Patient Rounding: An important new nursing initiative to
improve the patient experience and patient care OR
flavour of the month
Sue Langley, Head of Nursing, Division of Specialist Medical Services
Plan for Workshop
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Background and political context of rounding
My interest
Story so far at CMFT
The science of nursing – what is the evidence?
The art of nursing – care and compassion
Rounding, a theoretical framework
Round up of rounding
What do you think of Rounding?
My opinion next, what is yours?
A few things to think about
Great/Not so Great
Outcomes for patients
Outcomes for nurses
Documentation
Time it takes
Who does rounding?
Discuss in small groups – capture and share main thoughts
Background and political context
Concept of rounding – simplistic level process for regularly checking on patients
2006 Meade / Studer Group 4 P’s
2009 High Impact Interventions Falls Rounding – Ipswich Hospital
Concept of Rounding not new
Florence Nightingale, Ward Rounds, Back Rounds, Night Sister Rounds, Matron
Rounds
American literature – Improves patient safety, reduces falls, increases patient
satisfaction, reduces call bell usage
Adopted enthusiastically in UK
Political context – Prime Minister called for introduction nursing rounds in all NHS
hospitals, part of the recommendations Francis response
Political context
Nurses in England will have to do hourly rounds on hospital wards, make more bedside
visits but will have to fill out less paperwork, under plans announced by the Prime
Minister.
The changes are being made by David Cameron after a critical report from the Care
Quality Commission (CQC) in October.
It found issues with dignity and respect in many hospitals with some patients left to sit in
pain or unable to reach food and water.
Newsbeat has been talking to nurses at University College Hospital in central London.
My Interest? - Rounding’s biggest fan
Part of my role – new practice, reducing harm, organisation
of nursing work
Nursing and Midwifery Strategy Work – great fit
Personal approach / orientation – back to basics / not keen
on theoretical models
Study project – something that would make a difference in
day to day practice
High Impact Actions / Interventions work / productive ward
NHS Institute
BUT
As more knowledgeable about
background/evidence/historical context
? Views changing
Story so far at CMFT
1. Introduced Acute Medicine Division June 2010, HoN ‘Falls Rounding Project’
aim to reduce falls, nothing previously had reduced the falls rate
2. New Approach specific ward Nov 2011 – intentional rounding / patient focus
rounding
Wider than falls prevention, nutrition/hydration, skin integrity, nurse in charge
communication/engagement, improving patient experience
Use of IQP methodology / staff and patient feedback
3. Trust wide adoption April 2012 ‘Patient Focus Rounding’
Linked to ‘Brilliant Basics’ communication
IQP methodology
Launch, hand book, video, A3 reports
Based for most part on single question ‘Is there anything I can do for you?’
Single document
4. Additional question April 2013 “Worries and Fears”
Trust results
Patient focus rounding tracker data
Dec11
Jan-1
2
Feb12
Mar 12
Apr -1
2
May12
Jun-1
2
Jul- 1
2
Aug12
Sep12
Oct -1
2
Nov12
Dec12
Jan-1
3
Feb13
Apr -1
1
May11
Jun-1
1
Jul- 1
1
Aug11
Sep11
Oct -1
1
Nov11
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
Did you find somebody on the hospital staff to talk to about your worries and fears?
mean avg 2011
Did staff do what you wanted in order to help you?
mean avg 2011
Mean
average
improved
by 5%
The science of nursing – the evidence base
American Evidence base – quantitative cause and effect
Meade 2006 – seminal work 4 P’s
Studer Group 2007
Sobaski 2008
Tea 2008
Woodward 2009
Beneficial outcomes – improved patient safety through decreased falls, reduced call light
usage, increased patient satisfaction, increased staff satisfaction
Diverse clinical settings, RN and HCSW rounding
Some small scale studies qualitative Blakely 2011and Dietrick 2011 process of rounding
UK literature – very poor no quantitative/qualitative studies, discursive
Castledine 2005, Lucas 2010, Bartley 2011, Dix 2012, however descriptions of process
similar to American literature
Criticism – return to task orientation / American evidence base
The art of nursing – care and compassion
The bit we need to understand, why rounding is more than a checklist?
Maslow’s Hierarchy of Needs / Fundamentals of Care links to meeting patients’
physiological and safety needs –
social needs
Water
Warmth
Toileting
Personal
Health
Property
Belonging
Communication
Francis – critical of basic nursing care standards
What, as nurses, are we doing to meet patient need?
Rounding is a structured way to deliver communication, care and compassion, however
there is complexity within the process; rounding is more than a checklist of tasks
devoid of individual patient assessment and professional judgement
Perhaps what we haven’t done is focus on the art
Rounding a theoretical framework
Not a big fan of theoretical frameworks but may give us a better understanding of the
process to ensure robust implementation and significant outcomes
Trust
4 P’s
Studer
Spradley
Maslow
Anything I can do
for you?
How is your pain?
Opening words
Space
Drink
Any worries or
fears?
Are you
Actor(s)
Food
comfortable/position?
Perform scheduled
tasks
Help to the bathroom
Address 4 P’s
Activity
Warmth
Help with drink
(Possessions)
Additional comfort
needs
Object(s)
Toileting
*? 5 P presence*
Environment (assess)
Act
Personal safety
Closing key words
Events
Belongings/Property
Explain & return
Time/Timings
Own health
Goal
Belonging
Feelings
Communication
(personal needs)
Round up of rounding
10 points about rounding
1. Definitely a top agenda item for today’s nursing
2. Potentially seen as politically promoted
3. Adopted across the NHS
4. American evidence base
5. Limited UK evidence base
6. Controversial as seen as a return to task orientation
7. Not new - back to Florence
8. Potential to improve patient care and patient experience
9. Potential to improve staff experience
10. More research required
Questions / your views