Nursing Update 2007 - 2008 - Yale-New Haven Hospital

Hourly rounding boosts
satisfaction all around
Last summer, YNHH began hourly rounding by
nurses and patient care associates on pediatric
and medical units.
Marcelle Applewhaite, R.N., patient service manager
for the Infants/Toddlers Unit, and Francine
LoRusso, R.N., director of nursing, Medicine,
spearheaded the effort after a presentation last
summer by a nationally known healthcare consulting
company. The Studer Group had studied
hourly rounding in 14 hospitals across the country,
and found the protocol reduced monthly
call button use by 38 percent, patient falls by 50
percent and skin breakdowns by 14 percent. At
the same time, satisfaction scores soared.
Studer Group staff instructed YNHH nurses in
eight key behaviors, including making an initial
introduction to a patient with a description of
role and experience, and documenting each
visit so patients who are sleeping will know the
caregiver has been in the room. Each hour, nurses
also ask their patients about the four P’s: pain,
positioning, placement and personal needs.
Patient satisfaction scores rose at YNHH last
year, and LoRusso and Applewhaite believe the
new hourly rounding initiative contributed.
In fact, early results of hourly rounding are so
promising that the practice is being implemented
hospital-wide this year.
Rapid response teams
keep patients out of ICUs
When a nurse at YNHH notes a trigger sign in
a patient such as a drop in blood pressure or
simply has a hunch that a patient is deteriorating,
she or he may call in a rapid response
team—essentially an “ICU at the bedside.”
The team will arrive in less than ten minutes
to stabilize the patient.
Rapid response teams were among six evidence-based
safety interventions included in
the Institute of Healthcare Improvement
(IHI)’s campaign to prevent 100,000 in-hospital
deaths. In 2004, IHI recognized Yale-New Haven
Children’s Hospital as one of the first pediatric
hospitals in the country to implement a rapid
response team made up of critical care nurses
and physicians. Use of the teams at YNHCH
resulted in a dramatic decrease in cardio-respiratory
arrests outside of the pediatric ICU.
Adult units at YNHH began using rapid response
teams, which consist of critical care nurses,
physicians and respiratory therapists, to provide
urgent and emergent care in 2006.
For both adults and children, the teams have
been so successful in identifying early warning
signs, avoiding the ICU and saving lives that the
hospital is now planning pilot programs that will
allow families who sense a loved one is deteriorating
to activate the teams directly.
Nurses dedicated to safety
set new standards
YNHH actively protects its patients from preventable
danger through the work of two Yale-New
Haven Health System patient safety registered
nurses—one for obstetrics, one for Perioperative
Services.
Working under the umbrella of Performance
Management, the safety nurses’ primary role is to
educate peers about safety, explains Jean Zimkus,
patient safety nurse for Perioperative Services.
They review literature on safety topics, talk to
physicians and staff about unique challenges
at YNHH, and spearhead improvements. They
collaborate with other healthcare professionals
to promote communication such as briefings and
“hand-off communication,” essentially memos for
new caregivers with pertinent information about
patients who have been transferred from other
units. They installed white boards in surgery suites
for practitioners to make checklists about such
concerns as allergies and fetal heart rates before an
operation begins.
A safety attitude questionnaire conducted among
OB staff in 2004 and 2006, and in Perioperative
Services in 2006 and 2007, showed a statistically
significant improvement in attitude toward safety
and teamwork since their safety nurse was hired.
Patient safety nurses expect to see continued
improvement when they analyze the results of a
2007 survey in both their departments.
Our soon to be hospital-wide hourly rounding
initiative is a perfect example of something we
often find when we seek out the evidence and
take a hard look at how it fits with our needs
at YNHH. Often a simple solution can bring
greater rewards for less effort, and keep the
focus where it matters most – on providing
top-notch care for the patient.”
— Francine LoRusso, R.N., Director of Nursing, Medicine
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