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