The Rapid Spread model is a fast and effective way of managing change. A trust used the approach to introduce care rounds to its inpatient wards. Part 2 of 2.
Rapid Spread is designed to introduce evidence-based practice in a non-incremental style so that all affected areas implement the changes at the same time.
This article describes how care rounds were introduced to all inpatient wards in a large acute trust using a Rapid Spread approach. It discusses the rationale for, responses to, and the sustainability of, the care round concept.
Citation: Crossfield S et al (2012) Introducing care rounds using Rapid Spread. Nursing Times [online]; 108: 38, 22-23.
Authors: Sue Crossfield is lead nurse, safeguarding adults, but was a senior project nurse at the time of the care round implementation; Carolyn Pitt is lead nurse quality and workforce; both at Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham Foundation Trust.
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The in-house inpatient survey in 2010 at the Queen Elizabeth Hospital in Birmingham showed that inpatients felt they could not always find anyone to allay their worries and fears. This followed a move to a new hospital with 36-bed horseshoe-shaped wards with 40% single side rooms. The unavailability of nurses appeared to be because they had become less visible to all patients as they had been in Nightingale wards. To address this and improve interaction with patients, we introduced hourly care rounds, a form of intentional rounding, to all inpatient wards in early 2011.
Using Rapid Spread
The initiative was undertaken as part of a second wave pilot study with the Department of Health testing the use of Rapid Spread as a way of introducing evidence-based practice on a large scale and fast pace (DH, 2010). The methodology uses the principles of “mass mobilisation” through an immersion event, to support change management, and is discussed in more detail by Stevens and Edwards (2012).
In contrast to the Plan, Do, Study, Act approach (Deming, 2000), Rapid Spread makes change quickly, in all areas, at the same time. Its step-by-step approach begins with the identification of what is required for success and sustainability. Establishing baseline data is essential, an advanced clinical dashboard meant this was available so we could identify outcomes.
Care rounds were launched at the same time that the recording of clinical risk assessments (pressure ulcer, nutrition and falls) was transferred from paper to the electronic patient information communication system (PICS). In addition, in April 2011, the trust adopted the European Wound Management Association (EWMA) pressure ulcer grading system .
How we did it
In line with the Rapid Spread workbook and guidelines, we set up a multidisciplinary project team and the 12-week project began in December 2010. The project team consisted of: two senior nurse implementation leads; lead therapist, dietetics; lead nurse, falls and fracture prevention; lead nurse, older adults; tissue viability nurse; health informatics data management developer; and communications specialist.
We were also assigned a portfolio manager from the DH to provide coaching support to the implementation leads. Because of the potential work commitment, the executive lead (the chief nurse) decided to appoint two project leads to cover any pre-planned absence or work commitments. This proved invaluable over the 12-week project, providing peer support in addition to the benefits of a shared workload.
The immersion event
At the first meeting, we established a date for the immersion event and the launch one month later. Weekly meetings followed for the remainder of the 12 weeks. Working closely with the DH and in line with the Rapid Spread methodology, we prepared for the all-day immersion event, inviting all major stakeholders and change agents including senior ward sisters/charge nurses, heads of therapies and clinical nurse specialists. The chief nurse opened the event, which was the first time those potentially involved received any information about the initiative.
We explained the rationale behind care rounds and how they should be carried out, and offered workshops on nutrition, tissue viability and falls management and prevention. We also surveyed people to determine their understanding of care rounds; the results would help to shape the training. Members of the trust communications team were instrumental in promoting and advertising the launch, preparing a care round toolkit with all documentation - also accessible via the intranet - and delivering posters to wards for when the sisters returned after the event.
A four-week training period followed the immersion event; therapists and clinical nurse specialists ran generic workshops and ward staff were given buddies from the project team, who organised additional local training sessions. The training covered the rationale for and guidance on care rounds, in addition to specialised workshops on nutrition, tissue viability and falls, in preparation for the transfer to electronic recording.
Approximately 700 staff completed training; using a cascade system, they then passed on their knowledge to those who were unable to attend. There was a live countdown to the launch date on the intranet site and care rounds were introduced to all wards.
The benefits of care rounds
Care rounds offer a structured approach to delivering care that renders the workload more manageable, enhancing the patient journey and improving staff satisfaction.
It is a carrot rather than a stick approach, giving staff permission to get to know the person inside the patient. Nurses can combine observational and physical assessment, patient safety and interaction with the opportunity to detect early any signs of deterioration. The aims of the care round are to:
- Ensure interaction occurs with every patient within every hour on every inpatient ward;
- Improve patient safety through observation and timely completion of clinical risk assessments;
- Address the fundamentals of care, promoting proactive care delivery at the bedside;
- Improve documentation/care planning;
- Boost multidisciplinary teamworking.
Care rounds combine all aspects of care required, and a checklist (Fig 1) acts as an aide memoire and provides assurance.
Feedback from staff over the first few months was mixed: areas that embraced the idea felt that “care rounds make us talk to the patient more” and “they really help to structure the care we give”.
Elsewhere, there was some misinterpretation and confusion over care rounds being “something extra to do” or “just a tick list” rather than an opportunity to pre-empt essential care needs, interact with vulnerable patients such as those with dementia or learning disabilities who cannot ask for help, and support patients’ families.
The concept worked best in areas where leadership was strong and the ward sisters believed in the value of care rounds.
Results and sustainability
On reflection and evaluation, members of the project team felt that, depending on the size of the project and the organisation, flexibility over the training period would be useful, allowing longer if required. We also felt that a week of consolidation after the immersion event would be useful. Staff liked everyone being at the same stage and welcomed the short deadlines.
Over the first six months, there was a gradual overall improvement. The PICS system gives us accurate data on the recording of clinical risk assessments; the transfer from a paper to an electronic system and the introduction of care rounds resulted in an apparent substantial increase in assessments being undertaken and referrals to the dietitian and pressure ulcer reporting after adoption of the EWMA grading system, while the number of falls reduced. Patient feedback around being able to allay worries and fears improved continually over the nine months after care rounds were introduced.
A year after the launch, the care round message is continually emphasised in forums and teaching opportunities including induction programmes, student skills sessions and staff development. To reinforce the concept, the logo has been revised as a jigsaw puzzle with the care round as the centre piece and pieces of care fitting in to complete the picture.
- Rapid Spread is a fast and effective way of introducing change
- The method relies on the cascade of information and therefore commitment from initial trainees
- Rapid Spread requires some flexibility of timescales depending on the size of project and the organisation
- Bringing in fast-paced change requires communications and graphics teams
- Ward leadership is vital to ensure multidisciplinary communication and sustainability of the innovation
Deming WE (2000) Out of the Crisis. Cambridge, MA: MIT Press.
Department of Health (2010) Rapid Spread Methodology Workbook, Second Stage Test. Crown Copyright. DH.
Stevens J, Edwards G (2012) Using Rapid Spread to achieve change in practice. Nursing Times; 108: 37, 28-29.
Introducing care rounds using Rapid Spread