1. Improving Staff
Responsiveness to Patient
NeedsLourdes University
College of Nursing
BY: COURTNEY ARTHUR, COURTNEY GILLILAND, MARIA HOLUP, RACHAEL KILGUS, KRISTEN
OXENDER, JILL SCZESNY, TAYLOR ZAPADKA
2. Problem
o Wood County Hospital is scored at 72.3% in the category of
responsiveness to patients when evaluated by Hospital Consumer
Assessment of Healthcare Providers and Systems (HCAHPS) score
compared with the 80.0% required by the Centers for Medicare and
Medicaid Services (CMS).
4. Potential Problems
oFall risk
oPressure ulcers
oHarm to patient
oDecreased pain management
oIncreased call light usage
oDecreases other HCAHPS scores
oDecrease reimbursement from CMS
Call! Don't Fall! for Pediatric Patients. (2015). Retrieved November 18, 2015, from https://www.mskcc.org/cancer-care/patient-education/call-don-t-fall-peds
5. Root
Cause
Analysis
o Why is this a problem?
oScoring
oWhy did this happen?
oPatient satisfaction scores
oHow to reduce this from
happening again
oUse evidence-based practice
(2015.). Retrieved November 18, 2015, from http://www.becaudio.com/Shop/images/NHX-50M_small.jpg
6. Causes
System
oFunding of new technology
oCall light system
oPlacement
oLack of answering stations
People
oLack of motivation
oRole confusion
oLack of knowledge
Problem Resolution. (2015). Retrieved November 18, 2015, from http://www.statutorynuisancesolutions.co.uk/our-services/problem-resolution/
7. Suggestions
oDifferent call light placement
oIncrease number of call light answering
stations
oAlterative form of communication
oWalkie talkies
oBluetooth technology
oNurse phones
Lozze. (2015). Retrieved November 18, 2015, from http://lozzeisus.blogspot.com/p/suggestions-what-do-you-want-to-see.html
8. Data
Collection
Methods
oCollected over 5 hours
oResponse times measured
oTime to answer call light at central answering
station
oTime to respond to the call light by entering the
patients room
oHourly rounding monitored for each
patient
9. Staffing Ratio
On the day of data collection:
• Unit had a total of 28 patients
• Floor staffing consisted of 6 Registered Nurses, 3 Aides, and a Secretary
◦ Assignments consisted of:
◦ 4 RNs had 5 patients [1:5]
◦ 2 RNs had 4 patients [1:4]
◦ 2 Aides had 9 patients [1:9]
◦ 1 Aide had 10 patients [1:10]
10. Who Answered Call Lights
Medical-Cardiac Unit at an Acute Care Facility
11. Time to Answer Call Light
7:00-7:29 7:30-7:59 8:00-8:29 8:30-8:59 9:00-9:29 9:30-9:59
10:00-
10:29
10:30-
10:59
11:00-
11:29
11:30-
11:59
Total
Average 9.8 16.8 25.1 15.6 18.3 26.3 34.5 21.5 10.1 9.1 18.7
Median 8 10 18 14 9 20 15 14.5 8 7.5 12.4
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
AnswerTime(s)
Time Slot (AM) Medical-Cardiac Unit at an Acute Care Facility
12. Time for Staff to Enter Room
0.0
2.0
4.0
6.0
8.0
10.0
12.0
AVERAGEROOMENTRYTIME(MIN)
TIME SLOT (AM)
Room Entry Time
Medical-Cardiac Unit at an Acute Care Facility
14. Agency for Healthcare Research and
Quality (AHRQ)
oRecommendations for improvement:
oTreat all call lights as emergent
oProvide patient with correct number to call
oCreate empathy from nurses
oBe proactive
oInclude family
oStandardized white boards
Dave, A., Schulke, D., & Brady, C. (2013, February 13). Responsiveness. Retrieved November 18, 2015, from https://cahps.ahrq.gov/surveys-guidance/hospital/hcahps_slide_sets/responsiveness/responsivenesssl.html
Promise Hospital of Salt Lake » Promise Hospital of Salt Lake’s Interdisciplinary Patient Care Initiative Generates a Boost in Patient Satisfaction Scores. (2015). Retrieved November 18, 2015, from http://www.promise-saltlake.com/?page_id=206
15. Recommendations for Improvement
oIndividual nurse communication devices
◦ Cell phones, walkie talkies, Bluetooth
◦ Improves communication between staff and patients
oDirect communication from patient to nurse via individualized number:
oNoise reduced
oPatient call light being answered quickly
oDecrease cost
oDecrease unnecessary work hours
oCon: Cell phones/walkie talkies are bulky
Deamon et al., 2012, Digby, Bloomer, & Howard, 2011
16. Recommendations for Improvement
oEasily accessible placement of call light
receivers
oProvides safety and reassurance to patients
oHelps with monitoring alerts from rooms
oInconveniently placed call lights can result in poor
performance
oNurse call systems are a legal requirement and
there are legislations to help cover installation and
use
Dewsbury & Ballard, 2014
17. Recommendations for Improvement
oIncreased involvement from nurse managers
oEvidence-based practice leadership
oOrganize activities based on the issue
oModify the infrastructure to align with objectives
oActively intervene
oMonitor the work environment
oProvide teaching & coaching regarding objectives
oCommunicate about progress of meeting
objectives with staff
(2015). Retrieved November 18, 2015, from http://www.ionl.org/resource/resmgr/Images/Kellogg_pic.jpgStetler, Ritchie, Rycroft-Malone, & Charns, (2014)
18. Recommendations for Improvement
4 P’s Rounding Method:
Pain, Potty, Position, Periphery
(every 1-2 hours)
oIncrease in patient satisfaction
scores
oDecrease in patient call light use
oIncrease in urgency/seriousness
when call light activated
o“Patient complaints citing staff
rudeness decreased 43%”
(Blakley, Kroth, & Gregson, 2011)
Support Station. (2015). Retrieved November 18, 2015, from http://www.rifton.com/products/bathing-and-toileting-systems/support-station?tab=features
19. Recommendations
for Improvement
oIncrease awareness of call light answer times
oDiscuss call light response times at every opportunity
(i.e. team meetings, handoff report)
oPost informative information accessible to staff
oRaise staff awareness to improve the response to
patient calls
o“Increase of 5.21% of call lights answered in less than 5
minutes”
oDecrease in patient falls
Digby, Bloomer, & Howard
(2011)
20. Change Theory
oTranstheoretical Model
oBehavior focuses on personal change
and incorporates key aspects of learning
and behavioral change theories
oRecommended change:
oPersonal communication devices
Change. (2015, April 15). Retrieved November 18, 2015, from http://thisisagoodsign.com/change/
21. Change Theory
Stage One (Pre-contemplation)
oThose involved are unaware change is needed
Stage Two (Contemplation)
oStaff is aware the problem exists and thinks
about making a change, but does not take action
Stage Three (Preparation)
oPrepares for change in order to take action in the
future
oPreparation includes:
oResearch on the best devices
o Nurse input on the design of the device
o Current budgeting to purchase devices
o Research grants to cover costs
o Design a training program before implementation
22. Change Theory
Stage Four (Action)
oAction includes modifying behaviors to overcome the problem
oPurchase devices
oImplement training
oTrial runs to put the plan into action
Stage Five (Maintenance)
oEstablish change through intentional work to prevent reversion and
maintain gains
oMaintenance is achieved
23. Change Theory
Stage Six (Termination)
oChange process is complete and no further
work is needed to prevent reversion
oTermination is complete when:
oResponse time scores improve
oPatient satisfaction scores improve
oHCAHPS scores meet or exceed the national
standard
24. Hypothetical Evaluation Modification
POSITIVES:
Decrease in response times to patient needs
Decrease incidents of injury to patients
Increase patient satisfaction scores
Increase funding to the hospital
NEGATIVES:
Patient might feel like their care is being
interrupted
Patient safety issues resulting from system
failure
25. Hypothetical Evaluation Continued:
FINANCIAL:
Cost of implementing new communication
system(s)
Purchasing of the cell phones at another
institution had shown to save almost $125,000
a year in nursing work hours
Within 1 month, 166 Hours of nursing care
can be gained back
MORBIDITY:
Decrease in patient injuries
o Reduces patient falls by as much as 50%
o Reduces pressure ulcers by 14%
o Reduces use of call light by 38%
26. In Conclusion
oInterventions:
oIndividualized communication devices
oPurposeful hourly rounding
oIncrease staff awareness
oStaff education
oProper placement of call light answering
systems
oResults:
oImprove patient satisfaction scores
oDecrease cost to the hospital and patient
oDecrease risk of harm to the patient
Evidence-based
practice
27. Questions
Questions - Google Search. (2015). Retrieved November 18, 2015, from
https://www.google.com/search?q=questions&source=lnms&tbm=isch&sa=X&ved=0CAcQ_AUoAWoVChMI_cLxg86ayQIVQ3YeCh1brwT_&biw=1600&bih=736#imgrc=s36UoalyiHYH2M:
28. References
oBlakley, D., Kroth, M., & Gregson, J. (2011). The impact of nurse rounding on patient satisfaction in a medical- surgical hospital unit. MEDSURG Nursing,
20(6), 327-332 6p.
oCall! Don't Fall! for Pediatric Patients. (2015). Retrieved November 18, 2015, from https://www.mskcc.org/cancer-care/patient- education/call-don-t-fall-
peds
oDave, A., Schulke, D., & Brady, C. (2013, February 13). Responsiveness. Retrieved November 18, 2015, from https://cahps.ahrq.gov/surveys-
guidance/hospital/hcahps_slide_sets/responsiveness/responsivenesssl.html
oDearmon, V., Roussel, L., Buckner, E., Mulekar, M., Pomrenke, B., Salas, S.. Brown, A. (2012). Transforming care at the bedside
(TCAB): Enhancing direct care and value-added care. Journal of Nursing Management, 21, 668-678. doi:10.1111/j.1365- 2834.2012.01412x
oDewsbury, G., & Ballard, D. (2014). Nurse call systems: ensuring a fast response to emergencies. Nursing & Residential Care, 16(1), 32-34 3p
o Digby, R., Bloomer, M., & Howard, T. (2011). Improving call bell response times. Nursing Older People, 23(6), 22-27.
oDudkiewicz, P. B. (2014). Utilizing a caring-based nursing model in an interdepartmental setting to improve patient satisfaction. International Journal For
Human Caring, 18(4), 30-33 4p.
oHuey-Ming, T. (2010). Perspectives of staff nurses of the reasons for and the nature of patient-initiated call lights: An Exploratory
survey study in four USA hospitals. BMC Health Services Research, 1052-64. doi:10.1186/1472-6963-10-52
oKrepper, R., Vallejo, B., Smith, C., Lindy, C., Fullmer, C., Messimer, S., Myers, K. (2014). Evaluation of a standardized hourly rounding process (SHaRP).
Journal for Healthcare Quality, 36(2).
oStetler, C. B., Ritchie, J. A., Rycroft-Malone, J., & Charns, M. P. (2014). Leadership for evidence-based practice: Strategic and functional behaviors for
institutionalizing EBP. Worldviews On Evidence-Based Nursing, (4), 219.
Hinweis der Redaktion
The score has been decreasing over the months
Jan. 73.5%
Feb. 72.3%
March 72.9%
April 75.3%
May 74.7%
June 71.9%
July 72.4%
Aug. 72.5%
Sept. 72.3%
Oct. 70.9%
Nov. 69.7%
Graph represents HCAPHS scores beginning from January 2015-November 2015
Displays 3 different Trend lines:
-Where WCH Started
-Current WCH Score (Trendline demonstrates that without improvements, scores will continue to decline)
-CMS Benchmark
**Not sure if this needs a citation! Information for graph came from the photocopies that Casey made for the binder
Root Cause Analysis
Determine what happened.
Hospital was ranked at % and the benchmark is % in Responsiveness to staff
Determine why it happened.
Patients were given a survey of their experience while staying at the hospital and rated the staff low in this category
Figure out what to do to reduce the likelihood that it will happen again.
Staff will have a quicker response time to patients. Staff will reduce the time it takes to have patient needs meant.
Cause: This problem is an organizational cause. It is not one person’s fault, it is a group as a whole. Staff includes the whole hospital team, not just one department.
Suggestions for Improvement:
Have a better way of communication needs of patients to staff. Suggestions include call light in different placement, or have another call light phone station in all three nursing station corners, each nurse could have their own personal communication device like a walkie talkie, phone, or clip that the nurse could talk directly into device to have direct communication to other staff members.
Determine the two most likely problems:
We determined that the two main issues include communication and placement of the call light. For example, if the call light goes off and a nurse or nurse aid is not the one side of the nurse station, he/she is not able to reach it in a timely manner. The call light is placed in busy area where people frequently pass through but are not situated there during times of charting. It was noted during data collection that staff members would answer the call light and tell the patient that he/she would tell their nurse, and the staff member would not notify the nurse. Often times the staff member would continue to do what they were previously doing.
People may not know the importance of answering the call light
Funding for new technology is expensive and there may not be enough money in the budget
There is only one call light station for 3 different desk/counter areas, making it difficult to answer
People are under the impression that someone else will answer the phone, so no one answers the phone
Strengths and Weaknesses for each form of communication
Walkie talkies: Strengths: real time communication, cohesive because everyone hears what is being said to each other, affordable, user friendly
Weaknesses: Bulky, battery life, noise, patients can hear what is being said
Blue-tooth technology: Strengths: small, easily portable, current technology, confidentiality, less bother some, appears professional, evidence based practice is stating that this form of technology is the best form of communication
Weaknesses: cost, care of device, fragile, require training, dependent on technology to work,
Students were stationed at the call light phone and in each hallway. The time it took to answer the call phone was measured, and the time it took for someone to enter the patient’s room to fulfill their needs was measured. Students also recorded for each room if a staff member entered into every patient room every hour.
How long it took for call light to be answered (at call light answering station)
*WHO answered call light
How long it took to answer call light from answering station:
*Average (mean) response time: includes all data times
*Median: middle response time of collected data (another way to analyze response times; essentially, “outliers” are removed)
Time it took from call-light being answered (i.e. hung up at central answering station) to someone entering the patients room
*Average for each 30 min. increment
*Trendline indicates that as the day continues, response times to enter the patient(s) room increases
Uses number of active rooms (“off unit” not included for rounding)
The hallways with rooms 10-19 had the least amount of rooms checked for hourly rounding. It had a pattern where 3 of the rooms were missed more than twice in the 5 hour data collection period.
Emergent: Treat all lights as if it was a potential patient safety issue. You do not know why the patient is calling until you answer it.
Call number: if the nurse was to have his/her own phone or phone line, allowing the patient to have direct access to the phone number or code to call the nurse allows for direct communication
Empathy: During staff meetings have the staff sit on a bedpan or have a melting ice cube in their hand. This allows the nurse to feel what it is like to be a patient who is uncomfortable, which will create empathy. This can start to engage the staff in effective change theory.
Proactive: Purposeful hourly rounding, tell the patient when you will return
Including family: When including family members in the care of the patient, it can decrease call light usage and improve the family in caring for their loved one, which can improve care post-discharge
Standardized whiteboards: This displays the healthcare team for the day, it can have what the goals are for the day, what drugs the patient is taking, why they are taking them and when the next dose is due. This reduces the amount of times the patient uses the call light.
Day time hourly rounding is hourly, at night after 11 rounding should be every two hours (for stable, non-critical patients)
Stage one: One example includes pre-HCAHPS scores. These scores bring awareness to the problem.
Stage Two: They receive HCAHPS results and inform staff by posting them on their information boards and are available on the intranet. The floor focuses on one benchmark at a time. “Quiet Times” are the current focus on the medical-surgical floor.
Stage Four: Staff leaders (and Super-Users) should be involved in the training program to provide support to other staff.
Stage Five: Maintenance is achieved when nurses are properly utilizing equipment as part of their regular routine and they have accepted the change.