From the first day of training, hospital nurses learn the importance of hourly rounding. With advances in technology, rounding has become an increasingly valuable tool in patient care. When the electronic systems that must work in synchrony at the bedside don’t, nurses’ frustrations often increase. HCA North Texas, comprised of 16 hospitals in Texas and Oklahoma, addressed this frustration head on when the information technology and services department (IT&S) began rounding on nurses. The result: improved satisfaction and productivity among nurses and enhanced patient-centered care.
Developing a Plan
In May 2015, shortly after being named chief nursing executive of HCA North Texas, I was introduced to Leah Miller, our division chief information officer (CIO). I was immediately impressed that Miller genuinely viewed nurses, physicians and patient care staff as customers of the IT&S department. It wasn’t long before we were engaged in developing complementary strategies for our 3-year strategic plan, which included leveraging technology to increase the efficiency of direct-care nurses.
We began with an email survey of med-surg nurses across the division to learn their “pain points” related to IT&S support. Results showed that their frustrations centered on the equipment.
Scanning medications and patient identification bands ensures the “five rights” of medication use during administration, but when these scanners failed or malfunctioned, the nurses often used workarounds. This caused scanning compliance percentages to fall below target. The existing work order system to make repairs to PCs, keyboards and mice was not keeping pace because nurses were simply too busy to even place work orders.
One of the most revealing findings, however, was the stationary placement of the computers in the room. Nurses frequently had to document with their backs to patients, and this created a barrier to the patient experience-not to mention safety concerns.
When Miller read these results, she labeled it “tech fatigue” and took immediate steps to remedy it. She worked with the IT&S team to deploy proactive rounding in the spirit of hourly rounding and Studer Group leader rounds, already under way in our facilities. A partner round, as the CIO describes it, is a form of operational blitz in which every member of the IT staff, from IT nurses to clinical informaticists to clinical analysts to technicians and physician support staff, all round on a unit together to provide proactive problem solving. The activity has included running the latest updates on unit computers to identify items for repair and providing on-the-spot training for staff on various IT systems.
Results and Impact
As a result of partner rounding, the number of work orders received by the IT department, including high-priority patient-related items that could delay care, has dropped by 52%, or 787 fewer instances each month.
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I witnessed the success of the program while visiting a nursing unit at the Medical Center of Arlington, one of our HCA North Texas hospitals. I ran into an IT technician reporting to the nursing unit leader that he had finished checking all medication scanners on the unit.
The teamwork was palpable. Both people expressed their gratitude for each other’s help. Across the division, 3,775 medication scanners have been validated or repaired to ensure good working order as a result of IT&S partner rounds. Scanning compliance has improved to nearly 98%.
In addition, 113 keyboards and 90 computer mice have been replaced, 422 point-of-use supply scanners have been validated, and hundreds of PCs have been checked-all with an eye toward supporting nursing efficiency and effectiveness. This effort on the part of our IT partners allows our nurses to spend more time with their patients.
As a result of listening to our nurses’ voices about improving the patient experience, we are planning to replace stationary computers in patient rooms with those that can swivel, to install state-of-the-art nurse call systems throughout the enterprise, and to create centralized nurse call response centers.
Taking our strategic planning forward and with the support of HCA leaders, the CIO and I have partnered locally on new solutions for electronic capture of vital signs; tracking patient condition changes on electronic monitors centrally located at each nursing station; adding electronic patient communication whiteboards; reducing duplication of electronic documentation; implementing secure texting; and easing IV therapy charting and risk for patient injury assessments.
Patients in HCA North Texas are safer, nurses are happier, efficiency has improved, and both disciplines have a greater understanding of the importance of their contributions. It takes teamwork to create an excellent working environment for nurses and support staff, as well as to ensure a safe environment for patients and their families. We can never overemphasize the value of teamwork at all levels. Partnering-interprofessional collaboration-is a patient safety imperative in today’s increasingly complex, technology-driven patient-care setting.
Carol Gregory is the chief nursing executive for HCA North Texas Division.