Removing the Technology Barrier When Rounding – Here to Help, Not Hinder

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The inclusion of technology in rounding can be daunting at first glance but a few simple steps can transform you into an iPad all-star. If you keep an open mind and are willing to learn, you will discover that technology is going to save you time and take your rounding to new levels.

 

Incorporating Technology to Increase Patient Satisfaction

People complain that holding an iPad while rounding limits the amount of connection you can have with a patient because it physically divides you. Arguably, it is the same divider as paper. It comes down to the synergy between rounder, roundee, and rounding method. Get the patient involved. When they feel more connected, trust is built, they’ll provide more valuable feedback. You need to be able to balance the patient and the recording tool at the same time to hit optimum efficiency.

 

The largest problem with rounding on paper is that it creates an additional task to complete when you leave the room. When busy nurses finally have the chance to document their rounds, often hours later, they have forgotten what really happened. No one can successfully remember all details of every conversation they had over the course of a hectic day. Not to mention, it is time consuming to go through the rounding information twice by transcribing or uploading it to a digital medium; more work and less time. As my mom always says, follow the O.H.I.O. rule: Only Handle It Once.

 

Strategies for Success

General Rounding Strategies

While not all focused on technology, below are some rounding tips and reminders put together by our resident nurse and customer experience expert, Nikole Wagar RN, MSN, based on her experiences conducting nurse leader rounds in an acute care inpatient trauma one hospital.

 

Courtesy & Respect

Listening Carefully

Understandable Explanations

  • AIDET
  • Managing Up
  • Care Out Loud
  • Hi in the Hallways
  • Nurse Leader Rounding
  • Commit to Sit
  • No Multi-tasking
  • Communication/White Board
  • Purposeful Hourly Rounding
  • Bedside Shift Report
  • Nurse Leader Rounding
  • Hourly Rounding
  • AIDET (Focus on the E)
  • Set realistic expectations
  • Bedside Shift Report
  • Nurse Leader Rounding
  • “Nurse Leader Rounding is a proactive plan to engage, listen to, communicate with, build relationships with, and support patients and their families. It provides a structured mechanism to ensure that quality, safe, and compassionate care is delivered to every patient every time”1
  • Nurse leaders can determine if patients feel listened to and if other strategies implemented are effective. This provides nurse leaders the ability to recognize those who are upholding the standards and to coach those that are not in real time.
  • Rounding can validate if patients have received proper explanations in a way they can understand1

 

Commit to Sit

Don’t look down upon your patients; you are there for them, to help them. Putting yourself at eye level not only make you less intimidating but makes them more comfortable, resulting in a more open conversation. It is also going to be much easier to connect and involve them with the digital rounding technology if you’re on their level. Additionally, it’s proven to influence HCAHPS scores.

 

A partner facility in Florida implemented a new initiative: Commit to Sit. They encouraged all of their rounds to be conducted at patient eye level. One nurse leader found the initiative difficult to accomplish because they did not have enough seating in every patient’s room.  She took it upon herself to buy a small folding stool so she could successfully round on her patients at eye level. With a change as small as sitting while rounding, the hospital could notice an improvement in their HCHAPS scores. Another study found that when nurses sat for five minutes to round on patients their nurse communication scores went from the 9th to the 43rd percentile.2

 

Five Technology Strategies

Below are the five steps to utilizing technology in rounds compiled from proven MyRounding and Studer Group processes.

  1. Anything can be a barrier if you do not know how to use it properly. It comes down to your attitude towards what you are using to round. Confidence is everything when rounding. If you are comfortable with the iPad, then your patients will be too. Use technology as an engaging component instead of a task-based one. Make it your own. Show the patient what you’re doing and that you’re not just texting. Walk them through a question or two while showing them the screen. Use the voice to text feature to repeat back what they say to show that you truly are listening and recording what they have said. The iPad should seem like nothing more than an extension of your hand.
  1. No matter the medium used, set up your rounds purposefully. It is crucial for everyone within your organization or department to understand why you are asking the specific questions within a round. Know the reasons behind every question. What are you trying to measure by asking these questions? What are you hoping to achieve with this metric? Being transparent can help make rounding more meaningful and increase initiative adoption.

    Additionally, it is crucial every rounder becomes comfortable with the question set. It should be used as a guide, not a script, so encourage each rounder to tweak the questions. When you use language that is natural to the way you speak, you will not come across as robotic. Practicing this will also go a long way in helping you to transform the round into a conversation.
  1. Practice – The age-old adage “practice makes perfect” is true. In addition to getting comfortable with the question set, some organizations have found buddy rounding to be a very successful tactic to improve rounding skills. Buddy rounding is when two team members round together. One rounds on the patient, the other evaluates how well the first rounder performed. They review the round in the hallway before switching roles for the next patient. This tactic can help in several areas:
    • Before: To prepare for the round, first review rounding steps and key focus areas via the competency checklist. This is your first opportunity to coach each other.
    • During: The secondary rounder takes notes on observations about the room, rounding style, attitude, patient connection, etc.
    • After: Constructive criticism from your colleague will help call attention to areas of improvement that may go personally unnoticed. It is always helpful to have an outside perspective on what you’re doing well and where you could improve. We recommend providing this feedback in the form of a “constructive complement sandwich:”
      • Start building the sandwich on a positive note with a success you witnessed.
      • Next, ask them to explain an area where you think they could improve. For example, “Tell me about how you explained the plan of care.” Your goal is to lead them to their own solution versus critiquing weaknesses. This is the meat of your sandwich.
      • Top it off with another strength to complete the sandwich.
    • Bonus: Rounders can make improvements to their own rounds based on strengths and weaknesses witnessed during their buddy’s rounds.
  2. AIDET®Acknowledge, Introduce, Duration, Explanation, and Thank – “is a Studer Group communication framework for healthcare professionals to communicate with patients and each other in a way that decreases patient anxiety, increases patient compliance, and improves clinical outcomes.” AIDET is a methodology used to ensure patient anxiety is reduced. 

    When entering a room, set your expectations around who you are (first and last name, and title), why your rounding, how long the round will take, what the process is, and how it will impact them. Imagine you are a patient. How many people come to talk to you throughout your stay? Do you know who they all are and what they are doing? Do you understand every medical procedure that you’re undergoing or why they’re important? It’s easy for medical professionals to forget what it is like to be the patient with all the unknown variables. Setting expectations every time you’re in the room greatly helps reduce stress stemming from uncertainty.

    After setting expectations, sit down next to the patient and make eye contact throughout the round. Refer to our Nurse Leader Rounding Kit for more tips, but this is how we do it:

Knock, knock. <Wait for response> Hi Ms. Smith, my name is Kate Moreland and I am a director here at ABC Hospital. I’ve been with the organization for 12 years now. I check in with our patients every day. We want to make sure you’re receiving the best care. I’d like to take about five minutes to go over how your stay has been and discuss anything else on your mind. Does that sound okay to you? Do you have time?

 

<Pause for response>

 

Great. <Perform round here>

 

Ms. Smith, thank you so much for taking just a couple of minutes to speak with me. It’s really important that I got the opportunity to speak with you. I really appreciate your honest feedback about your stay here at ABC Hospital. I’ll make sure your nurse, Lucy, addresses your concerns about your machines beeping at night. She’s excellent at solving problems. I’ll also pass along your feedback about how wonderful Chris was when inserting your IV.

 

I’ll leave you my business card right next to the phone. Thank you again for your time and feedback, please feel free to reach out if you need anything.

    1. Use technology to benefit you.
      • One healthcare best practice is repeating back what the patient said to make sure you heard them correctly. It also involves them more in the round and gives them another opportunity to elaborate. It’s especially easy to do this using the iPad via the speech to text feature.

        It could look like this, “Your feedback is very important to us. I want to make sure I have understood completely. I’m going to repeat back what you said into the iPad. If I forgot or misinterpreted anything please correct me. We want to make sure to address any concerns or issues you have to improve your quality of stay.”

      • Why spend time on manual analysis if the technology can do it for you? Use technology to your advantage. With an electronic rounding tool, not only do you save time not double documenting round data, you can also use technology to manage issues, give recognition, and report in real-time.

Simple Changes Make a Lasting Impression

Don’t look at technology as a barrier. It is an aid that will provide you with more information to make data-driven decisions. It is here to make your life easier and save you time, and we both know that you could use a few more minutes hours in your day. Committing to even one of the initiatives mentioned in this blog can have greater impact on both your day and the patient experience than you might initially think. Go ahead, give one a try and jump the technology barrier.

 

Sources:

1. Cook, Karen; Kennedy, Bekki; Ketelsen, Lyn. The HCAHPS Handbook: Tactics to Improve Quality and the Patient Experience. Firestarter Publishing. 2014. Print. 

2. Lidgett, Cari D. "Improving the patient experience through a commit to sit service excellence initiative." http://pxjournal.org/journal/vol3/iss2/11/

 

 

Printable Rounding Infographics & How-to Guide Kit

 


 

Author

Kate Moreland

Client Specialist, MyRounding

 

Kate lives in Denver, Colorado where she grew up developing passions for learning, the outdoors, and helping others. As a Client Solutions Specialist for MyRounding, Kate consults with leaders from hundreds of healthcare organizations every month. Kate completed her undergraduate study at Stetson University in DeLand, Florida.