Rounding: A Way to Improve Staff

Awareness of Foley Process

AIM Improve staff understanding: Foley indications Foley removal when no longer

needed

Rounds by CEO and IP• Implemented a couple of years ago

– Central lines, MDRO’s– Checklist– Reward

• Visit a nursing area each month• Ask staff questions related to above

process• March 2012-Suggested to change focus

to foley catheters, general information

What did we notice during rounds?• Staff could answer

questions about the care of a foley

• Staff couldn’t consistently answer questions about our hospital indications for inserting a foley

• Staff didn’t seem to understand the importance of asking the physician each day if they could take the foley out

• What did staff notice?– Support of the CEO

for our process– CEO asked

questions during the rounds

Expanded Rounds• April 2012, CNO

joined foley rounds• Monthly rounds• Staff can “feel” the

presence/support from administration for our foley process

• May 2012 implemented weekly ACNO and IP rounds in all nursing areas

• More direct rounds-one on one

• Nurse leaders

Nursing area

Knows foley indication

Appropriate indication

Did nurse ask or plans to ask if foley can be d/c today

Pt has indication for long term foley

2, 3, 4, 4E, 5, ICU E, ICU W, CCU , Rehab

YES NO YES NO YES NO YES NA

2, 3, 4, 4E, 5, ICU E, ICU W, CCU , Rehab

YES NO YES NO YES NO YES NA

2, 3, 4, 4E, 5, ICU E, ICU W, CCU , Rehab

YES NO YES NO YES NO YES NA

Foley Catheter Rounding Data Date:_______________

Are the rounds making a difference?

YES!!!! Staff are beginning to verbalize the

indications to us and to each other Staff are starting to be more

comfortable asking physicians if the foley can be discontinued

Culture is starting to change Increased

engagement/excitement by nursing staff

Nurse Engagement/ExcitementRounds a couple of weeks ago:• Nurse couldn’t tell us the real indication for the

foley• Nurse had not discussed the foley with the

physician

Rounds last week:Same nurse

• Engaged nurse• Excited nurse

What have we gained from rounding?– Increase knowledge by our staff about foley

insertions for right reasons and removed when no longer needed (measuring in process)

– Decrease in CAUTI in one area that had recently had an increase

– HEN program unit• Zero since early January

– Incidental gain from rounding:– A couple of processes will be reviewed to assure best practice

is in place– Discovered that we an opportunity to review our stock of

catheters