Enhancing and sustaining AuthenticHourly Visitation to Improve Outcome

and Care ExperienceNneka Christiana Chukwu MSN, RN, CNL

METHODOLOGIES• Strength, Weaknesses, Opportunities, and Threats (SWOT) analysis• Informational interview• Questionnaires• Literature review• PDSA• Chart review• SWOT ANALYSIS

RECOMMENDATIONS• Maintain consistent collaboration between the leadership team

and the front-line staff to preserve the AHV process.

• Ongoing collection and review of data to ensure sustainability.

• Need for leadership team to listen and respond to the needs and challenges identified by staff.

SELECTIVE REFERENCESDaniels, J.F. (2016). Purposeful and timely nursing rounds: a best practice implementation project. Joanna Briggs system reviews and implementation reports. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26878929

Kaiser Permanente. (n.d.). Authentic hourly visitation for nurses: an evidence-based practice for performance improvement. Retrieved from www.kp.org.

Stanford Health Care. (n.d.). Nursing quality and safety: purposeful rounding. Retrieved from

https://stanfordhealthcare.org/health-care-professionals/nursing/quality- safety/purposeful-rounding.html

ACKNOWLEDGEMENTMy sincere gratitude goes to my Director Josephine Reyes for all her support.

I offer my heartfelt thanks to my teachers Dr. Cathy Coleman and Nancy Taquino for their selfless efforts and learning opportunities.

Finally, to my parents and children, my deepest appreciation and acknowledgment.

ABSTRACTAuthentic hourly visitation (AHV) otherwise known as purposeful rounding or hourly rounding is an evidence-based process, which focuses on safety of hospitalized patients using a proactive approach. Regular and purposeful, proactive rounding promotes safety, comfort, and responsiveness which has a direct impact on the care experienced by patients and their satisfaction with service delivery. The setting for this improvement project was the medical surgical unit and medical telemetry unit at Kaiser South San Francisco. This process improvement project aims to enhance and sustain the frequency and quality of Authentic Hourly Visitation. Improving the frequency and consistency of this interactive practice will ensure that patients receive timely and efficient care with a resultant improvement in their care experience. This goal is in alignment with that of this integrated delivery health care organization, which thrives to provide the highest quality of care to every patient at all, times. The CNL as an outcomes manager, risk anticipator and educator led this process improvement project in collaboration with all key players in these microsystems by administering questionnaires, informational interviews, chart review and observation.

Keywords: Authentic hourly visitation, barriers, care experience, patient safety, care experience.

NURSING IMPLICATIONSNurses are charged with providing safe and efficient care to patients. This is critical especially at a time when healthcare is undergoing reformation (value based purchasing). Healthcare institutions are no longer reimbursed for hospital acquired conditions or provision of sub-standard care. Additionally, the Centers for Medicare and Medicaid Services fine organizations for never events such as falls and hospital acquired pressure ulcers. This places financial burden on the organization. Furthermore, following implementation of Affordable Care Act (ACA) - Obama-care, patients are no longer limited to one healthcare plan. The implication is that patients who are not satisfied with their level of care can transfer care to another provider. Clearly, identifying and resolving barriers to AHV can impact the ultimate improvement in outcome of patient care as well as team and patient engagement.

TIMELINE

OBJECTIVESTo identify and eliminate barriers to Authentic Hourly Visitation.

To increase the overall rating of the hospital from 68.3% to 80% by December 2016.

To improve the quality and frequency of AHV in order to make it more meaningful to staff and patients.

SIGNIFICANCE• Performing the 4PS (presence, pain, position, & potty) during

AHV improves outcome of care and overall HCAHPS scores.

• AHV decreases the use of call light among hospitalized patients, decreases fall rate, and decreases interruptions in the workflow of the nurses and patient care technicians

LITERATURE REVIEWThe study of Daniel (2016) on hourly rounding showed a 5% increase in nurse to patient communication and an 11% increase in pain management scores. He cited the Institute for Healthcare Improvement (IHI) who “endorsed hourly rounding as the best way to reduce call lights and fall injuries, and increase both quality of care and patient satisfaction” (p.1).

Similarly, Stanford Health Care published the result of a research conducted in 14 hospitals on hourly rounding which showed that hourly rounding led to 14% decline in pressure ulcers and 12% increase in patient satisfaction scores. One of the hospitals reported a 20% decline in the distance the nurses walk each shift.

5/25 6/3-6/12

8/95/27 6/13-6/21

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Identify and define projecttopicAim Statement & Background

Develop Charter andQuestionnaire. Meeting withprofessor Coleman for updateReview of literature andquestionnaire

Review and update projectcharter and questionnaires Microsystem assessment withmanager.Work on charterMeeting with IT for datacollectionHand out questionnaires tostaff for data collectionData analysis and updates

Putting it all together. Reviewof project and presentation topreceptor and other leaders.Final poster Presentation

• Decrease patient falls and hospital acquired pressure ulcers• Improve nurse to patient communication• Decrease use of call lights• Improve patient care experience• Increase HCAHPS scores• Cost savings for the organization

• Improvement in patient satisfaction scores.• Changes in the rounding process (provide chairs for nurses to sit in the patients’ rooms) to make it more efficient.• Staff have received training on AHV• CNL in the microsystem will lead the process in collaboration with frontline staff.• Addressing barriers to AHV• Creating a location for staff to document AHV

Strengths Weaknesses

Opportunities Threats

• Inconsistent rounding by nursing staff.• Rounding that is not meaningful• Interruptions during rounding• Lack of team collaboration and frontline staff participation in decision making process• Lack of follow up

• Inadequate staffing• Reimbursement• Loss of clientele to competitors• Loss of reimbursement dollars

MODEL FOR IMPROVEMENT

FINDINGS• 70 questionnaires were distributed among registered nurses and

patient care technicians working in medical surgical unit and medical telemetry unit.

• 60 questionnaires were completed and returned for a return rate of 90%

• The questionnaire contained 11 questions aimed at identifying how AHV is currently performed and what challenges the staffs encounter.

Barriers Total Percent

Time Constraint 10 17%Inadequate Staffing 17 28%Patient Condition 9 15%Multiple Interruptions 24 40%

Total Percent

1-5 7 12%5-10 35 58%10-15 12 20%>15 6 10%

Time Spent on

AHV (mins)

DRIVER DIAGRAM