A structured approach for patient safety and experience: Enhancing traditional nursing practices with new dimension

Deepa Rani1, Lydia Annie2

1Deputy Nursing Superintendent, Kauvery hospital, Radial Road, Chennai

2Chief Nursing Officer, Kauvery hospital, Radial Road, Chennai

Introduction

Frequent patient rounding in the nursing profession and practice is a structured and comprehensive approach to patient care that is vitally important, and is proved to focus on patient clinical outcomes, improve patient satisfaction, and ensures patient safety.

What are they?

  1. Pain
  2. Platter
  3. Potty
  4. Positioning
  5. Possessions
  6. Pump
  7. Patient education

I. Pain

Pain assessment is done at the time of admission, during hourly rounding by the assigned nurses/ Charge nurses and continued as per patient’s need, and they would need appropriate evaluation, escalation and interventions.

The patient’s physiological signs suggestive of pain, e.g., sweating, tachycardia, pallor, facial grimace or flushed appearance, are noted and observed in detail.

On an hourly basis, a Nurse can assess peripheral IV site, catheter site, drain site, central line site and HD catheter site for pain by assessing signs of infection, and also assess positions that cause discomfort for the patient, Post-surgical/Cath pain and pain associated with disease condition.

Ongoing reinforcement update regarding the patient’s response to pain management therapy by the staff nurses and timely escalation of treating physician will enhance patient satisfaction.

While assessing pain a Nurse can use simple Verbatim: –

Do you have Pain? If yes, then

  • How you rate your pain from 0 to 10?

Following mnemonics can also be used to assess pain:

  1. “PQRSTU,”“OLDCARTES,”
  2. “SOCRATES”
  3. (P- provoke and palliate; Q- quality; R- region and radiation; S- severity; T- time)
  4. O-onset; L-location; D- duration; C- characteristic; A-alleviating & A-aggravating factors; R-radiation or relieving factors; T-timing; and S-severity
  5. S-site, O-onset, C-character, R-radiation, A-associated factors, T-timing, E-exacerbating/relieving factors, and S-severity

II. Platter

Addressing patient’s dietary needs and requirements is also nurse’s primary responsibility, and enables her to tailor the diet plan according to their medical condition. Collaboration between healthcare professionals, including doctors, and dietitians, is essential for providing comprehensive nutritional support.

Planning for dietary needs

  1. Nil per oral
  2. Diabetic diet
  3. Salt restricted diet
  4. Liquid diet
  5. Soft/Normal diet
  6. Neutropenic diet

Asking simple questions will make patients feel better: –

  1. Do you have any allergic to any food like Sea foods, Sardines, milk, eggs, peanuts, tree nuts, fish, shellfish, wheat, and soy
  2. Are you taking any drugs like Warfarin?
  3. Are you satisfied with your food taste?
  4. Do you feel nauseated (during NPO Breaking?)
  5. Are you feeling hungry?

III. Potty or Personal Hygiene

Addressing the personal and safety needs of the patients by assessing their elimination needs and other hygienic needs.

Assessment based on their ability to perform activities of daily living (ADL) and ask them,

  1. Do you need to use washroom?
  2. Do you need water for hand hygiene before and after eating?
  3. Do you need someone to help in grooming?
  4. Do you need me to move anything?
  5. Can you reach everything you need?

III. Positioning

Assessing patients’ need for re-positioning them every 2 hourly based, on skin integrity assessment to prevent pressure injury, also helps in pain management and to make sure safer positioning for post-operative patients with multiple lines and drains, and for vulnerable patients, especially children and the elderly.

Position the elderly immediately after feeds, and patients with compressive stockings., etc.

Ask simple questions to make them feel better

  1. Are you comfortable in this position? If No, then provide assistive devices like extra pillows, wedge pillows etc

IV. Possessions

Assessing and ensuring all needs are within reach of patients and in safer place enhances patient safety and fall prevention.

This includes items like call bell, footstool, urinals, phone, TV remote, and any personal items like a glass of water or tissues.

For children, the elderly, the vulnerable and for patients who are differently abled, make sure that hazardous items are out of reach, and reposition them to enhance safety.

Asking simple questions will make them feel better

  1. Do you need us to move call bell, tissue box, bed remote, TV remote, cardiac table or water jar close to you? If yes, then provide the objects as desired.

V. Pump

To check IV pumps and IV site is crucial for patient safety, as it helps to prevent errors in medication delivery, such as incorrect dosages or blocked IV lines.

  1. Checking during hourly rounds

To ensure that medications are being delivered correctly and that IV sites are functioning properly.

  1. Dose Accuracy

Checking’s pumps prevent accidental overdose or under dose, which can be harmful to the patient.

  1. IV Site Integrity

Regular assessment of IV site helps prevent complications like infiltration, phlebitis, and infection.

  1. Positioning

When a patient changes position, it can affect IV flow and pump functionality, requiring a check.

VI. Patient Education

Education increases patient safety by enhancing shared decision-making and foster a sense of responsibility by encouraging active participation in care.

Patient education

  • On admission- room orientation/facilities available, Insurance and billing process by multi-disciplinary team.
  • Vulnerable policy includes safety call bells, side rails usage, lowering bed and., etc.
  • Time of medication administration, blood transfusion, IV administration, POCT intervention, bowel preparation, before surgery/procedure, close monitoring during high alert drug administration- allergies, etc.
  • Medication reconciliation process, food and drug interaction.

Educating and empowering patient will help to enhance treatment adherence, patient safety, prevention of fall and finally patient satisfaction.

Impact of 7P hourly rounding

Incorporating 7P hourly rounding in nursing helps in:

  1. Early identification of clinical deterioration through early warning signs
  2. Prevention of code blues in timely escalation
  3. Enhanced communication and ensures trust and optimized nursing care
  4. Promotes clinical assessment of patient’s physical, mental and emotional wellbeing
  5. Close monitoring after administration of high alert medications, blood transfusions, chemo drug administration to ensure correct dosage and to monitor adverse reactions/transfusion reactions.
  6. Promotes patient engagement for patient safety by educating patient and family on all needed aspects about diagnosis, current nursing interventions and post discharge care, etc.
  7. Enhances patient experience, satisfaction and outcomes.
  8. Hourly rounding prevents fall and can reduces the use of call bells since need of the patients are proactively addressed.

Conclusion

Nursing rounds with consultant and senior leadership is bound to be a daily practice and where nursing leaders are the one frequently monitored the 360 degree of nursing intervention.7 “P” nursing purposeful rounding is structured process with several key benefits which empowers the assigned nurses to identify and address patient needs effectively to promote patient satisfaction and safety.

References

Nightingale Journals

Kauvery Hospital
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