APNA 29th Annual Conference Session 4022: October 31, 2015 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 Langenbach 1
APNA 29th Annual Conference Session 4022: October 31, 2015 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 The main goals of IHR Rounding (IHR) is: are to anticipate and address needs before – Systematic they arise with all – Proactive hospitalized patients – Nursing ‐ driven along with identify – Evidence ‐ based safety risks as quickly as possible. BENEFITS WHO BENEFITS? HOW? Reduced patient anxiety Improved safety; fewer falls Improved health; fewer skin breakdowns PATIENTS Improved pain management Improved patient satisfaction; higher trust and confidence in nursing More organized work day NURSING STAFF Happier patients make a better day for you Higher patient satisfaction Decreased negative events saves money HOSPITAL Decreased falls saves money Langenbach 2
APNA 29th Annual Conference Session 4022: October 31, 2015 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 Discuss with patient concerns ( I F APPROPRI ATE) 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 Starts with a warm welcome; friendly, smile, eye contact APPROACH 2 Calls pt by name, introduces self, explains here to do hourly rounding AIDET 3 Assess patient anxiety/agitation using verbal and/or non ‐ verbal cues ANXIETY/AGITATION 4 Asses patients safety level with self and others SAFETY 5 Discuss with patient concerns with activities of daily living ADLS 6 Takes a look around room and bathroom to check for cleanliness PICK ‐ UP Explains positive intent to patient 7 Offers help BEFORE I GO…. 8 Manages expectations BACK IN AN HOUR 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. Langenbach 3
APNA 29th Annual Conference Session 4022: October 31, 2015 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: o Be a positive role model on the unit o Notice when a co ‐ worker needs assistance/coaching o Have courageous conversations with co ‐ workers o Share IHR stories in Staff Huddles o Help staff incorporate IHR into daily workflow o Assist Nurse Manager with IHR observations Langenbach 4
APNA 29th Annual Conference Session 4022: October 31, 2015 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 Langenbach 5
APNA 29th Annual Conference Session 4022: October 31, 2015 Langenbach 6
APNA 29th Annual Conference Session 4022: October 31, 2015 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. Langenbach 7
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