By Janel Nour Omid
They can be prevented with Purposeful Rounding.
Venous thromboembolism (VTE), pressure ulcers, falls with harm, and adverse drug events (ADEs) are four healthcare-acquired conditions (HACs) that healthcare organizations can view as cross-cutting opportunities for patient safety improvement. This idea is among the many great insights presented in the “Nursing-Centered Initiatives Action Planning Resource Guide” from the New York State Partnership for Patients.
To provide effective preventive care for each of these four HACs, nurses and other caregivers must work within care models that promote patient safety, patient engagement, and patient satisfaction. Keeping patients safe, engaged and satisfied can lead to improved outcomes related to VTE, pressure ulcers, falls and adverse drug events.
Purposeful, or hourly, rounding is a proven way of keeping patients safe, engaged and satisfied by anticipating and addressing their needs. Implementing hourly rounding can increase patient safety and satisfaction by improving patient engagement and decreasing fall rates, skin breakdown rates, and patient calls (Bourgault et al, 2008). Purposeful rounding is also a good technique to use to prevent VTE and ADEs.
Purposeful rounding provides opportunities to reassess risk, customize interventions, and engage and educate
Whether the patient is at risk for VTE, pressure ulcers, a fall, or an adverse drug event due to being prescribed a high-alert medication such as insulin or an anticoagulant or opiate, each visit during purposeful rounding provides caregivers with the opportunity to 1) reassess the risk, 2) customize interventions according to the level of risk, and 3) engage with and educate the patient and any family members present about the nature of the risk.
Through purposeful rounding, patient expectations can be better managed, thereby increasing satisfaction (AHRQ 2009). This positive outcome becomes even more probable when caregivers check on the “Ps”: pain, position, potty, personal/physiological needs, and proximity of personal items (AHRQ 2011).
Vitalacy’s automated workflow monitoring and purposeful rounding solution (Nour-Omid, 2019) can enhance the effectiveness of purposeful rounding by using Bluetooth-enabled tracking devices to count every time a caregiver enters or exits a patient room. The devices also can identify the caregiver who visits each patient and how long each visit lasts – and provide an alert when a patient visit is missed. The devices also track the amount of hours each caregiver works and how many miles each one walks during their shifts; these data can help spot signs of fatigue. An association between caregiver fatigue and a higher prevalence of ADEs was noted by Hughes & Blegen (2008) in their chapter about medication administration safety in “Patient Safety and Quality: An Evidence-Based Handbook for Nurses” published by the Agency for Healthcare Research and Quality (AHRQ).
Acquiring these data via workflow monitoring can enable nursing unit managers to view purposeful rounding activity by staff and by room through a map view on a computer or tablet. The data can be used to determine baseline performance and to set ongoing improvement goals for the unit and each individual caregiver.
Automated workflow monitoring can create a comprehensive, integrated approach to patient safety
By monitoring workflow with this technology, a healthcare organization can implement a comprehensive patient safety approach that promotes patient engagement and improves patient satisfaction while reducing the incidence rates of VTE, pressure ulcers, falls with harm, and ADEs. Integrating all patient safety data into one platform can help organizations to develop consistent, cross-cutting interventional approaches across all units and departments.
The New York State Partnership for Patients’ guide emphasizes that all providers are central to making evidence-based care delivery systems work. Having an integrated, organization-wide approach to assuring patient safety and satisfaction is especially important at a time when demonstrating value through better-than-average outcomes is increasingly important. “Hospitals can no longer afford to address improvement in department or team silos since improvements are cross-cutting, impacting quality, efficiency, value, and satisfaction throughout the hospital,” the guide states.
The Vitalacy approach to patient safety reinforces the principle that health care can be improved by the gathering of performance data that holds each individual, unit and department within an organization accountable. Communicating performance improvement results and challenges in this fashion also reinforces the concept that patient care is a team effort. A chain is only as strong as its weakest link. Keeping all patients safe depends on an organization’s ability to make the responsibility of patient safety compliance everyone’s, together, with no exceptions.
Learn more about Vitalacy’s approach to patient safety, workflow monitoring and purposeful rounding at www.vitalacy.com.
Janel Nour-Omid is the VP of Product and Marketing at Vitalacy. Her background in computer science, passion for design, deep fascination in human behavior and personal losses due to healthcare-associated infections drives her to build high-performing patient safety products that can be easily used by caregivers in healthcare settings.
Agency for Healthcare Research and Quality. “Hourly Nurse Rounds Help to Reduce Falls, Pressure Ulcers, and Call Light Use, and Contribute to Rise in Patient Satisfaction” (November 2011).
Agency for Healthcare Research and Quality. “Proactive Rounding Reduces Call Light Use and Falls, Eliminates Pressure Ulcers, and Enhances Patient and Staff Satisfaction” (March 2009).
Bourgault, A.M., M.M. King, P. Hart, M.J. Campbell, S. Swartz, and M. Lou. “Circle of excellence. Does Regular Rounding by Nursing Associates Boost Patient Satisfaction? Nurses Improve Patient Satisfaction through Hourly Rounding.” Department of Physiological & Technological Nursing. Nursing Management. Vol. 39, issue 11 (November 2008); 18–24.
Hughes RG & Belgen MA. Chapter 37 – Medication Administration Safety. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Agency for Healthcare Research and Quality, Rockville, Md. (April 2008).
New York State Partnership for Patients. Nursing-Centered Initiatives Action Planning Resource Guide. (2013).
Nour-Omid J. Vitalacy blog. Introducing Vitalacy’s latest product updates: workflow monitoring & purposeful rounding. Feb. 20, 2019.