You are the nurse manager of a 30-bed medical-surgical unit in an acute care hospital. Over the past year, patients across all units have verbally and in writing expressed concerns about the following:
As a result, your unit, along with others, has experienced a continual decline in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. In part due to these poor patient satisfaction scores, the hospital has not achieved its financial goals for the year. The hospital’s CNO and CFO have chosen your unit to quickly implement a new performance improvement process in response to these issues. Your unit will serve as the prototype for other units to follow.
At today’s staff meeting, attended by RNs, nursing assistants, and unit secretaries, you announced the upcoming implementation of hourly rounding as a best-practice approach. Each RN will visit every assigned patient hourly to assess the “5 P’s”:
Current literature also suggests that hourly rounding can reduce patient falls and hospital-acquired pressure ulcers (HAPIs).
Your evidence-based proposal for hourly rounding has, however, been met with swift and significant opposition from staff members, who cite the following challenges:
Create a PowerPoint presentation that outlines your implementation plan for hourly rounding. This presentation will be shared with the CNO and CFO. The purpose of this task is to demonstrate your ability to be creative, concise, and informative. As a practice leader, you will often need to deliver presentations to your team members and organizational leaders.
Expert answer
DRAFT / STUDY TIPS:
PowerPoint Presentation Outline: Hourly Rounding Implementation Plan
Slide 1: Title Slide
- Include:
- Your Name
- Title: "Implementing Hourly Rounding for Patient-Centered Care: An Evidence-Based Plan"
- Hospital Name
- Date
Slide 2: Current Issues and Rationale for Hourly Rounding
- Key Points:
- Summarize patient concerns:
- Long wait times, feeling forgotten, communication issues.
- Impact:
- Declining HCAHPS scores.
- Negative financial performance.
- Evidence-Based Rationale:
- Hourly rounding addresses patient satisfaction, reduces falls and HAPIs, improves communication, and enhances safety.
- Support with literature: e.g., Studer et al. (2018) highlight improved HCAHPS scores after implementing hourly rounding.
Slide 3: Goals of Hourly Rounding Implementation
- Key Points:
- Increase patient satisfaction and HCAHPS scores.
- Improve quality of care by addressing the “5 Ps.”
- Foster better patient communication and staff efficiency.
- Reduce preventable adverse events (e.g., falls, HAPIs).
- Supporting Evidence:
- Reference articles demonstrating how structured rounding achieves these goals (e.g., Meade et al., 2006).
Slide 4: The 5 P’s Framework in Hourly Rounding
- Key Points:
- Explain the 5 P’s:
- Pain – Address pain management promptly.
- Potty – Assist patients with restroom needs.
- Proximity of Possessions – Ensure personal items are within reach.
- Patient Positioning – Prevent pressure ulcers, improve comfort.
- Safety – Verify environment safety.
- Include a visual diagram or flowchart for clarity.
Slide 5: Implementation Plan – Step-by-Step
- Key Points:
- Pre-Implementation:
- Staff education on benefits, evidence, and process of hourly rounding.
- Engage staff with training sessions and role-playing scenarios.
- Implementation:
- Pilot on specific shifts and gather feedback.
- Use visual rounding logs to monitor compliance.
- Post-Implementation:
- Collect HCAHPS data, compare pre/post-implementation results.
- Continuous feedback and adjustments.
- Visual: A timeline or process flowchart.
Slide 6: Addressing Staff Concerns and Barriers
- Key Points:
- Excessive Documentation: Integrate quick, standardized documentation templates for rounding.
- Nursing Assistant Shortages: Adjust staffing plans to optimize RN-NA collaboration.
- Increased Patient Acuity: Prioritize teamwork and redistribute workload for high-acuity patients.
- Travel Nurses: Develop mentoring programs to engage them in the hospital culture.
- Nurse Leaders: Leaders to conduct rounds to support staff and stay connected to unit needs.
- Example Solution:
- Use a “Rounding Buddy System” (RN + NA pairing) to share responsibilities.
Slide 7: Tools for Success
- Key Points:
- Visual aids: Checklists, rounding logs, EMR-integrated reminders.
- Staff incentives: Recognize high compliance with rewards or public recognition.
- Real-time feedback: Implement patient surveys or verbal feedback forms.
- Supporting Evidence:
- Examples from hospitals that successfully implemented hourly rounding using similar tools.
Slide 8: Metrics for Success and Monitoring
- Key Points:
- Quantitative Metrics:
- HCAHPS scores: Focus on “nurse communication” and “responsiveness” domains.
- Reduction in falls and HAPIs.
- Qualitative Metrics:
- Patient satisfaction surveys, staff feedback.
- Monitoring Tools:
- Monthly performance dashboards.
- Unit-based rounding audits.
- Include a chart showing example data trends (before/after hourly rounding).
Slide 9: Expected Outcomes and Benefits
- Key Points:
- Increased patient satisfaction, resulting in improved HCAHPS scores.
- Enhanced staff efficiency and engagement.
- Reduction in adverse events (e.g., falls, pressure ulcers).
- Financial improvements due to better patient satisfaction scores.
- Use a bullet-pointed summary with visuals for engagement.
Slide 10: Conclusion and Call to Action
- Key Points:
- Recap:
- Hourly rounding is evidence-based and directly addresses patient concerns.
- Improves outcomes for patients, staff, and the hospital.
- Call to Action:
- “Let’s work collaboratively to implement this proven strategy and make a positive impact on patient care and satisfaction.”
Slide 11: References
- Include all cited evidence and literature in APA format.
- Example sources:
- Meade, C. M., Bursell, A. L., & Ketelsen, L. (2006). Effects of Nursing Rounds on Patients' Call Light Use, Satisfaction, and Safety. American Journal of Nursing.
- Studer Group (2018). Hourly Rounding: Best Practice for Patient Care and HCAHPS Scores.
- Additional articles from credible journals like The Journal of Nursing Administration.
Voice-Over Recording Tips:
- Keep each slide narration clear and concise (1-2 minutes per slide).
- Use a professional tone but remain conversational.
- Highlight data points, solutions, and outcomes.
- Include phrases like:
- “Evidence clearly shows that hourly rounding improves both patient safety and satisfaction.”
- “Our plan addresses staff concerns by streamlining documentation and promoting teamwork.”
PowerPoint Content for Hourly Rounding Implementation Plan
Slide 1: Title Slide
Content:
- Title: "Implementing Hourly Rounding for Patient-Centered Care: An Evidence-Based Plan"
- Subtitle: Hospital Name
- Your Name
- Date
Voice-Over Script:
"Hello everyone. Today, I’ll present an evidence-based implementation plan for hourly rounding in response to our patient concerns. This strategy directly addresses issues such as wait times, communication gaps, and patient safety while improving our overall performance and satisfaction scores."
Slide 2: Current Issues and Rationale for Hourly Rounding
Content:
Patient Concerns Identified:
- Long wait times for call bell responses.
- Rarely seeing assigned nurses.
- Feeling forgotten and isolated.
- Lack of communication among caregivers.
Impact:
- Decline in HCAHPS scores.
- Negative financial performance.
Why Hourly Rounding?
- Proven to reduce:
- Call bell use (Meade et al., 2006).
- Patient falls and pressure ulcers (HAPIs).
- Improves communication and patient experience.
Voice-Over Script:
"Over the past year, patients have reported several concerns: long call bell waits, feelings of neglect, and communication breakdowns. These issues have impacted our HCAHPS scores, affecting both patient trust and hospital finances. Research demonstrates that hourly rounding significantly reduces such problems, making it a proven solution."
Slide 3: Goals of Hourly Rounding Implementation
Content:
Primary Goals:
- Enhance patient satisfaction.
- Address the “5 P’s” proactively.
- Improve communication between staff and patients.
- Reduce preventable adverse events (falls, HAPIs).
- Optimize workflow efficiency for nurses and assistants.
Supporting Evidence:
- Meade et al. (2006) show a 50% reduction in call bell use and increased HCAHPS scores post-hourly rounding.
Voice-Over Script:
"Our goals are clear: to address patient concerns proactively, optimize the delivery of care, and improve measurable outcomes. By implementing hourly rounding, we aim to reduce patient falls, increase satisfaction, and improve nurse-patient communication."
Slide 4: The 5 P’s Framework in Hourly Rounding
Content:
The “5 P’s”:
- Pain – Assess and address pain promptly.
- Potty – Assist with restroom needs to prevent falls.
- Proximity of Possessions – Keep items like phones, water, and remote controls within reach.
- Patient Positioning – Prevent pressure ulcers and ensure comfort.
- Safety – Ensure environment is hazard-free (IV lines, spills, etc.).
Visual: A diagram showcasing the “5 P’s” concept.
Voice-Over Script:
"During hourly rounds, nurses will address the '5 P's': pain, restroom needs, proximity of possessions, patient positioning, and overall safety. This proactive framework ensures we meet key patient needs efficiently, reducing the likelihood of preventable adverse events."
Slide 5: Implementation Plan – Step-by-Step
Content:
-
Pre-Implementation:
- Staff education and training sessions.
- Role-play scenarios to familiarize the team.
-
Implementation:
- Start with pilot shifts.
- Use rounding logs to track compliance.
-
Post-Implementation:
- Collect HCAHPS data pre/post-implementation.
- Conduct staff and patient feedback surveys.
Visual: A flowchart of pre-, during-, and post-implementation stages.
Voice-Over Script:
"The implementation process will occur in three stages. First, pre-implementation will focus on staff education and training. During implementation, we’ll pilot the process on specific shifts to identify challenges. Post-implementation, we’ll gather performance data to measure success and adjust as needed."
Slide 6: Addressing Staff Concerns and Barriers
Content:
Key Barriers and Solutions:
- Excessive EMR Documentation: Streamlined templates for quick documentation.
- Nursing Assistant Shortages: Adjust staffing models and improve collaboration.
- Increased Patient Acuity: Redistribute workload and prioritize teamwork.
- Traveling Nurses: Introduce mentoring programs for cultural integration.
- Disconnected Nurse Leaders: Leaders to conduct rounds and engage with frontline staff.
Visual: A table listing barriers alongside proposed solutions.
Voice-Over Script:
"We acknowledge staff concerns and have developed targeted solutions. For instance, documentation will be streamlined, and staffing will be adjusted to balance workload. Leaders will actively engage with staff by participating in rounds, addressing morale and accountability."
Slide 7: Tools for Success
Content:
Tools to Support Hourly Rounding:
- Visual aids (rounding checklists and logs).
- EMR-integrated reminders for rounding intervals.
- Staff recognition programs for compliance.
- Real-time patient feedback mechanisms (verbal or written).
Example: Hospitals like Cleveland Clinic have successfully used checklists to monitor and improve rounding compliance.
Voice-Over Script:
"To ensure success, we’ll provide staff with tools such as visual rounding logs and EMR reminders. Incentive programs will reward high-performing teams, and real-time feedback will help us continually refine the process."
Slide 8: Metrics for Success and Monitoring
Content:
Key Metrics:
- Quantitative:
- HCAHPS scores (nurse communication, responsiveness).
- Number of falls and pressure ulcers.
- Qualitative:
- Patient satisfaction surveys.
- Staff feedback via meetings and surveys.
Monitoring Tools:
- Monthly rounding audits.
- Performance dashboards showing real-time progress.
Visual: Example bar graph of pre- and post-rounding data.
Voice-Over Script:
"Success will be measured both quantitatively and qualitatively. Key metrics include improved HCAHPS scores and reductions in adverse events. Regular audits and dashboards will ensure transparency and accountability throughout implementation."
Slide 9: Expected Outcomes and Benefits
Content:
Expected Outcomes:
- Enhanced patient satisfaction and safety.
- Improved communication between patients and nurses.
- Decreased adverse events (falls, HAPIs).
- Increased staff efficiency and engagement.
Long-Term Benefits:
- Higher HCAHPS scores leading to improved hospital financial performance.
Visual: A summary table of outcomes and benefits.
Voice-Over Script:
"Implementing hourly rounding will enhance patient satisfaction, improve safety, and strengthen communication. Long-term, these improvements will lead to better financial outcomes, positioning our hospital as a leader in patient-centered care."
Slide 10: Conclusion and Call to Action
Content:
Summary:
- Hourly rounding addresses patient concerns and improves measurable outcomes.
- Staff engagement and tools ensure success.
Call to Action:
- Let’s work collaboratively to implement this proven strategy and deliver excellent care.
Visual: A motivational image (e.g., nurses interacting positively with patients).
Voice-Over Script:
"To conclude, hourly rounding is a proven practice that aligns with our commitment to excellence. By working together, we can address patient concerns, improve satisfaction, and create a safer, more efficient care environment."
Slide 11: References
Content:
References formatted in APA style:
- Meade, C. M., Bursell, A. L., & Ketelsen, L. (2006). Effects of Nursing Rounds on Patients' Call Light Use, Satisfaction, and Safety. American Journal of Nursing, 106(9), 58–70.
- Studer Group. (2018). Hourly Rounding: Best Practice for Patient Care and HCAHPS Scores.
- Ford, B. M. (2019). Enhancing Patient Safety Through Structured Rounding. Journal of Nursing Administration, 49(3), 123–130.