Locator System Can Track Hourly Rounding

TON - September 2016, Vol 9, No 5

San Antonio, TX—An electronic locator system worn by nurses proved helpful in measuring purposeful hourly rounding in an inpatient oncology unit. It also helped reduce falls and call bells.

At the Oncology Nursing Society 41st Annual Congress, Laurie Bryant, RN, MSN, OCN, ACNS-BC, described the locator system and its benefit to her 15-bed unit at the Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, Baltimore, MD.

“This is how we used technology to improve an evidence-based practice project for purposeful rounding,” she said.

Ms Bryant and her team evaluated the effect of hourly rounding, with staff wearing locators, on “the 5 Ps”: potty, pain, positioning, possessions, and pumps. Elaborating on these, she explained that 90% of falls are related to toileting, that pain should be controlled, that patients should be positioned comfortably (if they are unable to self-position), that important possessions should be within reach, and that pumps should be checked to prevent nuisance alarms.

The outcome of interest was the impact of hourly rounding on patients’ perception of staff responsiveness—measured by Hospital Consumer Assessment of Healthcare Providers and Systems scores—and on call bell usage and fall rates.

Purposeful rounding also includes customer service in the form of entering the room with a smile, introducing oneself, inquiring about the patient’s condition, and exiting the room with the same type of courtesy. Staff remind patients that someone will see them hourly between 6:00 AM and 10:00 PM, and every 2 hours during the night (without waking sleeping patients). The goal is to reduce calls that are not urgent.

The rounding is performed by clinical technicians (nursing assistants) and unit associates (support staff), with nurses responsible when these individuals are not available.

Transitioning from Paper to Electronic

The hourly rounding documentation began on paper. Nurses completed the form, assessing the 5 Ps and leaving additional comments hourly.

“This didn’t go over well in our electronic world, so this was an uphill battle. We decided quickly this approach was not working for us,” Ms Bryant said. “We asked what else we could do to monitor and track staff to be sure they were rounding hourly.”

The unit was already using locator badges on uniforms to find staff and prevent overhead paging. This became the technology they would use to track the hourly rounds. All staff were given locators to wear at all times.

Pros and Cons of Locator Technology

This technology eliminates the need for manual documentation of hourly rounding. The locator reports the number of visits per room in a 24-hour period, and the amount of time spent in the room (average and maximum per locator, and total number of minutes). The system can also determine whether the rounder is a clinical technician, support staff, or registered nurse.

“I could see how many visits our patients were getting over 24 hours, which, if it’s done appropriately, should be at least 20. When it’s less than this, I troubleshoot and drill down to take a closer look at what’s happening,” Ms Bryant said.

The locator system is not, however, without its downside. It is not possible to track patients temporarily off the unit, and the exact times of transfers. Discharges and admissions are not reported in the system, which requires reconciliation using other data sources. Staff sometimes forget their locators, and temporary or new staff may not be entered into the system. Locators can flip over—interfering with transmission—or break, and batteries can die during a shift. It is also time-consuming to retrieve data, and it is not possible to customize reports, she said.

Outcomes of Call Bells and Falls

Hourly rounding, reinforced by the locator system, had a very positive effect on outcomes. The number of call bells recorded for the unit before the intervention (in June 2013) and approximately 8 months postintervention (in September 2014) declined by 40%, from 3416 to 2063.

“Lately, they’ve been creeping back up, and we will be looking at that,” Ms Bryant added.

Similarly, falls declined from 16 in 2013 to 9 in 2015, a 44% reduction. This year, as of April 2016, “we have had only 1 fall,” she said.

Patient satisfaction was acceptable; in the latest survey, 67% indicated that staff always came promptly in response to a call bell, and 72% indicated staff always helped promptly with toileting.

“We have found our response time to be 3 to 5 minutes. Of course, the patient perceives this as 3 times longer,” she commented.

Ms Bryant and her team are taking steps to reinforce the consistent and correct use of locators.

“We are always educating staff, constantly mentoring, auditing, and tracking our responsiveness. We are getting a newer system, and we’re excited to see what that new system will do for us.”

Related Items


Subscribe Today!

To sign up for our newsletter or print publications, please enter your contact information below.

I'd like to receive: