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From the Bedside: Purposeful Rounding Essential to Patient Experience

Thursday, February 27, 2014
K. Kelly Hancock, MSN, RN, NE-BC, Executive Chief Nursing Officer, Cleveland Clinic Putting patients first requires more than just clinical expertise – it also requires demonstration of caring and compassion with every patient we encounter. Patients like to know that someone is watching over them and truly cares.

In order to assure every patient’s experience is always met with a nursing team of caregivers who are responsive to the needs of our patients and families, the Stanley Shalom Zielony Institute for Nursing Excellence at Cleveland Clinic implemented hourly purposeful nurse rounding at all Cleveland Clinic hospitals.

Effective nurse rounding helps manage patient expectations, provide necessary service recovery, promote quality care, recognize exceptional caregivers and role model behavior.

Rounding with a purpose is one of our initiatives that not only fulfills the routine requests that are usually made when the call light is used, but also demonstrates nurses’ availability to the patient and their readiness to anticipate their needs. It’s proactive and allows for nurses to manage patient care and their own time more efficiently. The key elements that should be considered during hourly rounding and can easily be remembered as the four P’s:
  • Pain – Ask the patient if they are in pain or check to see if it is time for their next dose of analgesics.
  • Position – Changing the patient’s position can alleviate pressure, pain or soreness.
  • Potty – Consider this especially with the elderly or those on diuretics or fluid replacement (IV’s)
  • Possessions - When you reposition the patient, be sure they can still reach the call light, remote control, glasses, tissues and bedpan (if applicable). These five items are the most frequently requested needs for which patients use their call light.
In addition to ensuring all of our nurses were practicing purposeful hourly rounding, we also implemented “effective nurse leader rounding” for our nurse directors, managers and assistant managers. Our five steps of effective nurse leader rounding include the following:
  1. Greeting/Introduction (knocking prior to entering,  introducing yourself and ask permission, using good eye contact)
  2. Managing up staff (“I see your nurse today is Lori, a great nurse with many years of experience. You are in good hands.”)
  3. Experience care questions (“What is important to you during your stay?” and two HCAHPS-related questions focused on an area of opportunity or validation of expected behaviors.)
  4. Exceptional staff recognition (“Is there anybody you would like to acknowledge that has been especially helpful?”)
  5. Thank and close (“It is important to us that you are well cared for during your stay. If you have any further comments or questions, please do not hesitate to contact me directly. Is there anything else I can do for you right now?”)
When we launched this initiative, training workshops were held for all inpatient acute care nursing directors, managers and assistant nurse managers. Our nursing leadership team also set a list of goals to ensure we were positively impacting the patient experience as well as the experience of our nurses and caregivers. Some of our goals for purposeful rounding include the following:
  1. Assure every patient’s experience at a Cleveland Clinic is always met with a nursing team of caregivers who are responsive to the needs of our patients and families.
  2. Manage patient expectations
  3. Provide service recovery as appropriate
  4. Quality Care: Observation and asking questions/monitoring initiatives
  5. “Manage up” caregivers
  6. Provide recognition for nurses and caregivers
Since we began practicing both purposeful hourly rounding and nurse leader rounding, we’ve seen HCAHPS scores in unites where nurses ‘always rounded’ enter the 90th percentile. We’ve also increases in our patient satisfaction scores.

It’s essential to remember that rounding is ultimately about building relationships and trust as much as it is about meeting the physical needs of the patient.

From the Bedside: Nursing on the front lines of patient experience is a new monthly column featuring best practices, research and news from experienced nurses around the country. The column examines patient experience from the front lines of care, through the eyes of the nurse.

Tags: service, HCAHPS, nursing, rounding
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