Hourly nurse rounding is a growing trend around the country
Tuesday, March 03, 2009
By STEVE DOYLE
Times Staff Writer steve.doyle@htimes.com
Crestwood Medical Center's promise to check every patient every 60 minutes as part of a new "hourly rounding" program appears to be paying off.
The year-old initiative was designed to stamp out common health problems associated with hospital stays, and the early returns are promising. Accidental patient falls at Crestwood are down 58 percent and bedsores are down 39 percent since November 2007, said Chief Nursing Officer Martha Walls.
"We've found that turning patients every hour instead of every two hours makes a significant reduction" in bedsores, Walls said. "It doesn't take long if you have fragile skin for a bedsore to start forming."
Hourly nurse rounding is a growing trend among hospitals, but Crestwood's parent company, Community Health Systems, may be the first to mandate it companywide. The Tennessee-based firm owns 119 U.S. hospitals, including Crestwood and DeKalb Regional Medical Center in Fort Payne.
Huntsville Hospital is also experimenting with the idea. Its Neuro Patient Care Unit, which treats people with neurological disorders such as stroke and epilepsy, is testing a caregiver rounding program called "MP3." Nurse Manager Lee Collins said caregivers on the 27-bed unit are required to check each patient hourly for "the three Ps - position, personal needs and pain."
Basically, that means making sure the patient is comfortable in bed, helping them to the bathroom if needed and checking their pain level.
If patients respond favorably to the pilot program, Collins said, hourly rounding could become the new standard of care hospitalwide. Huntsville Hospital is Alabama's second-largest hospital, with 881 patient beds.
Crestwood's rounding program focuses on the same three Ps and adds another: possessions. That means making sure patients have easy access to bedside tables, telephones, water, glasses, nurse call lights and bedpans.
Guest Relations Director Veronica Carter said the initiative has reduced accidental falls by ensuring that patients don't have to strain or get out of bed to reach things they need. And caregivers constantly drop by to help hobbled patients to the bathroom, she said.
Hospitals that can eliminate patient falls stand to reap huge savings: NurseWeek magazine reported in 2006 that each patient fall resulting in injury costs hospitals an average of $11,000.
Crestwood patients who can't move well on their own - the elderly and people coming off major surgery, for example - also get help shifting positions to prevent bedsores. The 150-bed hospital checks patients hourly from 6 a.m. to 10 p.m., and every two hours overnight.
"It's not just poke your head in the door, say, 'Hey, how are you doing?' and then leave," said spokeswoman Lori Light. "It's focused rounding."
Crestwood's patient satisfaction scores have soared since the initiative began 18 months ago, Carter said. The number of surveyed patients who say they would definitely recommend Crestwood to others has jumped from 73 percent before the program to 82 percent today, she said.
"We're seeing an increase in specific compliments, where patients name their nurse and caregivers and say that they went above and beyond," Carter said.
When the program was announced, some nurses wondered how they could squeeze hourly patient visits into an already busy schedule. But Carter said nurses are being paged less because patients know their next visit is just around the corner.
Patient use of nurse call lights is down nearly 30 percent at Crestwood since January 2008.
Hourly rounding is part of a broader "Crestwood Cares" initiative that aims to improve patient outcomes and satisfaction. All employees at the for-profit hospital - from nurses to janitors - are asked to introduce themselves each time they enter a patient's room, explain what they are there to do and thank the patient before leaving.
"The whole concept is to reduce anxiety," said nursing chief Walls, "and make the patient feel less nervous about being in the hospital. It makes the family know you care about that person as a person, they're not just a room number."
Huntsville Hospital is doing something similar. About 18 months ago, it brought Ritz-Carlton executives to the Rocket City to teach the hotel chain's customer service secrets to hospital bosses. That "Power of Excellence" training has since been given to about 3,300 employees at the not-for-profit hospital, said Director of Customer Service Pat Jackson.
Nurses and other staff have been taught to knock before entering patient rooms, introduce themselves, call the patient by name and ask if they need anything.
"It's a culture and what we want to be," Jackson said. "We feel we've been a good hospital for many years, but now we're striving for greatness."