Abstracts

Rationale: Transforming Care at the Bedside (TCAB) is a nation-wide research initiative, funded by the Robert Wood Johnson Foundation (RWJ) and supported by the Institute for Health Care Improvement. The overall aim of TCAB is to help hospital based nurses redesign delivery of work processes to improve patient care. Outcomes are assessed through comparison of baseline and ongoing measures including: work environment and culture; patient centeredness; number and types of innovations tested and sustained; and nursing variables that include, but are not limited to, adverse events (drug events, patient falls, and pressure ulcers) Patients admitted to the EMU are at greater risk for falls and injury than the general medical surgical patient population therefore any initiative to enhance an already comprehensive safety protocol for EMU patients is welcomed. Methods: 5W a medical-surgical unit with an integrated EMU embraced the TCAB philosophy in June 2007. As just one TCAB innovation, RN Hourly Rounds specifically pertains to the issues of patient safety and patient satisfaction. A new hourly rounding workflow for RNs was devised and tested quickly. Over a period of time it was adapted using the Plan, Do, Study, Act (PDSA) rapid cycle testing format. This enabled staff to make modifications and refinements in the process during the small tests of change resulting in a smoother transition once the hourly rounds were implemented on the unit as a whole. Results: The unit recently went 28 days without having a patient fall and has only had one fall in 40 days at the time of writing. Nurses subjectively felt that fewer call lights were triggered if they did hourly rounds. This was supported analysing call light data which showed a decrease in call lights post implementation of hourly rounds. Nurses were asked to carry pedometers and it was observed that there was a reduction in the number of steps that nurses took if they did hourly rounds. In keeping with the TCAB approach, small rapid cycle tests of change began in October 2007 in one geographical location of the unit. Nurses were expected to participate in the hourly rounds trial. However, there was initial resistance to the new process from some staff which required a different approach to ensuring the success of the test of change. A small number of advocates for RN hourly rounding were identified and asked to continue testing the new process wherever they worked during November and December 07. After a number of tests and adaptations, hourly rounds was adopted by the unit as a standard of practice on January 17 2008. Conclusions: TCAB is an exciting new approach that is designed to facilitate the enthusiastic engagement and contribution of staff in innovative ideas which have a positive impact on patient care and workflow. RN Hourly Rounds was successfully implemented as a result of utilizing the ideas and tools within the TCAB methodology and framework. As safety is a paramount concern for patients on our EMU, the introduction of RN Hourly Rounds serves as an enhancement to existing safety protocols that are already in place.