Dowloaded o 06 15 2018. Sigle-user licese oly. Copyright 2018 by the Ocology Nursig Society. For permissio to post olie, reprit, adapt, or reuse, please email pubpermissios@os.org Joural Club Article Roud ad Roud We Go: Roudig Strategies to Impact Exemplary Professioal Practice Nicole Reimer, BSN, RN, OCN, ad Laura Herbeer, BSN, RN, OCN The literature demostrates that diverse roudig methods have bee show to positively impact a wide variety of quality ad safety outcomes, as well as patiet ad staff satisfactio. Rather tha adoptig oe or two of these strategies, the cocepts ad recommedatios from the literature associated with roudig have formed the foudatio for a academic, commuity, Maget hospital to implemet a compedium of roudig efforts: patiet rouds, iterdiscipliary collaborative rouds, daily cliical rouds by the uit educator ad daily rouds by the uit maager, quarterly uit rouds by seior ursig maagers, ad safety rouds by seior executives. This article details each of these methodologies as implemeted o a 26-bed hematology/ocology uit. Positive Fuse/Thikstock outcomes perceived to be associated with the rouds have bee achieved for patiet, employee, ad physicia satisfactio, as well as cliical quality idicators. Nicole Reimer, BSN, RN, OCN, is a director of patiet care services ad Laura Herbeer, BSN, RN, OCN, is a patiet care specialist, both at Lehigh Valley Health Network i Alletow, PA. The authors take full resposibility for the cotet of the article. The authors did ot receive hooraria for this work. The cotet of this article has bee reviewed by idepedet peer reviewers to esure that it is balaced, objective, ad free from commercial bias. No fiacial relatioships relevat to the cotet of this article have bee disclosed by the authors, plaers, idepedet peer reviewers, or editorial staff. Reimer ca be reached at icole.reimer@lvh.com, with copy to editor at CJONEditor@os.org. (Submitted Jauary 2014. Revisio submitted March 2014. Accepted for publicatio March 15, 2014.) Key words: roudig; collaborative rouds; patiet rouds; executive rouds; safety rouds; lea methods Digital Object Idetifier: 10.1188/14.CJON.18-06AP A variety of roudig methods have bee icreasigly implemeted i healthcare settigs to improve patiet safety ad positively impact patiet ad staff satisfactio. At Lehigh Valley Hospital (LVH), a academic, commuity Maget hospital, six types of rouds were implemeted withi the ipatiet, emergecy, ad ambulatory patiet care areas (see Table 1). This article details each roudig methodology, icludig its purpose, structure, ad outcomes, emphasizig implemetatio o the 26-bed hematology/ocology ipatiet 7C uit at LVH. Literature Review Most of the literature associated with roudig methods relates to hourly patiet rouds by healthcare persoel i a ipatiet settig; however, the semial article o this subject is the quasi-experimetal research by Studer, Robiso, ad Cook (2010). The study demostrated that a protocol icorporatig specific actios ito patiet rouds ca reduce the frequecy of patiets call-light use, icrease their satisfactio with ursig care, ad reduce falls (Meade, Bursell, & Ketelse, 2006). Other research reported that patiet satisfactio was the most commo outcome, with statistically sigificat improvemets oted (Bourgault et al., 2008; Culley, 2008; Ford, 2010; Garder, Woollett, Daly, & Richardso, 2009; Meade et al., 2006; Tea, Elliso, & Feghali, 2008; Weisgram & Raymod, 2008). Studies also focused o call-light use, fidig reductios i use after implemetig hourly rouds (Bourgault et al., 2008; Meade et al., 2006; Weisgram & Raymod, 2008). A third variable positively impacted by hourly rouds was staff satisfactio (Bourgault et al., 2008; Garder et al., 2009; Leighty, 2007). Collaborative roudig has log bee supported i the literature ad cotiues to be a maistay i roudig methodologies. Accordig to Edwards (2008), team roudig reduces the likelihood of error, thus icreasig patiet safety. I additio, Vazirai, Hays, Shapiro ad Cowa (2005) reported icreased collaboratio amog members of the healthcare team, particularly betwee urses ad urse practitioers. Teachig rouds performed by a uit-based urse educator have bee foud to be coducive to staff developmet, particularly regardig the cultivatio of critical-thikig skills (Segal & 654 December 2014 Volume 18, Number 6 Cliical Joural of Ocology Nursig
Maso, 1998). This professioal developmet strategy prompts multiple outcomes, such as documetatio compliace, patiet ad staff satisfactio, ad quality cliical care. Seior executive roudig is aother methodology reported i the literature. Termed walk rouds, the focus of a study by Frakel et al. (2008) was to improve the safety climate ad the staff perceptio of patiet safety through ope dialogue ad collaboratio. Staff perceived that the walk rouds had a positive impact o the facility s safety climate ad patiet safety. Campbell ad Thompso (2007) corroborated those results i their retrospective study of patiet safety rouds. Through roudig, Studer et al. (2010) described how urse leaders ca reiforce care delivery to patiets, verify ursig actios, ad recogize their employees. Studer et al. (2010) oted that this is oe of the most importat actios... to improve patiet perceptio of courtesy ad respect ad of urse commuicatio as a whole (p. 46). The literature demostrates that various roudig methods have bee show to positively impact quality ad safety outcomes, as well as patiet ad staff satisfactio. Rather tha adoptig oe or two of these strategies, the cocepts ad recommedatios from the literature associated with roudig formed the foudatio for the curret article s authors to devise, implemet, ad evaluate a compedium of roudig efforts. Roudig Methods Hourly Patiet Rouds Hourly patiet rouds are iteded to icrease patiet safety ad satisfactio of patiets, family members, ad staff. The aim is to aticipate ad address patiet eeds. Rouds are completed by a RN or ulicesed assistive persoel every hour from 6 am to midight ad every two hours from midight to 6 am. For ease of memory ad stadardizatio, the authors focused o pai, positioig, ad persoal eeds. A stadardized electroic tool, the Patiet Roudig Log, was used to moitor completio. The tool is a part of the permaet medical record ad has prove useful whe ivestigatig quality issues. Stadardizatio is a key compoet i the hourly roudig process withi the hematology/ocology ipatiet uit ad throughout the hospital (see Table 2). Patiets ad families were otified that hourly roudig occurred i a stadardized maer, o matter the poit of etry or uit placemet. However, because the ocology populatio demostrates a heighteed eed for uiterrupted rest, based o their coditio ad eeds, patiets would be offered a customized roudig schedule. Iterdiscipliary Collaborative Rouds Iterdiscipliary collaborative rouds are coducted i a variety of ways, ad several factors determied the methods used, such as ideal times for family ivolvemet, optimum times for physicias ad other members of the iterdiscipliary team, ad patiet diagosis. Despite the use of various methods, the commo purpose of collaborative rouds is to review the curret pla of care, determie care priorities, ad resolve patiet care issues. Rouds always iclude the patiet ad family. O the ipatiet ocology uit, the iterdiscipliary team may iclude the patiet s primary urse, attedig physicia, ocology medical fellow, medical residet, advaced practice urse, physicia assistat, pharmacist, ad case maager. Rouds are completed daily for every patiet ad twice daily for patiets who require reevaluatio because of the acuity of their illess or who have complex discharge plaig issues. TABLE 1. Roudig Strategies i Use at Lehigh Valley Hospital Strategy Purpose or Focus Participats Frequecy Script Hourly patiet rouds Icrease patiet safety ad the satisfactio of patiets, family members, ad staff. Aticipate ad address the patiets eeds. Patiets, RN, techical parter Hourly Yes Iterdiscipliary collaborative rouds Review the curret pla of care, determie the care priorities, ad resolve patiet care issues. Patiet, physicias, urse practitioer, physicia assistat, RN, pharmacist, case maager Daily No Daily cliical rouds by uit educator Offer support to staff from a cliical expert to facilitate critical thikig related to care delivery; promote patiet safety, collaboratio of team members, ad quality patiet care; ad positively impact urse sesitive cliical idicators ad regulatory stadards. RN, patiet or family, patiet care specialist, techical parter Daily Audit tool Daily patiet rouds by uit maager Esure patiet ad family are satisfied with their care, build relatioships, ad be proactive to resolve patiet issues. Patiet or family, RN Moday through Friday Yes Quarterly uit rouds by seior ursig Recogize staff s hard work ad dedicatio to patiet care, ad ecourage discussio regardig ursig sesitive quality outcome metrics. Patiet or family, RN, techical parter Quarterly No Safety rouds by seior executives Demostrate to frotlie staff that seior executives care about ad are ivested i resolutio of staff safety cocers. Elighte executives about depth of frotlie staff cocers. All uit staff, patiet safety officer, seior vice presidet of quality ad safety, represetative of the seior hospital executive team Mothly Yes Cliical Joural of Ocology Nursig Volume 18, Number 6 Roudig Strategies for Exemplary Practice 655
TABLE 2. Lehigh Valley Health Network Patiet Roudig Stadard Work Actio Script ad Accompayig Work Kock o door Itroduce self Explai Ask Sca the room Pla for future Hi, I m Kim Smith. I am your RN today. A staff member will be comig aroud every hour from 6 am through midight ad every two hours from midight to 6 am Ca I get you aythig for pai? Do you eed to go to the bathroom? Ca I help you get repositioed? Is there aythig I ca do to help you get comfortable? Check if call bell, telephoe, ad bedside table are i reach; cords are safely positioed to prevet trip hazards; ad the pathway to the bathroom is free of clutter ad fall hazards. Is there aythig else that eeds to be cleaed up? We will roud agai i about a hour to check o you, but if you eed somethig or you eed assistace to get up, please use your call bell. Two types of physicias complete rouds o the uit, gyecologic ocologists (startig at 7 am) ad hematologic ocologists (startig at 9 am). The cosistet times promote participatio by all attedees ad esure that a urse does ot have more tha oe physicia roudig at the same time. Buyi for all disciplies to participate was drive from the oset because each disciplie quickly saw the value through gaied efficiecies ad resultat patiet ad staff satisfactio. Iterdiscipliary collaborative rouds begi with a presetatio of a earlier assessmet by oe of the aforemetioed team members. All members of the collaborative team, iclusive of the patiet ad family, the discuss ad agree o the pla of care. Efforts are made to esure that every participat offers iput. For example, the physicia ormally eds the discussio by iquirig if there are ay questios or if ayoe has aythig else to add. Special emphasis also is made to ecourage questios from patiets ad family ad the to esure uderstadig of resposes. This ormally is the resposibility of the primary urse. Based o her established relatioship with the patiet ad family, she is aware of their issues ad cocers ad makes certai, usig strategies such as Teach Back, that these have bee addressed. This roudig approach is orgaized, efficiet, ad predictable. For example, collaborative rouds for a patiet with acute leukemia focus o such thigs as determiatio of the appropriate chemotherapy regime, aticipated adir, patiet ad family preferece for maagig aticipated treatmet side effects, ad discharge eeds. Group dialogue through rouds ca idetify various outcomes. I some istaces, rouds idetify that a cosultatio is eeded with a acillary team member, such as a dietitia, spiritual couselor, ad/or pai maagemet specialist. Cliical practice guidelies ad other care stadards are foud to require developmet or revisio at other times. Daily Cliical Rouds by the Uit Educator LVH has a uit-based educator role, termed a patiet care specialist (PCS). The role requires a master s degree i ursig, ad most uits have 1.0 full-time equivalet i the positio. The PCS participates i idetifyig, plaig, ad implemetig educatioal programs withi specialty areas for hospital healthcare providers, patiets, families, ad/or commuity groups. The PCS coducts daily cliical rouds with staff regardig their patiets. The rouds bega because bedside urses expressed a eed for support by a cliical expert to facilitate critical thikig related to their care delivery. As a result, the rouds promote patiet safety, collaboratio of team members, ad quality patiet care. The roudig process fosters a learig eviromet, promotig critical thikig ad patiet care plaig. A more specific focus withi the rouds is to positively impact ursig-sesitive cliical outcomes ad regulatory stadards. The PCSs withi the medical-surgical divisio, workig collaboratively with the Nursig Quality Departmet staff, developed a comprehesive 125-idicator tool to guide the roudig process ad collect data. This template, referred to as the Quality Budle Tool, icludes prioritized cotet i the format of a quality checklist. Examples iclude documetatio of fall ad pressure ulcer assessmet scores ad associated itervetios i the pla of care. The PCS coducts rouds from Moday Friday, with oe urse daily, ad rotates to all shifts. Patiets are selected by the PCS for a variety of reasos, icludig complexity of care, patiet ad family kowledge deficits, high risk for falls ad pressure ulcers, request for follow-up by uit maager, ad the bedside urse s idetified learig eeds. The PCS cosiders the patiet s history, pla of care, ad curret assessmet ad egages the bedside urse through focused questioig to critically thik through the care. For example, a PCS oted a fugal toeail i a febrile ad profoudly eutropeic patiet. She led the urse through discussio to critically examie implicatios of the toeail to the immuocompromised patiet. Followig rouds, the PCS commuicates sigificat fidigs to the etire healthcare team, as well as to patiets ad families. That trasparecy for the eutropeic patiet prompted otificatio to a ifectious disease cosultat ad a podiatry cosultatio. I short, the educator rouds prompt opportuities for improvemet ad risk reductio. Daily Rouds by the Uit Maager All maagers reserve 8 11 am from Moday Friday for resposibilities, icludig patiet ad staff rouds. The goal is to iteract with all patiets ad staff; however, realistically, prioritizatio ofte is ecessary. A orgaizatio-developed survey tool o a electroic tablet is used by the maager to esure questio stadardizatio ad recordig of aswers for data collectio ad follow-up. Patiets are asked evidece-based stadard questios based o prioritized service ad quality issues. Priority topics iclude esurig high reliability for adherece with stadards for hourly patiet rouds, bedside shift report, ad patiet room commuicatio white boards. 656 December 2014 Volume 18, Number 6 Cliical Joural of Ocology Nursig
Implicatios for Practice u Use a compedium of roudig strategies to lik qualitative ad quatitative outcomes. u Be vigilat i reiforcig ad validatig roudig processes withi daily work after achievig iitial successful outcomes. u Stadardize roudig structures ad processes throughout a healthcare settig to reiforce staff ad patiet expectatios. Staff rouds are formal ad require the maager ad staff to meet i a quiet locatio. The purpose is to build relatioships ad be proactive versus reactive. Five stadard questios related to those appearig i the biaual employee satisfactio survey are used: What s goig well? Who are the idividuals that eed to be recogized? Do you have the tools ad equipmet to do your job? Where ca we improve? What else would you like me to kow? Maagers are able to gather iformatio i a costructive way ad i a timely maer. The rouds ehace maager visibility ad commuicate to the employees that their opiios are valued to create the ideal practice eviromet. Because ocology urses are particularly vulerable to compassio fatigue (Perry, 2008), the ocology urse maager pays specific attetio to possible sigs ad symptoms whe roudig with staff. Whe oted, the maager recommeds itervetios to avoid ad/or mitigate compassio fatigue (Reimer, 2013). Ay cocer oted i patiet or staff rouds that relates to quality of care is promptly commuicated to the ivolved ursig staff. The maager the provides educatio ad clarifies expectatios, promotig staff professioal developmet. Positive commets are immediately ad persoally commuicated to the caregiver, ad a commedatio is placed i the employee s file. Quarterly Uit Rouds by Seior Nursig Maagers Members of the seior ursig maagemet team, icludig the chief ursig officer ad the team that oversees multiple patiet care uits, perform rouds o cliical uits at least quarterly but ofte more frequetly. The primary goals are to recogize the work ad dedicatio of the staff related to patiet care ad to ecourage discussio regardig ursig-sesitive quality outcome metrics. The roudig schedule is commuicated prior to the visit. The uit maager ecourages her staff members to be prepared to relate desigated stories that illustrate their professioal practice as well as specific staff achievemets. I tur, the seior leaders recogize ad cogratulate these staff members. The seior maagers are o the uit for 20 30 miutes ad make efforts to greet every caregiver. I additio, every uit has a visibility board displayig the most recet ursigsesitive quality outcomes ad goals as well as the umber of staff recommedatios made durig a desigated week for urse maager staff rouds. Nurse leaders use the visibility boards to stimulate dialogue with staff. The rouds also are a opportuity for uit staff to ask questios of the seior maagemet represetative. Safety Rouds by Seior Executives Seior hospital executives, icludig the patiet safety officer, the seior vice presidet of quality ad safety (a physicia), ad a represetative of the seior hospital executive team (chief executive officer, chief medical officer, ad chief operatig officer), coduct safety rouds throughout the etwork, visitig oe uit per moth. The purpose of the rouds is twofold: to demostrate to frotlie staff that the seior hospital executives care about ad are ivested i the resolutio of their safety cocers, ad for the seior hospital executives to be elighteed about the depth of frotlie staff s cocers, witessig firsthad their passio for patiet ad staff safety. Each roudig sessio icludes frotlie licesed ad olicesed assistive persoel. Scripted questios, based o Istitute for Healthcare Improvemet Idealized Desig Group ad Frakel (2011), are used to facilitate the discussio of safety cocers ad iclude the followig. Have there bee ay ear misses that almost caused patiet harm but did t? (p. 4) Is there aythig we ca do to prevet the ext adverse evet? (p. 5) Executives clearly share their expectatios for ope, hoest discussio at the begiig of the sessio. Their iformal ad relaxed approach helps to create a ope eviromet. The fidigs from the discussio are the etered ito a electroic database for trackig ad evaluatio. All fidigs are shared with the etire seior executive team as well as with the maagers of affected areas, with status reports geerated by the patiet safety officer o a quarterly basis util the issues are resolved. Opportuities for improvemet that are able to be rectified easily are addressed quickly. Some suggestios that require log-rage plaig but were accomplished icluded revisios to uit architecture to promote medicatio safety, trials with wireless telephoes i patiet rooms to elimiate the fall hazard caused by log cords, ad purchase of defibrillators for each area of the cacer ceter. Rate (Per 1,000 Patiet Days) 5 4 3 2 1 0 2009 2010 2011 2012 2013 Fiscal Year Falls Pressure ulcers CAUTIs CAUTI catheter-associated uriary tract ifectio FIGURE 1. 7C Falls, Pressure Ulcers, ad CAUTIs for Fiscal Years 2009 2013 Cliical Joural of Ocology Nursig Volume 18, Number 6 Roudig Strategies for Exemplary Practice 657
100 could be perceived as impacted by the roudig methods. Mea Score 95 90 85 80 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2008 2009 2010 2011 2012 2013 Fiscal Year ad Quarter Q quarter Fidigs Quatitative Outcomes FIGURE 2. 7C Press Gaey Attetio to Special or Persoal Needs, 2008 2013 Note. Data courtesy of Lehigh Valley Health Network. Used with permissio. Quatitative evaluatio of the roudig methods is associated with four distict metrics: ursig-sesitive patiet outcomes ad patiet, employee, ad physicia satisfactio. Hourly patiet rouds ad safety rouds by seior executives were implemeted i their curret form i 2008; all other roudig methods were istituted i 2008 ad 2009. Therefore, metric time frames iclude these years. Amog ursig-sesitive patiet outcomes, treds were idetified for pressure ulcers, falls, ad catheter-associated uriary tract ifectios (CAUTIs). The overall tred for falls ad pressure ulcers decreased from fiscal year (FY) 2009 to 2013. The treds also was true for CAUTIs, except for FY 2013 (see Figure 1). Regardig patiet satisfactio, two specific Press Gaey items were used as metrics: attetio to special or persoal eeds ad adequate precautios to protect safety. Both of these items demostrated a upward tred (see 96 Figures 2 ad 3). Formal employee satisfactio surveys are completed at 94 LVH every two years. Table 3 92 details the 2013 satisfactio scores for questios that could 90 be perceived as associated with the various roudig methodologies. Scores for all ques- 88 tios exceeded the atioal 86 work group ad atioal comparisos of the database used 84 (HealthStream ). The most recet physicia satisfactio survey asked, How satisfied are you with ursig care? Niety-seve percet of Q quarter the staff was either satisfied or very satisfied, which is the 93rd percetile atioally. This score Mea Score Qualitative Outcomes Qualitative outcomes have bee achieved from the rouds. For example, durig the maager s daily rouds, a actively dyig patiet metioed he was frustrated i his usuccessful attempts to access the Iteret from his persoal computer. The maager arraged for a iformatio services techicia to immediately come to the patiet s bedside to troubleshoot the issue. Withi miutes, Iteret access was obtaied. I additio, examples of issues that were idetified ad addressed durig safety rouds by seior executives iclude the followig. Soiled lie bags piled up i the soiled lie storage areas o the weekeds, prevetig door closure. To address this issue, additioal weeked staff was hired to remove soiled lies. Cords i patiet rooms created a fall hazard for patiets, staff, ad guests. The solutio was to order special carabier-type clips placed uder the beds to hold cords off the floor ad away from traffic areas. Staff described difficulty i obtaiig IV pumps ad bed alarms whe eeded. Additioal pumps ad alarms were added to the uit par levels. Challeges ad Recommedatios Challeges ecoutered are associated with chage, maagemet, ad lea theories. First, eve after roudig processes Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 2008 2009 2010 2011 2012 2013 Fiscal Year ad Quarter FIGURE 3. 7C Press Gaey Adequate Precautios to Protect Safety, 2008 2013 Note. Data courtesy of Lehigh Valley Health Network. Used with permissio. 658 December 2014 Volume 18, Number 6 Cliical Joural of Ocology Nursig
TABLE 3. Lehigh Valley Hospital 7C Medical-Surgical Uit Employee Satisfactio Survey Results for 2013 Attribute 2013 Group X Health- Stream TM Compariso Group X Health- Stream TM Research Natioal X Overall satisfactio 3.4 3.03 3.15 Commuicatio: How opely ad hoestly immediate maager commuicates Costructive feedback: Lettig you kow whe ad how your work ca be improved 3.61 3.16 3.2 3.5 3.12 3.18 Persoal recogitio 3.44 2.95 3.07 Uderstadig eeds: How well executive maagemet uderstads eeds of your departmet Commuicatio: How opely ad hoestly executive maagemet commuicates Safe ad secure eviromet 3 2.51 2.66 3.07 2.64 2.77 3.44 3.16 3.26 Note. Data courtesy of Lehigh Valley Health Network. Used with permissio. were established withi the daily work ad achievig successful outcomes, the uit maagemet team must cotiue to be vigilat to reiforce the efforts. For example, the uit experieced periodic icreases i patiet falls ad CAUTIs as well as decreases i patiet satisfactio scores below target goals. As soo as those issues were oted, they were shared with staff to esure trasparecy ad reiforce expectatios, iclusive of roudig, to improve the deficiecies. I the begiig of the project ad o a ogoig basis, staff egagemet must be strategized. Staff champios should be idetified ad promoted, ad staff successes should be celebrated ad rewarded. Staff accoutability to complete hourly patiet rouds ad collaborative rouds is ehaced by commuicatig expectatios to patiets ad families. I additio, processes ca be chaged, particularly to correct somethig that is ot workig. For example, i FY 2011, LVH researchers coducted a ethographic study to examie issues associated with hourly patiet roudig (Deitrick, Baker, Paxto, Flores, & Swavely, 2012). A gap regardig the beefits of hourly roudig was idetified betwee admiistrators ad staff, ad clarity was lackig related to implemetatio of hourly roudig ito the patiet care workflow. The study fidigs prompted redesig of the roudig process i which direct care staff were icluded o the redesig team, educatio ad commuicatio became more robust, ad staff performace was validated usig a stadard checklist. Although lea theory promotes stadardizatio (Shook, 2008), it ca be difficult withi a large orgaizatio. Because LVH is committed to lea priciples, processes have bee stadardized throughout the istitutio for all roudig methods, except iterdiscipliary collaborative rouds. The variatios i these latter rouds are caused by patiet care uit structures, fuctios, ad patiet populatios. For example, a surgical uit may coduct rouds without the primary surgeo because he or she beig i the operatig room durig the time frame that other disciplies ad family members are available. The stadardizatio commuicates to staff, patiets, ad families the commitmet to cosistet expectatios that have prove effective i producig positive outcomes. Implicatios for Nursig Various roudig strategies ca be tied to qualitative ad quatitative outcomes. By stadardizig roudig structures ad processes throughout a healthcare settig, staff ad patiet expectatios are reiforced. However, eve after establishig roudig processes withi daily work ad achievig iitial successful outcomes, cotiuous vigilace is ecessary to reiforce ad validate processes. No sigle chage ca achieve patiet ad staff satisfactio ad exemplary cliical outcomes; istead, multiple roudig methodologies ca assist i goal attaimet. The authors gratefully ackowledge Kim S. Hitchigs, MSN, RN, NEA-BC, for her writig directio ad assistace. Refereces Bourgault, A.M., Kig, M.M., Hart, P., Campbell, M.J., Swartz, S., & Lou, M. (2008). Circle of excellece: Does regular roudig by ursig associates boost patiet satisfactio? Nursig Maagemet, 39(11), 18 24. doi:10.1097/01.numa.0000340814.83152.35 Campbell, D.A., Jr., & Thompso, M. (2007). Patiet safety rouds: Descriptio of a iexpesive but importat strategy to improve the safety culture. America Joural of Medical Quality, 22, 26 33. doi:10.1177/1062860606295619 Culley, T. (2008). Reduce call light frequecy with hourly rouds. Nursig Maagemet, 39(3), 50 52. doi:10.1097/01.numa.00 00313098.19766.d0 Deitrick, L.M., Baker, K., Paxto, H., Flores, M., & Swavely, D. (2012). Hourly roudig: Challeges with implemetatio of a evidece-based process. Joural of Nursig Care Quality, 27, 13 19. doi:10.1097/ncq.0b013e318227d7dd Edwards, C. (2008). Usig iterdiscipliary shared goverace ad patiet rouds to icrease patiet safety. Medsurg Nursig, 17, 255 257. Ford, B.M. (2010). Hourly roudig: A strategy to improve patiet satisfactio scores. Medsurg Nursig, 19, 188 191. Frakel, A., Grillo, S., Pittma, M., Thomas, E.J., Horowitz, L., Page, M., & Sexto, B. (2008). Revealig ad resolvig patiet safety defect: The impact of leadership WalkRouds o frotlie caregiver assessmets of patiet safety. Health Services Research, 43, 2050 2066. doi:10.1111/j.1475-6773.2008.00878.x Garder, G., Woollett, K., Daly, N., & Richardso, B. (2009). Cliical Joural of Ocology Nursig Volume 18, Number 6 Roudig Strategies for Exemplary Practice 659
Measurig the effect of patiet comfort rouds o practice eviromet ad patiet satisfactio: A pilot study. Iteratioal Joural of Nursig Practice, 15, 287 293. doi:10.1111/j.1440-172x.2009.01753.x Istitute for Healthcare Improvemet Idealized Desig Group & Frakel, A. (2011). Patiet safety leadership WalkRouds. Retrieved from http://www.ihi.org/resources/pages/tools/ patietsafetyleadershipwalkrouds.aspx Leighty, J. (2007). Hourly roudig dims call lights: A atiowide study sparks protocol to improve ursig efficiecy ad patiet satisfactio. Nursig Spectrum, 18(25), 8 9. Meade, C., Bursell, A., & Ketelse, L. (2006). Effects of ursig rouds o patiets call light use, satisfactio, ad safety. America Joural of Nursig, 106(9), 58 70. Perry, B. (2008). Why exemplary ocology urses seem to avoid compassio fatigue. Caadia Ocology Nursig Joural, 18(2), 87 99. Reimer, N. (2013). Creatig momets that matter: Strategies to combat compassio fatigue. Cliical Joural of Ocology Nursig, 17, 581 582. doi:10.1188/13.cjon.581-582 Segal, S., & Maso, D.J. (1998). The art ad sciece of teachig rouds: A strategy for staff developmet. Joural for Nurses i Staff Developmet, 14(3), 127 136. Shook, J. (2008). Maagig to lear: Usig the A3 maagemet process to solve problems, gai agreemet, metor ad lead. Cambridge, MA: Lea Eterprise Istitute. Studer, Q., Robiso, B.C., & Cook, K. (2010). The HCAHPS hadbook: Hardwire your hospital for pay-for-performace success. Gulf Breeze, FL: Fire Starter Publishig. Tea, C., Elliso, M., & Feghali, F. (2008). Proactive patiet roudig to icrease customer service ad satisfactio o a orthopaedic uit. Orthopaedic Nursig, 27, 233 240. doi:10.1097/01.nor.0000330305.45361.45 Vazirai, S., Hays, R.D., Shapiro, M.F., & Cowa, M. (2005). Effect of a multidiscipliary itervetio o commuicatio ad collaboratio amog physicias ad urses. America Joural of Critical Care, 14, 71 77. Weisgram, B., & Raymod, S. (2008). Usig evidece-based ursig rouds to improve patiet outcomes. Medsurg Nursig, 17, 429 430. For Further Exploratio Use This Article i Your Next Joural Club Joural club programs ca help to icrease your ability to evaluate the literature ad traslate those research fidigs to cliical practice, educatio, admiistratio, ad research. Use the followig questios to start the discussio at your ext joural club meetig. 1. What is the cliical problem that is addressed i the article? Why is the problem importat to members of the joural club? 2. What were the outcomes or recommedatios for practice, educatio, admiistratio, ad/or research based o the evidece preseted? 3. Which of the recommedatios would you cosider implemetig i your settig? Why or why ot? 4. What would be the ext steps i applyig the iformatio preseted i the article i your settig? Visit http://bit.ly/1vuqbvj for details o creatig ad participatig i a joural club. Photocopyig of this article for discussio purposes is permitted. Wat to Write But Need a Topic? Check Out These Ideas! The CJON Editorial Board has idetified curret gaps i the literature that it hopes to fill. The topics of iterest iclude but are ot limited to the followig. Visit www.cjo.org or cotact pubcjon@os.org for more iformatio. Cacer Comorbid coditios Geomics Itervetioal radiology Late effects Ocologic emergecies Palliative care Prevetio ad early detectio Radiatio therapy Surveillace Survivorship care Surgical itervetios Symptom maagemet Populatios Adolescets ad youg adults Caregivers Geriatrics Health disparities Cultural issues Lesbia, gay, bisexual, ad trasgeder Cacer Care Quality Nurse-sesitive patiet outcomes Patiet-reported outcomes Quality ad evidece-based practice processes Chemotherapy safety Cacer Care Issues Coordiatio of care Commuicatio Trasitios i care Barriers to cacer care Healthcare Systems Models of care Electroic health records Cacer care delivery/cacer programs Costs of cacer care Maagemet ad admiistratio issues Professioal Issues Leadership/empowermet of urses Burout ad compassio fatigue Nurse behaviors Iterprofessioal educatio ad practice Resiliecy Self-care for ocology urses Workforce issues mokeybusiessimages/istock/thikstock 660 December 2014 Volume 18, Number 6 Cliical Joural of Ocology Nursig