Striving for Five-- Buying Into Hourly Rounding

Customer Service!  Striving for five!  That's what its all about!

I don't know about you but I cringe just about every time we get to that part of the staff meeting and my departments' Press Ganey scores come to light.  It's even more fun when you look at the hospitals' websites and see the stats, those darn rehab nurses always beat us.  But I'm in the ER, and it's not easy to please people who are laying on stretchers, sometimes with no privacy in hallways, waiting for hours and having limited food choices- stale turkey or stale cheese sandwich.  

I've had some extra time to read a few books and professional journals lately.  I see pictures of smiling nurses and their happy patients, with happy captions, but does this reflect what is happening in the hospitals? There's has nursing research articles about how hourly rounding reduces call bell usage and reduces falls.  In theory this is a wonderful thing, but it's not a sure fire way to bump Press Ganey, is it?  

A recent article that appeared in the Journal of Emergency Nursing's January 2013 issue, written by two ER nurse managers supports hourly rounding.  Their article showed a statistical analysis of how their facility's Press Ganey scores dramatically increased.  It was reassuring.  In addition to hourly rounding the Emergency Room employees also had to buy into the concept that  they would meet specific goals that were directly related to the Press Ganey patient survey.  

The approach the authors reported is not unlike other emergency rooms.  AIDET was a key focus in addition to hourly rounds that included: "the 4 P's- personal issues, pain, position, and problems". 

So how did they get folks to buy in?  I know we have the same standards at the hospitals I work at, but it just doesn't seem to be uniform.  Rounding is generally left to the nurses, and when those nurses are busy and staffing is, well, short, hourly rounding sometimes takes a back seat. 

So how much of an increase did this particular hospital have?  The Press Ganey scores were at 57% prior to hourly rounding and increased sharply.  The authors also reported increased job satisfaction.  

The hospital was able to get the buy in from its staff and more importantly maintain it.  One of the ways they did that was through reward systems.  They utilized movie tickets, gift cards and employee recognition to keep their teams motivated.  In addition to the buy in from the employees side, the patient discharge paperwork also included a signed thank you note from the staff that cared for him.  According to Sharron Kelly, coauthor of the article, she stated that her department had not increased staffing levels, during that time.  She further clarified that the hourly rounding was a joint effort by physicians, techs and nurses.  

For more information please refer to the article "Improving the ED Experience with Service Excellence Focused on Team work and Accountability" by Sharon Kelly and Lou Faraone which was featured in the January 2013 issue of the Journal of Emergency Nursing.  

Little Hearts Big Love-- CCHD and CHD

February is a busy month of celebrations for matters of the heart.  Over the past few years heart health and wearing red has been in vogue for supporting the cause.  But who are we bringing awareness to exactly?

When you see CHD you might think coronary heart disease, but there is another CHD out there.  Congenital Heart Deformity  and Critical Congenital Heart Deformity which affects approximately 1 out of 120 infants. While some infants are diagnosed prenatally others may not show signs or symptoms until they are discharged home.

New Jersey has taken the lead in helping identify CHD by mandating a simple procedure that is non invasive and part of routine vital signs.  While most nurses wouldn't consider a pulse ox as being so groundbreaking, considering that we seem to use almost without thought.

Is that enough to diagnose CCHD and CHD?   No, it's not, but it is a start!

While some CHD can be suspected related to lowered pulse ox values, it is not the case for all forms of CHD.

Commonly associated CHD linked to low pulse ox include:

• Hypoplastic left heart syndrome

• Pulmonary atresia

• Tetralogy of Fallot

• Total anomalous pulmonary venous return

• Transposition of the great arteries

• Tricuspid atresia

• Truncus arteriosus

It is recommended that the pulse ox be done 24 hours or later, because newborns bodies will often show signs and symptoms several hours or days after birth. For optimal results it is important that the infant now be crying or moving during the reading.  The probe should be placed on the right hand or either of the feet.  
A positive screening includes one of the following

1. SaO2 measurement <90 percent
2. SaO2 measurement <95 percent in both upper and lower extremities on three measurements, each separated by one hour
3. SaO2 difference >3 percent between the upper and lower extremities

http://www.uptodate.com/contents/congenital-heart-disease-chd-in-the-newborn-presentation-and-screening-for-critical-chd#H270523895

While nursing is about medicine it is also about the families of these infants and children who are born with these serious and life threatening conditions.  Below is a link to some amazing stories that truly touch the heart.  http://www.chop.edu/service/cardiac-center/patient-stories/