Integrating QI Initiatives and QI Tools To Assist Front-Line Staff in an Initial Nursing Research Study

Purpose:
Purpose: To improve care through standardized practice using an anticipatory model of care. Goals: 1) Improve patient satisfaction scores, nurse-sensitive indicator results, and patient safety. 2) Assist staff in initial nursing research venture.

Significance:
Importance: Using the QI tools of Plan/Do/Study/Act, rapid-test-of-change and the DMAIC QI Model provided a foundation for nursing staff during their first nursing research study. The staff were able to replicate a classic "hourly rounding" study to achieve outstanding results.

Strategy and Implementation:
Innovation: Combining research techniques and QI methods to develop a new patient care model; tested by bedside care staff who then taught the model to their peers. Process: Multidisciplinary teams from the surgical and medical care units met weekly and independently to evaluate the current model of care with the goal of developing a more anticipatory model. Review of current literature, statistical analysis of patient calls, patient satisfaction data, and voice-of-the-customer surveys were combined with QI tools using the DMAIC (define, measure, analyze, improve, control) Model to develop the Purposeful Patient Rounds (PPR)model. Staff addressed pain, potty, position, personal needs, and presentation (5Ps) hourly, alternating every 2 hours by RNs and Patient Care Technicians. The rounding team tested the care model prior to implementation using rapid-test-of-change methodology. Institution of this model was disseminated throughout the hospital by January of 2010.

Evaluation:
Pre/Post Data (2008 to 2011 annual % excellent rankings): Nurses' Understanding/Caring: 51.3% to 87.5% Nurses' Communication With Patient: 47.1% to 88.9% Nurses' Responsiveness: 25.9% to 99.8% Pain: 78.6% to 92.5% Falls/1000 Patient Days: 3.42 to 2.25 Pressure Ulcer Prevalence: 6.87% to 2.73%

Implications for Practice:
Hourly rounding is effective in improving patient satisfaction and safety. Enlisting bedside caregivers in development and diffusion of best-practice is instrumental to peer acceptance of change. Replication research and existing QI methodologies are useful tools for novice nursing researchers.