CAREing for patients one round at a time
When hospital patients need a warm blanket, cold drink, or a hand getting out of bed, their go-to person for help has traditionally been their nurse.
But change is coming to hospital wards across Hamilton Health Sciences (HHS) that will see a wide range of team members pitching in to share the load with nurses when it comes to keeping patients comfortable and safe. Even patients’ support networks, like family and friends who visit them, can be part of this new team-based way of providing patient care.
This proactive approach is called CARE rounding, and a handful of HHS wards including the E4 and F4 surgical and surgical oncology units at Juravinski Hospital (JH) have already introduced it.
With CARE rounding, patients are ringing their call bell less often because their needs are being met early. These rounds also help reduce the number of falls and pressure injuries. And staff are enjoying a stronger sense of teamwork.
CARE rounding 101
CARE stands for Comfort, Activity, Restroom, and Environment, while ‘rounds’ are regularly scheduled visits to inpatients’ bedsides. “CARE rounds are truly an ‘all-hands-on-deck’ approach,” says E4 and F4 clinical manager Helena Adjekum-Persaud, where a team of 170 staff includes nurses, health care aides, social workers, occupational therapists (OTs), physiotherapists (PTs), OT and PT assistants, pharmacy and dietetic staff, clinical externs and business clerks.
The entire team participates in CARE rounds, with everyone pitching in to support patients.
Everyone takes part in CARE rounds, breaking into small groups of four or five to visit patients at their bedside, inquiring about any concerns they have and checking for clutter or hazards like slippers in the middle of the floor that could be tripped over.
“Our patients tell us that they’re happy with this approach, and really appreciate the bedside visits.” — Helena Adjekum-Persaud, clinical manager
These rounds happen twice per 12-hour shift and take 10 to 15 minutes to complete. “With CARE rounds, we have an opportunity to address patient concerns at one time, which I think is making a positive difference for patients and our teams,” says Ryanna Sparks, a JH charge nurse.
Since many patient needs are met during rounds, nurses can focus on the medical side of care, like checking vital signs, changing dressings and giving medications during their regular hourly patient checks. Rounds also give health-care aides more time for tasks like helping patients with dressing, grooming, toileting and medication reminders.
“Our patients tell us that they’re happy with this approach, and really appreciate the bedside visits,” says Adjekum-Persaud.
How can we help?
CARE stands for Comfort, Activity, Restroom, and Environment, while ‘rounds’ are regularly scheduled visits to inpatients’ bedsides.
Typical questions team members ask during CARE rounds include: Can I get you something to drink? Do you need a warm blanket? Are you feeling any pain or discomfort? Can we help you change positions, move into a chair or take a short walk? Do you need a washroom break, and would you like help with this?
They also do a safety check of patient rooms and remove any tripping hazards. “By taking care of patients’ needs in advance, they generally have better outcomes,” says Janny Proba, chief nursing officer for HHS.
Everyone plays a role, based on what the type of care they’re qualified to provide.
Staff also take action when they see a need. For example, they check to make sure patients who are sedated or at end-of-life are comfortable and safe. This could include checking their pain medication and repositioning them to help prevent pressure injuries.
Big picture care
CARE rounds are part of a larger effort across HHS called Care Transformation, which involves creating new and better ways of delivering standard, routine care. Teams choose times that work best for CARE rounds, and also decide the best way to break into smaller groups. For example, they could choose to visit patients in groups of four or five, or work in pairs.
The E4 and F4 team focuses on four key areas during CARE rounds: Comfort, Activity, Restroom, and Environment
“CARE rounding is a great example of putting new, standard ways of delivering care into practice, while also giving teams the flexibility to do this in a way that works best for them,” says Proba, adding that staff are able to meet patients’ needs more seamlessly, with fewer steps. The E4 and F4 units are in an older section of JH, with an inefficient layout and very long hallways. For example, prior to CARE rounds, a nurse could walk 15,000 steps in one shift, going back and forth, because some rooms are so far from the nursing station.
If at first you don’t succeed, try, try again
CARE rounding isn’t a new concept for this JH team. “We tried putting CARE rounds in place multiple times over the past few years but they didn’t last,” says Lauren Longley, a registered dietitian with E4 and F4 for 10 years. “This time, by far, has been the most successful.”
Support from leadership, consistency, a structured format and a shared determination to make CARE rounds work have all contributed to their success this time around.
“CARE rounds have allowed me to build and strengthen relationships, and highlight our role and how our dietetic team can help.” — Lauren Longley, registered dietitian
“We have a ton of engagement from our manager, clinical leader and charge nurses,” says Longley. Team leaders ensure rounds are held twice per shift, at precisely the same times. These leaders also take part in rounds, and expect all team members not dealing with urgent patient matters to join in.
Even staff not involved in direct patient care have roles to play. The team gave clinical manager Helena Adjekum-Persaud this “Water” apron, as a fun way to share that she helps organize water for patients.
Everyone plays a role, based on what the type of care they’re qualified to provide. For example, nurses, physiotherapists and occupational therapists can help patients move from their bed to a chair or the restroom during rounds, while team members who don’t work directly with patients, such as managers and business clerks, take on tasks like handing out glasses of water, fetching warm blankets or tidying up clutter.
Team members can also catch unmet needs during rounds, adds JH dietetic assistant Althea Camposilvan. For example, Camposilvan and Longley meet patients during rounds who would benefit from seeing a dietitian. “We’re laying eyes on these patients,” says Longley. “We can look for physical signs of malnutrition, check meal trays to see if they’re eating, and check to see if they’re taking their supplements.”
Proba adds, “We all have a duty, regardless of our role, to meet our patients’ needs.”
Finding the best fit
The team found that holding rounds at 11 a.m. and 2:45 p.m. for day shifts and 10 p.m. and 5 a.m. for overnight shifts worked best. They also visit in groups of four of five, with two nurses assigned to each group. As CARE rounds roll out across HHS, other teams can choose what times and set-ups work best for them.
Qualified staff members can help patients move from their bed to a chair, or take a short walk during CARE rounds. This gives nurses more time during their regular patient checks to provide medical care, like checking vital signs and changing wound dressings.
“The E4 and F4 nurses visit their own patients during rounds, so they have core knowledge about things like diet orders, medication and mobility, making it faster and easier to help patients,” says charge nurse Cavan Stoddart.
The team has a special focus on encouraging patients to move, since this helps with healing and preventing pressure injuries and post-operative complications. Two-person jobs, like helping turn, wash or move patients, can be done during rounds by staff qualified for such hands-on care. This helps nurses, because they don’t have to search for a second pair of hands for this kind of care when they’re on their own at other times of day or night doing patient checks.
Longley also finds rounds a nice way to get to know her colleagues better – especially the newer team members. “CARE rounds have allowed me to build and strengthen relationships, and highlight our role and how our dietetic team can help,” she says.
