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October 09, 2008

Hourly Rounding

Clock72x721 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 am a patient care tech at a very large brooklyn hosp, we are in the proscess of launching hourly rounding. maybe someone with good knowledge of this can help us iron out some of the kinks for exp if this is called hourly rounding, how do we do hourly rounding in the icu's where our nurses are sitting in the rooms with our patients, we are just trying to be consistent throughout the hosp your ideas would be appreciated. please Email me at fran196150@yahoo.com

Posted by: fran | Oct 7, 2011 9:45:42 PM

I am a patient care tech at a very large brooklyn hosp, we are in the proscess of launching hourly rounding. maybe someone with good knowledge of this can help us iron out some of the kinks for exp if this is called hourly rounding, how do we do hourly rounding in the icu's where our nurses are sitting in the rooms with our patients, we are just trying to be consistent throughout the hosp your ideas would be appreciated. please Email me at fran196150@yahoo.com

Posted by: fran | Oct 7, 2011 9:45:42 PM

We're now starting this on my pediatric unit. However, i work nights so I'm supposed to go in/assess my patients w/o waking them? Not gonna happen, but I'll be sure to tell my patients/parents I'll be rounding hourly...

Posted by: Elaine Ignots | Sep 13, 2011 10:14:49 PM

More staff is needed to reduce the nurse to patient ratio to at least 1 nurse to 4 patients and hourly rounding will work. It is a numbers situation the better care provided the better free verbal advertising the hospital gets. Hospitals need to make everyone happy and hire more nurses (there are too many without jobs 100-400 grads per nursing school) and keep happier patients.

Posted by: ToBecky | Sep 12, 2011 9:36:03 PM

i'm a casual nurse that works across a number of different surgical and medical wards. the first thing is everybody does whatever they want to do, or what they've always done. so much for our expensive university education and best practice. secondly, some of these wards are trying to enforce rounding. and i'm against it. i've seen some wards tick and flick all the boxes at the end of the shift, others you need to document specifically pain score, whether the patient is in bed or chair or somewhere else, pad is dry or wet or patient denied needing to go to toilet etc, and it's a lot harder to write retrospectively. i can see how it might reduce falls and some patients appreciate the extra attention but the reality is it takes time that i haven't got. i'm fortunate that the ratio i work is 1 nurse to 4 patients which is not so bad but they seem to be getting more acute all the time. the busier it gets the more i have to prioritise my work and skip things altogether. rounding is the first to go. it's mostly redundant. 1. 'potty' a patient is either mobile and can go to the toilet by themselves, bedbound and need assistance with a bedpan but they can ring the bell, and the demented or incontinent you need to clean up after regardless 2. 'pain' ring the bell or at least look like you're in pain 3. 'positioning' again, either they look uncomfortable or they'll tell you 4. 'proximity of call bell, tv remote, phone, water etc' you ensure they're within reach of the patient at the start of the shift or you've moved the patient so move the call bell too 5. "promise to come back at a specified time" but what if you don't, what if you're busy with another patient?

patient satisfaction? they need free tv to take their minds off themselves and to understand we have multiple patients and maybe most importantly, realistic expectations of the limits of hospital and staff. we can't always fix them or attend to them immediately. they have to wait for tests, for doctors, for nurses.

less call bells? toileting and pain are not so convenient to appear on the hour and patients generally let us know if and when they occur. IVs usually beep when they're finished or the patient bends their arm, nothing to do with rounding. and there'll still be accidental calls as well.

i guess rounding made sense back in the day when patients didn't have call bells, and maybe nursing homes where you can pre-empt urge incontinence and subsequent falls relating to toileting. for the rest of us, it's not particularly relevant, time-saving or welcome. i feel like i've already wasted too much time on this but i'm afraid this never ending documentation of nursing is only going to get worse. and the thing is, there'll still be shit nurses doing whatever they want to do because there's not enough good carers willing to do the job, and who can blame them?

Posted by: alan | Jun 19, 2011 11:16:06 AM

I don't mind hourly rounding if I have a good partner/CNA. It doesn't HAVE to be the nurse every hour as long as the patient's needs are being met. It's nice when you have a teammate you can depend on to take turns checking in on the patient.

Posted by: Crystal | Feb 28, 2011 9:32:34 PM

We just started hourly rounding ad it is not wrking. I shud not have to write every hr if my pt had to pee. The head nurse does nothing! U give me 6 pts on tele. 2 rr within 6hrs with 1 trnsfrr to icu and xpect me to do hrly rnding? Give me a break. I aong with several othr nuses refuse to do it period. Our patients are happy and its 1 less sheet of paper I have to worry about.

Posted by: sdprn | Feb 24, 2011 10:24:25 PM

At the End of the Day

Until you've learned your AIDET
You haven't really made it,
Acknowledge their name
At the threshold door,
Introduce yourself
(Try not to bore),
Define the time
Of the things you'll do,
Explain, entertain
Educate them too,
At the end of the day
When you're on your way,
Say, thanks for the fun
Now, what about my pay?

Fibril_late;
3/10/08

Posted by: Pete | Jan 17, 2011 9:17:05 PM

We are doing hourly rounding in our ED unit. Both techs and nurses are required to do hourly rounding. This is indeed a good idea to improve patient safety. However,the comment "validation is not a true reflection of patient care" is true. Nurses just check off the validation log even if no actual rounding occurred and then turn it in to the nurse manager for fear of being audited. Patients still receive poor nursing care as evidenced by wet diapers, slouching position, complaints of pain, dry IV bags and deterioration in patient's condition. If the intended purpose of hourly rounding will be done, this is an excellent way of improving patient safety and satisfaction. On the other hand , if nurses and other caregivers do not have the commitment to give excellent patient care, hourly rounding will be a burden thus checked off validation logs become meaningless.

Posted by: Amy | Dec 22, 2010 3:58:37 AM

I am employed by a hospital that is trying to implement hourly rounding. The RN patient load is typically six. I can appreciate and applaud everything that the hourly rounding is trying to achieve, however I wonder if a little common sense might be added to the discussion. Does anyone think it is remotely resonable to safely medicate and assess a patient in ten minutes? That would be the rate that I would need to accomplish in order to achieve timely rounding goals. I am often frustrated by nursing research that fatally flawed by the ivory tower. Please listen to the intelligent voice of the bedside nurse. She is so much more insightful in regards to patient care and safety than a PHD that hasn't been at the bedside for 20 years.

Posted by: Heather | Dec 18, 2010 2:03:06 AM

I work in a facility that does not practice hourly rounds. However my daughter was recently hospitalized after a motor vehicle crash in a nearby facility on a unit that does hourly rounds. What an amazing experience. I was with my child 34/7. We used the call bell TWICE in FOUR days.

The staff did not make the rounds sound scripted--the "Hi I'm Here for hourly rounds, how are things going" was enough. They then hit the four P's.

Most importantly on arrival we were given a flyer on the purpose of hourly rounds. This immediately set up an expectation on the part of my daughter and I--soon we learned that the staff was indeed consistent in making rounds--and all concerns were addressed quickly even if the skill required an RN and the LNA was the person doing that round.

Coincidently at my current facility we have had a run of patient complaints that would have been addressed by hourly rounds--WE WILL BE STARTING HOURLY ROUNDS SOON-IN SOME SHAPE OR FORM!

Posted by: sue | Nov 29, 2010 3:10:20 AM

well i work on a busy med surg floor and we are required to do hourly rounding. we have been doing this for about 4 months and i personally cant see the change in call lights.. as we all know that it is very important to see our patients and keep them safe what the heck is happening here? as you recite the dialogue and smile i cant stand the smart ass answers i get....can i get you anything??? "yeah i like a milkshake and fries or yeah ill take a hot blonde.....uggg and quote on quote our administrator states " i used to say this isnt a hotel... but now i say treat this hospital as if it was a hotel" omg make me puke... what the heck is happening to health care?

Posted by: JENNY | Nov 5, 2010 9:21:11 PM

well a few comments on hourly rounding... we are trying to do this where i work and as i can understand the importance of it all i cant get over how the call lights have not decreased.. if anything the patients seem to think they are at a hotel and definately take advantage of it all.. yes they are sick and need some attention but if you have to scratch peoples feet and backs... um i think that is getting carried away... as far as the call lights go ... the aides get stuck doing it all because the rns are too busy doing admissions , and medicating...but frankly for the managers who love this whole idea for their units.. are they getting out of the chair to help? it is a good idea if it works.. but i have not seen any progress....hey boss could you get off the phone with your husband and answer a call light .. im too busy doing my rounds??? OH YEAH BY THE WAY ... HEY BOSS ...how big of a raise did you get this time ? i hope a big one .. the staff is killing themselves trying to get the satisfaction scores up so you can get one!!

Posted by: JENNY | Oct 18, 2010 11:39:14 PM

we do what are called 30 minute safety checks. the problem is between 2 hours care rounds 2 nurses for 89 pts and 3 cna's for 89 pt's alot of care cannot be done the way it should be. the biggest problem is staffing they call us off but do not take into account the accuity of the pt's they are getting us. we technically do not do one on one care but every night I take no less than 5 pt's on my med pass as we get wrote up if they fall. never mind that this takes me over the time alloted for med pass and tx's. I remember when the pt's came first but due to medicare cuts and money hungry corporations I think those days have come and gone and it really upsets me!

Posted by: sheri moskey | Apr 21, 2010 10:34:43 PM

Well said by Lisa on Nov 9th
It is worth repeating..

" Nurses discretion dictates that those that need more care recieve it."

No matter the unrealistic execpectations placed on a R.N. by administration a prudent nurse prioritizes her time and skill and delivers care to the patients according to acuity and saftey.

The truth is we do far more than we are ever able to document.

Hourly rounding documentaion may be needed to prove patients are being checked on but it is not a true reflection of care given.

It is nurse:patient ratio that improves care if in fact administration is concerned with improving care at all. period.

Posted by: Cathy Sparacia | Apr 3, 2010 4:01:13 PM

I work in Dementia Carein Australia. We practice Proactive, Person centred nursing care.

Posted by: Debbie Draper | Apr 3, 2010 8:02:30 AM

sorry correction my e-mail is tcubbage@su.edu

Posted by: Tracy | Nov 26, 2009 6:13:13 AM

Hello to all. I am an ICU nurse who is receiving a Master in Nursing. My project before graduating is implementing FOCUSED Based Hourly Rounding. When the nurse enters the patients room, she is not only assessing th e(4) P's but also assessing how to better manage the patient's admission diagnosis. For example, if a patient is admitted to an inpatient unit with a diagnosis of Dehydration, then the nurse will be offering fluids. Is anyone doing this in your practice? If so, and you would want to assist me in my research, please contact me via e-mail at tcubbage@su.ed Thanks and good luck!

Posted by: Tracy | Nov 26, 2009 6:11:19 AM

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

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