Increasing the Reliability of Safety Checks Performed by Direct Care Staff in a Locked Medical-Psych Unit

Esperanza Alfaro


Problem: Research has demonstrated that healthcare settings that employ diverse rounding methods positively impact a wide variety of quality and safety outcomes in addition to patient and staff satisfaction. Unfortunately, in the Medical-Psych Unit (MPU) of the project site hospital, rounding processes showed workflow noncompliance.

Context: The project site MPU is an 18-bed unit that provides care to acutely ill adult patients with a wide variety of medical issues and who are concurrently psychiatrically unstable. Staff rounding on patients is an imperative workflow to patient health and safety outcomes and patient satisfaction. The MPU has not been meeting rounding compliance expectations. The improvement project described in this paper focused on improving the MPU’s electronic rounding tool reliability and outcomes.

Interventions: The project interventions consisted of establishing unit awareness of the issue, addressing ObservSmart, the electronic tool, usage and compliance issues, and engaging unit management via team inclusion and regular project updates.

Measures: Project metrics were developed to deliver outcome, process, and balancing measures. The outcome measure was set as charting adherence in ObservSmart by both MHWs and RNs. The process measure was set as forced or manual entries in ObservSmart. Balancing measures for this project were staff who could not use or who refuse to use ObservSmart, increase in patient falls or injuries (suicides, assaults, self-harm practices), and a decrease in patient satisfaction scores as captured in MPU HCAHPS scores.

Results: Three main plan-do-study-act (PDSAs) were implemented during the first three months of the nine-month project, which produced positive and steady progress toward measure goals. Unfortunately, project progress decreased as the COVID pandemic and other unit challenges evolved.

Conclusions: Initial project results showed positive and steady progress toward project goals. Unfortunately, project progress decreased as a result of the COVID pandemic and additional unit challenges. Despite project difficulties, this paper’s findings support the evidence base of complete and effective rounding practices.

Keywords: Noncompliance, nonadherence, rounding, forced entries, ObservSmart