SOLUTION: JOHN HOPKINS NURSING EVIDENCED BASED PRACTICE 2 Running Head: JOHN HOPKINS NURSING

JOHN HOPKINS NURSING EVIDENCED BASED PRACTICE 2

Running Head: JOHN HOPKINS NURSING EVIDENCED BASED PRCATICE 2

John Hopkins Nursing Evidenced Based Practice Individual Evidence Summary Tool

Johns Hopkins Nursing Evidence-Based Practice

Appendix G: Individual Evidence Summary Tool

EBP Question: Does the practice of consistent hourly rounding by registered nurses in the medical surgical nursing units improves patient safety, quality of care, patient satisfaction, and ultimately whether it enhances Nurse’s team pride?

Date: 03/06/2021

Article

Author & Date

Evidence

Type

Sample, Sample

Size & Setting

Study findings that help answer the EBP

question

Limitations

Evidence Level & Quality

Olrich, T., Kalman, M., & Nigolian, C. (2012).

Quasi-Experimental

Single Study

Setting – Two medical-surgical units in a 506 bedded teaching hospital

Sample – Patients discharged from two medical-surgical units during the one-year study period.

Sample Size –

(N- 4,418)

The purpose of this Study was to find the effect of hourly rounding on three variables such as call light usage, fall rate, and patient satisfaction. The results suggest that the experimental group’s fall rate decreased to 2.6/1,000 from 3.37/1,000 with rounding intervention. While this was not significant, statistically, a 23% reduction in falls clinically evident, and falls in the control group increased during the intervention time. Although due to one delirious patient, the call light usage was more in some weeks, the final statistical data showed no significant change in call light usage. The patient satisfaction surveys and statistical results do not show any evidence that rounding did not improve patient satisfaction; the anecdotal evidence from nurse leader’s rounds showed the hourly rounding increased patient satisfaction overall. Excluding statistical results, overall, the Study shows the hourly rounding has a positive effect on decreasing fall rate clinically, improving call light usage and patient satisfaction anecdotally

– Lack of non-randomized sample

Small sample size

– Delirious patient usage of call light 18 times in six days

– Non-availability of staff champion and inconsistency in training all staff on rounding procedures

– Temporary transfer of nurse manager during halfway of the Study to another unit

– Technical difficulties with the call light data collection system

– Lack of immediate weekly feedback on the rounding effects like reports of falls was not received until almost four months into the rounding process

Level 11 – Good Quality

Brosey, L. A., & March, K. S. (2015).

Non-Experimental

Quantitative Single Study

Setting – One medical-surgical unit in a large community hospital

Sample – Patients admitted in one medical-surgical unit over three month period

Sample Size – 582

The purpose of this project/study was to implement standardized structured nurse hourly rounding to monitor the outcomes of patient satisfaction, patient falls, and hospital-acquired pressure ulcer over three months. The overall results of structured nurse hourly rounding are effective, safe, and beneficial in today’s practice in decreasing patient falls, pressure injury, and improving patient satisfaction. After baseline assessment of 49% nurses compliance to hourly rounding, the goal set to 80%, and the results of 7-day consecutive assessment was 69.4%, 49.3%, and 59.2%, which is still an increase from baseline. The statistical analysis of fall rate and pressure injury helps to improve patient satisfaction. Out of 81 HCAHPS, surveys returned, the HCAHPS domain responses showing much more significant improvement after project implementation than preintervention time except nurses’ responsiveness domain. This project’s more outstanding results show that the fall rate decreased drastically, and only one pressure injury was reported during and after 12 months post-implementation of the project period. The corpus of evidence suggested that structured nurse rounding demonstrated favorable trends in

improving patient satisfaction and reducing patient falls, HAPUs, and call light usage. The Study showed an overall improvement of patient satisfaction indicators, decreased patient harm, and saving a lot of money spent treating hospital-acquired pressure injury and falls.

– Implemented only in one unit of a single hospital.

– Also, project period of three months is a concise period to evaluate the change in nursing workflow and cultural adoption of this intervention for sustainability

Level V, High Quality

Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014).

Systemic review

A systemic review of 16 published literature and GRADE analysis of evidence by a group of experts

The purpose of this systemic review was to examine the effects of purposeful nursing hourly rounds in reducing call lights, fall rates, improving nurse responsiveness, and patient satisfaction. This systematic review of 16 published articles found there is substantial evidence that hourly rounding has beneficial effects, particularly on the outcomes of patient satisfaction, call light use, and patient falls. Call light use fell substantially in all the studies where it was measured. Decreases ranged from 23 % to 70 %: the median reduction was 54 %. Among the studies in the review, nine also measured this outcome. The reported decrease in falls ranged from 24 to 80 %, with a median reduction of 57 %. The benefits on patient satisfaction scores and perceived responsiveness appear to be more significant for units that do not perform well at baseline, which supports a hypothesis that there is a ceiling effect on the impact of hourly rounding. Additional evidence is not likely to refute these conclusions; therefore, nurse administrators should invest in the development of hourly rounding programs adapted to their local circumstances

– Because of the lack of randomized control trials studies, there were not able to apply the modified Jadad scale as planned

– Little consistency in how results were reported across studies

– Variability in study protocols on each Study

Level III

Good Quality

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015)

Non-experimental

Setting – Two medical units at Christiana Hospital, a 907-bed hospital in Newark, Del

Sample & Size – 27 adult patients flowsheets from the stroke unit and 29 adult patients flowsheets from the hematology/oncology unit

The Study’s purpose was to determine the impact of patient-centered proactive hourly rounding on patient falls as part of a Lean Six Sigma process improvement project. In unit one, the one-year baseline mean fall rate was 3.9 falls/1000 patient days. The pilot period fall rate of 1.3 falls/1,000 patient days was significantly lower than the baseline fall rate. It was 2.6 falls/10000 patient days in unit two and was dropped to 2.5 falls/1000 patients a day during the project period. Out of 108 Staff members’ compliance data analyzed, 87% of the requirements were completed during rounding, 96% asked if they could do anything else, and only 73% asked, do the patient need positioning. 94% of staff in unit one believe that hourly rounding has a substantial impact on improving patient care and 89% said that it is an effective fall prevention strategy. Thirty-nine percent of staff on Unit 1 (7/18) perceived their overall workload to have been reduced following the introduction of patient-centered hourly rounding, and 83% (15/18) reported a reduction in call bell use by patients. By contrast, still, 25% of staff on Unit 2 (5/20) said that they believed patient-centered hourly rounding had a positive impact on patient care overall, and only 50% (10/20) felt that patient-centered hourly rounding is an effective fall prevention strategy. The overall results show that engaging an interdisciplinary team, including leadership and unit champions, to implement a patient-centered proactive hourly rounding program was associated with a significant fall rate reduction. The findings strongly endorse the inclusion of leadership support and front-line staff engagement in successful fall prevention program design.

– Short pilot period of 30 days

Level III, Good Quality

Ryan, L., Jackson, D., Woods, C., & Usher, K. (2019)

Integrative Literature review (Both Qualitative and Quantitative studies)

Setting – An integrative literature review from ProQuest, PubMed, InformIT, sage, Scopus, and The cumulative index to nursing and allied health literature

Sample & Size – A total of 18, including both quantitative and qualitative articles

The integrative literature review was conducted to establish the current knowledge about intentional rounding’s efficacy in current practice from nurses, patients, patient satisfaction, and safety indicators. The literature review of 18 articles, including qualitative and quantitative, demonstrated that Nurse’s intentional rounding has implications for nursing staff and patients’ satisfaction levels. Clinical safety outcomes have been vastly improved with purposeful rounding through increased pre‐emptive care and contact, leading to reductions in falls, pressure sores, and call light use and greater recognition of understanding. Nursing staff described positive benefits and increased satisfaction in more effective time management, fewer interruptions from call bells, predicting and pre‐emptive care needs, and having closer connections and awareness of patients’ needs. Nursing staff expressed comfort and reassurance in the practice of intentional rounding, that patients were observed at least hourly and that interactions were able to be recorded. Purposeful rounding was seen as beneficial, especially to more recent nursing staff, as it clarifies needs, giving direction and reminders to ensure quality care for patients. Intentional rounding is a successful practice in enhancing patient satisfaction and clinical safety outcomes, reducing falls, pressure areas, improving patient satisfaction, and a sense of pride among nurses.

– The limited robustness and week designs of many studies could impact the credibility of review findings

– Information depicted rigorously in research was missing in many studies, which affected the quality of findings.

Level IV, Good Quality

Hutchings, M., Ward, P., & Bloodworth, K. (2013)

Quality Improvement Project

Setting – 79 wards in Nottingham university hospital under NHS trust

Sample – Registered Nurses worked in

79 wards and patients admitted in 79 wards and their relatives during the project period

The new way of intentional hourly rounding technique caring around the clock, including clinical lead and senior leadership, was used in a range of setting across the 79 wards in Nottingham university hospitals under NHS trust demonstrated that the work was unique in the way it encouraged those settings to tailor rounding to the needs of their patients by selecting the appropriate Ps and Qs. The feedback from nurses, patients, and relatives has been positive. Patients understood the rationale behind the clocks use it to their advantage, knowing that they will have meaningful interaction several times a day with the Nurse looking after them. ‘Relatives have been assured by the clocks that their loved ones have been seen, attended to, by the nurses. The results also concluded the importance of leadership rounding together with intentional nurses rounding. One of the feedback from a ward sister was that the leadership rounds assure me that patients receive the care they require at regular intervals, and it is of a standard that I expect: top-quality and safety. The feedback indicated that the nurses hourly rounding helped improve communication, less documentation, more check on patients, improved nurses morale, more sense of pride, fewer patient concerns and complaints, reduced call lights, more settled patients, and improved patient satisfaction. Overall, the intentional rounding helped improve patient satisfaction because communication has been enhanced, and buzzers have decreased.

– Lack of literature on leadership Rounding

– Short Staffing

– Lack of cognitive impaired patients involvement due to improper project design to adapt them

– Not having good healthy clock machines

– Poor involvement of the multidisciplinary team.

Level V, Good Quality

Allen, T., Rieck, T., & Salsbury, S. (2016)

Non-Experimental, qualitative descriptive Study

Setting – 400-bed community hospital in the Midwestern United States

Sample & Size – 14 Adults Medical/Surgical Inpatients

The qualitative study was conducted to find more knowledge about the patient perceptions of an AIDET and hourly rounding program in a community-based hospital. An open-ended interview question about the hospital stay, AIDET, and hourly rounding was asked to fourteen participants identified. Overall the results showed that the use of AIDET and hourly rounding helped improve patient experience during the hospital stay. Patients may experience loneliness in a hospital setting when family and friends may be far away or non-existent, working through daytime hours, or have limited transportation access. Many patients mentioned that they liked when staff checked on them, even if it was to talk or chat with someone. Hourly rounding with a purpose has been found to reduce the number of call lights by reaching the patient’s need to use the restroom, manage pain, and adjust positioning before the need becomes present. The results also identified the importance of communication and the need for staff skills to provide comfort, alleviate fear, and improve understanding during hourly rounding

Not Addressed

Level III,

Low Quality

Daniels J. F. (2016)

Quality Improvement Project

Setting – 28-bed medical-surgical unit at a tertiary care non-academic faith-based facility in the United States

Sample & Size – Direct observation of Nurse’s rounding sessions working in the unit. 32 rounding on day shift, 12 rounding sessions on the night shift, Another 44 rounding session on both day and night shift sessions

The hourly rounding was found to a best practice to improve patient satisfaction and patient safety outcomes, such a better communication, and staff responsiveness. The project demonstrated quality improvement and increased patient satisfaction scores with nursing hourly rounding as their care and increasing patient safety during hospitalization. The project’s aims and objectives were realized as staff embraced the change and comprehended how best practice hourly rounding intervention could significantly improve patient outcomes. The intervention implementation demonstrated that the patient satisfaction scores and safety would continue to rise over several months as rounding becomes a hard-wired practice.

– Barriers are various in other units because nursing workflows and patient populations differ

– Results were not compared with a control unit

– Direct observations could have biased nursing behaviors

– The call light usage rate by patients not evaluated

– Sustainability measures needed to be established to maintain the gains and to continue to improve the outcomes

Level V, Good Quality

Mulugeta, H., Afenigus, A. D., Wagnew, F., Haile, D., Tadesse, A., & Kibret, G. D. (2020)

A quasi-experimental non-randomized control trial

Setting: Debre Markos Referral Hospital, Northwest Ethiopia

Sample & Size – 104 hospitalized inpatients admitted more than three days in medical and surgical wards during the study period

The Study was a non-randomized control trial to assess nursing hourly round’s effect on patient satisfaction. The Study had a control group and an intervention group. The results revealed that the intervention group patients have higher satisfaction scores than the control group, providing evidence that hourly nursing rounds improve patient satisfaction with nursing care and quality of care. The non-randomized control study implies that hourly nursing rounds in the intervention group help to meet primary patient needs during the increasing length of hospital stay and helped to improve overall patient satisfaction

– Quasi-experimental Study does not ensure equivalence between two groups

– Due to the small sample size study, the generalizability of the results might questionable

– Staff’s perceptions on hourly rounds not assessed

Level II, High Quality

Attach a reference list with full citations of articles reviewed for this EBP question

References

Allen, T., Rieck, T., & Salsbury, S. (2016). Patient perceptions of an AIDET and hourly rounding program in a community hospital: Results of a

qualitative study. Patient Experience Journal, 3(1), 42-49. doi:10.35680/2372-0247.1115

Brosey, L. A., & March, K. S. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of

nursing care quality, 30(2), 153–159. https://doi.org/10.1097/NCQ.0000000000000086

Daniels J. F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI database of systematic reviews and

implementation reports, 14(1), 248–267. https://doi.org/10.11124/jbisrir-2016-2537

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success?. Nursing, 45(2), 25–

30. https://doi.org/10.1097/01.NURSE.0000459798.79840.95

Hutchings, M., Ward, P., & Bloodworth, K. (2013). ‘Caring around the clock’: a new approach to intentional rounding. Nursing management (Harrow,

London, England : 1994), 20(5), 24–30. https://doi.org/10.7748/nm2013.09.20.5.24.e1075

Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: a systematic

review. The Journal of nursing administration, 44(9), 462–472. https://doi.org/10.1097/NNA.0000000000000101

Mulugeta, H., Afenigus, A. D., Wagnew, F., Haile, D., Tadesse, A., & Kibret, G. D. (2020). The effect of hourly nursing rounds on patient satisfaction

at Debre Markos Referral Hospital, Northwest Ethiopia: A non-randomized controlled clinical trial. International Journal of Africa Nursing Sciences, 13, 100239. doi:10.1016/j.ijans.2020.100239

Ryan, L., Jackson, D., Woods, C., & Usher, K. (2019). Intentional rounding – An integrative literature review. Journal of advanced nursing, 75(6),

1151–1161. https://doi.org/10.1111/jan.13897

Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly rounding: a replication study. Medsurg nursing : official journal of the Academy of Medical-

Surgical Nurses, 21(1), 23–36.

Johns Hopkins Nursing Evidence-Based Practice

Appendix G: Individual Evidence Summary Tool

Purpose: This form is used to document the results of evidence appraisal in preparation for evidence synthesis. It provides the EBP team with documentation of the sources of evidence used, the year the evidence was published or otherwise communicated, the information gathered from each evidence source that helps the team answer the EBP question, and the level and quality of each source of evidence.

Header: Record the EBP question and date of the EBP project for reference.

Article #: Assign a number to each reviewed source of evidence. This organizes the Individual Evidence Summary and provides an easy way to reference articles.

Author and Date: Indicate the last name of first author, or the evidence source and the publication/communication date. It is important to list both author/evidence source and date because several documents may be from the same source.

Evidence Type: Indicate the type of evidence reviewed (example: RCT, meta-analysis, qualitative, systematic review, case study, narrative literature review).

Sample, Sample Size, and Setting: This is only applicable for evidence levels I, II, III, and level V quality improvement, financial or program evaluation. Provides a quick view of the population, number of participants, and where the Study took place.

Study findings that help answer the EBP question: Although there may be many points of interest to the reviewer, list only findings that directly apply to the EBP question.

Limitations: Include information that may or may not be within the text of the article regarding drawbacks of the piece of evidence. The evidence may list limitations, or it may be evident to you as you review the evidence that an important point is missed, or the sample does not apply to the population of interest.

Evidence Level and Quality: Using information from the individual appraisal tools, transfer the evidence level and quality rating into this column.

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