Objectives Identify how Intentional Hourly Rounding can be used in - - PDF document

APNA 29th Annual Conference Session 4022: October 31, 2015 Langenbach 1

Intentional Hourly Rounding in an Acute Mental Health Department

Beckie Langenbach, MSN, RN-BC

The speaker has no conflict of interest to disclose.

Objectives

• Identify how Intentional Hourly Rounding can be used in an

inpatient setting to ensure patient safety and decrease safety related concerns or negative events.

• Identify key factors that are involved with Intentional Hourly

Rounding in a Mental Health setting.

• Implement Intentional Hourly Rounding in all Mental settings

to benefit patient safety and patient satisfaction.

Regions Hospital

• Level 1 Trauma & Burn

Center

– 400+ licensed Beds

• Mental Health Services

– 5 units – 100 licensed beds – Outpatient Services

• Partial Hospitalization
• Chemical Dependency

APNA 29th Annual Conference Session 4022: October 31, 2015 Langenbach 2

Intentional Hourly Rounding (IHR)

A patient’s satisfaction with nursing care depends principally upon their perception of how well the nursing staff was able to meet his/her needs.

Reference: Meade, Bursell & Ketelsen, 2006.

Intentional Hourly Rounding

• Intentional Hourly

Rounding (IHR) is:

– Systematic – Proactive – Nursing‐driven – Evidence‐based

The main goals of IHR are to anticipate and address needs before they arise with all hospitalized patients along with identify safety risks as quickly as possible.

BENEFITS

WHO BENEFITS? HOW? PATIENTS  Reduced patient anxiety  Improved safety; fewer falls  Improved health; fewer skin breakdowns  Improved pain management  Improved patient satisfaction; higher trust and confidence in nursing NURSING STAFF  More organized work day  Happier patients make a better day for you HOSPITAL  Higher patient satisfaction  Decreased negative events saves money  Decreased falls saves money

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Mental Health IHR ‐ ASAP

ANXI ETY/ AGI TATI ON Assess patient anxiety &/ or agitation using verbal and/ or non-verbal cues SAFETY Asses patients safety level with self and others ADLS ( I F APPROPRI ATE) Discuss with patient concerns with activities of daily living PI CK-UP Takes a look around room and bathroom to check for cleanliness

IHR STEPS

STEP ELEMENT EXPECTATION

1 APPROACH Starts with a warm welcome; friendly, smile, eye contact 2 AIDET Calls pt by name, introduces self, explains here to do hourly rounding 3 ANXIETY/AGITATION Assess patient anxiety/agitation using verbal and/or non‐verbal cues 4 SAFETY Asses patients safety level with self and others 5 ADLS Discuss with patient concerns with activities of daily living 6 PICK‐UP Takes a look around room and bathroom to check for cleanliness  Explains positive intent to patient 7 BEFORE I GO…. Offers help 8 BACK IN AN HOUR Manages expectations  Return in 1 hour

Remember

The key is we are possibly doing all these tasks at multiple different times – with IHR, we can combine them to one trip and also meet the expectations of our patients.

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Nursing Out Loud

• AIDET
• Individualized care
• Positive intent
• Identify “warning

signs”

• Manage expectations

IHR Implementation

• Unit IHR Champions
• On‐line education
• Classroom education
• Organizational recognition
• Clear expectations
• Follow‐up

IHR Champions

• Assigned to each unit & on each shift
• Expectations:
• Be a positive role model on the unit
• Notice when a co‐worker needs assistance/coaching
• Have courageous conversations with co‐workers
• Share IHR stories in Staff Huddles
• Help staff incorporate IHR into daily workflow
• Assist Nurse Manager with IHR observations

APNA 29th Annual Conference Session 4022: October 31, 2015 Langenbach 5

Implementation Process

• Champions
• Setting expectation
• Sharing feedback

– Positive & Negative

• Identifying barriers
• Overcoming barriers

Documentation Patient Satisfaction

• Survey with a specific question

– During your hospital stay, how often did staff check with you every hour (during the day) to ensure you felt safe on the unit?

• Never
• Sometimes
• Usually
• Always
• The expectation was that staff were rounding

hourly while the patient was awake

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APNA 29th Annual Conference Session 4022: October 31, 2015 Langenbach 7

References

• Halm, M. (2009). Hourly rounds: what does the evidence indicate?

American Journal of Critical Care, 18(6), 581‐584.

• Meade, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing rounds on

patients’ call light use, satisfaction, and safety. AJN, 106(9), 58‐70.

• Moran, J. (2011). Improving care on mental health wards with hourly

nurse rounds. Nursing Management, 18(1), 22‐26.