Getting Sustainable Quality Outcomes by Conducting Daily Rounding

Purpose:
To showcase an evidence-based quality improvement program designed to achieve superior for the appropriate care measure (ACM) score. The ACM is comprised of the Acute Myocardial Infarction (AMI), Pneumonia (PN), Heart Failure (HF), and Surgical Care Improvement Project (SCIP) core measures.

Significance:
The rationale for initiating the daily rounds was to ensure that there was a clear plan of care, core measures were completed, and infection prevention measures were instituted. These strategies were implemented to ensure quality outcomes for patients and to focus on patient safety.

Strategy and Implementation:
On a daily basis nursing quality rounds occurred on the Medical/Surgical Units and the Intensive Care Unit. The rounds are limited to one hour. Team members included nursing directors and managers, quality management staff, the charge nurse, and the staff nurse responsible for a group of patients. The focus of the rounds included adherence to core measure requirements, updating nursing care plans, and improving critical thinking skills. In order to monitor the progress of the ACM, a retrospective medical record review of patients was conducted for patients with the core measure sets of AMI, PN, HF, and SCIP that were admitted to the hospital between January 1, 2009 and December 31, 2010. The quality management coordinators screened the medical record and if an AMI, PN, HF, or SCIP patient was found to be a candidate for the core measures, documentation that the core measure indicators were followed needed to be found in the medical records.

Evaluation:
ACM Results Quarter 1 2009- 84.9% Quarter 2 2009-86.2% (Nursing Quality Rounds began July 2009) Quarter 3 2009-93.7% Quarter 4 2009-93.0% Quarter 1 2010-93.8% Quarter 2 2010-97.6% Quarter 3 2010-95.7 Quarter 4 2010-96.1

Implications for Practice:
Quality rounds are a method to achieve success in core measure outcomes. Nurses now view rounds as an educational tool or opportunity. The rounds have helped nurses to focus on the critical elements that are the building blocks for quality. May be used in other settings.