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ADVANCE Perspective: Nurses

Hourly Rounding Improves Patient Care

Published April 15, 2014 7:46 AM by Guest Blogger

By Lauren Petrillo, MSN, RN-BC

As nurses, we are charged with the responsibility of ensuring patient safety and improving patient satisfaction. Although at first it may seem like another task to add to the list, hourly rounding can help us achieve these goals while also organizing our workflow. Hourly rounding, or checking on the patient at regular intervals to assess the 4 P’s- pain, position, potty and proximity of personal items, does not have to be done by the RN alone. Sharing the responsibility with the CNA is a good way to avoid becoming overwhelmed. For example, RNs can check on the patients on even hours and CNAs on odd hours (Halm, 2009).

Hourly rounding has been shown to decrease call bell usage, improve patient satisfaction and decrease falls rates (Olrich, Kalman & Nigolian, 212). These are three things that nurses are always striving to do! By planning ahead and performing hourly rounds while clustering tasks such as pain assessments and medication administration, nurses can achieve goals while organizing their workflow and becoming more efficient with time spent in patient rooms. When the patient knows when to expect someone back in his/her room, he/she is less likely to press the call bell, thus limiting interruptions to the nurse’s workflow.

Hourly rounding is a multidisciplinary action which can help improve the patient experience. By assessing patient needs on regular intervals, the patient is more satisfied, less likely to call and less likely to fall. In my institution, we hold each other accountable for performing hourly rounds by having a sheet in each room where the staff member making rounds on that patient can initial in the space next to the corresponding hour. We hold each other accountable by reminding each other to make rounds and passing along messages regarding patient needs discovered during rounds to the appropriate staff members. Making this a shared responsibility helps improve teamwork and benefits everyone.

Lauren Petrillo s a senior staff nurse at New York-Presbyterian/Weill Cornell Medical Center, New York City.

References
Halm, M. A. (2009). Hourly Rounds: What Does the Evidence Indicate? Am J Crit Care,18, 581-584.
Olrich, T., Kalman, M., & Nigolian, C. (2012). Hourly Rounding: A Replication Study. MESURG Nursing, 21(1), 23-36.


 

14 comments

I understand the comments and complaints from both sides.  I see it everyday in the clinical setting.  I appreciate that the nurses of FL are overworked... I notice that the comments that are from FL nurses show that they cannot meet the demands of the staffing/acuity of their patient loads.  Most other positive comments are those from other states, hence they may have different staffing levels and patient acuity.

As an Instructor, I teach hourly rounding and charting as you go, therefore no charting left undone at the end of a shift.  But, in the real world, there aren't computers in each patient room, or a C.O.W. available.  So, one must either chart or round...!

We do round on our patients regularly, just some get more time and attention than do others. Thanks for the blog and information nurses.

Dawn, Education - RN, CTC June 7, 2014 1:10 AM
Port Charlotte FL

We challenged all the Nurses on our management team, including nurse managers, our unit manager, her boss, and the educator to do our job with "Hourly rounding" on our busy hospital unit for a 12 hour shift for one full day. With only necessary guidance from us, they could barely keep up with the basic routine. By the end of the shift, no one had any breaks, including no lunch. No assessments were fully charted. The 9:00 am meds were still being given at 11:00 am. The regular RN floor staff stepped in and did all the medications for the remainder of the shift to avoid lateness. There were 11 discharges and 13 admissions. The management staff were running in circles. They had difficulty keeping up with patient needs and priorities, MD rounds, orders and calls, family members calling and conversations, admitting and discharging. Not once did the management staff have time to do "intentional" hourly rounding. It was quite a day and I will never forget the look on their faces. It was a huge "eye opener" for everyone. Even an experienced, organized Nurse with great time management skills cannot do hourly rounding as planned. As the management team found out... If they want hourly rounding, then major changes need to be made. After this day... they have a NEW respect for us. I challenge other hospitals to try this and bring back their experience and data to those upper management micromanagers!!!

Christina, PCU - RN May 29, 2014 11:54 PM
Orlando FL

Doing hourly rounds was usually obtained few years back and without thought or "checked off on a paper" for managements proof. Although back in those days we were appropriately staffed! Today's nursing is on a strict budget that CAN'T afford good care! No techs, No unit secretary, & higher nurse/pt ratio. By the time I do my vitals, give all meds, enter all orders, walk out my discharges, deliver AND pick up meal trays, round with Drs, start IVs on new pts/restart those that went bad, answer phones and call lights- etc... The 12 hrs are up and I haven't charted on most of what I have done, forgot lunch or any break, and still haven't gone to the bathroom! And now they want us out on time and make sure we remember to check off we entered all our pts rooms each hour-- I am still praying I didn't forget a pts med or a pt itself!  I don't have any good remedies, but I think less LAZY/useless chiefs and more hard working Indians would help.

Debbie, Pediatric - RN May 29, 2014 5:20 PM
Pensacola FL

Hourly rounding is an essential component to excellent patient care. I work 7p-7a on an extremely busy telemetry-med/surg unit and I have found that when myself or my CNA round on patients every hour it cuts down on call bell usage a lot. With that said, you will always have exceptions to that because we are always going to have patients and/or their families that need us more, and to them they/or their family member is our only patient. As frustrating as that can be at times, I sure would hate to think I couldn't take a deep breath and try my best to make them feel that I have a few extra minutes for them. On nights when I am blessed with a light patient load (4-5 pts) it is easier, and I do struggle with a heavier assignment, but good CNAs and the help of my fellow nurses make it possible. I had the unfortunate chance to be on the other side of the bed recently when my mother had to have a CABG and two stents placed. Let me just tell you, I expected and received the best care for my mother, so I try to provide that for my patients and their families. Hourly rounding is a positive mind-set and just comes down to good time management and means the world to your patients and their families.

Michelle, Tele/Med/Surg - RN, Hospital May 27, 2014 7:03 AM
Farmville VA

In today's world in  the nursing profession it is virtually near impossible to monitor patients on an hourly basis unless you are like me and work in crisis intervention on an individual basis..I am able to monitor my patient's condition hourly as I sit by the bedside and observe for symptoms and any change in status..On a hospital floor at any given time, nurses are up to their necks in assessments, documentations, admissions and discharging patients not including calling for new orders, administering medications and other interventions within a 8 to 12 hour period.

sonia, Nursing - RN, Home Health April 29, 2014 8:39 PM
Hollywood FL

The article sounds nice, but is impossible on the units I work on with 5-6 patients with high needs ranging from explaining to families type of care their loved one is receiving, calling physicians for orders, phone calls from families and hospital staff regarding patients, and on the list goes. There is also explaining medications, and contending with the computer...scanning medications, computer issues, ect...I think it is time management take a look at the patient/nurse ratio. It is very difficult to perform hourly rounding on 5-6 patients on any day...and some are patients with congestive heart failure, renal failure, COPD, long term care patients with multiple issues...all requiring a lot of care.

Annette, PCU/MS - RN April 28, 2014 7:09 PM
Tampa FL

This makes me feel like I am back in my Masters program with the University of Phoenix.

Hourly rounding has been around forever, we have been practicing this unofficially since Flo's days, what makes it a bitter pill to swallow is some executive has made some big bucks marketing the positive results of nursing's hard work. I can not say I disagree with the concept, but micromanaging the process is where staff rebellion begins and the concept unravels. Hourly rounding is great when you don't have admissions and discharges. You sequentially see your patients give your meds do your treatments life is good. The you have a patient that goes bad, or an admit or another interruption and the well laid plans of hourly rounding go down the drain. Administration needs to know we try and appreciate our efforts for trying, the less nursing is beat up about this the more successful hourly rounding will become.

Susan, Surgical unit - Team Leader, Acute care April 27, 2014 8:49 PM
MA

This is all very nice, but in many facilities, they are not staffed well enough to allow for this.

Mary April 26, 2014 6:25 PM

I work 7p-7a in an ED that sees about 160 patient visits a day on average. Of course some days are more and some are less. Each nurse has 4 rooms assigned with a hall bed. On my shift, during an average to busy night, I can easily have 5 patients for at least 6-8 hrs of my shift. There is not enough time in an hr to round on my pt's. I usually get 2-3 pts that demand most of my time. The other 2 pt's I may rarely see. If I am working with a tech that is engaged in his/her job the pt's will get seen by the tech. If I am working with a tech that would rather facebook using his Iphone at work my pts will not get seen.  I would love to see my pt's every hr but it just isn't realistic. Less pt's per nurse would solve the problem but that isn't an option in todays world.

Debra, ED - RN April 26, 2014 5:18 PM
IL

I read the above blog and all of the 4 comments that followed. I was not suprised to find that at least 3, if not 4, of the comments are written by those who do not work "the floor" of a busy hospital unit. I mean 12 plus hours of a demanding, high energy, fast paced surgical unit. On our unit, you can get up to a total of 10 acute care surgical patients in one shift. We have a high turnover of nurses, who leave because of the additional stress that today's nurse has to endure. Years ago, things were more simple. Now, hourly rounding is virtually impossible. Management demands hourly rounding, but they can't do it themselves when given the challenge. This is NOT the answer to better patient safety, satisfaction, and decrease in falls. Nor does it decrease call bell use on our unit. If management would listen to patients and their nurses, patients would remain safe and satisfied. Nurses LOVE to be with their patient's, but the art of nursing has been taken away. We are forced to the Doctor's jobs now and multitask more than ever before. Nurse's are multidisciplinarian's. We receive little support but are highly demanded, by the mentality of society and the organizations that we work for, to "do everyone's job"! This leaves little time for what we do best, take care of our patients'. HOURLY ROUNDING IS GREAT, BUT IMPOSSIBLE TO DO IN TODAY' WORLD, ESPECIALLY CONSISTENTLY AND WITH PURPOSE.

Kristi Eckart, Surgical - RN , Florida Hospital April 26, 2014 4:49 AM
Winter Park FL

I've always done hourly rounding.  This is nothing new.  All nurses should be doing this.

Jeannine , RN April 25, 2014 5:20 PM

Hourly rounding was a requirement of ALL when I was a student nurse.  One NEVER walked by a call light that was on-even if you were not covering for that patient.  Working on medical/surgical units for 40 years, I found that before leaving the bedside of any patient, checking to see that call light, phone, water, bedside table were within reach; patient was in a comfortable position and without pain; questions answered and letting the patient know that I would return to check on him within the hour was the standard of care I practiced.  As hospitals became increasingly more busy I continued to do this, but with much more difficulty.  I also became aware that this was not the standard that was always followed by others.  When nursing leadership started to advocate hourly nursing

rounds, the patients call lights did not come on as frequently and patient satisfaction rose. Hourly rounding is not NEW but a basic nursing function that I hope will never go out of style!

Bernadette, Hospital-med-surg - RN retired April 25, 2014 9:12 AM
CT

I am fortunate to work for an organization where it is the expectation of our inpatient staff to round hourly during the day and every two hours at night.  This expectation is not merely an inpatient phenomenon; our ED staff round in the waiting room hourly as do our outpatient units staff.  I am convinced that utilization of rounding schedules by nurses, nursing aides, and emergency room techs improves communication which is often the source of poor patient satisfaction scores, decreases patient/family anxiety, and improves patient outcomes by the early recognition of even subtle changes in patient status.  Thank you for sharing your blog with us!

Susan, Workforce Development - RN April 25, 2014 8:40 AM

We were taught to always make hourly rounds as a student nurse.  It is still  a needed and an excellent practice for the best interest of patients and for legal liability reasons.

Jean, Geriatric - Case manager April 25, 2014 7:51 AM
NC

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