Date of Conferral

2018

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Sue Bell

Abstract

The clinical practice problems addressed by the DNP project were the low patient satisfaction scores and the high number of falls on a hospital neurological step-down unit. The purpose of this project was to improve the Hospital Consumer Assessment of Healthcare Providers and Systems score on one patient satisfaction question and decrease the number of patient falls by implementing hourly rounding, using a script related to patient comfort and toileting needs. The scripted questions were expected to increase the satisfaction of patients and decrease unassisted falls due to increased attention to patient pain and positioning and timely help with toileting and retrieving personal items. The project was guided by Rosswurm and Larrabee's change model and facilitated by the plan, do, study, act model for rapid change. The satisfaction scores on the survey question 'I received help as soon as wanted' and the number of falls were compared before and after hourly rounding with scripting was introduced. During the 3 months of the project, the average monthly number of falls increased from 3 to 3.6 and changes in the patient satisfaction score were within upper and lower control limits indicating normal variation in the process. These findings indicated that barriers to the change on the unit need to be examined further and another short-term, rapid change cycle initiated to meet or exceed the national benchmarks for patient satisfaction and falls incidence. The project may inform quality improvement efforts at other hospitals and assist in social change by increasing scripted communication between nursing staff and patients to ensure that patients' needs (pain, positioning, pottying, and proximity of personal items) are addressed during each hourly rounding encounter.

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