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CME Disclosure
• Accreditation Statement
– Studer Group is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
• Designation of Credit
– Studer Group designates this educational event for a maximum of 12 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the educational event.
• Disclosure Policy
– Kate Cronin and Julie Kennedy have disclosed that they do not have any relevant financial relationships with any commercial interests related to the content of this educational event.
Never Say Never – A Nursing Journey to
Safer Patient Care Through Hourly Rounding
Kate Cronin, RN, MS
Senior Vice President, CNO, Cheshire Medical Center/Dartmouth Hitchcock Keene
(Keene, New Hampshire)
Julie Kennedy, RN
Studer Group Coach
Presentation Objectives
• Identify tactics for successful implementation and sustainability of hourly rounding to reduce Never Events;
• Learn to use a collaborative leader rounding model to assure leader accountability and hardwiring of hourly rounding;
• Understand reward and recognition as tools for hardwiring behavior changes to decrease Never Events.
Evidence-Based Leadership (EBL) SM
Standardization AcceleratorsMust
Haves®
Performance
Gap
Leader
Evaluation
Leader
Development
Foundation
STUDER GROUP:
Must Haves®
RoundingThank You NotesEmployee SelectionPre and Post Phone CallsKey Words at Key Times
(Principle 3, 5, 6,
& 9)
Re-recruit high and middle performers
Move low performers up or out
(Principle 4)
Agendas by pillar
Peer interviewing
30/90 day sessions
Pillar goals
(Principle
1 & 2)
Leader Eval MgrTM (LEM)
Staff Eval MgrTM (SEM)
Discharge Call MgrTM
(DCM)
Rounding MgrTM
Idea ExpressTM
Aligned Goals Aligned Behavior Aligned Process
Create process to assist leaders in developing skills and leadership competencies necessary to attain desired results
(Principle 4 & 8)
Implement an organization-wide leadership evaluation system to hardwire objective accountability
(Principle 7)
What is Hourly Rounding?
• Hourly rounding is a strategy to decrease patient’s anxiety and help them feel safe.
• The three P’s of hourly rounding are Pain, Positioning and Potty.
• Hourly rounding improves both patient and staff satisfaction.
Eight Behaviors for Hourly Rounds
Hourly Rounding Behavior Expected Results
Use opening key words Contributes to trust, therapeutic relationship
Accomplish scheduled tasks Contributes to efficiency
TOP THREE REASONS FOR CALL LIGHTS
Address 3 P’s (pain, potty, position)
Quality indicators – falls, pressure ulcers, pain management
Address additional comfort needs Improved pain management, concern and caring, therapeutic relationship
Conduct environmental assessment Contributes to safety, quality
Ask “Is there anything else I can do for you before I go, I have time
Contributes to efficiencyImproves teamwork and communication
Tell each patient when you will be back
Contributes to efficiency, proactive, therapeutic relationship
Document the round Quality and accountability
Never EventsWhat’s the Financial Impact?
Condition Cases in 2007 $/Stay
Stage III & IV Pressure Ulcers 257,412 $43,180
Falls & Traumas 193,566 $33,894
Deep Vein Thrombosis/Pulmonary Embolism 140,010 $50,937
Vascular Catheter-Associated Infection 29,536 $103,027
Certain Manifestations of Poor Control of Blood Sugar Levels
16,060 Range: $35K –45,989
Catheter-Associated Urinary Tract Infections 12,185 $44,043
Foreign Object Retained After Surgery 750 $63,631
Surgical Site Infections Following Certain Elective Procedures
747 Range: $63K –180,142
Infection after Coronary Artery Bypass Graft 69 $299,237
Air Embolism 57 $71,636
Blood Incompatibility 24 $50,455
Source: CMS Fact Sheet, *CMS PROPOSES ADDITIONS TO LIST OF
HOSPITAL_ACQUIRED CONDITIONS FOR FISCAL YEAR 2009*
Facility Acquired Pressure Ulcers
Hourly Rounding and Hospital Acquired Pressure Ulcers
# o
f P
ressure
Ulc
ers
Source: CMS Fact Sheet, *CMS PROPOSES ADDITIONS TO LIST OF
HOSPITAL_ACQUIRED CONDITIONS FOR FISCAL YEAR 2009*
Cost avoidance from reduction in
average pressure ulcers/qtr from
1Q08 to 1Q09
= $647,700/mo = $7,772,400/year
Acute Care Patient Falls
Financial ImpactReduction in falls
from 64 in 2007 to 47
in 2008 resulted in a
cost avoidance of
$561,000
Cost Avoidance calculated using $33,000 cost/fall
# o
f F
alls
The Journey Begins
• Commit to a start date
• Audit call lights
• Educate staff on hourly rounding concept
• Set the stage for patients.
Hourly Rounding Log
Initial Struggles and Lessons Learned
• Don’t implement a change leaders do not believe in;
• Training involves more than telling;
• Effort is appreciated but results counts;
• Leaders need to stay focused and work together.
Rounding for Outcomes
• Better documentation of present on admission
• Increased frequency of skin assessment
• Established standards for surface use
• Provided extensive training for all staff
• Increased frequency of P&I studies
Preventing Pressure Ulcers
Decreasing Patient Falls
• Education of all staff
• Fall risk assessment done/shift
• Identification of patients at risk:
– Falling Star program
– Use of red blankets and socks
– Call Don’t Fall posters
• Leader weekly review of falls
• Fall Huddles
Falls Huddle
Leader Patient Rounding
Happy Safe Patients = Happy Nurses
• As patients learn to expect nurses to come to their rooms to check on them, call lights decrease and patient care is better organized
• With less interruptions to the plan of care, nurses are happier
Response to Call LightsReceived Date
%ile
Rankin
g
Reduction in Call BellsMarch 2007 compared to March 2009
# o
f C
all
Be
lls
Total Reduction in Call Bells = 5746.
Total RN Time saved = 383 hours.
Patient Satisfaction Nursing Composite Score
Rolling Average
We are WELL ABOVE the National Norm for Both CMC/DHK Combined
Employee Satisfaction
% improved from 2006 to 2008
% i
mp
roved
Percent Improvement in Employee Survey Questions
Recognize Success
Pain Management
“How well was your pain controlled?”
Percent “Very Good”
% o
fp
ati
en
ts a
nsw
ere
d “
very
go
od
”
How well was your pain controlled?
%ile
Rankin
g
Next Steps
• Pain Management
• A team approach to patient satisfaction
• Reducing infections
Never EventsWhat’s the Financial Impact?
Condition Cases in 2007 $/Stay
Stage III & IV Pressure Ulcers 257,412 $43,180
Falls & Traumas 193,566 $33,894
Deep Vein Thrombosis/Pulmonary Embolism 140,010 $50,937
Vascular Catheter-Associated Infection 29,536 $103,027
Certain Manifestations of Poor Control of Blood Sugar Levels
16,060 Range: $35K –45,989
Catheter-Associated Urinary Tract Infections 12,185 $44,043
Foreign Object Retained After Surgery 750 $63,631
Surgical Site Infections Following Certain Elective Procedures
747 Range: $63K –180,142
Infection after Coronary Artery Bypass Graft 69 $299,237
Air Embolism 57 $71,636
Blood Incompatibility 24 $50,455
Source: CMS Fact Sheet, *CMS PROPOSES ADDITIONS TO LIST OF
HOSPITAL_ACQUIRED CONDITIONS FOR FISCAL YEAR 2009*
• Changing a culture
• Hold leaders accountable
• Involve and train all staff
• Provide staff with data
• Identify and remove barriers
• Round for outcomes
• Never say never
The Real Story
Lessons Learned
• Don’t implement a change leaders don’t believe in
• Use key words and tactics to train and support staff
• Be consistent and hold leaders and staff accountable
• Focus on the patient – listen to them
• Celebrate and recognize achievements
Thank You!
Kate Cronin, RN, MS Senior Vice President, CNO,
Cheshire Medical Center/Dartmouth Hitchcock Keene (Keene, New Hampshire)
Julie Kennedy, RNCoach, Studer Group