Patient Safety / Quality

From our readers…Hourly rounding benefits patients and staff

Studies have shown hourly rounding decreases call light usage and unit noise levels, increases patient satisfaction, and reduces falls. Some researchers also report increased staff satisfaction and productivity, likely because staff feel they have more control over patient care. Despite these benefits, hourly rounding isn’t performed consistently according to results from a survey we completed. Engaging staff more may help improve implementation.

 

How rounding works

Hourly rounding is the process in which every hour, a staff member (either a nurse or nursing assistant) enters a patient’s room to assess the person’s needs. Generally, rounding occurs every hour during the day shift and every two hours on the night shift. A nurse and nursing assistant often rotate on the even and odd hours. As the staff make their hourly rounds, they focus their assessment on four key concepts — pain, position, potty, and placement of environmental items. Staff members use a checklist to ensure everyone asks the same questions. Staff place a checkmark next to the patient name at each rounding time.

Valued, but not always done

To determine nurses’ perceptions and use of hourly rounding, we distributed a 10-question to nurses on three medical surgical units (n=37) in a large urban teaching hospital; all three units have used hourly rounding for a year. Six questions were asked related to hourly rounding; if that process was valued, any barriers to performing hourly rounding, and if the process was being performed regularly.

Here are the results:
Nurse response to hourly rounding (n=37)

Question % of agree or strongly agree # of agree or strongly agree
Hourly rounding is performed on consistently on my unit 51% 19
Hourly rounds are performed during my shift 81% 30
There are benefits and value to hourly rounding for patients 94% 35
There are benefits and value to hourly rounding for staff 86% 32
Hourly rounding decreases workload and saves time 72% 27
I am satisfied with the current process for performing hourly rounding 48% 18

Despite the strong agreement that hourly rounding holds value for patients and staff and decreases nurse workload, only half of the nurses agreed that hourly rounding was performed consistently and were satisfied with this current process.


Path to improvement

The challenge for nurse leaders is to implement hourly rounds to improve patient outcomes while incorporating it into the already pressured workflow of today’s staff. Staff need to become engaged in hourly rounding, so they will find value in its application.

One way to improve engagement is to include staff in the planning and implementation of the program so they can learn about its benefits and help develop a workable plan. Posting patient outcome data such as falls, pressure ulcers, and patient satisfaction so nurses can see the tangible difference they are making in their patient’s hospital stay will also make hourly rounding successful. And, nursing staff will ultimately see the benefits as time is put back in their day allowing for more time for patient care. Allowing them more quality time at the bedside with their patients also promotes safe medication practice and documentation.

As staff are engaged in the hourly rounding program, it will truly be considered a success—for patients and for staff.

Leslie L. Cairns, MSN, RN, CMSRN, is the unit director of a trauma/telemetry unit. Kristine K. Wolff, MSN, RN, is the clinical director of Professional Support Services. Laurie L. Rack, MSN, RN, is the clinical director of Patient Support Services. All three work at UPMC Presbyterian-Shadyside in Pittsburgh, Pennsylvania. Linda A. Dudjak, PhD, RN is associate professor at the University of Pittsburgh School of Nursing.

References

Meade C, Bursell A, Ketelsen L. Effects of nursing rounds on patient’s call light use, satisfaction, and safety. Amer J Nurs. 2006;106 (9):57-71.

From our readers gives nurses the opportunity to share experiences that would be helpful to their nurse colleagues. Because of this format, the stories have been minimally edited. If you would like to submit an article for From our readers, click here.

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7 thoughts on “From our readers…Hourly rounding benefits patients and staff”

  1. mrybndt says:

    If a method applicable to all hospitals could be developed, the hourly rounds would be done consistently. With cost containment today having a nursing assistant with each nurse is not feasible, but how about one na to two nurses and the nurse and the aids will do alternate rounds on their own patients not on half or all the patients with the director and unit secretary taking an hour each of rounding.Isn’t the person the patient wants to see is the register nurse caring for them.

  2. TexRN says:

    In our facility we have instituted a “button” you push to “prove” hourly rounding …. but then, you have to remember to push the button! Let’s make the charting required more streamlined, so the nurses can spend more time with the patient, and less time at the station with the chart. Many of the “charting” tasks assigned to nurses could safely be assigned to a non-clinical provider, or at least not the bedside nurse (making sure core-measures are implemented, for example).

  3. rehabnurse01 says:

    When I’m assigned 45-49 residents per noc shift, there’s no way timewise that I can do hourly rounding. I have to rely on my aides to be my eyes and ears. I do round on the residents who are on alert, though. Rounding is, however, impossible for residents who use their call light every 30 seconds!

  4. Anonymous says:

    Whatever happened to an individualized Plan of Care. I have slept in hospitals for weeks at a time with ill family members.There is nothing more disturbing to the healing process than people constantly rounding.During the day the constant flow of mandated rounding is disturbing to the healing process. The professional RN along with the patient should determine if rounding is the best choice for the individual. PRIVACY for many patients is a priority, and sleep and rest a necessity.

  5. Anonymous says:

    could not agree more hourly rounding is best practice but can we have a disscusion about practical aspect of current acute care setting pt acuity and nursing work load demands as well

  6. Anonymous says:

    Hourly rounds prevent falls

  7. gabe.northwest says:

    Hourly rounding is all about the nurse being able to spend more time at the bedside with patient. How about addressing the same old issues nurse pt ratios, charting, acuity levels, etc. which keep nurses from the bedside instead of trying to convince nurses of something they already want to do.

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