Date of Conferral

2017

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Mary T. Verklan

Abstract

The Center for Medicare/Medicaid Services reduced the hospital's reimbursement by $500,000 due to patient care linked to the poor outcomes of marginal fall rates and low patient satisfaction survey scores as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The scores for fiscal years 2013 and 2014 for the medical-surgical unit fluctuated between 40-42.9%, without significant improvement, while the house-wide scores were 63.17%. To address the problem, a quality improvement project (QIP) was implemented. An evidence-based (EB) hourly rounding intervention was initiated following an education program for nursing staff (n=47) tailored to enrich patient communication. The Iowa Evidenced-Based Practice Model that guided the QIP focused on improving patient perceptions of staff responsiveness to call lights, hourly rounding, decreasing patient falls, and increasing the overall HCAHPS score. Random chart audits and participant observations were used to collect data specific to hourly rounding and response to call lights while patient satisfaction and fall data were captured from the facility's HCAHPS survey and balanced scorecard. A descriptive comparative design with scatter plot was used to evaluate the hourly rounding program pre- and post-implementation. The hourly rounding improved from 0% to 79% with an increase in the HCAHPS score from 46% to 78% for 3 consecutive months. The staff responsiveness increased from 46% to 85% and the patient fall rate decreased from 1.2 to 3.8 falls to 0 to 1.4 falls per 1,000 hospital days. The nurse-led EB project was successful in creating positive social change and developing a process to enhance clinical practice through structured staff communication with patients about their care needs.

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