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The Many Benefits of Strategic Rounds

May 11, 2018
by Amy Stewart, RN, DNS-MT, QCP-MT, RAC-MT
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It’s easy to go through the motions when it comes to rounds, which can seem to gobble up precious time while offering few benefits, especially when competing with the many urgent issues of the day. But with careful observation and assessment, nurse leaders can conduct rounds that lead to strategic interventions, reducing the number of emergencies by identifying problems sooner, and ultimately improving resident outcomes. 

The benefits of rounding are many:  

  • It makes nurse leaders visible and approachable, which builds relationships with staff and residents.
  • It allows nurse leaders to visualize care delivery by seeing the facility from the perspectives of residents and resident families.
  • It helps nurse leaders to identify care delivery areas that are working well and those that need review.
  • It provides an opportunity to informally observe task performance and assess staff competencies, helping to identify educational needs.
  • It enables nurse leaders to acknowledge staff successes on the floor.
  • It encourages staff to be part of the solution to real or potential care delivery issues.

By following the practical approaches to rounding described below, you can maximize what you learn about care delivery and achieve the greatest results.

Observe clinical care closely

Too often, clinical rounds are driven by preparation for survey; rounds become geared to identifying areas where regulations are not being met (for example, looking myopically at sufficient fall risk interventions or pressure ulcer care). It’s crucial to remember that the reasons for conducting clinically focused rounds extend beyond survey. Improving clinical systems improves quality of care and resident outcomes, in turn improving public reporting measures on Nursing Home Compare, which can increase referrals for admissions and the success of the facility.

Clinically focused rounds should identify areas of the care delivery system that need improvement by reviewing standard processes and spot-training staff as needed. They also cultivate a culture of safety by demonstrating to staff that leaders can be approached with concerns and are committed to improving conditions.

Clinical rounds are also a time to interact with staff who are most vulnerable to leaving the organization, including nurses and nurse aides. It is important for the nurse leader to understand what front-line staff members know and do and how their work is impacted by leadership decisions. For example, during rounds a nurse leader might observe that because of a recent policy change, staff must complete an additional hour of paperwork to implement an alarm. The nurse leader learns that this feels so burdensome to staff that they avoid implementing alarms even with residents who may benefit from their short-term use. This could negatively impact the quality of care.

Tune in to resident experience

Time on the floor allows facility leaders to ensure that patient-centered care is being practiced by staff and that resident input is being sought and used to develop care plans. It also helps nurse leaders to get a sense of residents’ experiences, increasing the likelihood that a satisfied resident will recommend the facility’s care and services to others and that a less happy resident will speak to the nurse leader about improvements that could ensure satisfaction. During rounds, nurse leaders can ask residents about how they view the care they are receiving from staff, for example, “Is there a staff member you wish to recognize for high-quality care?”

The purpose of measuring residents’ experiences in the facility is also to ensure that if residents do have concerns, these are addressed to the residents’ satisfaction before discharge. Taking time during rounds to talk with residents demonstrates a commitment to resident-driven care and signals that residents’ opinions matter. Nurse leaders can use the information reported by residents to track issues and look for trends. For example, if four residents indicate that second-shift staff are less responsive to call lights, an in-depth analysis of this concern can be done during that shift.

Keep an eye out for unnecessary expenses and needed upgrades

Financially focused rounding means strategically touring the facility to observe for items that may be contributing to unnecessary expenses as well as potential equipment shortages or upgrade requirements. For example, is there a storage area housing equipment that is being rented but not used? Are special mattresses being rented for extended periods when they could have been bought for less? Could less-frequent dressing changes using higher-quality products cost less over the lifespan of a wound? While making rounds, the nurse leader should be cognizant of equipment and supplies that are older or outdated and may soon require replacement. Planning and budgeting for replacements over time will help lessen the financial burden of replacing a number of items at one time (for example, buying a set number of mattresses per month can be less burdensome than replacing them all at once).

Conclusion

Rounds conducted with a clinical, resident-centered, and financial focus can greatly inform the facility’s quality improvement strategies. Observations obtained during rounds can be brought to morning staff meetings to help pinpoint improvement steps that will impact not only the survey process but also resident and staff satisfaction, quality outcomes, and the facility’s budget. Implementing these types of rounds may seem to take time at first, but in the end they will save nurse leaders time, money, and much more. 

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