Nursing: the Hourly Rounding Program - Essay Example

Research Continued Section E: Evaluation Plan Methods to be used to evaluate the Solution The hourly rounding program can be evaluated by using various methods. First, there has to be a record of the rate of patient falls before implementation of the hourly rounding program. This will be compared with the rate or amount of patient falls after implementation of the hourly rounding program. Secondly, the solution can be evaluated by checking whether there are notable reductions in call lights (Krepper, et al., 2012). In addition, evaluation can be done by analysing the response to call lights. Finally, the hourly rounding program can be evaluated by gathering patient and staff feedback about impact of hourly rounding to gauge painted satisfaction. Outcome Measure It is imperative to note that when nurses take too long in one patient’s room, they lag behind in their work, yet they are charged with the responsibility of providing surveillance to prevent errors and ensure quality care. Patient safety is enhanced when effective hourly rounding is implemented (Deitrick, Baker, Paxton, Flores, & Swavely, 2012). Therefore, an appropriate outcome measure ought to be developed, which evaluates the extent to which the project objective is achieved. An outcome that is used to evaluate achievement of the project’s objectives involves patients and nurses. The nurses are required to provide health care to the patients in their wards or rooms, through hourly rounds. During these hourly rounds, nurses are supposed patient needs are expected to offer proactive care, addressing patient needs before patients ask for assistance. This can reduce patient falls and increase patient satisfaction. On the other hand, nurse satisfaction can be enhanced. Therefore, the outcome measure addresses patient satisfaction, nurse satisfaction and barriers, which nurses face, as they seek to achieve the objectives of the solution. The outcome measure register/log consists of five major rows and nine minor rows. In the major rows, outcomes such as patient falls, call lights, response to call lights, patient satisfaction and nurse satisfaction, as well as barriers to achieving hourly rounds’ objective are assessed. Response to call lights, patient satisfaction and nurse satisfaction outcomes are categorised into subdivisions of highly efficient to inefficient and high to low (See Appendix). In each column, each column represents a day, and the last column is meant for overall remarks. The nurses are supposed to fill all the sections of the outcome measure except the patient satisfaction part, which should be filled by patients. A weekly meeting, involving nurses, will be held to discuss the components of the outcome measure for each nurse. Nurses are allowed to provide their recommendations on how the project can be improved, as well as, note the challenges they face and the barriers they encounter, as they pay hourly rounds to patients. This will evaluate the extent to which the project objective is achieved. This outcome measure is valid and reliable because it incorporates all the subjects. Both nurses and patients are included in the assessment of outcome measures. Secondly, the outcome measure uses data from all units within the hospital, increasing internal validity and reliability of the outcomes reported. In addition the outcome measure is sensitive to change because allows patients and nurses to make overall remarks, which could be used to make changes to the measure, when appropriate. Therefore, the outcome measure is valid, reliable, sensitive to change and appropriate for use in this project. Evaluation Data Collection According to Berenson, Pronovost and Krumholz (2013), process or outcome measures require that data is collected manually, and should be performed by quality improvement staff so as to divert their ability to participate in efforts of improving care. Therefore, appropriate methods should be used in collecting outcome measure data. Hourly recording of the time of the hourly round and the patient care activities performed, in the hourly rounding register/log, is among the methods of data collection which will be used to collect outcome measure data. Nurses will be required to record the exact time of the hourly round and the health care or patient care activities that they provide during the hourly call or round at the patient’s room. They are also expected to provide information pertaining to the challenges and barriers they encounter during the hourly rounds. Secondly, nurses have to collect data pertaining to patient falls and call lights and record it in the hourly rounding register/log. A patient fall rate record that will document the number of falls per patient and any other emergent issues such as injury while call lights rate record will document the amount of call lights per nurse. These methods are effective for use in collecting data for this project because they can be monitored and improved to meet the goals of the project effectively. For instance, during a weekly meeting, where records will be reviewed, discussions involving nurses can be held to discuss issues of compliance and barriers identified, as well as proposals for improvement. The resources needed for evaluation include the hourly rounding information register/log. In this register/log, nurses will record the number of patient falls and emergent issues. They will also record the number of call lights and other aspects such as their satisfaction levels and barriers and challenges. Another resource is the weekly meeting meant to discuss compliance issues. This evaluation plan is highly feasible because it can be achieved easily. The plan incorporates nurse and patient feedback, which can be easily acquired. According to the findings of a study carried out by Rondinelli, Ecker and Crawford (2012), patient satisfaction and patient perception that they receive high quality care are imperative outcome considerations in evaluation. Therefore, collecting information pertaining to patient satisfaction is beneficial towards achieving the project’s objectives. Secondly, feedback from nurses pertaining to the challenges that they face can be easily obtained, increasing feasibility of the project. Nurses are mainly challenged with issues of documentation and skill mix (Neville, Lake, & LeMunyon, 2012). When this information is obtained and discussed during the weekly meeting, it is probable that the project’s objectives can be achieved. The two possible grant funding sources for this project are the Agency for Healthcare Research and Quality (AHRQ) and the hospital’s funding system. AHRQ will be an ideal source of funds because the proposed project is a feasible project that seeks to improve quality. Similarly, the hospital‘s funding or finance system will fund the proposed project to enable it achieve its objectives. These two sources of funds are ideal for the proposal due to ease of their accessibility. Section F: Decision Making Methods to be used to decide the Future of the Solution In deciding the future of the proposed hourly rounding project, accountability and cross learning support will be used. Therefore, nurses and other officials and hospital leaders of the project will be required to comply with the requirements. All units will be included and discussions will be held to identify what has gone on well, the barriers identified and leaders will make decisions from the findings and suggestions to ensure future success of the project. A successful will ensure review of call light logs and patient satisfaction, as well as, nurse satisfaction. Leaders will be required to offer feedback to nurses and other leaders and discuss improvement proposals, as well as agree on the next courses of action to maintain and ensure success. The successful hourly rounding project can be extended to other units and departments within the hospital. This can be done by training of the existing nurses of the requirements of the new solution. New nurses will have to undergo the same training. Upon completion of the training, nurses will be provided with the necessary tools to achieve the project’s objectives. In revising an unsuccessful solution, the responsible personnel will have to go back to the first phases of implementation. Revaluation of training will have to be carried out. New approaches will be used while retraining the nurses and this will be followed by provision of appropriate tools. Monitoring of the project should be reinforced and feedback to be provided on a more frequent basis. In case the solution becomes unsuccessful, then there has to be a right approach of terminating it. All the nurses responsible for the hourly rounding program will have to be summoned to a meeting. In this meeting, barriers and obstacles that have led to failure of the program and why it may be impossible to revise the solution will have to be explained adequately. Management will request the nurses to hand over the tools that had been distributed for proper custody till the time when the solution will be revaluated. In offering feedback and communicating the project and its results to professional groups external to the project, management has to make use of published reports about the achievement of the proposed solution. Such reports will include statistics such as the rate and number of patient falls, call lights and response rates to such calls before implementation, compared to the current number of patient falls, call lights and response rate. Also, staff and patient satisfaction levels reported after implementation of the program, will be included. These reports will then be sent to professional groups. Appendix Hourly Rounding Information Register/Log Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Overall Remarks Number of Patient Falls Number of Call Lights Response to Call Lights (Tick where appropriate and include notes about any observations in the Overall Remarks) Highly Efficient Satisfactory/ Average Inefficient Patient Satisfaction (Tick where appropriate and include notes about any observations in the Overall Remarks) High Remarkable Low Nurse Satisfaction/Barriers (Tick where appropriate and include notes about any observations in the Overall Remarks) High Remarkable Low References Berenson, R. A., Pronovost, P. J., & Krumholz, H. M. (2013). Achieving the Potential of Health Care Performance Measures: Timely Analysis of Immediate Health Policy Issues. Robert Wood Jonhson Foundation, pp. 1-31. Deitrick, L. M., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly Rounding: Challenges With Implementation of an Evidence-Based Process. Journal of Nursing Care Quality, Vol.7, No.1, pp. 13-19 . Krepper, R., Vallejo, B., Smith, C., Lindy, C., Fullmer, C., S.Messimer, et al. (2012). Evaluation of a Standardized Hourly Rounding Process (SHaRP). Journal for Healthcare Quality, pp. 1-5. Neville, K., Lake, K., & LeMunyon, D. (2012). Nurses’ Perceptions of Patient Rounding. Journal of Nursing Administration, Vol. 42, No. 2, pp. 83-88. Rondinelli, J., Ecker, M., & Crawford, C. (2012). Hourly Rounding Implementation: A Multisite Description of Structures, Processes, and Outcomes. Journal of Nursing Administration, Vol. 42, No. 6, pp. 326-332. Read More