Shigo, Jody, RN, CMSRN

Tavianini, Holly, RN, BSN, MSHSA, CNRN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingA Successful Patient Rounding Redesign: StaffEmpowerment Blended With a Research ProjectJody Shigo RN, CMSRNLehigh Valley Health Network, Jody.Shigo@lvhn.orgHolly Tavianini RN, BSN, MSHSA, CNRNLehigh Valley Health Network, Holly.Tavianini@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Presentation is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works byan authorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtResearch Day 2012: Transforming Culture Through Evidence-Based Practice, October 29,2012, Lehigh Valley Health Network,Allentown, PA. A Successful Patient Rounding Redesign:  Staff Empowerment Blended with a Research Project   Presented by:  Jody Shigo, RN, BSN, BA Holly Tavianini, RN, BSN, MSHSA, CNRN Workshop Objectives ■ The attendee will: – Identify a clinical issue and collaborate to uncover cause  – Describe research methods used to uncover root cause – Explain how to translate research findings to redesign a clinical process – Recognize the need to create an evaluation plan to monitor effectiveness of a clinical process change   What is Evidence Based Practice (EBP)? ■ “The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research."    (Sackett D, 1996)  What Is Patient Rounding? ■ LVHN adopted and adapted the Studer Group Patient Rounding Process – A process to assure that patient’s needs are met in a timely fashion • Pain, position, and personal needs – Assess comfort – Conduct environmental assessment – Nursing assessment – Outcomes • Improve clinical and quality outcomes • Decrease risks • Improved patient satisfaction • Reduce call lights • Improve employee satisfaction Why Round On Patients? ■ According to the literature, patient rounding reduces the frequency of call bell use, increases patient satisfaction with nursing care, and reduces falls. (Meade, Bursell & Ketelsen, 2006) Addressing the Problem ■ A3 Methodology – Background – Current Condition – Goal/Target Condition – Root Cause Analysis • The 5 WHY’s – Analysis method that is used to move past symptoms and understand the true root cause of a problem.  – Asking "Why?" five times will allow you to fully delve into a problem deeply enough to understand the ultimate root cause.  – Countermeasures – Results – Follow Up    Background Over the past five years, patient rounds have been widely adapted by healthcare organizations.  However, more recent reports relate lack of consistent adherence to defined protocols, although proven to have positive effects on patient safety.  We instituted hourly patient rounds in 2008.  Two years later, an ethnographic, grounded theory approach was used to study the rounding process and issues associated with implementation Goals/Target Condition ■ Improve clinical and quality outcomes ■ Decrease patient risks ■ Reduce call bell use ■ Improve patient and staff satisfaction Root Cause Analysis  ■ Quantitative and Qualitative Research Methodology utilized – Observations’ – Staff surveys – Interviews – Call bell observations 7A/NSU Pareto Chart Analysis ■ Descriptive statistics ■ Tests of statistical significance ■ Repeated measures for monitoring ■ Clinicians and statisticians should collaborate – Statistician knows how to do analysis but not necessarily what is meaningful – Clinician helps statistician interpret results ■ Statistically significant vs. clinically significant ■ Be aware of limitations, confounders, threats to validity of your results Research Findings Common Themes ■ Attitude toward rounding – in room anyway ■ Ambiguity ■ Staff not included in development and implementation of the rounding process  Barriers to Rounding ■ Patient load and care demands ■ Interruptions ■ Documentation requirements ■ Patient churn and flow Translating The Evidence ■ Moving from Research to Redesign of Clinical Process – Rounding Redesign Retreat • Change Agents – Frontline staff and leadership from 5A/TTU and 7A/NSU – Staff from original pilot units – 6T and 6B – SPPI Coach – Health Studies Research Colleagues – Reframing Through Forestry • Problem Trees  • Possibility Trees – Seven Models Refined To One • Achieved through brainstorming  • Development of standardized work Retreat Work Groups ■ Scripting ■ Log Tool Development  ■ Patient Rounding Standard Work ■ Communication ■ Leadership Rounding Standard Work ■ Measurement   Countermeasures ■ Redesign Rounding Log  ■ Standard Work  ■ Leadership Rounds Key Elements of the Redesign Process ■ Enhanced communication regarding expectations of the rounding process ■ Improved communication and team work amongst beside clinicians ■ Staff involvement in developing guidelines for rounding ■ Determine frequency of patient rounding and documentation requirements  Results Measurements of Success ■ Call bell use ■ Nurse sensitive quality indicators ■ Patient and staff satisfaction ■ Decreased adverse events   Lessons Learned and Recommendations ■ Identify unit champions ■ Involve direct care staff in design and implementation of patient rounding process ■ Clearly communicate relation between: – Patient rounding and safety – Patient rounding, nursing assessments, and clinical judgment ■ Standardize rounding log for consistency and efficiency Follow Up ■ Convert documentation tool to an electronic format – Pilot on 5A/TTU, 7A/NSU and 5C ■ Transparency of quality metrics through visibility board ■ Re-conduct call bell observation study ■ Resurvey staff – Process effectiveness – Satisfaction In Closing… ■ Just because it is EBP doesn’t mean it will automatically work ■ Involve the right people and collaborate ■ Ask for help; take advantage of resources available to you ■ Plan, plan, plan  know what you are trying to accomplish and determine your measures of success Questions? Jody Shigo, RN, BSN, BA Jody.shigo@lvh.com 610-402-8769  Holly D. Tavianini, RN, BSN, MSHSA, CNRN Holly.tavianini@lvh.com 610-402-5671 References Crow, K. (2002). Collaboration. DRM Associates , Retrieved October 17, 2011 from http://www.npd-solutions.com/collaboration.html.  Meade, C., Bursell, A., & Ketelsen, L.  (2006)Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety. American Journal of Nursing. 106(9) 58-70 Newsletter of the Consensus Building Institute, (Winter 2008). Future Issues for Collaboration and Consensus Building Processes. CBI Reports, XI. Retrieved October 17, 2011, from http://cbuilding.org/sites/default/files/  CBI%20Reports%20Winter%202008.pdf  Wolff, T. & Associates, (Summer 2008). Tom Wolff & Associates Coalition Building for Healthy Communities. Retrieved October 17, 2011 from http://tomwolff.com/collaborative-solutions-newsletter-summer-05.htm#banner  

Showcase of projects: A Successful Patient Rounding Redesign: Staff Empowerment Blended With a Research Project

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Showcase of projects: A Successful Patient Rounding Redesign: Staff Empowerment Blended With a Research Project

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