Response time on medsurg floor

[rtaz315]

Does anyone have any feedback on better response time on a medsurg floor. I have recently been ask to research how to improve response time on a medsurg floor and have been unable to find anything on the net or in journals short of better staffing. The hospital I work for has a ratio of 1 nurseto 6 patients and 1 Aide to 9 patients. That is pretty much the standard for this area so I can't cry over staffing. We do use a Matrix system that does staffing based on number of patients rather than acquity of care. But still in extreme cases they will call someone in. Any suggestions or thoughts, it appears that our lowest scores from an independent company survey was response time for assistance with bedpans and medications not being given when expected by the patient.

[LouisVRN, RN]

Is your manager open to you trying different nursing care models like team nursing? One nurse passes scheduled meds and does assessments, the other takes care of PRN needs of the patients. Sometimes you just have to be willing to try things and see if they work.

[RNperdiem, RN]

Hunting for supplies is a big time waster. I once worked in a 6 patient "pod" that had its own supply cart, linens, computer and phone. It saved me a lot of time since the cart was right outside the patient rooms.

How about the nursing assistants. The numbers sound good. In practice are there that number most times? I would see an absent CNA not get replaced and the floor work short, or the CNA would get pulled to sitter duty, and the floor work short.

Medications. Do a survey of nurses. What percent of the time are all medications available when needed?

This used to drive me crazy when I worked med surg. The patients' meds were kept stocked by pharmacy in locked drawers and way too often there was something missing. Calls to pharmacy are big time drains.

[Scarlette Wings]

just a thought but first i would take a 2-4 week period of time and research the reality of the problem. i would have a log book placed beside the nursing call system. this also helps when there are patient complaints that they called "a hour and a half ago for someone to help me".

when a patient calls have someone write down the time the patient called (a room number works fine) and a reason ie: pain rx, bedpan, meal help, etc. then if it is at all possible create a way the person answering the call can let the desk know, maybe hit the call light again or jot the time on a note pad and then enter it on the desk call log. it really helps protect the nurse/staff if it is one of those constant complainers or one who just flat out lies.

until you can actually see the real problems verses a "i think it's a problem" there needs to be an assessment of what is actually going on. that helps you look for any patterns.

1. are the call wait times really excessive?

2. what is the average wait times? when is the time periods of the longest waits?

3. are you and the nurses doing hourly rounding (say nurses round even hours, aids on odd hours, or something like that) so that patients know there is a finite and definite time they can expect a nurse or caretaker to pop in? patients will wait for a lot of things (some not all) if they know that someone is coming in to check on them regularily.

4. is there a pattern to the times that patients really do have to wait such as during shift change, or meal times, bed care times or during bathing times?

5. if there is a specific time period where patients are really and truly having to wait? meet with your peers and at staff meetings and brainstorm and ask staff what they think can be done to improve it.

can extra hands on the floor during those times help?

6. will rounds just before shift change or just before meal time decrease that?

you kind of need to know if there is a problem and if so when the problem seems the worst before you can try an intervention and then re-evaluate its effectiveness.

by the way, joint commission loves to see that a problem is identified as a patient safety and quality care issue, a plan is worked out and then a follow up evealuation is done so discuss it at staff meeting and somehow make a paper trail or have a way of documenting it. maybe a pi project or something.

hope this helps. good luck.

[rtaz315]

Thanks for the feed back, I will certainly take your suggestions and but them to work the best we can. We have a CIQ them working on this and reporting all evaluations, problems, solutions and suggestions etc. We have had a nurse suggest team nursing but have not tried it. We are also trying to track response time of all staff on the floor to see if one area is better than another etc. This is a project started after comparing our scores with two other hospitals in the surrounding area and considering patient replies to call backs after discharge. Staffing is sufficent most times, in hospital nursing there will always be the times you are short staffed but we pull together to try to make up the shortage. I work with a wonderful bunch of nurses and aides and could not have a better manager but administration would like to see survey numbers go up and set this team up to try to accomplish that. My problem has been finding document models of nursing that seem to work better. Does anyone know of a website or journal that would explain different models for managing medsurg? This would be helpful in having backup or proof that a model works better than what we currently have.