CASE STUDY 16-2 Tailored Purposeful Rounding Implementation on a Hospitalist Unit

Dejau Jones

obstacles for staff members. The interaction and conversation between staff members and patients are more critical communications than repetitive hourly rounds. Using a standardized (tailored) method of rounding is optimal for quality patient care. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, monitors, and reports multiple metrics related to a patient’s hospital stay. HCAHPS scores concerning patient satisfaction and patient safety outcomes can be improved by implementing a standardized rounding protocol. Evidence-based research reveals that integrating purposeful rounding into nursing workflow can contribute to improvement in patient experience and staff satisfaction. The purpose of this project was to organize nursing workflow and improve patient experience with the implementation of a tailored purposeful rounding process within an academic medical center environment. The focus of the tailored rounding approach was to reduce the barriers of nonurgent call light usage, increase response times to patients truly needing nursing assistance, and reduce distraction and disruption caused by unpredictable call light usage. The project question is as follows: On the hospitalist unit HSP2, which admits adult patients 18 years and older, how will the implementation of tailored purposeful rounding, compared to customary hourly rounding, affect the patient experience, responsiveness of hospital staff, patient perception of pain management, and communication between patient and provider in the next three months? The author used the Acknowledge, Introduce, Duration, Explanation, Thank You (AIDET) framework to conceptualize the project. This framework provided the fundamentals of service excellence (Nelson, 2014). In addition, the Donobedian framework of structure, process, and outcomes was also used in the project plan for implementing tailored purposeful rounding. Leadership rounds, using the rounding app, were used to validate that the intervention was being done appropriately. This was particular important for the fidelity of the intervention. Benefits of tailored purposeful rounding included improved the use of the communication board, and more positive patient experiences. With increased call light timeliness, improved patients’ perception of tailored rounding expectation, and improved patients’ perception of pain management, Hospital Consumers Assessment of Healthcare Providers and Systems (HCAHPS) scores showed improvement as well. The patients’ perception of staff meeting their rounding expectations increased from 87% to 96%. Communication board compliance increased from 1 to 12 boards being totally compliant. Also, there was a decrease from 25 boards with no pain goal present on the communication boards to only 4, as well as a decrease from 25 communication boards with missing plan of care to 10. Communication boards not having medication last dose and next dose listed decreased from 26 to 8. According to the rounding app, using the call light for pain medication was reduced and call light delay decreased. Pain as the sole purpose for call light usage decreased from 50% to 16%. The majority of the patients surveyed with the rounding app on the hospitalist unit HSP2 had not used the call light during the course of the hospital stay for this project. Communicating the expected change is essential to empowering broad-based change. The nurse manager should reinforce accountability both before and after the tailored purposeful rounding implementation. The center of nursing excellence partnering with the nursing manager, as well as the nurse educator, is essential to sustaining the intervention over time. With the success of the project, the next phase will be sustaining the intervention and expanding it throughout the system.
Case Study Questions

1. Using the overall processes outlined in the implementation of tailored purposeful rounding, what implementation strategies are most effective? Would you include different approaches? If so, what would be your rationale? 2. Consider the tips for leading and facilitating teams for effective implementation. Which strategies would you incorporate into your overall implementation and dissemination at the unit level? 3. Sustaining the intervention at the unit level and expanding it throughout the system were recommended. What strategies would be most effective in this case study?