Hourly Rounding Improves Patient Safety

About Hourly Rounding as an Effective Patient Safety Strategy

Hourly rounding can be defined as “a systematic, proactive nursing intervention designed to anticipate and address the needs of hospitalized patients.” Because studies have shown that hourly rounding, done correctly, can promote quality, safety, and satisfaction, it is considered to be an evidence-based nursing practice. It is sometimes called purposeful rounding.

These are some of the improvements documented by researchers who collected data from 14 hospitals:

  • 52% reduction in patient falls
  • 37% reduction in patient use of call bells/lights
  • 14% decline in skin breakdowns and pressure ulcers
  • 12% increase in patient satisfaction ratings

Other researchers have found evidence of reduced noise levels in hospital units and increased job satisfaction and productivity among nurses after hourly rounding was implemented.

The most common model is to have a nurse or a nursing assistant make patient rounds every hour during the day and evening shift, but every two hours overnight when patients are more likely to be sleeping. In some types of units, an RN might be more effective at anticipating the patients’ upcoming needs. When nursing assistants are making rounds, overall success of the rounding program will depend on excellent communication and teamwork between the unit’s staff members.

To be effective, rounding programs should employ a script or specific tactics. Many programs rely on the 4 Ps: pain, position, potty, and possessions. The focus on positioning not only helps to ensure patient comfort, but can reduce the incidence of pressure ulcers as well. And providing help with the bedpan or getting to the restroom can prevent the call light from going off in ten minutes. “Possessions” refers to the placement of key items, like the phone, TV remote, tissues, water glass, or any personal items a patient might want close by, like a book or reading glasses.

Most scripts begin with a staff introduction and an explanation of the purpose behind making rounds. After the 4 Ps are addressed, nurses can close by asking if the patient needs anything else, and explaining that someone will be back again in about an hour. This is an important strategy toward reducing the use of call lights – if the patient knows someone will be checking on her soon, she may hold off on buzzing for a non-immediate need.

When call bells are going off constantly, nurses may become strained to answer them in a timely manner. This can have a negative effect on patient safety, for example if a patient at risk of falls decides not to wait for help getting to the restroom or obtaining an item from across the room. Rounding can help restore the call bell to its status as a lifeline, rather than allowing it to become a constant annoyance.

Another common tactic is using whiteboards in each patient room to help with more focused rounding. Nurses can write their own names or the name of the next staff member who is scheduled to make rounds, along with a reminder of what time rounds will next take place. They can also jot down the time that pain medication is next scheduled for, and any special concerns the patient has, to be sure they are addressed consistently during rounding. This might be a note that the patient is prone to feeling cold or is wondering about discharge details.

As patient safety has become an increasingly important issue in healthcare, nursing’s role in contributing to safety initiatives has grown as well. Do you want to make a difference in the lives of your patients? Empower yourself with knowledge through an online RN to BSN or RN to MSN degree. American Sentinel University is an innovative, accredited provider of online nursing degrees, including programs that prepare nurses for a specialty in case management, infection control, and executive leadership.

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