Authors (including presenting author) :
Lau FSY
Affiliation :
Department of Medicine & Therapeutics, Prince of Wales Hospital
Introduction :
Daily nurse rounding is important to improve the quality of care and build a safety ward culture for maintaining patient safety in the acute medical wards. The total number of patients are around 50-60 per ward in the acute medicine unit in Prince of Wales Hospital. Number of nursing staff is 4 -5 in day shift and 3 in night shift. Nursing staff to patient ratio is 1:12 – 1:15 in day shift and 1:20 in night shift. Maintaining patient safety is a raising challenge to the front-line-nurses in the acute medical ward. According to the systematic review, the quality of nursing care could be significantly improved through the nurse manager rounding. Therefore, it is expected that the pilot program of structured hand-in-hand nurse round (⼿牽⼿護理監察計劃) by the senior nurse leaders (Ward Manager and Advanced Practice Nurses) could contribute to build a safety culture in a busy acute medicine ward setting. Besides, nursing staff could develop a professional image and improve their satisfaction. A daily hand-in-hand nurse round with the digital rounding report (⼿牽⼿護理監察計劃及⽇常電⼦監察報告) was implemented in the acute medical ward M&T 12B of Prince of Wales Hospital in Hong Kong from April 2023 to October 2024. A qualitative evaluation study was conducted to explore the nurses' perception of the structured Hand-in-hand nurse round on patient safety culture.
Objectives :
Aim : Investigating the effect of nurse leaders’ Hand-in-hand nurse round on patient safety culture in an acute medicine ward setting.
Objective 1 : To explore the nurses’ perception of the structured Hand-in-hand nurse round on patient safety culture.
Objective 2 : To evaluate the effect of structured Hand-in-hand nurse round on the reduction of clinical incidents.
Methodology :
Intervention: A hand-in-hand nurse round (⼿牽⼿護理監察計劃) was implemented in 12B ward at 9:30am -11am daily. Total 4 teams joined the nurse round. Team members were included 1 nurse leader (WM/ APN) and 1 team-nurse. Four aspects and focused outcomes were standardized in the nurse round: staff & patient communication, fall prevention, pressure injury prevention and infection control. The daily nurse rounding report (⽇常電⼦監察報告) was shared in the in-house 12B chat group of the organization internal communication electronic application (HA Chat). Nurse leaders and team nurses could further discuss the advanced practice in the confidential HA chat group. It was the non-experimental design. It was a pilot program with evaluation by a semi-structure interview to evaluate the program detail. Total 22 nursing staff (5 APNs, 17RNs) were interviewed and guided by the interview questions.
Result & Outcome :
From April 2023 to October 2024, 1 WM, 5 APNs , 17 RNs participated in the program.
1. Nursing staffs' perception were generated through the face-to-face interview and qualitative content analysis.
2. Reduction of clinical incidents were presented by the descriptive statistics which comparing the number of incidents between two time points ( 1year before starting the program and 1 year after starting the program) Number of fall incidents and pressure injury was compared between two time points April 2022- March 2023 (1 year before starting the program ) & April 2023- March 2024. Number of fall incidents decreased from 8 to 3. Number of Pressure Injury Incidents from 1 to zero. Number of Catheter related blood stream infections maintained zero.
Conclusion: Hand-in-hand nurse round & digital rounding report led by nurse manager or advanced practice nurses could promote the effective communications, positive safety culture and team spirit, improve staff alertness of patient safety and significant in reduction of the clinical incidents.
