Influential Nursing Rounds: Impact on Falls in an Inpatient TBI Rehab Program Dawn Rankin, RN, BSN, CRRN

Transcription

1 Background Implications to practice Transformational Leadership Hourly rounding Evidence Action Plan Outline Objectives Be able to identify the purpose of hourly rounding Identify how to increase staff compliance with hourly rounding List what the 4 p s of hourly rounding are November 5,

2 Background Falls will endure more than $4200 higher hospital bills than patients who did not fall (Biggs, 2013). 50% of patients who suffer a fall in hospital will have a second fall (Tariq, 2013). Estimated 34 billion dollars are spent for medical care of injuries suffered from a fall (CDC, 2015) Stuber group Implications to practice Proactive Instead Of Reactive Care Value- Based Purchasing Patient & Staff Satisfaction 34 Billion Dollars Are Spent For Medical Care Of Injuries Suffered From A Fall (CDC, 2015). Transformational Leadership Staff Buy-in Consistency Of Completing Maintaining Compliance Effectiveness Of Rounds Rehab Specific Fall Tool How do staff identify fall risk? Surveys were given to 81 rehab staff of different disciplines with 68% being returned Fall risk variables identified by staff 1. History of falls ( 5% of staff) 2. Age (11% of staff) 3. Medical history 4. Medications 5. Vision deficits 6. Abnormal lab values 7. Incontinence Ruchinskas, 2001 November 5,

3 Evidence Are we properly identifying fall risk in rehab? ROSARIO, KAPLAN, KHONSARI & PATTERSON (2014) New fall tool including rehab FIM data trialed 30/174 patients suffered a fall 72% unattended falls & 28% assisted falls 90% success rate of predicting fall. the sensitivity of the new risk tool is 0.88 Most falls during breaks, nights, & ADL times. TBI- night time Rosario, E., Kaplan, S., E., Khonsari, S., & Patterson, D. (2014). Predicting and assessing fall risk in an acute inpatient rehabilitation facility. Rehabilitation nursing, 39 (2), Doi: /rnj.114 (Frisina, guellnitz, & alverzo, 2010). What else should we be including? Functional status.fim scores Devices? Patient compliance Staff judgment??? Do you think the patient may be at risk to fall? Have we involved visitors? Are we covering the unit during busy times? How can we influence change? Identify fall risk and individualize plan of care Hourly Rounding Communication with team members Transformational leadership: leadership style that works with employees to identify the needed change creating a vision to guide the change through inspiration executing the change in tandem with committed members of the group. November 5,

4 Hourly rounds Goal is to anticipate and identify patient needs before incidence occurs Four P s of hourly rounds: Pain Position Personal possessions Potty Evidence Care and comfort rounds: improving standards Ciccu-moore, R., Grant, F., Niven, B., Paterson, H., Stoddart, K., & Wallace, A. (2014). 604 admissions, data review Staff education, monthly meetings, review of data, checklist development for rounding, leaflet of education for patients, patient experience questionnaires Falls were reduced by 39% & call buzzer use decreased by 36% According to pt feedback: quieter environment, patients offered and assisted with food and fluids, communication with families improved, documentation improved, time for education was given, and staff satisfaction in care provided increased. Evidence Staff nurse perceptions of nurse manager leadership styles and outcomes Casida, J., & Parker, J. (2011). 278 staff nurse & 37 nurse managers given the multifactor leadership questionnaire (MLQ) Positive outcomes with transformational leadership + correlated rewards Negative outcomes with transactional or passive leadership Leadership extra effort, leadership satisfaction and leadership effective= + outcomes Leadership subscales: Attributed & behavior influence, inspirational motivation, intellectual stimulation, & individual consideration November 5,

5 Plan for action Identify implications for unit PATIENTS Gather your data and your team RESEARCH Discuss smart goal Action plan 6e Fall data Column2 Column1 Series 1 Smart Goal Specific- In 2 months the nurse leader on the unit will coordinate staff committee and meeting to brainstorm regarding how rounds will work best into the flow of current unit and staff as well as barriers for purposeful rounding, and create an implementation plan.. The goal of completing the hourly rounding will be to decrease falls by 10% in the next 2 months. Measurement/Assessment- Staff will complete a rounding questionnaire at the beginning and at the end of 2 month trial regarding compliance and list barriers. The clinician will monitor falls and compare to the 2 months prior to the discussion regarding rounding. Attainable/ Achieve- Decrease falls by 10% on unit compared to 2 months prior to trial Relevant- Clear expectations for hourly rounding. Rounding should include the 4 P s-pain, position, potty, and personal belongings. The expected result is 10% reduction in fall rates on the brain injury rehab unit. Timed- Staff education and planning will occur for 1 month within unit meeting and program development meeting. A start date for hourly rounding will be given and a 2-month time frame will be measured for falls and rounding compliance. November 5,

6 Casida, J., & Parker, leadership styles of nurse managers and age % educated above at or above BSN and an error probability of x+0.05 with G power Statistical Analysis: means and standard deviations were TFL demos positive correlation with LEE, LS, and LE Negative correlation with management by SN s Quality: Good leadership styles Influential Nursing Rounds: Impact on Falls in an Inpatient TBI Rehab Program Action Steps Responsibilities Timeline Action Plan Resources Potential Barriers Evaluation Plan What Will Be Done? Who Will Do It? By When? A. Resources Available A. What individuals or organizations might resist? (Day/Month) B. Resources Needed (financial, human, political B. How? & other) What methods? How often? Step 1: clinician during staff meeting and PDC Committee formed 2 weeks A. Staff for planning A. Education for staff A. Staff may push back if they don t understand the process Committee monitoring of falls, and benefits round completion, clinician rounding (18 per week). monthly mtg A. Not completing the rounds Step 2: Staff education clinician and rounds 2 weeks A. Baseline data regarding research findings comm. A. Process development, tools A. Ensuring all staff attend education session A. Keeping facility data updated & open communication ongoing Maintain checklist of staff attendance Clinician ensuring all fall data maintained, shared monthly Step 3: All staff Implementation of intentional rounding After 2 week A. Clinician rounding, to demonstrate importance & A. Unit obligations, only 1 clinician Rounding should influence compliance occur hourly B. Try to ensure that staffing to unit guidelines A. Staff buy-in and monitoring completion of rounds Schedule rounding on clinician calendar. Step 4: Evaluation all staff, and comm. Monthly, staff A. Log all falls and share with staff & leadership A. All staff able to rounds to monitor patient satisfaction clinician A. By not completing Continue to monitor and have open communication regarding staff and patient satisfaction & falls data Bialek, R. (2011). Core competencies for public health professionals-background & tools. Retrieved from References Biggs, J., & D'aurio, L. (2013). An interdisciplinary approach to fall prevention in patients with brain injury. Rehab management: the interdisciplinary journal of rehabilitation, 26(7), Casida, J., & Parker, J. (2011). Staff nurse perceptions of nurse manager leadership styles & outcomes. Journal of nursing management, 19(4), p. Doi: /j X Center for disease control and prevention. (2015). Important facts about fall. Retrieved from Ciccu-moore, R., Grant, F., Niven, B., Paterson, H., Stoddart, K., & Wallace, A. (2014). Care & comfort rounds: improving standards. Nursing management - UK, 20(9), Fabry, d. (2015). Hourly rounding: perspectives and perceptions of the frontline nursing staff. Journal of nursing management, 23(2), p. Doi: /jonm Frisina, P.G., Guellnitz, R., & Alverzo, J. (2010). A time series analysis of falls and injury in the inpatient rehabilitation setting. Rehabilitation nursing, 35 (4), 141. Forde-johnston, c. (2014). Intentional rounding: a review of the literature. Nursing standard, 28(32), p. Doi: /ns E8564 Hicks, D. (2015). Can rounding reduce patient falls in acute care? An integrative literature review. MEDSURG nursing, 24(1), Hutchings, m., Ward, P., & Bloodworth, K. (2013). 'Caring around the clock': a new approach to intentional rounding. Nursing management - UK, 20(5), Hutchinson, m., & Jackson, D. (2012). Transformational leadership in nursing: towards a more critical interpretation. Nursing inquiry, 20(1), Kumar, s., Kumar, N., Adhish, V. S., & Reddy, R. S. (2015). Strategic management and leadership for health professionals skills to leverage resources to achieve health goals. Indian journal of community medicine, 40(3), p. Doi: / Needleman, J., Pearson, M. L., Upenieks, V. V., Yee, T., Wolstein, J., & Parkerton, M. (2016). Engaging frontline staff in performance improvement: the american organization of nurse executives implementation of transforming care at the bedside collaborative. Joint commission journal on quality & patient safety, 42(2), p. Rosario, e., Kaplan, S., E., Khonsari, S., & Patterson, D. (2014). Predicting and assessing fall risk in an acute inpatient rehabilitation facility. Rehabilitation nursing, 39 (2), Doi: /rnj.114 Roussel, L. (2013). Management and leadership for nurse administrators (6th ed.). Burlington, ma: jones and bartlett learning. RUCHINSKAS, R. A., MACCIOCCHI, S. N., HOWE, G. L., & NEWTON, R. A. (2001). CLINICAL DECISION MAKING IN THE PREDICTION OF FALLS. REHABILITATION PSYCHOLOGY, 46(3), DOI: / Tariq, H., Kloseck, M., Crilly, R. G., Gutmanis, I., & Gibson, M. (2013). An exploration of risk for recurrent falls in two geriatric care settings. BMC geriatrics, 13, Doi: / Titzer, j., Phillips, T., Tooley, S., Hall, N., & Shirey, M. (2013). Nurse manager succession planning: synthesis of the evidence. Journal of nursing management, 21, To explore the 278 staff nurses (SN) 91% Sample was a effect size NM s who with TFL +CR had the most SN s with 2011 correlation of female, 7.6% males, mean of 0.10, a power of 0.98 Procedure: A descriptive exploratory correlational design. perception of favorable efforts. Level: V- J. (2011). Staff nurse perceptions of nurse manager leadership styles and outcomes. Journal Of Nursing Management, 19(4), p. doi: /j x outcomes 37 nurse Manager(NM) statistical program 94.6% females, 5.4% males, version 3.1. mean age 45.7, 81% at or MLQ used to measure above BSN LEE measures NM ability Sample was a effect size of to influence follow 0.10, a power of 0.98 and an LEE-leadership extra error probability of x+0.05 effort with G power statistical LE- leader effectiveness program version 3.1 LS- leader satisfaction Table of evidence calculated for scales, subscales and items showing a normal distribution of data. Pearson s moment correlational analyses used to identify relationship among leadership variables. Multiple linear regression analyses were employed to determine which style of NM predicts a specific outcome, SPSS version 18.0 software for data analyses. Instruments: multifactor leadership questionnaire (MLQ) when NM demonstrated TRL(transactional) or passive leadership. Best predictor for LS is IA (attributed idealized influence). More women use TFL and CR than men. CR does not affect an individualized outcome. LEE is biggest predictor for positive outcomes. Five leadership suscales: attributed influence, behavior influence, inspirational motivation, intellectual stimulation, individual consideration Strengths: this article supports knowledge of perceived behaviors and Weakness: Difficult to read with all of the initials. Multiple low and high performance units were not evaled to help identify styles vs outcomes. Implications: November 5,

7 ?? Questions?? November 5,