Abstract
Background: Healthy People 2020 identified unintentional injuries, such as patient falls, as a widespread problem in the United States. The Joint Commission ranked poor communication as one of the top 3 causes of sentinel events, or unintentional injuries. Nebraska, along with other states, have struggled to meet HCAHPS scores as many hospitals are below the national average in the nursing communication and responsiveness categories.|Significance: Fall prevention has been a priority in the acute care setting for over 50 years, and was deemed a National Patient Safety Goal again for 2017. The HCAHPS survey, developed by CMS is the first of its kind that measures how satisfied patients were with recent hospitalizations. This marks given by patients is important for hospitals as reimbursement from CMS is altered depending on the scores.|Clinical Problem: CHI Health-Lakeside is similar to the national average in the “effectiveness of care” HCAHPS category, and below the national average in the “safety of care” category. There have been 35 falls over the past 3 months at CHI Health-Lakeside.|Purpose: The purpose of this project is to evaluate the effectiveness of a nurse driven program focused on improving hourly rounding on the medical surgical oncology unit (4West) to increase HCAHPS categories: timeliness and frequency of rounds, and timeliness of call lights while also decreasing falls and MET calls.|Literature Review: Research to discover what quality of care means to patients was conducted. Compassion, Providing Information, and Competence were the overarching themes found to define the meaning of quality care to patients. The root of each of these themes is communication, and healthcare personnel are able to bring forth these themes through hourly rounding, which has been proven to decrease falls, and increase patient satisfaction.|Theoretical Framework: The Power of Positive Deviance Framework is based on the concept of “Doing, not telling.” The focus is on what is going right in an ecosystem and intensifying it, instead of focusing on what is going wrong and trying to fix it.|Methods: Prior to implementation, a baseline assessment of 2 specific HCAHPS scores pertaining to nursing responsiveness, and call light data, fall data and MET calls from the past 90 days will be conducted. After the 3 month data collection period the 2 specific HCAHPS scores pertaining to nursing responsiveness, along with call light and fall data from post implementation will be analyzed and compared to prior implementation data. A survey to assess 4 West RNs perception of hourly rounding directly after the system-wide initiative will be distributed. The same survey will be distributed at the conclusion of the initiative in order to analyze a trend. A post-implementation survey assessing CHI Health’s specific hourly rounding initiative will also be distributed in conjunction with the perception survey at the conclusion of the initiative.|Results: Call light response times, falls, and MET calls all showed a decrease in post implementation months while HCAHPS scores showed only minor changes.