Evidence-based Approach To Improve Patient Safety

Purpose:
The 4Ps Proactive Nursing Hourly Rounding program was developed and implemented collaboratively by nursing leadership and frontline staff to reduce falls and improve patient satisfaction. Utilizing the team approach the RN/patient care associate conduct hourly rounds by engaging the patient/family.

Significance:
Clinical excellence and patient satisfaction have become a high priority for the hospital in the growing push toward accountability among healthcare providers. Patient falls and patient satisfaction scores are the top indicators at Long Island Jewish Medical Center.

Strategy and Implementation:
The 4Ps Proactive Nursing Hourly Rounding model is a proactive approach to patient centered care. It is the physical presence of direct care provider in the patient's room hourly from 6am-10pm and every 2 hours from 10pm-6am to address the 4Ps - personal needs, positioning, pain and possessions. Nursing leadership and staff worked collaboratively in developing the program and was implemented in September 2011 after 60 educational sessions incorporating case studies were provided to the staff. Rounding script was developed to assist the staff as well as rounding behaviors were incorporated into the rounding competency. A mechanism for unit ownership and accountability was established by having the nurse manager or assistant nurse manager speak with patients/family daily to assess their perspective of the proactive rounding experience and review the rounding sheet. Ongoing leadership support and staff willingess to change practice were key in the successful implementation.

Evaluation:
Utilizing the existing Press Ganey satisfaction survey and monthly fall index, pre-hourly rounding data was compared with Q4-2011 through April 2012 YTD. Results show 2.5 points and 4.5 points improvement in overall nursing and likelihood to recommend. Fall index rate improved from 2.07 to 1.40.

Implications for Practice:
The 4Ps Proactive Nursing Hourly Rounding when done consistently is an evidence-based practice to improve patient safety and satisfaction. This basic nursing practice can be done utilizing a team approach. A mechanism to ensure staff onwership and accountability is key in sustaining the gain.