I could concentrate on my tasks because I was interrupted less often.”o “When patients used their call lights, they really needed our help and it was agood use of our time.”o “Our unit was much quieter and fall less hectic.”Bedside Shift Report – A Tool for Effective CommunicationWhat it is – Bedside shift report improves safe care for patients and enhances both patientand associate satisfaction. It is an effective tool to use for nurse hand off of patients toone another and meets our Joint Commission required standard of conducting effectivepatient handoffs. (2007 NPSG) What it does:o Introduces the on-coming nurseo Manages up the skill of the next care providero Puts the patient at ease, reduces anxietyo Increases trust with the patient and familyo Communicates the plan of careo Keeps the patient informedo Ensures that immediate needs are meto Decreases call lights during reporto Enhances patient safetyo Verifies IV fluidso Increases teamwork between shiftso Gives a consistent message to the patiento Provides another opportunity to use key words: very good care, privacy, safety.Bedside Shift Report Using A.I.D.E.T.o Acknowledge: Acknowledge the patient and family. Make eye contact, smile,greet, and say good morning/good afternoon.o Introduce: Introduce yourself and manage up your skills or the skills of others(on-coming nurse, physicians, etc.). Update the patient’s white board with yourname and goal for the day.o Duration: Explain the report process – we do bedside shift report so that we candiscuss important information to ensure you receive safe care, reinforce hourlyrounding and when we will return on rounds.o Explanation: Explain tests, procedures, or plan of care. Give your report, discusspain management, treatments in progress, keep your patient informed andencourage the patient to participate in the plan of care, using key words such as“Very Good Care,” “I’m closing your door for your privacy.”o Thank you: Thank the patient for coming to St. Vincent’s East. Tell them youknow they are in good hands and will receive very good care.

o Always end every encounter with “Is there anything else I can do for you? I havetime.”Special Note Related to Bedside Shift Report – There may be rare occasions that youcannot report every thing you need to at the patient’s bedside. If this is the case, pleasemake sure these conversations are held in confidential locations that cannot be overheard.We have received comments from patients and families that they have overheard thenurses talking about the patient outside the room. Confidential information should bekept confidential. Bedside shift report should be given at the bedside with the patientinvolved in the discussion.DISCHARGE TELEPHONE CALLSBenefits:o Reconfirms discharge instructionso Reduces patient anxietyo Reduces complaints and claimso Reduces adverse drug eventso Reinforces patient perception that very good care has been providedDischarge Call Study – State University of New York – Mayo Clinic Proceedings,August 2005o Only 28% knew medication nameso Only 37% knew the purpose of the medicationso Only 14% knew the side effectsAdverse Events After DischargeAnnals of Internal Medicine, Feb.2003Type of Adverse Events“Nearly 1 in 5patients”*Other400 patients surveyed76 (19%) had adverseevents after ated17%66%AdverseDrugEvent* 81 events occurred in 76 patients

Discharge Call Questionso Call all inpatients within 24-48 hours of dischargeo Review discharge instructionso Ask about recognizing staff for giving very good careo Review discharge medicationso Answer questionso Ask if there were ways that we could have improved our careo Remind the patient of the surveyPlease complete the attached Patient Care Excellence Post Test and Statement ofCommitment. When complete, please return to your manager.

PATIENT CARE EXCELLENCEPOST TEST1. are the identified rounding behaviors?a. Use opening words and/or actions to introduce yourself, yourskill set, your experience, and others.b. Perform tasks.c. Address the 4 P’s of , , , and.d. Assess additional needs.e. Conduct assessment.f. Use closing and/or actions.g. Tell each patient .h. the round on the log.What are the results of implementing hourly rounding in your unit? Writedecreased or increased.a. decubitus ulcersb. patient fallsc. call lightsd. patient satisfactionWhat are the 4 P’s? , , ,and .Name at least three things to do during an environmental assessment.True or False?a. You always have to go through every rounding behavior thoroughlyevery time you interact with the patient.b. Only nursing can use the rounding behaviors.c. Hourly rounding is proven to reduce call lights.d. Hourly rounding saves nurse time overall.e. Patient satisfaction with nursing is at the center of the Patient CareExcellence Model.What is a closing key word or phrase you can use?The four tactics outlined in the patient care model are:a. Roundingb. Patient Centered Carec. Shift Reportd. Phone Calls

Statement of Commitment – Hourly Rounding/Bedside Shift ReportI acknowledge that I have received training on how to implement hourly rounding andbedside shift report on my unit. I know that my unit is currently performing hourlyrounding and bedside shift report.I understand that hourly rounding and bedside shift report have been proven to increasepatient satisfaction and safety. Hourly rounding has also been proven through evidencebased practice to enable nurses to be proactive and not reactive to patient caremanagement related to the use of call lights.I also understand that hourly rounding and bedside shift report will support our hospital’smission of providing patient-centered care, and will help us to sustain the appreciationand trust of our patients.By signing this statement, I commit to hourly rounding and bedside shift report in mydaily patient care activities, consistent with the training I have received, and using thetools that the hospital has provided. This includes: Educating the patient upon arrival on the unit regarding hourly rounding andbedside shift report. Making hourly rounds every hour from 6:00 am until 10:00 pm and every 2 hoursfrom 10:00 pm to 6:00 am. Assessing the “4 P’s” on each round. Leaving “Sorry I Missed You” cards when the patient is out of the room. Giving bedside shift report at the bedside with the oncoming nurse and involvingthe patient. Updating the patient’s white board to include care giver’s names and goals for theday.Name:Signature:Date:Unit: