Path to Home Covenant Health Comfort Rounds February 2014
Purpose This tool kit offers resources to assist the leadership team with the implementation and sustainability of Comfort Rounds. It provides an outline of key strategies that are suggested to assist with the implementation of comfort rounds on a unit with the resultant benefits for both patients and staff. What is a Comfort Round? Comfort Rounds provide an opportunity for nursing staff to enhance patient care, involve patients in their care and improve communications. A comfort round provides a formal planned check-in with patients at a minimum of every two hours during the day and evening. The key elements to a comfort round include: 1. Positioning: Making sure the patient is comfortable and asking if they need to change their position 2. Personal needs: Scheduling patient trips to the bathroom 3. Pain: Asking patients to describe their pain level 4. Placement: Making sure the items a patient needs are within easy reach What are the benefits of comfort rounds? Who needs comfort rounds? Comfort rounds have proved popular with patients and families, reporting increased satisfaction with their nursing care. Evidence that a rounding program has helped to reduce patient falls, pressure ulcers and call bell use and has contributed to improvements in patient satisfaction. All patients can benefit from a comfort round, some patients may require more frequent rounds. Who performs comfort rounds? A comfort round is performed by the nursing team (RN, LPN, HCA). When do comfort rounds need to be performed? 23Feb2014 Page 2
During the Day, Evening and Night Comfort rounds should occur at least every two hours Documentation of comfort rounds? Report and record any relevant observations, interventions or assessments in the appropriate Patient Care Record Suggested Steps to Implement Comfort Rounds How do we assess success? Arrange a staff meeting to introduce the concept and provide the following information sheets: o How to Carry Out a Comfort Round (Appendix I) o Comfort Rounds Seven Key Behaviors (Appendix II) Survey the unit staff regarding their opinions about how to implement comfort rounds o This will help gauge the units readiness to implement comfort rounds, and identify focused areas that need improvement to address patient s needs o Discuss with the staff the unit workflow processes and how comfort rounds will be integrated into the current flow. The Staff Audit Tool has been designed to assess the staff with the concepts of comfort rounds by observation. Appendix III Patient Survey developed as a feedback tool to staff. Appendix IV Sustainability Discuss comfort rounds at staff meetings. o Provide feedback of patient survey to staff. Stress the importance of family centered care. o Provide feedback on the comfort rounds audit tool to staff. Include in program orientation for new staff Provide ongoing education and support Recognize staff who consistently integrate comfort rounds into their daily routines Must be ongoing and frequent communication between staff (RNs/LPNs/HCAs), not just at shift change. 23Feb2014 Page 3
Appendix I How to Carry Out a Comfort Round Day and Evening Comfort Rounds At the Beginning of the Comfort Round Approach the patient calmly: Let the person know you have the time and want to help them Introduce yourself and your role and explain that you are there to do a comfort round: NOD (Name, Occupation and Duty). NOD is expected every time you enter a patients room Orient the patient (if needed): Remind the patient where they are, the time of day and the day of the week Help the person put on their glasses and hearing aids (if they have them) Think of the key elements: Position, Personal Needs, Pain and Placement Ask the person if they have any pain or discomfort or observe their body language: address pain, offer a warm blanket, and arrange for pain medication. Help the person to change their position: If they can stand, get them out of bed or chair and up for a walk. If they cannot stand, make sure the person changes position to prevent skin breakdown. Help the person to the bathroom: If not able, offer the urinal or bedside commode. Ambulating out of bed is best whenever possible. Placement: ensure personal belongings are within reach (call bell, bedside table, glasses etc). Consider other care needs Offer a drink and snack: Unless the person s food and fluids are restricted or limited because of their medical condition Consider doing mouth care, or skin care (lotion) etc. Carry out routine care: Medications, or vital signs Consider what else the person may need based on their condition Check the Environment Are the persons personal items close to them: Phone, tissues, drinking glass Is the call bell within reach of the person: Does the person know how to use it, If appropriate remind the person to call for help Look around the environment for risks to falling: Is the end in the lowest position that is right for the person s height? Is the end or chair alarm turned on and working? Are most of the bedrails left down? In most cases, at least one lower rail should be left down to prevent climbing over the rail. Is the clutter moved out of the 23Feb2014 Page 4
way? Ending the round Before you leave: Ask the person is there anything else you can do for them: Remind them that you have the time to help. Carry out the care that is within your role, or tell the person when you will be back to do that care. If the request is for something you don t do in your role, find someone who can, and tell the person who to expect to come and help. Tell the person when to expect the next round Team Communication about the round Night time Comfort Rounds After the round, talk to the rest of the team: Share any changes in the person s condition that you noticed (pain, increased confusion). Ask about care that needs to be carried out by another team member (medication) Document the round: Report and record any relevant observations, interventions or assessments in the appropriate Patient Care Record The last comfort round before the person goes to bed should include care that helps the patient settle. Ask the person (or family) if there are special night time routines that might help with sleep. Try: warm milk, warm blanket, back or hand massage, reduce noise, lower the lights, talk quietly and calmly. During the night Try to let the person sleep Within the team: arrange for staff to go into a room together during the night, rather than one after another to allow longer sleep periods Assess pain throughout the night and treat appropriately At least every two hours, re-position those who need help moving Help to the bathroom when they are awake during the night 23Feb2014 Page 5
Appendix II Comfort Rounds Seven Key Behaviors 1. Use opening Key Words (NOD) Name Occupation Duty 2. Address the 4 Key Elements Position, Personal Needs, Pain & Placement a. Position change position every 2 hours / up and walking b. Personal Needs up to bathroom c. Pain access and manage d. Placement hearing aids, glasses, teeth, call bell, blankets are all within reach 3. Address additional comfort and safety needs (environmental check) 4. Ask Is there anything else I can do for you before I leave 5. Tell each patient when you will return 6. Communicate and inform other team members of relevant changes 7. Document the round on the patient care record 23Feb2014 Page 6
Appendix III Comfort Rounds Staff Audit Tool Date: Unit: Staff Name(s): Assessor(s) Name: Instructions: Observe staff completing a Comfort Round. Assess each component of the Comfort Round using the following key: - Did not complete component - Completed component Key Component to Be Assessed 1 2 3 4 5 Hand hygiene in view of patient NOD Name: Introduces by name Occupation: Informs of occupation Duty: Identifies the reason why they are there, Duty At the beginning of the Comfort Round Orient the patient (if needed): Remind where they are, time of day, day of week Help patient put on their glasses and hearing aids (if they have them) 4 Key Elements (Position, Personal Needs, Pain, and Placement) Asks the person if they have any pain or discomfort or observe their body language Helps the person to change their position Helps the person to the bathroom Ensures personal belongings are within reach Care (if appropriate resources are available) Offer a drink and snack (unless foods and fluids are restricted) Consider performing mouth care or skin care Carry out other routine care medications or vitals Consider what else the patient needs Environment Patients personal items close Call bell within reach Assess risks to falling: bed in lowest position, bedrails down, clutter out of the way Ending the Round Ask the patient is there anything else you can do for them Tell the patient when to they can expect you to return After the Round Documents round and intervention on patient care record 23Feb2014 Page 7
Communicate and changes with the team Comments or Feedback Provided to Staff 23Feb2014 Page 8
Appendix IV 23Feb2014 Page 9