In conjunction with the rounding improvement effort, the organization implemented a standard call light system across its departments in 2005. The Zettler Sentinel system, from SimplexGrinnell, replaced multiple call systems, says Christian Harrocks, senior systems engineer. With the call light system, patients could summon nurses to the bedside by pushing a button at the head of the bed, or pulling a cord. Some messages, such as the need for pain meds or bathroom assistance, could be routed electronically to an ASCOM phone nurses carried. In that scenario, the patient used the system to alert the unit secretary at a central desk, who in turn, would manually enter data into the software to send out an alert via the phone.
The call light system has a nursing presence button built into a wall panel, which nurses could push when they entered the room. That in turn would turn on a light display outside the room. That capacity was primarily used as a means of cancelling a service call-if a patient request went out, the nurse would enter the room, hit the presence button, and in turn, let the unit secretary know the call request was fulfilled. But nurses did not use the presence button as part of their routine process-when they entered the room they documented on the paper form.
That form, however, was not popular with nursing staff, acknowledges John Schooley, R.N., assistant vice president of patient care services. He learned that during a series of quality improvement meetings conducted in Jan. 2010, in which the cornerstone of the nursing rounding program-the eight behaviors of hourly rounding identified by the Studer Group-was reviewed (see box). "The staff was not fond of paper tracking," Schooley says. "The paper idea was driving them nuts." Carolinas Medical Center had mandated that nurses document their presence, "but it was a hassle and not as accurate as you like," Schooley adds.
Technology investigation
Shortly thereafter, Slagter began investigating ways to use technology to replace the hourly rounding paper form. "We wanted to improve the process," she says. And as Schooley points out, if nurses forgot to document every time they entered a room, or if nurses did not return to a room within the prescribed timeframe, it was understandable. "Nurses are very busy," Schooley says. "It is easy to forget and have one or two hours go by. The goal of our hourly rounding technology project was to improve quality and also provide an accountability tool."
In early 2010, Slagter conferred with Harrocks, the senior systems engineer, about streamlining the documentation effort. Harrocks determined that the call light messaging system-used to summon nurses intermittently and log completion of service calls-could also automate a service request message. In essence, the system could be modified to send out messages to nurses on a regular basis when their presence in the room was due. And when nurses punched the presence button, the system could record and track that data. Rather than relying on nurses to remember when they were due to check in on a patient, the system could send them a text alert via the ASCOM phone. "Our call light system was a largely untapped resource," Schooley observes, adding that the system covers about 450 beds in the hospital. It's not deployed in critical care, where nurses are at the bedside more frequently nor in the pediatric area, where falls are not an issue, he explains.
Adapting the system to generate time-based alerts was not very difficult, Harrocks attests. "Turning it on was simple," he says. "The biggest hurdle was to create a nursing process and train nurses how to use the system properly." Slagter spearheaded the training effort, demonstrating the new system in training sessions and educating unit secretaries throughout May of 2010. Unit secretaries update the system with the appropriate phone numbers when shifts change and the phones are assigned, Harrocks says. The system went live the following month, with few hitches and little resistance-the staff welcomed the introduction of technology to replace the dreaded paper form, Schooley says.
Four-step process
Nurses now use to document their presence in a straightforward, four-step process. Here is a summary, excerpted from Carolinas Medical Center's winning contest entry:
* Step 1: The intercom piece of the call light system located on the wall behind each patient's bed has two buttons available to indicate nursing presence. The RN button is green and the Nursing Assistant (AIDE) button is yellow.
* Step 2: When either of these two buttons is pressed one time, the appropriate light will illuminate on the wall display and outside the patient's room above the door frame indicating nursing presence. When pressed again these lights turn off indicating departure. Both these times (along with the date) are recorded in the system (which is measured in seconds) and transferred into the call light report log. Touching the button in this manner does not trigger the call bell at the nursing station.
* Step 3: If nursing presence is not identified every hour, an hourly reminder ("check on patient" alert) is sent to the ASCOM phone of the R.N. assigned to the patient. This reminder alert is also recorded within the system and transferred into the call light report log.
* Step 4: A reminder alert will continue to be sent to the R.N.'s phone, and if no presence is indicated within 15 minutes, an alert message is sent to the Charge Nurse's ASCOM phone for action.
