10 Exemplars 235
and 12 expert opinion or quality improvement articles. Two were not applicable to
the search. All the evidence appraised was given a high- or good-quality rating. The
majority of the evidence reviewed focused on two outcomes: reducing patient use of
call bells and increasing patient satisfaction. Fourteen studies measured call bell use.
Eleven of those found a reduction in call bell use, and three found no change in call
bell use.
Of the 17 articles on increasing patient satisfaction, 13 found an improvement in
patient satisfaction scores, and 4 found no change. The evidence review suggests that
additional studies measuring nurse satisfaction and patient pain levels are needed.
Translation
Using the literature as a guide, we planned to conduct rounds every hour from 0600
to 2200 and every two hours overnight using 5 Ps interventions. The literature used
4 Ps: Pain, Potty, Position, and Possessions. We added the fifth P, for pumps, because
of the number of pump alarms on our inpatient oncology unit. Initially, we imple-
mented a rounding checklist based on samples from the literature; however, we
experienced low compliance and discovered existing technology that we could use
to monitor hourly rounds. The clinical staff were educated about the benefits and
implementation plan for hourly rounding at staff meetings. Upon admission to the
oncology unit, patients and caregivers were informed about the rounding project us-
ing handouts and room signage that explained the 5 Ps: Pain is managed, Position is
comfortable, Potty needs are met, Possessions are in reach, and Pumps (IV) are not
beeping.
Summary
A high level of adherence with this practice change was achieved by monitoring the
practice of purposeful hourly rounds, which included continued education of all
staff and giving feedback about compliance; and also surveillance of call bell and fall
rates and quarterly HCAHPS scores. Post-implementation call bell rates fell 40%,
and fall rates decreased 44%. Patient satisfaction scores for staff responsiveness to
toileting improved from 50% “always responsive” to 67%; and responsiveness to
call bell, from 66% “always responsive” to 73%. Future goals include involving the
patient in the PHR process and using an upgraded staff locator system and call bell
technology to monitor compliance.
