PICO QUESTION 2

Running Head: PICO QUESTION 2

PICO Question

P: Registered Nurses working in the medical-surgical unit

I: Implementation of an evidence-based bundle which includes improving registered nurses knowledge, patient education, and hourly rounding practices

C: The current practice of hourly rounds

O: Improved quality and safety of patients as evidenced by;

Reduced fall rate

Reduced pressure injuries

Fewer call lights

Improved patient satisfaction and

A sense of enhanced nurses team pride

PICO Question

Q: 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?

Abstracts

The effect of hourly nursing rounds on patient satisfaction at Debre Markos

Referral Hospital, Northwest Ethiopia: A non-randomized controlled clinical

trial

Henok Mulugetaa,⁎, Abebe Dilie Afenigusa, Fasil Wagnewa, Dessalegn Hailea, Aster Tadessea,

Getiye Dejenu Kibretb, 2020

a Department of Nursing, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia

b Department of Public Health, College of Health Science, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia

A R T I C L E I N F O

Keywords:

Hourly nursing rounds

Nursing care

Patient satisfaction

Ethiopia

A B S T R A C T

Background: Today, implementation of hourly bedside nursing rounds is an important component of evaluating the excellence of hospitals and it is one of the strategies to increase the quality of care. Nevertheless, there has been little emphasis on the implementation of hourly nursing rounds and limited evidence is available on its

effect on patient satisfaction with nursing care in Ethiopia. Hence, the objective of this study was to determine the effect of hourly nursing rounds on patient satisfaction with nursing care.

Methods: A quasi-experimental nonequivalent groups study design was used to determine the effect of hourly nursing rounds on patient satisfaction with nursing care at Debre Markos Referral Hospital. A convenience sample of 104 hospitalized patients participated in this study (52 in control and 52 intervention group). The control group received the usual care in the selected units compared with the intervention group who received care with hourly nursing rounds. Patient satisfaction with nursing care scores was taken on the second and fifth days of hospitalization in both groups. Independent t-test was used to compare the statistical difference between the mean satisfaction scores of the two groups. A P-value of less than 0.05 was considered significant.

Results: The result of the t-test demonstrated that patients in the intervention group had a higher satisfaction score than patients in the control group on the second day of hospitalization although it was not statistically significant (P = 0.215). However, there was a significant difference in the mean satisfaction scores on the fifth day of hospitalization (from 71.02 } 14.37 in the control group to 79.69 } 12.21 in the intervention group, P = 0.001).

Conclusion: This study revealed that patients in the intervention group have higher satisfaction scores than the control group, providing evidence that hourly nursing rounds improve patient satisfaction with nursing care and quality of care. Therefore, policymakers (FMoH) need to consider the implementation of consistent hourly nursing rounds in our hospitals to improve patient satisfaction and overall quality of care at large

J Nurs Care Qua

Vol. 30, No. 2, pp. 153–159

Effectiveness of Structured

Hourly Nurse Rounding on

Patient Satisfaction and Clinical

Outcomes

Lisa A. Brosey, DNP, RN, CPHQ;

Karen S. March, PhD, RN, ACNS-BC

Structured hourly nurse rounding is an effective method to improve patient satisfaction and clinical

outcomes. This program evaluation describes outcomes related to the implementation of

hourly nurse rounding in one medical-surgical unit in a large community hospital. Overall Hospital

Consumer Assessment of Healthcare Providers and Systems domain scores increased with the exception

of responsiveness of staff. Patient falls and hospital-acquired pressure ulcers decreased during

the project period. Key words: accidental falls, evidence-based nursing/standards, hourly

rounding, PARiHS framework, patient satisfaction, pressure ulcer/prevention and control

CONCLUSIONS

Change management strategies were used

to influence the culture of nursing practice, so

changes were not be perceived as simply additional

tasks to complete. Recommendations

for project sustainability include incorporating

unit-based rounding champions to continue

to stimulate enthusiasm and prioritize

discussions so that the initial improvement

changes do not drift. Periodic monitoring and

public display of the data stimulate continual

focus on the results of this intervention.

Evidence indicates that structured hourly

nurse rounds are safe, efficient, and useful

in today’s practice. Performing hourly nurse

rounding may be cost-effective as an intervention

because it promotes cost avoidance by

reducing injuries related to patient falls and

pressure ulcer formation, both of which may

extend hospital length of stays. 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. This

project demonstrated overall improvement in

patient satisfaction indicators and decreased

patient harm through lower patient fall

and HAPU rates. Reduced patient harm

contributed more than $200 000 in cost

avoidance of care that is not reimbursed to

organizations.

Intentional Rounding – An integrative literature review

Liz Ryan1 | Debra Jackson2,3 | Cindy Woods1 | Kim Usher1,3

1School of Health, University of New

England, Armidale, NSW, Australia

2Faculty of Health, University of

Technology, Sydney, NSW, Australia

3Oxford Institute of Nursing, Midwifery &

Allied Health Research, Oxford, UK

Correspondence

Liz Ryan, School of Health, University of

New England, Armidale, NSW, Australia.

Email: eryan26@une.edu.au

Funding information

This research received no specific grant from

any funding agency in the public,

commercial, or not-for-profit sectors.

Abstract

Aims: To establish current knowledge about the efficacy and acceptance of intentional

rounding in current practice, from the perspective of nurses, patients, patient

satisfaction and safety indicators.

Background: Intentional Rounding is a formal means of nursing staff checking care

needs of patients in hospital settings on a regular basis.

Design: An integrative literature review conducted following the Joanna Briggs

Institute manual.

Data sources: A literature search from 2000 – 2017 was conducted using the following

electronic databases: The Cumulative Index to Nursing and Allied Health Literature,

ProQuest, PubMed, Informit, Sage and Scopus.

Review methods: Articles were assessed for quality and rigor using the Critical

Appraisal Skills Program tool and the Effective Public Health Practice Project Quality

Assessment tool for Quantitative Studies. A sequential explanatory mixed studies

approach was used to combine qualitative and quantitative evidence in a single

review. In‐depth parallel reviews of the quantitative and qualitative evidence were

undertaken, and then a synthesis of the combined qualitative and quantitative evidence

conducted.

Results: Intentional Rounding has positive outcomes on patient satisfaction and

safety. Nurses perceive benefits related to intentional Rounding; however, some

nurses perceive it as an additional, unnecessary task. The effectiveness of intentional

Rounding is influenced by external factors including leadership and formal

rounding education, workload, ward layout, staffing and experience level.

Conclusion: Intentional Rounding is a positive intervention in patient safety and satisfaction

generally, but needs further research and consideration about actual

impact, staff delegation, education and engagement, student nurse involvement,

documentation and specializing the structure of intentional Rounding.

KEYWORDS

clinical decision making, clinical rounds, falls, nurse–patient relationship, nursing, nursing

education, patient safety, patient satisfaction, review literature

HHS Public Access Author manuscript J Nurs Adm. Author manuscript; available in PMC 2015 September 01. Published in final edited form as: J Nurs Adm. 2014 September ; 44(9): 462–472. doi:10.1097/NNA.0000000000000101

Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review

Matthew D. Mitchell, PhD, Julia G. Lavenberg, PhD, RN, Dr. Rebecca Trotta, PhD, RN, and Dr. Craig A. Umscheid, MD

Center for Evidence-based Practice, University of Pennsylvania Health System, Philadelphia PA (all authors), Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Trotta and Umscheid), University of Pennsylvania Perelman School of Medicine, Philadelphia PA (Dr. Umscheid)

Abstract

Objective—Synthesize the evidence concerning the effect of hourly rounding programs on patient satisfaction with nursing care, and discuss implications for nurse administrators.

Background—Patient satisfaction is a key metric that influences both hospital ratings and reimbursement. Studies have suggested that purposeful nursing rounds can improve patient satisfaction but the evidence to date has not been systematically examined.

Methods—Systematic review of published literature and GRADE analysis of evidence regarding nursing rounds.

Results—There is little consistency in how results of hourly rounds were measured, precluding quantitative analysis. There is moderate-strength evidence that hourly rounding programs improve patients’ perception of nursing responsiveness. There is also moderate-strength evidence that these programs reduce patient falls and call light use.

Conclusions—Nurse administrators should consider implementing an hourly rounding program while controlled trials discern the most cost-effective approach.

Journal for Healthcare Quality

Evaluation of a Standardized Hourly

Rounding Process (SHaRP)

Rebecca Krepper, Beryl Vallejo, Claudia Smith, Cheryl Lindy, Cheryl Fullmer, Sharon Messimer, Yun Xing,

Karen Myers

Abstract: Current research suggests that hourly rounds on hospitalized

patients may be associated with improvements in care delivery

and in the patients’ perception of care, as well as a reduction

in patient safety events. Implementing an hourly rounding protocol

involves a major change in nursing staff workflow and a substantial

training and education program to ensure the success of

the program. This quasi-experimental study aimed to determine

if a standardized hourly rounding process (SHaRP), implemented

through a formal education program, would result in improved

efficiency, quality, safety, and patient satisfaction metrics when

compared to a less standardized process introduced through the

traditional train-the-trainer method. Data were collected over a

6-month period and results were trended for an additional 6

months later to determine if significant gains were sustained over

time. Significant reductions in call light use during the study period

(p = .001) and the number of steps taken by the day-shift staff

(p = .02) were seen on the intervention unit. Differences in the

number of patient falls, 30-day readmission rates, and patients’

perception of care were not statistically significant.

RESEARCH CORNER

Hourly Rounding and patient falls:

What factors boost success?

By Jennifer Goldsack, MChem, MA, MS; Meredith Bergey, MA, MPH, MSc; Susan Mascioli, MS, BSN, RN, CPHQ, NEA-BC;

and Janet Cunningham, MHA, RN, NEA-BC, CENP

Background: Falls are a persistent

problem in all healthcare settings,

with rates in acute care hospitals

ranging from 1.3 to 8.9 falls per

1,000 inpatient days, about 30%

resulting in serious injury. Methods:

A 30-day prospective pilot study was

conducted on two units with preand

postimplementation evaluation

to determine the impact of patientcentered

proactive hourly Rounding

on patient falls as part of a Lean Six

Sigma process improvement project.

Nurse leaders and a staff champion

from Unit 1 were involved in the

process from the start of the implementation

period, while Unit 2 was

introduced to the project for training

shortly before the intervention began.

Results: On Unit 1, where staff and

leadership were engaged in the project

from the outset, the 1-year baseline

mean fall rate was 3.9 falls/1,000

patient days. The pilot period fall rate

of 1.3 falls/1,000 patient days was

significantly lower than the baseline

fall rate (P = 0.006). On Unit 2,

where there was no run-in period,

the 1-year baseline mean fall rate

was 2.6 falls/1,000 patient days,

which fell, but not significantly,

to 2.5 falls/1,000 patient days during

the pilot period (P = 0.799).

Discussion: Engaging an interdisciplinary

team, including leadership

and unit champions, to complete a

Lean Six Sigma process improvement

project and implement a patientcentered

proactive hourly Rounding

program was associated with a significant

reduction in the fall rate in

Unit 1. Implementation of the same

program in Unit 2 without engaging

leadership or front-line staff in program

design did not impact its fall

rate. Conclusions: The active involvement

of leadership and front-line staff

in program design and as unit champions

during the project run-in

period was critical to significantly

reducing inpatient fall rates and call

bell use in an adult medical unit.

Research for Practice

Hourly Rounding: A Replication Study

Todd Olrich, Melanie Kalman, and Cindy Nigolian, 2012

Abstract

Preventing falls in hospitalized patients, increasing patient satisfaction, and decreasing call light usage are constant challenges nurses face every day. This quasi-experimental study replicates Meade, Bursell, and Ketelsen’s (2006) study on a rounding protocol, demonstrating improvements in the above variables.

‘Caring around the clock’: a new

approach to intentional Rounding

Correspondence

marie.hutchings15@yahoo.co.uk

Marie Hutchings is Caring around

the clock project lead, Nursing

Development Department

Paula Ward is assistant director

of learning and organisational

development

Kerry Bloodworth is assistant

director of nursing

All at Nottingham University

Hospitals NHS Trust

Date of submission

March 5 2013

Date of acceptance

July 8 2013

Peer review

This article has been subject to

double-blind review and checked

using antiplagiarism software

Author guidelines

www.nursingmanagement.co.uk

Abstract

Intentional Rounding is a widely debated topic and,

in this article, Nottingham University Hospitals

NHS Trust shares its experience and learning from

implementing an innovative approach based on the

process across 79 wards. The authors look at the

need for education and for cultural shift to achieve

the best results.

The issue of intentional Rounding was raised

in 2012 by prime minister David Cameron, who

responded to a report of failings published by the

Parliamentary and Health Service Ombudsman

(2011) by announcing that all nurses would be

expected to do hourly rounds to improve care. The

need for the process has been demonstrated further

in the recommendations from the Mid Staffordshire

NHS Foundation Trust Public Inquiry (Francis 2013).

Keywords

Comfort rounding, hourly Rounding, intentional

rounding, leadership

Patient Experience Journal

Volume 3, Issue 1 – Spring 2016, pp. 42-49

Patient Experience Journal, Volume 3, Issue 1 – Spring 2016

Downloaded from www.pxjournal.org 42

Patient Perceptions

Patient perceptions of an AIDET and hourly rounding program in a

community hospital: Results of a qualitative study

Tosha I. Allen, Genesis Health System, allent@genesishealth.com

Tyné Rieck, Genesis Health System, rieckt@genesishealth.com

Stacie Salsbury, Palmer Center for Chiropractic Research, stacie.salsbury@palmer.edu

Abstract

Quantitative evidence links patient satisfaction scores to the use of communication strategies such as AIDET

(Acknowledge, Introduce, Duration, Explanation, and Thank you) and Hourly Rounding. However, little is known about

patient perceptions of these tools in regards to their hospital experience. Qualitative interviews were conducted with a

convenience sample of 14 adult medical/surgical inpatients in one mid-sized, community hospital, following hospital

discharge. The interview data was transcribed and opened coded, utilizing constant comparison to identify common

themes. Themes emerged in four topical areas: (a) patient experience of hospitalization, (b) AIDET, (c) Hourly

Rounding, and (d) unexpected findings. Patients placed significant value on having their emotional needs met by staff

during their hospitalization. While patients felt hospital staff explained procedures well, but staff did not explain the

illness or its treatment effectively. AIDET was found to be applied consistently; however patients did not understand the

duration aspect of AIDET. Hourly Rounding with a purpose was not noticeable by patients; descriptions by patients of

the practice included medication passes and vital checks. However, reduction of call light usage and sleep interruptions

were mentioned. Unexpected findings included feelings of loneliness while hospitalized and inconsistent delivery of

patient’s pain relief regimens. The results overall suggest a focus on meeting emotional needs may be necessary to

improve patient experiences in the hospital. More intentional use of AIDET and Hourly Rounding may help to

maximize the benefit of these tools. Further research is warranted to validate findings from this study.

Keywords

AIDET, hourly Rounding, patient experience, nurse-patient relations, health communication, hospitalization, quality of

health care, patient satisfaction, qualitative methods

Introduction

The patient’s experience in a hospital setting is a rising

concern in the health care arena as value-based purchasing

and Hospital Consumer Assessment of Health Care

Providers and Systems (H-CAHPS) become organizational

priorities.1 The patient experience encompasses every

aspect of the hospital stay, from nurses to physicians to

food services. Dempsey, Reilly, and Buhlman1 asserted

that although patients interact with over 20 health care

workers, most of the patient’s time is spent with nurses

and this shapes their inpatient experience. Organizations

are seeking innovative ways boost satisfaction scores and

improve the patient experience.2

Patient experience and satisfaction may fall short of the

consumer’s expectations, most often from a gap in

communication.3 One communication tool used by

numerous healthcare organizations is AIDET, which

stands for Acknowledge, Introduce, Duration,

Explanation, and Thank You (Table 1). The AIDET

communication tool was created to help health care

provid

Purposeful and timely nursing rounds: a best practice implementation project

Juli F Daniels 1DOI: 10.11124/jbisrir-2016-2537

Abstract

Background: Purposeful and timely Rounding is a best practice intervention to routinely meet patient care needs, ensure patient safety, decrease the occurrence of patient preventable events, and proactively address problems before they occur. The Institute for Healthcare Improvement (IHI) endorsed hourly Rounding as the best way to reduce call lights and fall injuries, and increase both quality of care and patient satisfaction. Nurse knowledge regarding purposeful rounding and infrastructure supporting timeliness are essential components for consistency with this patient centred practice.

Objectives: The project aimed to improve patient satisfaction and safety through implementation of purposeful and timely nursing rounds. Goals for patient satisfaction scores and fall volume were set. Specific objectives were to determine current compliance with evidence-based criteria related to rounding times and protocols, improve best practice knowledge among staff nurses, and increase compliance with these criteria.

Methods: For the objectives of this project the Joanna Briggs Institute’s Practical Application of Clinical Evidence System and Getting Research into Practice audit tool were used. Direct observation of staff nurses on a medical surgical unit in the United States was employed to assess timeliness and utilization of a protocol when rounding. Interventions were developed in response to baseline audit results. A follow-up audit was conducted to determine compliance with the same criteria. For the project aims, pre- and post-intervention unit-level data related to nursing-sensitive elements of patient satisfaction and safety were compared.

Results: Rounding frequency at specified intervals during awake and sleeping hours nearly doubled. Use of a rounding protocol increased substantially to 64% compliance from zero. Three elements of patient satisfaction had substantive rate increases but the hospital’s goals were not reached. Nurse communication and pain management scores increased modestly (5% and 11%, respectively). Responsiveness of hospital staff increased moderately (15%) with a significant sub-element increase in toileting (41%). Patient falls decreased by 50%.

Conclusions: Nurses have the ability to improve patient satisfaction and patient safety outcomes by utilizing nursing round interventions which serve to improve patient communication and staff responsiveness. Having a supportive infrastructure and an organized approach, encompassing all levels of staff, to meet patient needs during their hospital stay was a key factor for success. Hard-wiring of new practices related to workflow takes time as staff embrace change and understand how best practice interventions significantly improve patient outcomes.

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