Documentation of Purposeful Rounding as a Tool to Reduce Patient Falls
Routine, purposeful rounding is when a nurse goes to a patient’s room every one to two hours to assess and meet patient needs; thus, emphasizing communication and nursing presence. Several publications recommend that purposeful rounding include documentation of the 4 Ps: 1. Pain/Comfort: Staff will be asking – Are you comfortable? Do you need pain medicine? What can we do to make you more comfortable? 2. (Potty) Toileting: Staff will be taking you to the bathroom at least every 2 hours 3. Position: Staff will help you change your position (at least every 2 hours).
This helps your circulation and protects your skin. 4. Possessions: Staff will make sure that water, tissue, call bell etc…are within your reach , , . Situation: The current Providence flowsheet build in Epic does not provide a clear, unambiguous location to chart the four components (4 Ps) of purposeful rounding. There is no report available to track compliance with charting the four components of purposeful rounds.
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Providence Regional Medical Center Everett ( PRMCE) has continued to experience a high rate of patient falls, in spite of numerous internal actions to correct fall risk.
Prior to the implementation of the Epic electronic health record, Providence Regional Medical Center (PRMCE) had a screen in the electronic health record for charting purposeful rounds containing the four components (4 Ps) in one flowsheet. The facility had a report that reviewed nursing assessments charted on these components as required (every two hours during hospital stay) compared to performed and documented rates for inpatients, and calculated a percent of compliance. Clinical leadership staff were able to track and manage compliance by unit on a monthly basis.
In Providence Epic flowsheet charting, in order to chart on three components of purposeful rounding, staff must chart on at least two flowsheet locations; the fourth component is not present in Providence’s build of Epic today. 1. Pain/Comfort: Vital Signs/Pain assessment flowsheet Observed/reported pain/comfort pain management interventions response to pain intervention. 2. (Potty) Toileting Quickchart or Adult PCS Safety Precautions/ Fall Toileting scheduled. (Note: safety/fall precautions does not include documenting about personal items within reach). 3.
Position: Quickchart or Adult PCS; Skin (Adult) Skin Interventions, Hygiene Care Hygiene items including bath, foot care, linen change, etc. a. Second way to chart Position: Quickchart or Adult PCS; Musculoskeletal Interventions (Adult) Activity/Level of Assistance, Ambulation distance (feet), symptoms noted during/after activity, positioning 4. Possesions: Not specifically available in Providence Epic flowsheet. There is no current report for Epic on purposeful rounding documentation. Certified Nursing Assistants (CNAs) do a majority of the care and frequently round on patients.
Assessment: Best practice for hospital fall prevention includes purposeful rounds with scripted assessment and interventions. The current Providence Epic charting regarding purposeful rounds does not contribute to and in fact may hinder our goal of providing a safe environment for all our patients. We find it difficult to educate staff to chart within all areas consistently, and thus cannot be assured that our standards for purposeful rounds are being met. We cannot monitor on a daily, hourly basis which patients have received or not received purposeful rounds.
We cannot monitor the purposeful rounds charting monthly via a report as we did in ProvClinicals. We do not feel that the current Epic charting build is capturing the needed components of purposeful rounding in a central place, easy for clinical caregivers (including C. N. A. s) to chart. Recommendations: 1. Development of a purposeful rounding flowsheet using existing flowsheet data, which combines information about pain/comfort, toileting, positioning, hygiene and possessions in one location for all caregivers.
We recommend that a new cascading row be added to the QuickChart tab, including all the Purposeful Rounds items above in a single location. 2. Make the flowsheet easily accessible to caregivers including C. N. A. s. 3. Add the ability to view ‘purposeful rounding’ as complete or incomplete for each patient to individual patient lists (similar to whether Admit Req Doc is complete). 4. Following implementation of the above suggestions, develop and support a report request to extract information about compliance with purposeful rounding.
This form will be submitted to the Interdisiplinary Coordination Workgroup (part of the Providence Electronic Health Record governance structure) for review and if approved, will create a help desk ticket to get this into the queue for the Epic analyst team to make the recommended changes above. Key Stakeholders and Communication Plan: This change would affect all inpatient units on all live ministries. Information and potentially education would need to occur for caregivers. ——————————————- [ 1 ]. National Quality Forum. (2013). Patient Safety Measures: Complications Endorsement Maintenance from http://www. qualityforum. org/Projects/n-r/Patient_Safety_Measures_Complications/Patient_Safety_Measures_Complications. aspx [ 2 ]. Lakatos, BE, Capasso V, Mitchell MT, et al. Falls in the general hospital: association with delirium, advanced age, and specific surgical procedures. Psychosomatics 2009; 50:218-26. [ 3 ]. Degelau, J, Belz M, Flavin PL et al.
Acute Care prevention of falls: rate of inpatient falls per 1,000 patient days. National Quality Measures Clearinghouse 2012 from http://www. qualitymeasures. ahrq. gov/content. aspx? id=36944 [ 4 ]. Meade, CM, Bursell, AL, Ketelsen L. Effects of nursing rounds: on patients’ call light use, satisfaction, and safety. AJN. September 2006; 106: 58-70. [ 5 ]. Halm, MA. Hourly Rounds: What Does the Evidence Indicate? Amer J Crit Care 2011; 18(6): 581-584. [ 6 ]. Studer Group. Hourly Rounding Supplement. Best