Hourly Rounding on Patients

A. Introduce your innovation proposal by doing the following:

1. Explain the role of an innovative nurse leader.

An innovative leader plays the role of developing strategies to meet the special needs of the patients. Innovative nurse leaders develop new knowledge, enhance quality care, create practices and policies and advance healthcare information technology. More so, innovative leaders aim at optimizing, protecting, and advocating for the health of populations, communities, groups, families, and individuals that align with the objectives of Triple Aim such as minimizing per capita healthcare costs, enhancing healthcare of populations, and patient care experience including satisfaction and quality and NQS aims including to offer better and affordable care for the community and individuals. Innovative leaders develop health information technology and utilization of data expertise to further the evidence-based practice to accommodate the evolving and expanding roles of leaders in a healthcare setting (Thomas, 2016). Some of the technologies that promote quality healthcare include patient registries, health records or EHRs, and telehealth among others. More so, the nurses develop innovative solutions that address quality improvement in healthcare such as innovative measures to minimize infections, including the urinary tract infections associated with catheters among others. Innovative leaders further influence the creation of healthcare policy which entails authoritative decisions concerning health (Thomas, 2016).

2. Summarize the community of practice (CoP) established during your CPE, including the following points:

a. organizational characteristics, services provided, and size of the service area

Community of practice offers an important practice-based framework for creating work depending on collaborative learning and engagement promotion with communities, professional groups, and local groups. It acts as an innovative strategy for practitioners to collaborate to manage and create emerging practices and new knowledge. The author will concentrate on Sibley Memorial Hospital in Washington, D.C which is a member of the John Hopkins Medicines. Since its foundation in 1890, the facility possesses a differentiated history of serving the community the organization is a non-profit, full-service community healthcare facility that offers skilled inpatient services, psychiatric, obstetric, surgical, and twenty-four-hour state-of-art Emergency Department. The mission of the hospital includes delivering compassionate and excellent care to each individual each time and a vision of remaining a role model for innovation in wellness and healthcare for all. The values of the organization include collegiality and respect, inclusion and diversity, integrity and leadership, and discovery ad excellence. The organization has approximately 2,309 workers, 11,798 yearly admissions, and 318 licensed beds. In 2019, the hospital had 662 registered nurses, 949 medical staff, 2,309 workers, 4,237 births, 11,654 surgical procedures, 41,211 emergency visits, 11,798 admissions, and 318 licensed beds and 190 operating beds (John Hopkins Medicine., 2021).

b. Demographic characteristics of the population served

The hospital serves various individuals from Washington which has a population growth of eleven percent from 2010 to 2015. The age composition of the population includes 6 percent of children aged 0 to 4 years, 12 percent older children aged 5 to 17, 47 percent of young adults aged 18 to 44 years, 23 percent of middle-aged 45 to 64 years, and 12 percent older grownups aged 65 years and above. The area consists of a diverse population with 45.2 percent Blacks, 41.5 percent White, 11.7 percent Latino or Hispanic, and 4.2 percent Asian. Females represent 52.5 percent of the population, while the median age of the population includes 34.6 years. (Merrill, et al., 2016). 45.5% of the low-income attended college while 94.1% of the wealthy attended college. The median income of the low income stands at $34,824 while that of high-income earners stands at $136, 832. The unemployment rate for low income was 18.5%, while that of high-income earners stood at 2.9 percent. The adult obese for low income was 70% , while for the wealthy stood at 44.9%. The adult with diabetes in less wealthy regions in the district stands at 14.5 percent, while in the wealthy regions it stands at 4.8%. More so, the adults with depression in less wealthy regions stood at 16.3%, while in wealthy regions it stood at 14.7 percent. Adults with hypertension in low-income neighborhoods stood at 42.2 percent, while in wealthy neighborhoods it stood at 19.7 percent and adult prevalence of asthma stood at 13.1 percent in the low-income region while in high-income regions it stood at 11.6 percent (Merrill & Rieke, 2019)

c. Team member roles—formal and informal

Physicians: Assist the patients in caring for their health by discussing topics such as hygiene and proper nutrition, address the concerns of the patients by answering their questions concerning their health, design and recommend a treatment plan, order tests for the nurses and other healthcare staffs to conduct, update the patient information and charts and take the medical history of a patient (World Health Organization, 2010). Nurses: The nurses remain responsible for offering advice and support to the patients, educate the patients on illness management, conduct diagnosis tests, operate medical equipment, administer treatment and medication, record signs and monitor patient health, collaborate with teams to develop a plan for patient care and record the symptoms and medical history of the patient (World Health Organization, 2010).

Ward managers: Remain responsible for the management of the hospital wards. Matron: Remains responsible for ensuring that the patient access safe and excellence patient experience (McKay, 2018). Pharmacists: Advise patients on the medications including their reactions, how to take the medications, and answer the patient’s questions, ensure that the prescribed medications remain suitable, ensure that the medicine supply aligns with the law and ensure that the medications supplied to the patients are of high quality (World Health Organization, 2010).

Dietitian: Assess, transform and maintain the appropriate quality standards in nutrition and food care services, create, adapt and manage the nutrition care system, and offer counseling in diseases and health and determine the nutrition issues and evaluate the nutritional status of a patient in the hospital as well as create diet plans and counsel patients of special diet changes (McKay, 2018). Medical social worker: Medical social worker remains responsible for working closely with other team members and offering groups, families, and individuals the required psychosocial support to cope with their terminal diseases, advise patients in family caregivers, counseling, patient education, and making referrals to appropriate services, and offer care and intervention to prevent illness, promote health and address the access barriers to healthcare (World Health Organization, 2010)

d. Shared team values

The shared team values will include honesty because the team members must recognize the need for effective communication including transparency of mistakes, uncertainty, decisions and aims to maintain and enhance mutual trust to function appropriately. Discipline will ensure that the team members perform their tasks with discipline, share and seek new information to enhance team and individual functioning, and stick to the set protocols and standards. Creativity will ensure that the member attains the objectives and will recognize that unexpected outcomes remain an opportunity to improve and learn. Humility will enable the members to recognize that humans can make mistakes and must depend on each other to assist in recognizing and averting failures despite their hierarchy (Mitchell, et al., 2012).

3. Focusing on the organization identified in your CPE, discuss the internal and external factors that prompted this proposal

The internal factors that promoted the proposal to implement hourly rounding at the hospital include the lack of an hourly rounding program in the hospital. As a result, the patient satisfaction and safety of the patient remain inadequate. The external factors that promoted the implementation of hourly rounding at the hospital include the need to minimize healthcare costs due to unnecessary infections and injuries among patients (Francis, et al., 2019)

4. Assess how your proposed innovation aligns with other professional, regulatory, and/or governmental strategic initiatives.

The proposal aligns with the policies that demand high-quality and safe healthcare in the nation. The hourly rounding ensures that the number of falls is minimized, minimize the occurrence of preventable events including infection among patients, ensure patient safety, meet the needs of the patient, promote patient-centered communication in healthcare between family members and friends, patients, and staff to ensure appropriate patient outcome (Muluge, et al., 2020).

5. Construct a purpose statement for your proposed innovation

The purpose statement of the proposal include improve communication between healthcare professionals and patients and their families, remain responsive to the needs of the patients, anticipate the needs of the patient before they arise, and minimize patient falls using the 5 Ps including peaceful environment, possessions, positions, pain, and potty to increase patient safety and satisfaction

6. Create a goal of the proposed innovation in SMART+C format (i.e., Specific, Measurable, Achievable, Relevant, Timed, and Challenging).

The goal of implementing hourly rounding at Selby Memorial Hospital includes using hourly rounding tools to evaluate the recent conditions of the patient and meet their anticipated needs on an hourly basis to increase patient satisfaction and safety through the reduction of falls and preventable infections by 50 percent after three months. The healthcare team will check on patients every one hour to ensure their needs are met.

B. Complete a “Relevant Sources Review” by doing the following:

1. Identify fivescholarly peer-reviewed sources published within the last five years that are relevant to your innovation proposal.

The identified articles include the following

Francis, K., Kurtsev, A., Walter, D., Steele, C., & Staines, C. (2019). Nurses’ Experiences and Perceptions of Hourly Rounding: A Private Australian Catholic Hospital Single Case Study. Francis et al. Int Arch Nurs Health Care 2019, 5:125, Volume 5 | Issue 2.

Harris, R., Sims, S., Levenson, R., Gourlay, S., Ross, F., Davies, N., et al. (2017). What aspects of intentional rounding work in hospital wards, for whom, and in what circumstances? A realist evaluation protocol. BMJ Open. 2017; 7(1): e014776.

Masangkay, R. (2021). Purposeful Nurse Hourly Rounding: A Plan To Decrease Patient Falls During a Pandemic (2021). Doctor of Nursing Practice (DNP) Projects. 237.

Muluge, H., Afenigus, A., Wagnewa, F., Haile, D., Tadesse, A., & Kibret, G. (2020). The effect of hourly nursing rounds on patient satisfaction at Debre Markos Referral Hospital, Northwest Ethiopia: A non-randomized controlled clinical trial. International Journal of Africa Nursing Sciences, volume 13, 2020, 100239.

Shin, N., & Park, J. (2018). The Effect of Intentional Nursing Rounds Based on the Care Model on Patients' Perceived Nursing Quality and their Satisfaction with Nursing Services. Asian Nursing Research, Volume 12, Issue 3, September 2018, Pages 203-208.

2. Summarize your findings from each source, using the Relevant Sources Summary Table in the attached “Evidence-Based Innovation Plan Template.”

3. Identify the evidence strength and the hierarchy of each source, using the WGU levels of evidence hierarchy outlined in the attached “WGU Levels of Evidence” document.

4. Synthesize your findings by identifying patterns, trends, and gaps in the literature as they relate to the proposed innovation.

Harris et al. (2017), states that the initial reaction to the Francis inquiry in the UK claims that most hospitals have adopted intentional rounding in their wards, however, limited evidence exists to support the intentional rounding benefits and promote its spread across the United Kingdom. The authors argue that the healthcare professional remains a valuable resource and it remains significant to employ their effort and efforts on the most appropriate way to meet the needs of the patients. More so, the authors claim that the intentional rounding must result in benefits to the patients and it remains critical to offer the cost benefits of intentional rounding.

The study by Mulugeta, et al., (2020), states that limited evidence exists on the adaptation of the hourly nursing rounds and their impacts on patient satisfaction. The author found that hourly rounding possesses a positive impact on the patients and increases the patient satisfaction scores as the length of the stay increases. Therefore, the policymakers must consider and create a guideline to adopt stable hourly nursing rounds in hospitals to enhance patient outcomes, quality, and safety of patients. The nursing leaders must work as a team with policymakers to implement hourly rounding in nursing practice. Shin & Park, (2018), argue that the study aims at filling the existing gap on assessing the perceived nursing quality. The author found that intentional nursing rounds that rely on the care model remain effective in enhancing the perception of satisfaction in patients and quality nursing care. According to Masangkay, (2021), limited studies and evidence exist on the impacts of purposeful nurse hourly rounding during a pandemic. The author discovered that collaboration among the entire team and concentration on the safety of patients reduces the patient fall incidence on a COVID-19 acute nursing unit. More so, Francis, et al., (2019) conducted a study and found that adaptation of rounding in a hospital setting remains useful and participants supported its implementation. However, various barriers exist that prevent effective adaptation, and relocating documentation and reviewing the care model can improve the support and compliance of rounding.

5. Develop recommendations for the proposed innovation based on the literature.

The hourly rounding in nursing must consider the barriers that exist and prevent successful implementation such as documentation and time-pressure and high workload. Therefore, while implementing the innovation, the team must ensure that the care model is reviewed to enhance compliance and support for the innovation and documentation must get relocated to convenient areas (Francis, et al., 2019). Standardized procedures to prevent preventable patient falls and the development of a standard work protocol for nursing hourly rounding remain important to ensure the effectiveness of the innovation (Masangkay, 2021). Additionally, the innovation must remain patient-centered and depend on the care model to enhance patient satisfaction, communication capabilities, the performance of nurses’ capabilities and needs, and the safety of the patients (Shin & Park, 2018). The innovation must ensure improvement in quality care, safety, and patient outcome (Mulugeta, 2020). The innovation must possess guidelines to adopt stable hourly nursing rounds in hospitals to enhance patient outcomes, quality, and safety of patients (Harris, et al., 2017).

C. Discuss the data-collection methods and technology used to identify and support the proposed innovation by doing the following:

1. Explain the process you used to generate ideas for innovation from the CoP.

First, the problem was identified in the healthcare facility and it included the need for hourly rounding by the healthcare professionals to enhance patient satisfaction and increase quality and safe care. The healthcare professionals were mobilized to support the importance of implementing the innovations. The team identified the demographic characteristics of the population to determine their needs and how the innovation would assist them and meet their needs. The team evaluated the innovation to determine its effectiveness and importance in improving patient satisfaction and enhancing the quality and safe care through conducting research and reviewing studies on the effectiveness and barriers of the innovation. The innovation was adapted to meet the needs of the patients and improve safety and quality care in addition to increasing the patient satisfaction score at the healthcare facility (Allen, et al., 2016).

2. Provide examples of big and small data within your current healthcare setting.

Big data in healthcare include data gathered from various individuals to enhance prediction and description of a certain phenomenon for others, such as disease patterns and control measures such as people with diabetes, hypertension, or other diseases and causes. Small data in the healthcare setting include data stored in electronic health records, pharmacy systems, and paper charts and may include individual patients’ missed clinic appointments, allergies to drugs, turnovers in operating rooms, individual level prescription, description, and control for a certain unit (Hekler, et al., 2019)

3. Discuss how big data could be used to support the proposed innovation.

The big data remain significant in supporting the innovation because data from Electronic Health Records would get utilized to determine the needs of a certain patient and assist the team in working collaboratively by viewing the records electronically to offer the needs hourly rounding care effectively (Hekler, et al., 2019).

4. Describe the technology enhancements required for the proposed innovation.

Some of the technology enhancements include the Electronic Heath Records, which possess each patient's digital records, including their lab test results, allergies, medical history, and demographics among others. The records are shared among the healthcare professionals to care for patients. The EHR can trigger reminders and warnings to track prescriptions and when a patient obtains new lab results to view if the patient adheres to the orders of the physician and assist them in their hourly rounding. Telemedicine includes medical technology that assists in delivering remote clinical services. Real-time alerting include big data, such as Clinical Decision Support software that assist in analyzing medical data immediately and provide practitioners with advice on how to make prescribing decisions and the team members can use the information in their hourly rounding (Hekler, et al., 2019)

D. Discuss how to support interprofessional collaboration in the midst of disruptive innovation by doing the following:

1. Analyze how disruption from the proposed innovation could impact individuals, processes, and organizations.

The disruption from hourly rounding could affect patients positively by ensuring their needs are met regularly to increase their satisfaction ad determine any preventive diseases early. The healthcare professionals will have to create a schedule to ensure they conduct their hourly rounding effectively. More so, the organization will experience a change in the way the healthcare professionals operate and will experience increase quality and safe care in the wards. The facility will have to reposition documentation to increase access (Francis, et al., 2019)

2. Develop strategies to mitigate the challenges of disruption for individuals, processes, and organizations.

To mitigate disruption challenges, the healthcare facility will have to develop policies that support hourly rounding and support the healthcare team in implementing the innovation in their daily activities. More so, education remains significant to inform individuals on the importance of innovation within the healthcare system. More so, effective communication remains necessary to prevent miscommunication and develop a positive outcome. Codes of conduct remain necessary to ensure that the healthcare professional and patient adhere to the codes (Longo, 2010).

3. Discuss how the proposed innovation can leverage the benefits of disruptive innovation for cost-effective, quality healthcare outcomes.

The innovation will minimize fall injuries, reducing the number of cases connected to fall injuries and bed sores. More so, the patients will experience safe and quality care, reducing the readmission rates hence decreasing costs. More so, patient satisfaction will increase and the patients can recommend others to the facility. (Francis, et al., 2019)

E. Discuss your pre-implementation plan by doing the following:

1. Discuss diffusion of innovation as it relates to the implementation of your plan.

The diffusion of innovation includes the procedure in which an innovation remains accepted by the intended users. Knowledge includes providing adequate information on the innovations to the intended users and audiences through training. The researcher will persuade the users on the importance of the innovation to the patient, healthcare teams, organizations, and healthcare systems. The users will make a decision on whether to implement the innovation and after agreeing on its benefits and usefulness of the organization, the innovation will get implemented and a confirmation will happen after the organization decides to maintain the innovation to meet the needs of the patient and the healthcare facility.

2. Identify the roles and responsibilities of five team members needed to implement your proposal using the Innovation Action Plan table in the attached “Evidence-Based Innovation Plan Template.”

3. Discuss the financial implications of implementing the proposed innovation.

The project is expected to reduce the number of cases associated with falls and bed sores hence reducing healthcare costs. The innovation will further provide safe and quality care to the patients reducing the number of readmission and infection, hence minimizing the oval healthcare costs (Masangkay, 2021).

4. Develop an interprofessional communication plan accounting for the logistics (i.e., the who, what, when, and where) of facilitating the innovation and its usability.

The project manager will conduct meetings throughout the project to ensure effective coordination with other team members every week at the hospital. The nurses will provide updates to other team members daily on the project to ensure appropriate coordination and communication using emails and social media platforms. The physicians will also update the entire team on the progress of the innovation thrice in a week using social media platforms and emails to ensure the member remain updated. Innovators will further communicate with other members via emails and meetings weekly to update the team on any changes or new strategies to ensure the innovation remains effective at the hospital. The advocates should communicate to the entire staffs at the hospitals, including stakeholders such as patients and hospital administration using meetings, emails, and face to face communication to educate them on the effectiveness and importance of the technology for two months to ensure successful implementation and prevent resistance at the hospitals and other offices. and prevent resistance at the hospitals and other office (Allen, et al., 2016).

5. Discuss how you will evaluate the effectiveness of your proposed innovation.

To assess the outcome success of the project, utilization of unit bases shared governance council, unit dashboards, and nurse leadership rounds remain important. The unit-based shared governance groups' input remains important in addressing the immediate concerns of the staff and get feedback. The nurse leadership rounds incorporation routinely permits the nurse leaders to access real-time feedback from the staff and patients concerning the effectiveness of the project and should create unit guidelines, policies, and protocols for the functions of hourly rounding. The training plan will ensure that every worker recognizes the process, documentation, and equipment used to attain success in hourly rounding. The dashboard will display the outcomes of a unit from the hourly rounding program to increase awareness among the leaders, visitors, and patients on safety and quality delivery of care (Masangkay, 2021).

F. Conclude your innovation proposal by doing the following:

1. Reiterate the purpose and rationale for your proposed innovation.

The goal of implementing hourly rounding at the Selby Memorial Hospital includes using hourly rounding tools to evaluate the recent conditions of the patient and met their anticipated needs on an hourly basis to increase patient satisfaction and safety by 50 percent after three months.

2. Reflect on your experience identifying and innovation for your setting.

Identifying the innovation remained challenging because I had to conduct a thorough study on the suitability of the innovation at Sibley hospital and determine its success. However, it remains satisfying to recognize that the innovation will increase patient satisfaction at the hospital and ensure safe and quality healthcare delivery.

3. Discuss the strengths and challenges of the process used for developing this innovation plan.

The project utilized valid information from scholarly articles and studies which offered adequate information to conduct the project. More so, team collaboration assisted in ensuring the success of the project. However, some of the studies had limited findings due to the small size of the sample.

4. Discuss how you will apply what you have learned for future initiatives.

From the initiative, I have learned the use of scholarly articles to find reliable information to conduct a project which I will use in future projects. I have learned communication skills that will assist me in future projects. More so, I have learned to work in a team to achieve a set objective and the skills will assist me in working on future projects that will require teamwork and collaboration.

References

Allen, T., Rieck, T., & Salsbury, S. (2016). Patient perceptions of an AIDET and hourly rounding program in a community hospital: Results of a qualitative study. Patient Experience Journal: Vol. 3: Iss. 1, Article 7. DOI: 10.35680/2372-0247

Francis, K., Kurtsev, A., Walter, D., Steele, C., & Staines, C. (2019). Nurses’ Experiences and Perceptions of Hourly Rounding: A Private Australian Catholic Hospital Single Case Study. Francis et al. Int Arch Nurs Health Care 2019, 5:125, Volume 5 | Issue 2. https://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-5-125.pdf

Harris, R., Sims, S., Levenson, R., Gourlay, S., Ross, F., Davies, N., et al. (2017). What aspects of intentional rounding work in hospital wards, for whom, and in what circumstances? A realist evaluation protocol. BMJ Open. 2017; 7(1): e014776. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5223681/

Hekler, E., Klasnja, P., Chevance, G., Golaszewski, N., Lewis, D., & Ida Sim, I. (2019). Why we need a small data paradigm. BMC Med. 2019; 17: 133. doi: 10.1186/s12916-019-1366-x

John Hopkins Medicine. ( 2021). Sibley Memorial Hospital. https://www.hopkinsmedicine.org/sibley-memorial-hospital/about/index.html

Longo, J. (2010). Combating Disruptive Behaviors: Strategies to Promote a Healthy Work Environment. OJIN: The Online Journal of Issues in Nursing Vol. 15, No. 1, Manuscript 5. https://ojin.nursingworld.org/MainMenuCategories/

Masangkay, R. (2021). Purposeful Nurse Hourly Rounding: A Plan To Decrease Patient Falls During a Pandemic (2021). Doctor of Nursing Practice (DNP) Projects. 237. https://repository.usfca.edu/cgi/viewcontent.cgi?article=1281&context=dnp#:~:text=Nurse%20hourly%20rounding%20is%20an,the%20incidence%20of%20patient%20falls.&text=The%20two%20studies%20with%20the,falls%20per%201%2C000%20patient%20days.

McKay, D. (2018). 14 Health Professionals. https://www.thebalancecareers.com/health-professions-525635

Merrill, C., & Rieke, A. (2019). Community Health Needs Assessment, June 2019. https://www.dchealthmatters.org/content/sites/washingtondc/2019_DC_CHNA_FINAL.pdf

Mitchell, P., Wynia, M., Golden, R., McNellis, B., Okun, S., Webb, E., et al. (2012). Core Principles & Values of Effective Team-Based Health Care. Institute of Medicine of the National Academies. https://nam.edu/wp-content/uploads/2015/06/VSRT-Team-Based-Care-Principles-Values.pdf

Muluge, H., Afenigus, A., Wagnewa, F., Haile, D., Tadesse, A., & Kibret, G. (2020). The effect of hourly nursing rounds on patient satisfaction at Debre Markos Referral Hospital, Northwest Ethiopia: A non-randomized controlled clinical trial. International Journal of Africa Nursing Sciences, volume 13, 2020, 100239. https://www.sciencedirect.com/science/article/pii/S2214139120301165

Shin, N., & Park, J. (2018). The Effect of Intentional Nursing Rounds Based on the Care Model on Patients' Perceived Nursing Quality and their Satisfaction with Nursing Services. Asian Nursing Research, Volume 12, Issue 3, September 2018, Pages 203-208. https://www.sciencedirect.com/science/article/pii/S1976131718300392

Thomas, T. S. (2016). Registered Nurses Leading Innovative Changes. OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3, Manuscript 3. DOI: 10.3912/OJIN.Vol21No03Man03

World Health Organization. (2010). Classifying health workers: Mapping occupations to the international standard classification. https://www.who.int/hrh/statistics/Health_workers_classification.pdf