The HCAHPS survey asks about the measure of responsiveness in a very specific way. It doesn’t ask about responsiveness as it relates to how food trays are delivered, how medications are handled or how transportation is provided throughout the hospital. The HCAHPS survey asks about responsiveness in two specific areas:
How responsive you were to call lights, and how responsive you were to toileting needs.
It’s important to remember that the HCAHPS survey asks for answers on a range from “never” or “always.” That means consistency: every patient, every time.
Call lights are one of the most ubiquitous and common experiences of any patient. Every patient has a button in their room that is not only a way that they can ask a question, but sometimes it’s their only link to help. It’s the only way that they can reach outside their room, especially if they must stay in bed. Problems arise when there is a disconnect between how important the call light is to a patient, as opposed to how important it is to staff. A survey recently showed that half of nurses believe that call lights are not related to patient safety, and another half of nurses believe that call lights just get in the way and are a distraction. That’s a big disconnect between how important those call lights are to patients and how important they are to staff. There are some specific tactics that can be used to address the issue and improve the patient experience.
THE FIVE-FOOT RULE
The five-foot rule basically says that if a call light goes off in a nurses’ station, anyone within five feet of the call center is required to answer. If you want to take it to the next level, go into that patient’s room and have a personal interaction with them.
NO PASS ZONE
A no pass-zone means that any staff member-any transporter, any environmental services staff, any facilities employee, anyone walking by a room when that call light is going off-cannot pass the room. They have to stop and at least ask the question, “Can I get your nurse? Do you need anything right now?” Let the patient know that you are responding to their needs.
The keyword here is regular. If patients can rely on staff members to round on patients at predetermined intervals, you will begin to foster a trusting relationship. If a patient knows that they don’t have to get up to ask a question or to get something that’s in their room because in the next 30 minutes you’re going to be there anyway, you’ve created trust and a safer environment.
Like the issue of call lights, toileting is something that every patient experiences. Being in a hospital bed ties toileting to many other issues and concerns. One of the biggest concerns is safety. Eighty percent of falls happen in a patient’s room, and over half of those falls are toileting related. To address these concerns, some of the same tactics used with call lights, such as the five-foot rule and no pass zones, can be implemented. With toileting, there are a couple of areas where extra emphasis can also be used to make a difference.
BEDSIDE SHIFT REPORTS
When the bedside shift report happens between an oncoming nurse and off going nurse, try to avoid asking yes or no questions regarding toileting. A real conversation needs to occur regarding the toileting process, and if the patient needs any extra help.
Once again, establish regular rounding times so the patient expects staff to arrive at set intervals. This will build confidence for the patient to wait for staff to arrive, rather than trying to do it on their own. Call lights can still be used for more emergent needs, but if the patient trusts you to come in regularly then you will have created a safe toileting environment.
If you implement one tactic to improve responsiveness scores for HCAHPS it should be to make regular rounding a skill. Determine intervals that are good for your staff and patient population. Whether you choose to round every hour or every 90 minutes, the key is to keep it consistent where the patient trusts you to come in at that regular time.