Foundation of Nursing Studies Patients First Programme – … Reports... · feedback from patients and staff on the experience of intentional rounding, as well as gathering falls

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Foundation of Nursing Studies

Patients First Programme – Project Report

The Introduction of Intentional Rounding to Aid Falls Prevention in an

Acute Stroke Unit

Key Words: Falls, Quality, Intentional Rounding, Patient Safety, Practice Development

Duration of Project: December 2010 – February 2012

Report completed: December 2012

Project Lead: Suzanne Luxton - Ward Sister

Contact: [email protected]

Summary

This project was carried out on a 25 bedded acute stroke unit and involved both staff and

patients on the unit. The project aimed to prevent patients falling by introducing intentional

rounding which in turn would lead to a new way of organising the nursing care on the unit.

Intentional rounding is described as a systemised, proactive approach to patient care

(Owensboro Medical Health Care System, 2008) and a systematic, proactive nurse-driven

evidence-based intervention to anticipate and address needs in hospitalised patients (Deitrick

et al., 2012).

The methods used were intended to be collaborative and participatory and involved gaining

feedback from patients and staff on the experience of intentional rounding, as well as

gathering falls data before and after the introduction of intentional rounding. The intentional

rounding tool was developed and amended as part of the project and is now established in

practice. Although a reduction in falls was not achieved in the six months following

implementation, it appeared that there was a reduction in the severity of consequence to the

patient. Staff reported benefits from patient rounding in terms of getting to know the patients

and feedback from multi-disciplinary team members was positive about patient care.

Introduction

The stroke unit at Musgrove Park Hospital has 25 beds, arranged in three bay areas (one bay

of eight beds, two bays of six beds) and five side rooms. The unit has an integrated

multidisciplinary team comprising of nurses, occupational therapists, physiotherapists, speech

and language therapists, a dietician and a social worker who care for the patients in the acute

phase of their stroke and during the patient’s initial rehabilitation.

In 2009, the Department of Health published the High Impact Actions for Nursing and

Midwifery (Department of Health, 2009) which identified eight actions for care. The actions

that are relevant to the stroke unit are “staying safe - preventing falls”, “your skin matters”

and “keeping nourished”. At the time of publication, the ward sister (the project lead) also

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became concerned about the number of patients who were falling on the unit and

investigated the falls data for the year 2010. The data showed that 104 patients had

experienced a fall on the unit. This led the project lead to undertake a literature search which

identified that other clinical areas have successfully implemented intentional rounding to

prevent patients falling.

Intentional rounding is described by Bartley et al., (2011: p 2) as: “A structured process where

nurses on wards in acute and community hospitals and care home staff carry out regular

checks with individual patients at set intervals, typically hourly”. It has also been described as

a proactive approach to patient care. Using this approach, nursing staff check on each patient

at least once every hour, asking specific questions and assessing the care environment. The

project lead believed that introducing this approach to organising care could help the nursing

staff to reduce the number of falls on the stroke unit by proactively interacting with the

patient on a regular two hourly basis. Although the methodical way for undertaking ‘rounds’ is

not new, intentional rounding in its current format comes from the U.S.A. and its

development and testing over the last 10 years has highlighted improvements in patients’

experiences and falls prevention (Murphy et al.,2008).

The project lead proposed introducing two hourly intentional rounding on the stroke unit to

change the way nursing staff delivered care, supporting a proactive, rather than a reactive

approach to care. It was anticipated that by implementing intentional rounding:

• communication between patients and the nursing staff would increase by ensuring a

committed presence from the nursing staff and allow patients to voice concerns

• repeated interactions with the patients would allow trusting relationships to develop

with patients and relatives

Intentional rounding requires the nurse to structure his/her time to enable them to visit/meet

with the patient either hourly or two hourly. This then allows the nurse to gather information

in a structured way, addressing problems as they occur (Bartley et al., 2011). There is a set

pattern to the meeting, with each nurse introducing themselves and asking the patient a

series of questions relating to comfort and wellbeing. The intentional rounding encounter

ends typically with “Is there anything else I can do for you – I have the time?” Before leaving

the nurse gives an estimate of the time they will return, how to use the call bell as required

and the intentional rounding encounter is documented by the nurse.

Aim of the project

The overall aim of this project was to introduce intentional rounding on the stroke unit to

prevent patients falling.

Objectives of the project

The following objectives were identified. To:

• Engage with nursing staff to understand their views about intentional rounding and to

clarify the purpose

• Introduce two-hourly intentional rounding for all patients, as a way of delivering

nursing care

• Understand the patient and carer experience of intentional rounding

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• Gather data as to whether the introduction of intentional rounding has prevented falls

on the unit

Methods and approaches

A number of methods and approaches were used within the project including:

• Engaging with staff using staff groups/discussions/ward meetings

• Developing an understanding of the context of care using the Context Assessment

Index (CAI)

• Gathering feedback from patients and relatives

• Gathering falls data

Engaging with staff

A number of methods and approaches were used to engage the nursing staff in the project.

These are summarised below:

Table 1: Methods and approaches used to engage staff on the unit

Month and year Method Aim

January 2010 Staff meeting

To inform staff of successful

application and acceptance of the

Patients First Project

September 2010

Meeting with wider organisational

stake holders

Present project aims and objectives

January 2011 onwards Monthly ward meeting - agenda

item

Two way feedback

Understand staff views

To discuss – what’s good, what’s

not so good, what could you

change, do differently?

February 2011

Poster for staff (see Appendix 1)

Poster for relatives

Letter to patients and relatives

Provide information on project

February 2011 Context assessment index Assess the culture and context of

the unit

February 2011

Claims, concerns and issues Understand nursing staff concerns

pre introduction of rounding

February 2011

Identified two “champions” To ensure clarity about

responsibility within the project

One RN and one HCA who had

worked with intentional rounding

in another Trust and had

experience of IR and could speak

about their experiences

March 2011 Intentional rounding form designed Provide information on project

June 2011 Responsibility chart

Confirm commitment for the

project

June 2011 INTENTIONAL ROUNDING STARTED

December 2011 Claims, concerns and issues Understand nursing staff concerns

post introduction of rounding

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The project lead used the ward team meetings for a variety of purposes:

• to ask nursing staff for their thoughts and ideas and discuss any questions/concerns raised

• to elicit feedback on the design, layout and ease of using the intentional rounding

documentation (see Appendix 2)

• to help develop the responsibilities framework (see Appendix 4)

• to enable everyone to contribute to the process for implementing intentional rounding Staff were approached individually to ask if they had any ideas or feed-back about the

introduction to intentional rounding. All these interactions were based on supporting staff

with the change in practice and the introduction of a new way of working and ensuring that

staff were involved in the process.

The project lead also introduced an “ideas car park” where staff were encouraged to put their

comments (positive or negative) on a “post it” and stick it on a flip chart poster; the poster

was left in place in the ward throughout the time of the project and could be accessed by staff

at all times. The purpose of the “ideas car park” was to allow staff to put up any thoughts that

came to them during their shift, however disappointingly this only produced one response.

Claims, concerns and issues group work

The claims, concerns and issues exercise (Guba and Lincoln, 1989) is an approach that

facilitates the understanding and involvement of stakeholders in a project and reinforces the

value of stakeholder contribution. The claims are favourable statements about the proposed

change, concerns are unfavourable statements and issues are questions that are raised in

relation to the proposed change.

The claims, concerns and issues exercise was carried out with nursing staff before and after

the implementation of intentional rounding. All grades of nursing staff (Band 7, 6, 5) and

health care assistants were invited to be involved in this process. A total of 13 nursing and

healthcare assistants took part and groups were held over several weeks, to ensure that staff

on days off, annual leave or night duty were able to access the groups and increase the

number of staff members involved. The first group was facilitated by the external facilitator

from FoNS, but after this the project lead facilitated the groups.

During the initial sessions, staff first wrote their individual claims, concerns and issues on

“post-it” notes and then placed them on flip charts. The staff were then encouraged to discuss

their claims, concerns and issues in the group. The information gathered from this was used

by the project lead within team meetings to drive the implementation of the project. Once

intentional rounding was established, the exercise was repeated with nursing staff. Table 2

shows the outcomes of these two groups.

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Table 2: Outcomes from claims, concerns and issues

Pre –intentional rounding - February 2011 Post – intentional rounding - December

2011

Claims/Positives Claims/Positives

• Oral hygiene/oral fluid more

regularly improve continence

• Patients will be happier

• Reduce falls

• Assessing/preventing anxiety

• Staff satisfaction

• Positive patient care

• Better patient outcomes

• Reduce complaints

• Team work

• Pain management

• When ward busy it helps you to

remember fluids and position

• Effective

• Rounding is making a difference as

far as keeping charts up to date

• Patients know we will come to them

regularly and feel reassured

• Helps promote regular toileting and

promotes continence

• Helps prevent falls

• Patients in side rooms will not be

forgotten

• Communication with all patients

improved

Concerns Concerns

• Time management

• Is there enough staff

• Delays in other care

• Accuracy of recording

• Expectations of patients and

relatives

• How to do IR

• Becoming a paper exercise

• Staff getting involved

• More paperwork

• Colour in document difficult to read

• Forgetting the time and trying to

catch up

• 12 o’clock round difficult lunch time

etc.

• Not able to get a reliable response

from patients with

receptive/expressive difficulties

• Time

Issues /Questions Issues /Questions

• How recorded?

• Staffing levels to do IR

• Other priorities e.g. ward round

• How can we involve patients and

relatives?

• What do we want to achieve?

• Will one staff member be allocated

to do IR?

• Patients who cannot respond e.g.

patients who are dying, have

expressive difficulties

• Difficult to access comfort

• Positioning – on chart to change B to

bed

• Do independent patients need 2

hourly IR?

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The claims, concerns, issues feedback showed that before the implementation of intentional

rounding, staff were concerned that using the tool would impact on the their work load, about the

purpose of the tool and the amount of time the process would take. The project lead acknowledged

this feedback and this allowed her to appreciate that supporting the change in practice needed

constant engagement and discussion of the benefits to the staff and patients such as getting it right

the first time, and delivering proactive care. When intentional rounding had been in place for a few

months the post implementation collection of claims, concerns issues proved much more positive.

This showed that there was on-going support, information, and encouragement to facilitate the

change. The project lead aimed to provide facilitation to enable change, making a safe environment

for staff to contribute and question the process and allow the team to reduce activities that did not

add value to patients and staff.

Context Assessment Index

Drennan (1992) describes the culture of a work place as “how things are done around here”.

Manley, McCormack and Wilson (2008) suggest that practice development involves transforming

the culture of the care within work places so it can sustain effective patient centred and evidence

based care.

The Context Assessment Index (CAI) (McCormack et al., 2008) is a means of enabling health care

professionals to assess the context within which care is provided. The CAI is a questionnaire which

has three elements; culture, leadership, and evaluation, all of which are assessed along a

continuum of strengths from “weak” to “strong”. For a work place context to be receptive to

change and have person centred ways of working, the three elements all need to be “strong”.

In order to assess the culture and context on the unit prior to the implementation of intentional

rounding, the nursing staff were asked by the project lead, to complete the CAI questionnaire via

ward team meetings, posters in staff rooms and reminders to staff to complete the questionnaire

during their shift.

CAI Analysis

The final response rate was disappointingly low at 27%, despite repeated requests from the project

lead. Despite this the analysis of the questionnaires was undertaken with the assistance of the

Stroke Research Nurse and it appeared that in all the elements of culture, leadership and

evaluation the collated score was in the upper quartiles, or appearing to be “strong”. However,

because of the low response rate, it was difficult for the project lead to draw solid conclusions from

the results, and it was only possible to say that they were an indicator of the context of care only.

This led the project lead to reflect on the possible causes of the low completion rate which are

listed as follows:

1. Staff on the unit had not previously participated in this type of questionnaire and were

unsure of its purpose

2. There may have been no perceived “advantage” in participating and completing the

questionnaire. On reflection, an incentive could have been offered, such as a prize for a

questionnaire randomly drawn from the completed forms

3. Completing the questionnaire may have been of low priority to some staff due to the

demands of the unit

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The project lead concluded that the CAI could not be used further within the project, but reflected

that if it was to be used again in another project the areas that she would do differently are as

follows:

1. Send a personalised letter to explain the project to all the staff members as a form of “pre-

contact” to ensure that members of staff unable to attend the meetings, briefings etc had

information about the project

2. Ensure that the questions were not ambiguous to avoid the “wasted” papers received

3. Identifying a “buddy” or champion to encourage the completion of the questionnaires

4. Allocate protected time to complete the questionnaire, by adding on 10 minutes to a meal

break

Implementation of intentional rounding

Following the staff meetings and claims, concerns and issues work, the project lead wrote to all the

nursing staff individually and negotiated a start date for the implementation of intentional rounding

(week beginning 20th

June 2011). Along with the letter was an information leaflet explaining the

purpose of intentional rounding and how to use the intentional rounding documentation (see

Appendix 3). This documentation was developed by the project lead in collaboration with the

nursing team. Initially the nursing staff reviewed a number of examples of different documentation

from various sources that had been gathered to see what was usable and useful. The intentional

rounding document chosen was clear, precise and simple which would make it easier and more

likely to be completed. In addition there continued to be short meetings with nursing staff to

reiterate the purpose of the project and the use of the documentation. Finally in the ward’s

multifunctional room an “information chart” was also displayed.

Feedback from patients and relatives

Approximately half way through the project and with intentional rounding underway, the project

lead wanted to establish the patients’ and relatives’ perspectives and experiences of intentional

rounding. An appreciative approach (Cooperider et al., 2000) was used to identify from patients and

carers what was working well about intentional rounding and how this could be developed further

for the future. The project lead randomly asked ten patients and their relatives three questions to

gain their perspectives about their care. Informed consent was gained at the time and the

responses were anonymised. Patients and carers were informed that their responses would be

themed by the project lead and they would not be identified. It is planned to use this patient and

carer feedback to plan further developments in the future. Diagram 1 below shows the results.

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Diagram1 – Feedback from patients and relatives

Answer 2: “Nothing” “Waiting for toileting”

“Need more staff” “Want someone to approach

you first and give update on progress” “Not

always easy to find someone” “Comfort issues

– cold feet” “Food on clothes” “Weekend care

marked different from the week” “Information

from doctors” “Wait 48 hours to speak to a

doctor” “Nursing staff do not approach

relatives with information - relative had to

approach a nurse - nurses negative response to

question – not my area to discuss information

with relatives”

Answer 1: “Excellent Care” “Well

looked after” “I would want to be

looked after as my relative has been

(referring to a patient that was very

confused)” “Open and friendly”

“Reassuring” “Kept relatives informed”

“Caring” “Nurses approach to relatives

was brilliant” “Treated with respect”

“Good feeling” “Staffed listened” “Staff

go the “extra mile” “Staff do all they

can” “Felt more confident with staff

during the week”

Question 2: What

would you like us to do

differently? What

could we do better?

Question 1: We want to make

sure you were very satisfied

with your care. How were we?

What was good?

Question 3: We are

always looking to get

better at what we do.

Do you have any

suggestions for what

we could do better? Answer 3: “Flexibility re working

hours” “Patients therapy sessions

coinciding with visiting hours – Need

negotiation” “Difference in week and

weekends”

“Information for relatives on

admission”

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Falls data

Falls prevention was one of the primary aims of this project, as falls by patients are associated

with increased mortality, morbidity and functional decline (Murphy et al., 2008). Falls data

was collected prior to and after the implementation of intentional rounding as part of the

Trust’s normal clinical data collection. The project lead made a request to the Trust’s Clinical

Governance and Risk Coordinator for the data relating to the relevant periods of time.

Before the implementation of intentional rounding, data was collected over a period of twelve

months, and there was an average of 7.91 patients who had fallen per month. After the

implementation of intention rounding data was collected over a period of six months, and

there were an average 8.33 patients who had fallen per month. Further analysis of the data by

the project lead identified that of the 50 falls during the post implementation period, 30

occurred at night between the hours of 7.20pm – 7.15am.

Graph 1 shows the percentage of falls during the 24 hour period post implementation of

intentional rounding.

Although the numbers of patients who had fallen were almost the same before and after the

implementation of intentional rounding, the project lead found that the numbers of those

who had fallen resulting in “moderate” consequences were much higher in the non-

intentional rounding period. The project lead believes that the introduction of intentional

rounding has reduced the severity of the consequence of the patient falling, because the

frequency of nurse/patient contacts has increased and are more regular over the twenty four

hour period.

In addition, the Trust had at this time introduced the “safety cross” (Bartley, 2009) (see

Appendix 5). The safety cross is a visual aid to support clinical teams in their aim of falls

prevention. The cross represents one calendar month, and is divided into 31 boxes, each box

represents 1 day. Every day the box is colour coded by the person in charge, to allow staff to

be visually aware of when a patient has fallen and the consequence to the patient. The unit

also identifies the time of the fall on that day. The staff can also see when a number of days

have passed without a patient falling. The safety cross on the stroke unit is displayed in the

area where the staff have safety briefings each shift and so can refer to it when identifying

patients that are at a high risk of falls. The display also allows visitors to see the data. The

safety cross information is then taken to the monthly ward meeting to allow further

40%

60%

Day %

Night

during the nights

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discussion of the issues relating to a fall. The use of the safety cross does not replace formal

incident reporting but allows the staff to locally monitor what is happening in real time.

Discussion

The initial aim of the project was to reduce the number of patients falling by introducing

intentional rounding, as this had been found to be successful in the literature. The project

lead collaborated and engaged with the nursing staff using different approaches to implement

this initiative and to promote the use of intentional rounding, showing the benefits for both

staff and patients. With the introduction of intentional rounding, the project lead was able to

work with the therapy leads to ensure that the Trust’s falls risk assessment, which was only

previously being completed by the nursing staff, was contributed to by all professionals within

the multi-disciplinary team. Intentional rounding on the ward has highlighted patients who

are at risk of falling and has aimed to meet individual patient’s personal requirements e.g.

encouraging fluids. The introduction of intentional rounding on the ward has given the ward

its own objectives for improving patient safety and encouraging staff to question and

implement solutions to prevent patients falling. The display of a falls safety cross to chart the

number of patients falling over a monthly period also helps the nursing staff to review the

safety of the ward in relation to falls.

The project lead has reflected on the FoNS Patients First Programme and believes that some

of the methods and approaches that were introduced to the project lead encouraged staff to

take ownership of the project and to embrace new ways of working like intentional rounding.

The project lead found the whole experience of being a participant on the Patients First

Programme a positive one. Participating in the active learning throughout the workshops and

networking with other programme participants, alongside the support of the facilitators who

challenged and enabled new ways of thinking and learning gave the project lead confidence in

facilitating the process of change on the unit.

A number of testimonials from the wider multi-disciplinary team were received at the end of

the project, which spoke about the positive changes to patient care that were noted. This

feedback was made available to nursing staff which demonstrated the positive impact

intentional rounding had on nursing practice. One of the testimonials stated:

“After returning to work on Dunkery Stroke Unit two months ago, I feel compelled to email you

about the positive changes I have noticed with regards to continence management and patient

toileting. Since I was last on the stroke unit, nearly four years ago, many developments have

taken place, one of which is the intentional rounding, which potentially has had a positive

impact on continence management. Previously, although patients were well cared for, I often

found that treatment sessions were delayed due to issues surrounding incontinence or that a

large part of the therapy session would involve assisting the patient with toileting and

personal hygiene. This would often mean the patient would subsequently be too tired to

complete the rest of the therapy session. However, during this rotation I have noticed that this

has greatly improved. I have completed several physiotherapy rotations on Dunkery Stroke

Unit over the last nine years and each time the positive forward movement of the unit is

evident. Also, after the recent feedback from the Kings Fund project, I feel very proud to be a

member of the Dunkery MDT once again!”

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(At the time of this FoNS project the ward was also asked to be involved in The Point of Care

project organised by the Kings Fund the unit was one of four wards in the hospital to be

involved in this initiative. The ward was involved improving the patient/relatives experience).

A number of on-going developments have arisen as a result of this project. As a direct

outcome, the stroke unit will continue with two hourly intentional rounding with all patients.

However, although the stroke unit has not seen a reduction in the number of patients falling,

the nursing staff have experienced other benefits. They report that they are able to speak to

all patients and ask the same questions, they are not just speaking to those patients who are

identified as at “risk of falling”. The nursing staff identify that their working day is more

structured now, allowing time to speak and discuss information with relatives when they

come in to visit. And the patient experience has been positive overall, as indicated in their

feedback.

In the future the project lead plans to work with the nursing team to further identify patients

who are at high risk of falling, and how to care for them effectively.

Understanding the process of change and practice development will be of benefit in reviewing and

taking forward the project. The staff looked at what had not worked so well and this was often to

do with the paperwork. The use of “turning circles” to record position changes as well as the

intentional rounding paperwork was found to be a doubling of documentation. The unit has since

stopped using “turning circles”.

The feedback from the relatives and patients will also be used with the nursing staff to further

develop the delivery of care. On-going data collection will continue in relation to the number

of patients falling, the number of complaints received and staff feedback. A full evaluation of

the introduction of intentional rounding is planned at the one year anniversary. It is hoped an

evaluation combined with the on-going audit of the process of intentional rounding will

demonstrate the on-going benefits and help to refine the process for the future.

Whilst undertaking this project, the project lead has experienced a number of challenges,

these have included, finding time to meet with ward staff, juggling the project whilst meeting

the needs of the service and the wider strategic priorities of the hospital. On reflection the

project lead severely underestimated the time needed for organising the project, pulling the

project together, writing the report as well as managing the day to day activities of an acute

stroke unit. In the future the project lead would be able to use this experience to better

allocate time to complete the different components of any new project. This project has

allowed all nursing staff to be involved and as observed by the project lead has appeared to

inspire confidence and commitment in the nurses, which has transferred to many other

aspects of the unit. The project lead believes that the Patients First Programme creative

approach acted as a catalyst to get the project going and that the introduction of intentional

rounding and the participation of nursing staff enabled them to feel energised.

Conclusion

In conclusion the project lead worked with the nursing team to understand their claims,

concerns and issues and used these to facilitate the implementation of intentional rounding.

Unfortunately falls data before and after the implementation of intentional rounding suggests

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that the occurrence of falls is at the same level but it appears that the severity of the

consequences of a patient falling has been reduced. Also initial feedback from patients is

positive but a full evaluation is planned for the future. One of the other outcomes is the

development of the project lead as a facilitator through participating in the Patients First

Programme.

Acknowledgements

The project lead would like to take the opportunity to thank the stroke unit for their

commitment, support and collaboration in the project. To thank the Foundation of Nursing

Studies and the Burdett Trust for Nursing for supporting the project as part of the Patients

First Programme.

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Bartley, A., Cornwell ,J.

and Fitzsimons, B.

2011 Intentional rounding: its role in supporting essentials care.

Nursing Times. Vol. 107.No. 27.pp 18-21.

Cooperrider, D., Sorensen,

P., Whitney, D. and

Yeager, T.

2000 Appreciative Inquiry: Rethinking Human Organisation

Toward a Positive Theory of Change. USA: Stipes

Publishing.

Department of Health

2009 The Nursing Roadmap for Quality. London:

Department of Health.

Dietrick, L.M., Baker, K.,

Paxton, H., Flores, M.,

Swavely, D.

2012 Hourly rounding challenges with implementation of an

evidence- based process. Journal of Nursing Care Quality.

Vol. 27. No. 1. pp 9-13.

Drennan, D.

1992 In McCormack, B., Manley, K. and Garbett, R. (Eds) (2004)

Practice Development in Nursing. Oxford: Blackwell

Publishing Ltd.

Guba, E.G. and Lincoln,

Y.S.

1989 Fourth Generation Evaluation. California: Sage.

Manley, K., McCormack,

B. and Wilson, V.

2008 International Practice Development in Nursing. Oxford:

Blackwell Publishing Ltd.

McCormack, B.,

McCarthy, G., Wright, J.,

Coffey, A. and Slater, P.

2008 Development of the Context Assessment Index. University

of Ulster: University College Cork. Retrieved from:

http://www.fons.org/resources/documents/tools%20+%

resources/8- CAI Report.pdf

Last accessed: 12/2/12.

Murphy, T., Labonte, P.,

Klock, M. and Houser, L.

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nursing practice initiative. Critical Care Nurse. Vol. 31. No.

1. pp 33-39.

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Last accessed July 2012.

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Appendix 1

DUNKERY STROKE UNIT

TEA COFFEE AND CAKES PROVIDED

Any Queries please do not hesitate to

contact me.

Suzanne Luxton

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Appendix 2

Intentional Rounding Dunkery Stroke Unit

Intentional rounding Chart

Q1. Did you get any feed back from the patient? – if yes please describe Q2. Did you find the Chart user friendly? Yes No Suggestions? Q3. Did you find the “script” (on reverse) helpful? Yes No Q4. How did you find undertaking the intentional rounding: Q5. Any Other comments/ suggestions:

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Appendix 3

INTENTIONAL ROUNDING WITH A PURPOSE DUNKERY STROKE UNIT

Ask “is there anything else I can do for you? I have the time. Remind the patient that a staff member (let them know who) will be back in at least 2 hours, but they can use the call bell at any time.

DATE

0600 0800 10.00 12.00 14.00 16.00 18.00 20.00 22.00 00.00 02.00 04.00

TOILETING OFFERED (√ )

POSITION - ASK PATIENT IF THEY ARE COMFORTABLE :In bed - R=RIGHT L=LEFT B=BACK OR C=CHAIR I=INDEPENDENT

ASK PATIENT IF THEY HAVE PAIN Y=yes N=no IS MEDICATION NEEDED?

PROMOTE COMFORT: PROVIDE BLANKET/PILLOW, MOVE ITEMS IN REACH CALL BELL

PATIENT SLEEPING ( √ )

PATIENT OFF UNIT (√ ) OFFER/GIVE PATIENT DRINK/MOUTH CARE (√ ) R=REFUSED

INITIALS DATE

PATIENT STICKER TO BE PLACED HERE

TOILETING PERSONAL NEEDS

POSITION

ASSESS ENVIRONMENT

HYDRATION

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Appendix 4

INTENTIONAL ROUNDING

Responsibility Chart (This chart gives clarity about who is responsible for ensuring

intentional rounding is undertaken)

Individual Registered Nurse

HCA Therapists (OT, Physio, Dietician, SALT.)

Housekeeper Sister Deputy Sister

Matron

Decision/Role Undertake 2 hourly intentional rounding

Responsible Responsible Inform/ give information to Nursing staff

Inform/ give information to Nursing Staff

Responsible Informed

Monitor 2 hourly intentional rounding undertaken

Responsible Responsible Informed

Monitor project and why intentional rounding not undertaken

Responsible Support Support Support Responsible Informed and support

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Appendix 5

Falls Safety Cross

Hunches Table: What do you think caused the fall

1

2

3 4

5 6

7 8 9 10 11 12

19

14

3 3

15 16 17 18 13

3 3

20

3 3

21

3 3

22

25

3 3

27

3 3

28

3 3

24

3 3

29

3 3

30

3 3

31

3 3

23

26

3 3

KEY:

CONSEQUENCE 3+ FALL

CONSEQUENCE 1-2 FALL

NO FALL

Ambition:

Prevent serious injury falls

Reduce total number of falls by 10%

Goal:

100% Completion of daily safety cross

MONTH: WARD:

Serious injury:

All falls that require more than simple first aid.

Typically will include most head injuries and all fractures as well as significant bruises swellings