Playing their card right

At Jewish Eldercare Centre, Nurse Donna Koutsandreas makes sure that resident Marcel Scheinfeld is ready to stand and begin using his walker.
At Jewish Eldercare Centre, Nurse Donna Koutsandreas makes sure that resident Marcel Scheinfeld is ready to stand and begin using his walker.

Nursing rounds project enhances patient safety

It’s only been a few months since nursing staff at SAPA long-term care sites were given small laminated cards to carry with them during their shifts reminding them of the “4 P’s” of Purposeful Rounding, but the results so far are telling. In the month of May prior to the cards being introduced, 28 falls were reported on the 4th floor at Jewish Eldercare Centre. By the end of August, the number of falls on that same unit had dropped to six.

Nurses at sites across CIUSSS West-Central Montreal have adopted Purposeful Rounding, a Quality project initiated by the Department of Nursing that introduces a more proactive, systematic approach to hourly rounds. The card serves as a reminder to nurses of residents’ risk factors for falls. At long-term care sites, 200 cards were distributed to nursing staff to have on hand during their shifts. When they enter a resident’s room, they pull out a card that lists the 4 P’s of Purposeful Rounding: Pain, Position, Personal needs and Possessions.

The concept of the 4 P’s was borrowed from existing literature and further developed by the CIUSSS Purposeful Rounding committee, co-chaired by Marineh Carapetian, an Advanced Practice Nurse in Medicine and Jennifer Clarke, a long-term care Advanced Practice Nurse. The idea of placing the 4 P’s on a card was proposed by the SAPA long-term care Fall Prevention committee. The multidisciplinary team, representing professionals from departments including rehab, nursing and social work, wanted to adapt Purposeful Rounding to a long-term care environment.

“In long-term care, unlike in acute care, Purposeful Rounding doesn’t need to be done across the board, but only for certain individuals,” Ms. Clarke points out. “We first needed to identify which residents were at risk for falls, then develop criteria especially for them.”

Purposeful Rounding helps nursing staff tailor their level of care to the needs of each patient and resident. Nurse Vanessa D’Aquila says her patients on the JGH Cardiovascular Unit sense the difference in care with Purposeful Rounding: “When we verify the 4 P’s and ask our patients about them, this may seem repetitive, but it helps our patients to recognize and describe any differences they may be experiencing,” she says. “This is particularly crucial for our cardiac patients who may, for example, suddenly begin feeling chest pain, or have a change in their elimination habits while on fluid restrictions. It also reassures patients, who feel that their nurse is taking the time to efficiently assess their well-being throughout the course of the day.”

The project involving the Purposeful Rounding card in long-term care is undergoing an audit, but Ms. Clarke is encouraged by the reaction so far. “It’s such a good feeling knowing staff appreciate the 4 P’s card, and the impact that Purposeful Rounding has had in improving the quality of life of our users.”