Improving Staff Responsiveness to

Patient Needs Lourdes UniversityCollege of Nursing

BY: COURTNEY ARTHUR, COURTNEY GILLILAND, MARIA HOLUP, RACHAEL KILGUS, KRISTEN OXENDER, J ILL SCZESNY, TAYLOR ZAPADKA

Problemo Wood County Hospital is scored at 72.3% in the category of responsiveness to patients when evaluated by Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score compared with the 80.0% required by the Centers for Medicare and Medicaid Services (CMS).

HCAHPS Report Scores

Janua

ry

Febr

uary

March

April

May June

July

Augus

t

Septe

mber

Octobe

r

Novem

ber

64.0%66.0%68.0%70.0%72.0%74.0%76.0%78.0%80.0%82.0%

HCAHPS Report

Where WCH Started Current WCH Score Linear (Current WCH Score) CMS Benchmark

Months (2015)

Scor

e

Medical-Cardiac Unit at an Acute Care Facility

Potential Problems oFall riskoPressure ulcers oHarm to patientoDecreased pain managementoIncreased call light usageoDecreases other HCAHPS scoresoDecrease reimbursement from CMS

Call! Don't Fall! for Pediatric Patients. (2015). Retrieved November 18, 2015, from https://www.mskcc.org/cancer-care/patient-education/call-don-t-fall-peds

Root Cause Analysi

s

o Why is this a problem?oScoring oWhy did this happen?oPatient satisfaction scores oHow to reduce this from happening againoUse evidence-based practice

(2015.). Retrieved November 18, 2015, from http://www.becaudio.com/Shop/images/NHX-50M_small.jpg

Causes System

oFunding of new technologyoCall light systemoPlacementoLack of answering stations

PeopleoLack of motivationoRole confusionoLack of knowledge

Problem Resolution. (2015). Retrieved November 18, 2015, from http://www.statutorynuisancesolutions.co.uk/our-services/problem-resolution/

SuggestionsoDifferent call light placementoIncrease number of call light answering stationsoAlterative form of communicationoWalkie talkiesoBluetooth technologyoNurse phones

Lozze. (2015). Retrieved November 18, 2015, from http://lozzeisus.blogspot.com/p/suggestions-what-do-you-want-to-see.html

Data Collecti

on Method

s

oCollected over 5 hoursoResponse times measured

oTime to answer call light at central answering station oTime to respond to the call light by entering the

patients room

oHourly rounding monitored for each patient

Staffing Ratio On the day of data collection:• Unit had a total of 28 patients• Floor staffing consisted of 6 Registered Nurses, 3 Aides, and a Secretary

◦ Assignments consisted of:◦ 4 RNs had 5 patients [1:5]◦ 2 RNs had 4 patients [1:4]◦ 2 Aides had 9 patients [1:9]◦ 1 Aide had 10 patients [1:10]

Who Answered Call Lights

Medical-Cardiac Unit at an Acute Care Facility

Aide27%

RN22%

Secretary51%

Answers by Job Title

Time to Answer Call Light

7:00-7:29 7:30-7:59 8:00-8:29 8:30-8:59 9:00-9:29 9:30-9:59 10:00-10:29 10:30-10:59 11:00-11:29 11:30-11:59 Total0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Time Slot (AM)

Answ

er T

ime

(s)

Medical-Cardiac Unit at an Acute Care Facility

Time for Staff to Enter Room

7:00-7:29

7:30-7:59

8:00-8:29

8:30-8:59

9:00-9:29

9:30-9:59

10:00-10:29

10:30-10:59

11:00-11:29

11:30-11:59

0.0

2.0

4.0

6.0

8.0

10.0

12.0Room Entry Time

TIME SLOT (AM)

Aver

age

Room

Ent

ry T

ime

(min

)

Medical-Cardiac Unit at an Acute Care Facility

Hourly Rounding

7:00 8:00 9:00 10:00 11:000.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

64.3%

88.9% 85.7%80.8%

92.3%

Time (AM)

Perc

enta

ge o

f Roo

ms C

heck

ed

Medical-Cardiac Unit at an Acute Care Facility

Agency for Healthcare Research and Quality (AHRQ)

oRecommendations for improvement:oTreat all call lights as emergentoProvide patient with correct number to calloCreate empathy from nursesoBe proactive oInclude family oStandardized white boards

Dave, A., Schulke, D., & Brady, C. (2013, February 13). Responsiveness. Retrieved November 18, 2015, from https://cahps.ahrq.gov/surveys-guidance/hospital/hcahps_slide_sets/responsiveness/responsivenesssl.html Promise Hospital of Salt Lake » Promise Hospital of Salt Lake’s Interdisciplinary Patient Care Initiative Generates a Boost in Patient Satisfaction Scores. (2015). Retrieved November 18, 2015, from http://www.promise-saltlake.com/?page_id=206

Recommendations for Improvement

oIndividual nurse communication devices ◦ Cell phones, walkie talkies, Bluetooth ◦ Improves communication between staff and patients

oDirect communication from patient to nurse via individualized number:oNoise reduced oPatient call light being answered quickly oDecrease cost oDecrease unnecessary work hoursoCon: Cell phones/walkie talkies are bulky

Deamon et al., 2012, Digby, Bloomer, & Howard, 2011

Recommendations for Improvement

oEasily accessible placement of call light receivers oProvides safety and reassurance to patientsoHelps with monitoring alerts from roomsoInconveniently placed call lights can result in poor

performance oNurse call systems are a legal requirement and

there are legislations to help cover installation and use

Dewsbury & Ballard, 2014

Recommendations for Improvement

oIncreased involvement from nurse managersoEvidence-based practice leadershipoOrganize activities based on the issueoModify the infrastructure to align with objectivesoActively interveneoMonitor the work environment oProvide teaching & coaching regarding objectivesoCommunicate about progress of meeting

objectives with staff

(2015). Retrieved November 18, 2015, from http://www.ionl.org/resource/resmgr/Images/Kellogg_pic.jpg Stetler, Ritchie, Rycroft-Malone, & Charns, (2014)

Recommendations for Improvement

4 P’s Rounding Method: Pain, Potty, Position, Periphery

(every 1-2 hours) oIncrease in patient satisfaction scoresoDecrease in patient call light useoIncrease in urgency/seriousness

when call light activatedo“Patient complaints citing staff rudeness decreased 43%”

(Blakley, Kroth, & Gregson, 2011)Support Station. (2015). Retrieved November 18, 2015, from http://www.rifton.com/products/bathing-and-toileting-systems/support-station?tab=features

Recommendations for

Improvement

oIncrease awareness of call light answer timesoDiscuss call light response times at every opportunity

(i.e. team meetings, handoff report)oPost informative information accessible to staff oRaise staff awareness to improve the response to patient callso“Increase of 5.21% of call lights answered in less than 5

minutes”oDecrease in patient falls

Digby, Bloomer, & Howard (2011)

Change Theory oTranstheoretical Model

oBehavior focuses on personal change and incorporates key aspects of learning and behavioral change theories

oRecommended change:oPersonal communication devices

Change. (2015, April 15). Retrieved November 18, 2015, from http://thisisagoodsign.com/change/

Change TheoryStage One (Pre-contemplation)

oThose involved are unaware change is needed

Stage Two (Contemplation)oStaff is aware the problem exists and thinks about making a change, but does not take action

Stage Three (Preparation)oPrepares for change in order to take action in the future

oPreparation includes:oResearch on the best deviceso Nurse input on the design of the deviceo Current budgeting to purchase devices o Research grants to cover costso Design a training program before implementation

Change Theory

Stage Four (Action)oAction includes modifying behaviors to overcome the problem

oPurchase devices

oImplement training

oTrial runs to put the plan into action

Stage Five (Maintenance)oEstablish change through intentional work to prevent reversion and maintain gains

oMaintenance is achieved

Change Theory Stage Six (Termination)

oChange process is complete and no further work is needed to prevent reversionoTermination is complete when:oResponse time scores improveoPatient satisfaction scores improveoHCAHPS scores meet or exceed the national

standard

Hypothetical Evaluation Modification

POSITIVES:

Decrease in response times to patient needs Decrease incidents of injury to patients

Increase patient satisfaction scores Increase funding to the hospital

NEGATIVES:

Patient might feel like their care is being interrupted

Patient safety issues resulting from system failure

Hypothetical Evaluation Continued:

FINANCIAL: Cost of implementing new communication

system(s) Purchasing of the cell phones at another

institution had shown to save almost $125,000 a year in nursing work hours

Within 1 month, 166 Hours of nursing care can be gained back

MORBIDITY:

Decrease in patient injurieso Reduces patient falls by as much as 50%o Reduces pressure ulcers by 14%o Reduces use of call light by 38%

In Conclusion

oInterventions:oIndividualized communication devicesoPurposeful hourly roundingoIncrease staff awarenessoStaff education oProper placement of call light answering

systems

oResults:oImprove patient satisfaction scoresoDecrease cost to the hospital and patientoDecrease risk of harm to the patient

Evidence-based practice

Questions

Questions - Google Search. (2015). Retrieved November 18, 2015, from https://www.google.com/search?q=questions&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAWoVChMI_cLxg86ayQIVQ3YeCh1brwT_&biw=1600&bih=736#imgrc=s36UoalyiHYH2M:

References oBlakley, D., Kroth, M., & Gregson, J. (2011). The impact of nurse rounding on patient satisfaction in a medical- surgical hospital unit. MEDSURG Nursing,

20(6), 327-332 6p.

oCall! Don't Fall! for Pediatric Patients. (2015). Retrieved November 18, 2015, from https://www.mskcc.org/cancer-care/patient- education/call-don-t-fall- peds

oDave, A., Schulke, D., & Brady, C. (2013, February 13). Responsiveness. Retrieved November 18, 2015, from https://cahps.ahrq.gov/surveys- guidance/hospital/hcahps_slide_sets/responsiveness/responsivenesssl.html

oDearmon, V., Roussel, L., Buckner, E., Mulekar, M., Pomrenke, B., Salas, S.. Brown, A. (2012). Transforming care at the bedside (TCAB): Enhancing direct care and value-added care. Journal of Nursing Management, 21, 668-678. doi:10.1111/j.1365- 2834.2012.01412x

oDewsbury, G., & Ballard, D. (2014). Nurse call systems: ensuring a fast response to emergencies. Nursing & Residential Care, 16(1), 32-34 3p

o Digby, R., Bloomer, M., & Howard, T. (2011). Improving call bell response times. Nursing Older People, 23(6), 22-27.

oDudkiewicz, P. B. (2014). Utilizing a caring-based nursing model in an interdepartmental setting to improve patient satisfaction. International Journal For Human Caring, 18(4), 30-33 4p.

oHuey-Ming, T. (2010). Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: An Exploratory survey study in four USA hospitals. BMC Health Services Research, 1052-64. doi:10.1186/1472-6963-10-52

oKrepper, R., Vallejo, B., Smith, C., Lindy, C., Fullmer, C., Messimer, S., Myers, K. (2014). Evaluation of a standardized hourly rounding process (SHaRP). Journal for Healthcare Quality, 36(2).

oStetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence-based practice: Strategic and functional behaviors for institutionalizing EBP. Worldviews On Evidence-Based Nursing, (4), 219.