Patient-centered Care: Part II

October 23, 2008

Bedside report is only one component of patient-centered care. The other two components are hourly rounding and patient care teams that include safety huddles.

Part one of "Patient-centered Care" dealt with the difficulties that arise when trying to implement bedside reporting. We’re on the right track but just not quite there yet.

Bedside report is only one component of patient-centered care, however. The other two components are hourly rounding and patient care teams that include safety huddles. The idea behind the concept of care teams with safety huddles is that instead of just knowing about your own set of patients, two to three nurses and patient care assistants are teamed together to work as back up for each other. One nurse is still primarily responsible for the patients assigned to him or her. It is that nurse’s responsibility to complete the assessments, administer medications, and carry out procedures. But when you work in care teams, there are other people who can assist in things like turning patients, completing vital signs and other like tasks. After each nurse has finished receiving report (at the bedside of course) and assessed their patients a safety huddle ensues. Each member of the care team gives a brief overview of their patient and what the main issues are for that patient. In particular fall status and skin care issues are addressed. The patients that are identified as higher risk are then known by more than just the nurse caring for them.

During the safety huddles, the hourly rounding can also be addressed and assigned to different members of the care team. The concept of hourly rounding is not new. We all learned in our very first nursing classes that you need to check on your patients at least hourly. But somehow with the higher acuity of patients and increase in nurse patient ratios, that seems to have fallen by the wayside in many instances. Hourly rounding has been the only thing that has shown to improve patients fall rates and decrease skin breakdown. In addition, hourly rounding has shown to decrease the number of call lights and takes much less of the nurses time when they are faced with higher acuity patients. John Leighty in his discussion of this at http://include.nurse.com/apps/pbcs.dll/article?AID=200661228023 speaks of 27 nursing units in 14 hospitals across the country that show how consistently checking on patient needs reduces monthly call-light use by 38%, patient falls by 50%, and skin breakdowns by 14%, while satisfaction scores move upward. The patient is assessed for pain, bathroom and skin. It’s not a secret that most falls in hospitals happen on the way to or from the bathroom. Patients don’t want to bother the care givers or simply think they are stronger than they are. So they try to go on their own and the next thing we know, we have a fall. These studies mentioned earlier though, show that if a patient is consistently asked if they need to get up to the bathroom, those falls decrease. Patients who know that someone will be in within the hour will wait until someone comes rather than trying to make it on their own. Finally, checking a patient for pressure areas, turning them every two hours and assessing the need for further skin interventions while on rounds, has shown to decrease skin breakdown. The added bonus for care givers is that, contrary to what is believed, completing hourly rounds does indeed save time for the nurse. Again, if a patient knows that someone will be there within the hour to check on them, they are more likely to wait until that occurs than to put on their call light and ask for something. This allows a more structured use of the nurse’s time and decreases interruptions for them.

None of these are new concepts. Many of them are interventions that simply stopped happening. With the advent of the hospital report cards and the ability for any person to inquire about the fall rate or the skin breakdown rate, more and more hospitals are trying to find creative ways to increase patient safety, increase patient satisfaction and increase staff satisfaction. Patient-centered care seems to address all of these issues. There will be barriers and we all know that change is difficult. But we also know that these interventions work and if we can struggle through the growing pains, we are sure to see positive results with the implementation of patient-centered care.