Nurse-Led Continuous Improvement Project Improves Call Light Responsiveness

In 2018, nursing leaders on the bariatric surgery unit on Cleveland Clinic’s main campus realized that their HCAHPS responsiveness scores didn’t consistently meet the national benchmark of 81%, so they launched a continuous improvement project to examine call light responsiveness, decrease the total volume of patient calls and reduce the number of calls that extend beyond five minutes. The project was so successful that the two nurses who led the year-long process are now working on a manuscript to share their findings and intervention strategies.

Nurses collect data to understand the problem

Maya Shamailov, MSN, APRN, AGCNS, PCCN, a clinical nurse specialist, and Suzanne Neal, BSN, RN, CMSRN, a clinical nurse, spearheaded the continuous improvement project under the guidance of Kevin Gazley from Cleveland Clinic’s Continuous Improvement Office.

When nurses began the project in January 2018, the 10-bed bariatric surgery unit’s HCAHPS responsiveness scores were 67.5%. First, Shamailov and Neal tracked the total number of patient calls during a three-month period, as well as the number of calls greater than five minutes. They also sought to learn the reasons why patients pushed their call light buttons. Whenever a patient used the call light, the nursing caregiver or health unit coordinator who responded recorded the reason for the call in a chart kept at the nurses’ station. Neal compiled all data, placing it in a spreadsheet and summarizing the results.

“We found out that 80% of our calls were related to pain, positioning, needing to use the bathroom, IV beeping (alarms) and needing an item,” says Shamailov. “The most common reasons for using a call light were requests that could be addressed in hourly purposeful rounding.” Shamailov and Neal met with nursing caregivers on the unit to share results, discuss barriers to timely response to call lights and generate ideas to improve responsiveness.

Interventions to improve responsiveness

The bariatric surgery unit implemented a multifaceted approach to enhance responsiveness, which included the following:

• Renewed emphasis on purposeful hourly rounding. “Rounding is more than just walking into the patient’s room and asking, ‘Do you need anything?’” says Shamailov. She and Neal created a script for nurses to reinforce asking about the four Ps – pain, position, possessions and potty.
• Addition of a 5th “P” to rounding. Nursing caregivers began proactively addressing issues with IV pumps during rounding.
• Robust use of in-room whiteboards. Enhanced whiteboard content regarding the daily plan of care, the frequency and times of pain medication administration and patient goals, such as ambulation, is now utilized on the unit. Easy access to this information helps reduce call light activation from patients and family members with questions about these issues.
• Designation of a staff lounge for breaks only. Previously, caregivers would frequently use the back room next to the nurses’ station to document during their shifts. The same room was utilized as a staff lounge. Designating that room solely as a staff lounge allowed for uninterrupted breaks for nursing caregivers, increased their visibility on the unit while on duty and helped ensure they saw (and heard) call lights, which are not visible from the room.
• Addition of an employee recognition program. Anyone on the unit can recognize a peer for promoting responsiveness by placing the caregiver’s name on a Post-it® Notes are displayed in the staff lounge on a whiteboard that also includes updated data on call light responsiveness and the unit’s HCAHPS scores. For instance, a PCNA might be thanked for telling a nurse when a patient’s IV bag is low or a nurse might receive kudos for taking a patient to the bathroom. Once a month, the Post-it notes are placed in a drawing for a small giveaway.

“It’s all about teamwork,” says Shamailov. “We want nursing caregivers to work together to address all patient calls proactively and, by doing so, reduce call light activations.”

Bundled interventions yield statistically significant results

Post-intervention data, collected three months after the intervention, and maintenance data, collected in the third quarter of 2018, shows the bundled intervention strategy is working: The number of calls/bariatric patient and calls/unit day significantly decreased over time.

Shamailov attributes the success of the call light responsiveness initiative to the bundling of several interventions. “Even though the individual interventions we deployed were not new, when combined, patient needs were more likely to be met,” she states. “The combination of interventions and the consistency in which nurse caregivers implemented them was the right balance in meeting patients’ responsiveness expectations.”