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October 09, 2008
Hourly Rounding
I just read some interesting articles about hourly nurse rounding. Hourly rounding was described as the nursing practice of regularly checking on patients' needs using the 4 Ps — positioning, personal needs, pain, and proximity of personal items such as the call light — with the promise to return in 1 hour. I recall performing hourly rounding on the night shift over 20 years ago when I was just beginning my career as a new, young, inexperienced graduate. It worked! At the time team nursing was also in vogue. I wonder if we need to return to this practice?
How many times have we found an unresponsive patient at 4 am, when we last saw them joking to us at 12 midnight? Our time now seems to be preoccupied with individualized care plans, transfers and admissions, bed shortages, and electronic documentation rather than actually visibly seeing our patients on an hourly basis.
Of course, a major difficulty is how to establish a work-day design that actually makes hourly rounding possible. This might be a particular problem with the nursing shortage today.
What are your thoughts on hourly rounding? Has your facility implemented this practice and how is it working? Should we return to this practice?
Articles
Collaboration Helps Hospitals Fine-Tune Hourly Rounding
Ring for the Nurse! Improving Call Light Management
October 9, 2008 in Beka | Permalink
Comments
I work on a 36 bed med-surg/oncolgy unit where we are required to make hourly rounds. Nurses round on even hrs & techs on odd hrs. We also wear hill-rom tracker badges & required to sign the paper on the door. These papers are collected every morning & turned into the manager. Once a month a door report is reviewed by various staff from administration & the nurse manager. This has reduced our number of falls but adm does not take into account pt acquity & adequate staffing. I pray every day when I go to work to provide the best care I can for my pts that day despite the lack of staff & resources. I agree like others who have posted comments that these things are dreamed up by others who do not work on the floor nor do bedside nursing. They shouldcome out their offices & try hrly rounding & complete all the other tasks to provide pt care before compiling mandatory practices. I try to round on my pts evey hr as this is my personal preference but I don't agree with the BS that happens when you miss a round on 1-2 pts because of other pt circumstances.
Posted by: Shelia | Nov 13, 2009 11:32:04 PM
Does anyone have experience with HOurly rounding on Peds units or Children's Hospitals?
Posted by: Wendy | Nov 9, 2009 11:55:18 PM
I work on a 36 bed med teaching floor. We typically have a ratio of 9 patients per RN, with only one or two aide's on the floor. Hourly rounding sounds great on paper, but putting it to practice is a joke. The A+Ox3 stable ones get checked about three times a night with the understanding that they can call me at anytime and I will assist them. The 90 yr old dementia patients are constantly checked on because they usually have no concept of time and will call the moment you leave the room. Nurse's discretion dictates that those that need more care receive it. With a mountain of charting and admissions to do and only one aide to help out, realistically, that's the way it's got to be. If administration wants me to recite my script every hour to these patients and sign my sheet, they need to mandate a better nurse:patient ratio.
Posted by: Lisa | Nov 9, 2009 2:08:40 AM
HI all,
I am about to graduate from nursing school and am researching hourly rounding. Does anyone know if actual research has been done on it and where might it be found? Thanks,
Steve
Posted by: Stevan Pierce | Nov 6, 2009 3:08:50 PM
I totally agree. We SHOULD be checking every hour, however it is very hard because many hospitals do not staff according to accuity. I am very fortunate that i work in ICU and it is really not a problem. I have seen the acute care floor staffed inadequately. a note to nurses....please check your patients and dont abuse the aides. I hate it when i hear a nurse say "I didn't go to nursing school to wipe butts." YES WE DID> that is part of patient care.
Posted by: michael johnson | Oct 28, 2009 7:58:08 PM
We do this at UAB (Birmingham, AL) - it's call the 5P's though...we include potty. :)
Posted by: Candace | Sep 14, 2009 10:33:59 PM
I have done hourly rounding for about 2 years and I have not seen the success from it to be honest. Patients call whenever they want something and don't wait until you come back. The numbers at our facility support my viewpoint, call lights didn't change much and patient's are still falling. The patients that constantly call out and are at risk of falling don't grasp the concept of hourly rounding and therefore will still push the button constantly and still climb out of bed. The answer is not only hourly rounding, but better nurse/patient and tech/patient ratios and better access to sitters.
Posted by: Stephanie | Jul 30, 2009 4:31:16 PM
One other thing... We must work in teams. The team can look anyway. But doing the work we do alone is not the answer. It is also making sure that every patient is checked...
Posted by: Becky | Jul 27, 2009 5:34:48 PM
We have implemented hourly rounding at our hospital. I am the director of a very busy, 27 bed post op unit. Those comments above I understand and hear those at our hospital as well. First, the log should be used as a teaching tool. If you don't have some sort of accountability, people will not do it. It also reminds you of your focus. Second, hourly rounding is a quality issue. Checking your patient frequently prevents falls, IV mishaps etc... have you ever walked in and found your patient bleeding, IV disconnected etc...hourly rounding prevents that from occuring. Third, If you round on your patients consistently, call lights reduce drastically. Pts have better pain control (another quality issue) Less incontinence, better skin care...hello, this is a quality issue. Fourth..if your patients call you less, you will have more time to do the care. I can tell when my staff hourly round and when we are not doing it well. I hear call lights or I don't it is that simple. Would you rather do care on your schedule or someone elses... Finally scripting. Scripting is important for these reasons. If a patient knows when to expect you back you have increased their trust and decreased their need to call you. Asking a person if there is anythig else I can do for you is not a wrong thing to do...there is always one more thing that they would have called you for and they feel more cared about.
I am concerned that we have lost our purpose and forgot that the reason we work, the reason we are in health care...the reason we do what we do is for our patients.. That should be first and formost in our hearts and care.
You may think I sound sappy, but it works. I see it every day. And I believe making our patients cared about is why we are in health care..it is not about the numbers.
Posted by: Becky | Jul 27, 2009 5:30:30 PM
I will start implementing hourlyrounds on a Step Down Unit. I know I will have challenges since my unit is a busy floor with multiple procedures and admissions.We'll try and will validate.
Posted by: marieta | Jul 23, 2009 10:02:33 PM
Our hospital has had hourly rounding for about a year now and while I fully understand the purpose of it with the 4P's and checking on the patients it is way overdone. We are supposed to walk in and state "I'm (name)RN/LPN/CNA, and I'm doing my hourly round" to the patient and assess for the 4P's. Which whatever but then have to fill out yet another log stating we did it and then file it in the chart at midnight. While the rounding is something we need to all be doing this is just another mountain of paperwork for the staff to have to do to please the administration and take more time away from delivering patient care.
Posted by: Bryan | Jun 30, 2009 12:51:02 PM
I'm the charge nurse of my dialysis unit, I make myself do half hour round to make sure my patients are safe during treatment, you never know when code blue strikes!!!
Posted by: hoiyeeyung | Jun 25, 2009 12:18:57 PM
I've been interested to see these comments as we are now beginning to institute this hourly rounding program on our Women's & Children's Services Floor. I have the same questions about how this fits into an LDRP unit (with a tiny peds population) which normally has only healthy patients of childbearing age. As a nurse with over 27 years in practice, I often see these "new" ideas come from those who haven't done a great deal of bedside care, nor do they want to. The "rehearsed
dialogue" might be helpful for very inexperienced personnel, but we who have been floor nurses for years already have systems in place that work well. More paperwork, added redundancy, and it is not a "one size fits all" solution. I think this is really designed more for the M/S & ICU type units, not those with mothers who are up feeding babies every 2 hours anyway!
Posted by: Kathra | Jun 19, 2009 11:43:15 AM
It has been really interesting to read all the comments submitted as my ward is in the process of " transforming care at the bedside " and one aspect we will be focusing on is rounding. We have our share of skeptics about the entire process,especially rounding ( which is something we also already do on night duty ) so it is great to be able to read about all your experiences.
Posted by: megan buckle | Jun 4, 2009 5:01:38 AM
My unit does hourly rounding and I have noticed that the pt's call lights are hardly ever on, and that the pt's are more satisfied with the care.
Posted by: Melissa | May 14, 2009 1:39:04 PM
We have implemented hourly rounding on our unit. We are suppose to use a script that was devised by someone I have no Idea who, obviously someone who doesn't have to work as a floor nurse and go through what we go though each day. To comment on someone else's comment above,I also think it's ridiculous to have a rehearsed dialogue to round on the patient. I feel stupid saying it. And the worst part is we have to be competencied on it each year and have someone witness that we are saying it. How freakin awkward is that.
Posted by: Lucy | May 1, 2009 2:32:38 PM
Hourly rounding happens for me on every shift... we wear hillrom trackers, so the mgt can see where we have been. I absolutely hate the paper we have to sign in our facitilty. First, I don't need one more thing to remember to do. Second, it isn't part of the chart or record and won't help anyone in court. Third, I write nursing notes q 2 hrs for each patient. We are a busy step down unit... the PRACTICE is awesome, if we are fully staffed and have no emergencies... it's just the way that mgt throws things at floor nurses. yes, i see the validity in the research and think it will work... but also, aquity, staffing, etc need to be considered when new practices are introduced. Additionally, signing a paper means nothing... one can just poke their head in, sign the sheet and say they did what they should. If the staff is good, caring, patient focused and on the ball those things are taken care of anyway!
Posted by: donna | Apr 22, 2009 8:07:25 PM
Hourly rounding is an attempt to make patients feel that they are getting "very good care", so they'll respond positively on their Press-Ganey surveys. It is not about actually improving the quality of the care provided. Our hospital went so far as to try to script what we say to each patient on each "round".
If I were a patient and RNs came into my room Q hour and recited a scripted statement (like an automaton), I would have a hard time believing anything that came out of those RN's mouths, no?
RNs need to use professional judgement to make decisions about how often to see and access each patient based on acuity. For med-surg, for example, I think that all patients should be ideally seen a minimum of Q2 hours. Some should be seen more often. Should I walk away from my unstable patient to make sure that I check off a bunch of boxes on my less acute patients every hour? I don't think so!
Posted by: Jan Rodolfo | Apr 6, 2009 7:40:08 PM
We have implemented the hourly rounds on our med/surg floor recently, where we have to sign a paper as we go into the patient's room. I think most of us were doing the hourly rounds already anyway. On nights, we are only required to "sign-in" every two hours when we do the position changes. We don't wake the patients up on the hourly rounds that don't require the position change, but do make sure that they are breathing and that their call light is in reach. This seems to be working for the most part, but like many of you have already mentioned - there are times when you get "tied up" in a patient's room and are unable to make that hour's rounds on our other patients. It is especially hard when you already have as many as 8 patients for one RN and maybe 1 or 2 of them are confused as all get out, requiring more frequent observation to preserve their lines and to prevent falls. If you get an admission you can forget the hourly round too, with all the paperwork that we are now required to fill out, that in itself takes at least an hour. Thankfully, the paper that we sign is NOT part of the chart, our director reviews it, but doesn't get on us if it is not completely filled out every hour. She just reminds us to, she understands that sometimes we forget, plus we also have a tracking nursing system in place.
Posted by: Sandi | Apr 6, 2009 4:32:12 PM
When I worked as a staff nurse, we did hourly rounding and I think it is a terrific idea. Not only do you cater to the patients physiological needs ( the 4Ps) but you also let the them know that you are always close by. I currently work as a nurse manager and am trying to implement hourly rounding on my unit, as this will also improve patient satisfaction.
Posted by: angela r | Feb 14, 2009 5:58:30 PM
We do hourly rounding in our ICU and you may think it should be easy with the patient ratio being 2:1, but it's not. There are times I'll be stuck in a patients room doing a drsg change for over an hour. We have very sick and complicated patients on our floor. To go and check, vs, uop, IVF's( I've had up to 15gtt) going at the correct site and rate. huge abdominal wounds, vents, then you have to turn and do mouth care, but by then he's left you a surprise and you have to find someone to help you clean BM thats from head to toe from his tube feeding and insert a flexiseal so you can start counting that into his output. You finally get someone and by the time you get him clean and the bed changed, he looks about a riker of 4, it's time for the next hourly check. So Even though I didn't want to and didn't plan on it both of my patients were so acutely ill they take up all my time with their care. It's hard to do but we do the best we can and we try to give our patients the best care we can give. Oh, and I forgot, when we have to carry the ACT/Code beeper, we could be off the unit for hours at a time, and you are just praying that someone is watching your patients. They are pretty good on our unit though. They are great team players.
Posted by: Rebecca | Nov 24, 2008 11:31:28 PM
Hourly rounding would be fine- if our CNAs didn't have 10-15 patients on PM shift, if RNs didn't have 5:1 plus 1 or 2 resource pts to cover when we have LVNs. It would be wonderful if we didn't have admits and discharges where we have mammoth amounts of the ALMIGHTY PAPERWORK to do. If we didn't have so many orders to take off, 24 hour auditing, 8 hour auditing, the "hand off" we now have to fill out for the next shift. The Flow Sheets, Progress Notes, Graphics, the constant phone calls, family issues, new orders, etc.
If we could just have our patients and not all this other stuff to do, then yes, we would be able to do hourly rounding. At this point, in many situations, it works only in the minds of whomever dreamed it up while sitting at their desk.,
Posted by: Cat | Nov 24, 2008 4:42:51 PM
My hospital does every 2 hour rounds. the problem is that CNA's do most of the work and I believe patients really want their nurses to do rounding. THe original premise was the nurse gives meds usually on even hours and therefore the CNA's do the rounds on odd hours. It doesn't really seem proportionate.
Posted by: Kerri | Nov 23, 2008 8:39:00 PM
I work on OB, and I think it is horrible, at least for our floor. I think there are too many people sitting around trying more things for us to do, and and more things for us to get in trouble for (reprimanded for forgetting to sign when you are in the room). The whole idea is to work with a sick population and anticipating needs so you can be on a more controlled schedule, meeting their needs before they have to call out for them on an hourly basis. The problem with OB is that it is, for the most part, it is a healthy population. Our patients are already sleep deprived and hormonal. The last thing they want is to be bothered every hour. We have a deal to "contract" with the patients to lessen the frequency of our visits, and usually do it every 2-3 hours when it's time to feed the babe, with the understanding that they will call if they need anything before then. Maybe if there was less paperwork and politics, we would have time to care for our patients the way they deserve, and not have to demean ourselves by signing a paper on the wall to prove that we really doing our jobs.
Posted by: Tera | Nov 18, 2008 11:43:27 PM
Of course hourly rounding works...but wouldn't half hour or 15 minute ruonding work even better? Why not just have 1 on 1 with each patient?
Just being facitious, but we have patients who if you went into their room every hour and woke them, they'd rebel! Think of hourly turn & position...how much sleep does the patient get?
Posted by: Gregg | Oct 29, 2008 1:02:15 AM
