Evidence-Based Practice and Purposeful Rounding: A Chief Nursing Officer’s Perspective
By Edward L. Beard, MSN, RN, NEA-BC
In the recent past, as practice changes have occurred in nursing, we’ve become accustomed to being accountable to the principles of evidence-based practice (EBP). The fundamental steps of the EBP process are being used at Catawba Valley Medical Center (CVMC) and are having a tangible impact on the nursing practice.
One recent program developed using the EBP process is Purposeful Rounding, a nursing practice currently being implemented across all patient care departments at our hospital. Purposeful Rounding involves structured visits by nurses and nursing assistants aimed at assessing and meeting patient needs in a timely fashion. It encourages and allows caregivers to be proactive in anticipating patients needs rather than reactive in responding to requests. Purposeful Rounding directs caregivers to evaluate the “3 Ps” - Pain, Potty, and Positioning (for comfort and a safe environment) – at regular intervals throughout the day and night for their patients.
The decision to begin Purposeful Rounding at our hospital came after a search of relevant literature revealed mounting evidence for improved patient safety and satisfaction as a result of Purposeful Rounding programs. A study, conducted at SacredHeartHospital in Florida (9), reported patient falls were reduced by 33% and hospital-acquired pressure ulcer cases were reduced by 56% on units practicing hourly rounding. Additionally, overall patient satisfaction increased 71 percentile points to the 98th percentile by the second quarter post-baseline.
A pilot project was trialed on our hospital’s telemetry unit, where the patient fall rate decreased from 7.24 to 4.85 and then to 3.53 over a period of 9 months. We also learned that of the total falls that occurred during the trial period, 50% involved toileting at the time the patient incurred a fall. Real-time patient satisfaction surveys of telemetry patients at discharge revealed satisfaction rates on measures related to pain, positioning, items within reach and other needs met or exceeded 80%.
EBP is at times a process of trial and error. Just because the result obtained isn’t necessarily the one expected or even wanted doesn’t mean that a project is a failure. It means that assumptions were incorrect or that unexpected factors have an impact on the situation. This can be just as useful, or even more so, than achieving an expected result, because it provides more insight into the practice intervention associated with specific patient populations. In this case, learning of the high number of falls associated with toileting highlighted the need to reinforce fall prevention strategies with staff, e.g., bed exit alarm and Posey® Sitter Select usage, and the importance of patient education in calling for assistance to the bathroom.
Purposeful Rounding has been based on best evidence and our organization-specific data, and its implementation demonstrates that evidence-based nursing practice is becoming the norm at our hospital. In time, I expect the EBP process – “Assess, Ask, Acquire, Appraise, Apply, Analyze” – will be as automatic in a nurse’s practice as the nursing process – “Assessment, Plan, Intervention, Evaluation” – itself.