There are clearly many elements to delivering consistent, superior patient care. In terms of patient satisfaction and experience, proactive rounding that incorporates the 5 Ps is the foundation. You can do a lot of other things well but poorly executed patient rounding has the potential to negate all other efforts.The combination of hourly rounding and the 5 Ps is designed to meet the needs of patients and their caregivers, by improving access to timely, quality and safe healthcare.
Furthermore, this approach improves detection of the deteriorating patient, improves patient satisfaction, reduces the rate of falls, pressure ulcers, medication errors and call light usage. Not to mention the positive impact it has on HCAHPS scores.
We attest that an hourly check on every patient every day (less at night to ensure proper rest) provides the best care and experience possible.
I know you are thinking "we cannot go with scripts." If you want to be able to sustain this approach long term, you will insist on a script. Can they be personalized some? Of course. Scripts serve two important functions: 1) you have a standard to which you can hold staff accountable and 2) you have a basis on which to train new staff. Our advice: MAKE A SCRIPT.
1) introduce yourself
Introduce yourself to your patient. Tell them a little bit about yourself, including how long you have been working in your profession, your title, etc.
2) use your patient communication board
Using your patient communication boards 100% every day contributes as a significant factor in improving patient satisfaction. Make sure the communication board is current and that the rounding is checked on the board. See our Communication Board video here.
3) describe what you are doing
“Because we want you to receive the best care possible, we are going to round every hour while you are in the room. We will not wake you if you are sleeping unless your doctor has asked us to do so. We will check on your pain, your comfort, and ask if you need to use the bathroom.”
4) assessing the 5 ps
PAIN: “How is your pain?”
POSITION: “Are you comfortable?” [Turn and position patient for comfort.]
POTTY: “Do you have bathroom needs?”
PERIPHERY: “Do you need me to move the phone, call light, trash can, water cup, or over-bed table?” [Move the phone, call light and/or trash can within reach. Arrange the over bed table and fill the water cup. Ensure all equipment is plugged in. Eliminate unnecessary clutter.]
PUMP: Check the IV pump.
5) in closing
Close with, “Is there anything else I can do for you while I’m here? I have the time."
improves ROUNDING RESULTS• Saves steps for the nursing staff
• Promotes safety
• Brings nurses back to bedside
• Increases patient satisfaction
• Improves clinical outcomes
• Decreases patient anxiety
• Builds the patient’s trust
• Provides the best possible care
improves PATIENT experience“I feel safer and more secure.”
“I can reach everything I need.”
offers MEASURABLE RESULTS
Fall Reduction: Over 50% -- Numerous studies have shown that ensuring patients have access to their personal items, are comfortable and have their bathroom needs met reduces fall rates by more than 50%.
Pressure Ulcer Reduction: 10% -- Many hospitals implementing this approach have shown a decline in skin breakdowns and pressure ulcers in excess of 10%.
Call Light Reduction: 40% -- Call light usage can be reduced over 40% with effective deployment. The improvement in patient satisfaction is significant but perhaps the biggest benefit with this reduction is the decrease in walking time for nursing staff and the improvement in job satisfaction due to not being constantly interrupted.
Overall Patient Satisfaction Typically Improves over 10%.
Despite much set-up effort, most hospitals are unable to execute hourly rounding well and consistently.
why is it so hard?
There are some easy, obvious reasons:
- Lack or disorganization of nursing leadership commitment
- Lack of staff training
- Lack of communication boards in place
- The inability to quantify or analyze results
And then the not-so-easy reasons:
- The Culture: Hourly rounding is a culture shift. Be aware that it will not become a part of your hospital culture in 60 days. This requires sustained focus and attention to have an impact.
- The Script: Train, educate and insist on scripting.
- The Purpose: Make it about doing the right thing for patient safety.
- The Focus: Focus on reducing falls and skin breakdowns and most nursing staff will become very engaged.
- The Communication Board: Ensure you have daily patient rounds that include getting patient feedback and evaluating effective use of the communication board.
Despite these seemingly insurmountable obstacles, affecting real change is not just possible, it is attainable with steadfast implementation - and the results are worth it.