Intentionally Round Like A CHAMP: Communicative, Hourly, Anticipatory, Mindful and Purposeful Rounding
By Melody Haworth, RN, PHN, MSN, CCTN, CNL
The aim of this project was to identify techniques from existing literature and apply them to hourly rounding on 9 Long, the adult abdominal transplant unit. The success of the intervention would be reflected in a decreased use of call light and incidence of falls, along with an increase in patient satisfaction and staff experience.
Patients awaiting or recovering from liver, kidney and pancreas transplants are often deconditioned, confused and require frequent toileting. Hourly rounding reduces call light use and fall incidence. This increases patient satisfaction and improves staff experience. Due to the high acuity of the patient population on 9 Long, new programming must resonate with staff and readily connect with increased patient safety and overall satisfaction.
A multi-modal survey was submitted electronically to 88 staff members to evaluate perceived effectiveness of current rounding techniques and to gather suggestions for change. Effective hourly rounding techniques reported in the literature on units comparable to 9 Long were analyzed and common successful components were identified. These are combined into the acronym CHAMP: Communicative, Hourly, Anticipatory, Mindful and Purposeful rounding. A Wizard of Oz-themed interactive poster was developed reflecting the patient journey from admission to hospital discharge. This was displayed in the unit charting room. The various components of CHAMP were each highlighted for two week periods. Four novel and current evidence based practices were noted on different bricks lining the yellow brick road. Every two weeks, a new technique, chosen for its likelihood to be adapted to the unit, was placed in the ‘featured evidence’ section of the poster, where the support for the technique could be easily reviewed. All literature referenced during the program was displayed in full text next to the poster for further, more in-depth reading. The interventions were disseminated to staff via one-on-one interactions, electronic correspondence, and at a staff meeting.
The survey response rate was 30.7% (27 surveys completed). Call light data compared between July 2015 and 2016 showed a 6% increase in call light use after the intervention. Fall incidence data compared over fiscal years 14, 15, and 16 did not reflect a decrease in rates which could be attributed to the project. Comparing falls with injury over the same period, rates progressively decreased from five to three during that period. Patient satisfaction scores after implementation, as reported via HCAHPS, are pending.
Cultural shifts require time and participation from the targeted staff. This small test of change initiated a way to conceptualize hourly rounding, discuss where current practice could improve, and which novel interventions staff perceive important to a more effective program. The number of fall incidents measured after the intervention did not reflect the current interventions, as many falls were staff assisted. Continued dissemination of current literature regarding CHAMP rounding elements should be considered. Methods for continued engagement and evaluation of rounding elements may include one-on-one discussion with staff and patients, journal club discussion, and Participatory Action Research to trial CHAMP rounding interventions.