Proactive Rounding – Actively Caring

Trudy Reid & Mary BurkeSouthern HSC Trust

WSCNTL 2014, Kings HallLeading Care, Leading Teams - Innovating and Supporting Person-Centred Care

Southern Health and Social Care TrustTrudy Reid & Mary Burke

Actively Caring

Organisation of Care

The aim of this project is to review and address how nursing / midwifery care is organised and delivered in acute wards /

departments, identify areas of best practice and to recognise opportunities to deliver patient safety and improve the patient

experience.

Phased approach

Two acute Hospital sites Base Line 12 hour Observations of practice

Phase 1 – 11 pilot wards

Phase 2 - 19 wards across both sites

Evaluation included repeat Observations of practice

Safe Administration of MedicinesAim

– To support individual nurses and midwives achieve safe administration of medicines and reduce inappropriate omitted and delayed medicines

Methodology/Implementation – Observation of medicines assessment tool– Self-assessment– Reflective learning– Work shop for band 6-7 (39 sisters attended)

Evaluation – Observation of practice– Audit – Reduction in all medication incidents (although incidents may increase initially as

awareness heightened)– 53% completed self evaluation programme

This work was shared with Nurse Consultant, Clinical Education Centre, who will integrate the elements of this work stream

Medicines Self Assessment 1.0 What is a critical medicine?

Critical medicines are those where the omission or delay is likely to cause the most harm.

2.0 Name groups of critical medicines Anti infectives (all IV Antibiotics, oral & suspensions) Insulin Medicines to treat Parkinson’s Resuscitation medicines (held in Resuscitation trolley) Steroids Stat doses

3.0 How many hours do you have before a medicine dose is recorded as an (a) omitted dose (b) delayed dose? (a) before the next dose is due (b) 2 hours

4.0 What would you do if a critical medicine was not available at 10.pm if a critical medicine was not available? Contact emergency duty pharmacist

5.0 What would you do if you noticed that a critical medicine had not been given? What should happen next? Escalation. Short RCA carried out by ward sister, ward pharmacist and patient’s consultant.

5.0 If a patient is nil by mouth and taking critical medicines what would you do? Refer to Trust Guidance

6.0 Knowledge of medicines: Therapeutic effect ,Side effects , Usual Dose and Route Demonstrates an understanding of the uses and side effects associated with the medicines for administration (take three examples from medicine round)

7.0 As a nurse, what guides your practice in relation to management of medicines? NMC Standard for Medicines Management (2010) Medicines Management Code (March 2009)

8.0 Have you completed the IV cannulation course? Do you use it to keep your skills up? 9.0 Have you attended Administration of Medicines in the last 3 years? 10.0 Any other questions arising from the observation of practice

Shift HandoverAim

– To review how shift handover currently takes place– To review the literature on shift handover– To provide a standardised approach to shift handover

Methodology/Implementation – Use SBAR guidance and template or adapt current templates

Evaluation – Observation of practice– Audit of handover process

Outcome– The principles of the SBAR model of communication for handover are

now implemented in all wards, most areas now generated electronically– Shift handover observed to be effective – reduction in time of handover -

45 mins – 25mins in MAU and 30mins-15 mins in Surgical admission ward, with only applicable and relevant information communicated

Hand Over Template Situation Background Assessment Recommendations

No of days in patient

NameAge

Reason for Admission/Diagnosis / Investigations

Relevant

Medical History

Allergy statusInfection Control

DNAR

MEWS, nutritional, hygiene, elimination, change in condition etc

Planned investigations,On-going plan of care

EDD

Bay 1

1

2

3

4

Customer CareAims

– To ensure all staff are aware of their responsibility to inspire public confidence in all aspects of delivery of care

Methodology /Implementation – Delivery of PowerPoint presentation – Nursing supervision– Engaging with staff

Evaluation – Evaluation from participants – Observation of practice– Improve patient/client experience– Reduction in complaints

Outcome – Overall total- 764 staff attended (58%)– Extended to other areas and disciplines – outpatients/community

midwives/AHPs/medical staff (approx. 100)

Proactive Rounding Aim To ensure that all patients have face to face contact with nursing

staff minimum of two hourlyMethodology Use of proactive rounding toolEvaluation Observation of practice Patient rounding audit tooOutcomes Falls reduction by 25% *‘At first I thought intentional rounding was nothing more than a paper exercise, now I feel it is really beneficial to patient care as now I hardly ever hear a buzzer and all patients are able to tell exactly who their nurse is..’

Patient Name: _____________________ HSC Number: __________________________

Guidance notes Introduce yourself

May be completed by any member of Nursing staff, to be carried out on ALL patients, (using discretion if patient is independent re some areas eg toilet/position)

Tick boxes indicate you have had contact regarding these issues- Actions taken are recorded in nursing evaluation/appropriate charts

To be completed during night and record PA – Patient appears to be asleep

(if patient at high risk of falls carry out hourly – min 2 hourly) Rounding to be carried out ________hourly

Date Time Pain Position Toilet

Needs Check

Environment is clean and tidy/bed in

lowest position

Check ‘is there anything else you need’

Staff initals

Addressograph

Proactive Rounding Audit ToolPatient Rounding Audit Tool

Date:________ Time:_________ Ward:_____________ Please tick for Yes and cross for No

Patient 1 Location on ward____________

Patient 2 Location on ward____________

Patient 3 Location on ward____________

Patient 4 Location on ward____________

1. Patient can correctly identify name of nurse (and HSW) caring for them that: Morning/Afternoon/Night duty. (Delete as appropriate)

2. Patient can indicate that someone has spoken to them within the past two hours with regards to comfort, pain and toilet needs.

3. Patient can indicate that nursing staff reassured them when they would return

4. Did the patient need to use Call Bell today?

5. Is bed table/call bell always within easy reach?

Name of person carrying out the audit: _________________________________

Other elements of organisation of care

Model of care Prevention of Health Care Associated

Infection Roles and Responsibilities

Rotational Programme Induction Programme Competency based Programme Named preceptors Rotational programme

– ED/MAU 6 months ED 6 months in MAU

– Trauma/orthopaedics Clinical supervision

Lunch & Learn

MDT Learning together Sharing the learning New Initiatives Examples of good practice and areas for

development NIPEC Educational Audit

Patient Safety Briefings

Weekly meeting at ward level New guidance, policies, procedures and

best practice Audit feed back including NQI Sharing the learning from complements,

complaints, incidents, RCA and SAI Feed back from weekly sisters meetings Correspondence

Actively Care