Hourly Rounding Research Paper

Hourly Rounding

Jessica Williams
Technical Communications
Allison Johnson
November 2010

Have you ever felt like you have been running from call light to call light your whole eight hour shift, haven't had any time to sit down to chart, and didn't even get a chance to get to know your patients? There is a solution out there, and it is proven to be the simplest, easiest option available; hourly rounding. Rounding on your patients every hour is proven to reduce the amount of call lights, raise patient satisfaction scores, and make the hospital a safer place for patients by reducing the amount of falls that occur. Hourly rounding on your patients is proven to reduce the amount of call lights on the unit. Call lights are both frustrating and essential features in most hospital units. Although the lights are invaluable
for alerting staff to patient needs, those needs often are not emergencies, and constantly answering the calls can tie up a workday. As nursing staff, we have becoming our own worst enemy when it comes to instructing patients to use their call light. We tell the patient to push the call light if they need anything at all. This makes the patient rely on the call light as the only source of communication with the nursing staff. In order to reduce the amount of call lights when rounding every hour, you need to make sure you follow a certain dictation. Make sure to let the patient know that you are doing hourly rounding, ask if there is anything else they need before you leave, and assure them you will be back in an hour to check on them. Reminding your patient you will be back in an hour, and actually following through with this, will build trust between the patient and nursing staff. The patient is more likely to only push the call light for urgent reasons and keep the non-urgent issues for when the nursing staff returns. Lyn Ketelsen is a coach for the Studer Group, which conducted a study on hourly rounding. She says the group came up with this idea after the group would go to hospitals for consulting work. The group noticed that most nursing units are continuously reacting to events after they would happen, which kept staff agitated and under stress. When this happens, it led to call lights that weren't answered, which would anger patients. "You could see which units functioned proactively and which ones did not. There's a disparate difference, and patients feel that difference. The group devised the program of hourly rounding, along with required key language and points to cover during rounds for clients to try. They noticed a positive change and decided to study the concept. It may seem counterintuitive, but asking nurses to commit to rounding every one or two hours actually saves them time overall. That is because patients used their call lights less frequently, which led to less running back and forth for nurses. They felt they had control of the day, now the standard of care is consistent" (Ketelsen).
While working on a forty-bed medical and oncology unit, we trialed hourly rounding. Down on hallway we rounded every single hour, while the other side did not. In a three hour period, on average, the hallway that was rounded on had six call lights go off, where the other hallway had twenty-one call lights. Sharp Memorial Hospital in San Diego also saw a huge success with hourly rounding. The 340-bed hospital has since implemented hourly rounding for eight hundred nurses and nursing assistants in all impatient units (Leighty). Jennifer Jacoby, RN Chief Nursing Officer of Sharp Memorial Hospital had her nursing staff wear pedometers before and after hourly rounding. She found her nurses walked 5.2 miles per shift before the implementation of hourly rounding, and 4.3 miles per shift afterward. "They were shaving 20% off the steps they were taking to meet patient’s needs by being more proactive" (Leighty). Using the correct dictation when rounding hourly on your patients will drastically reduce the amount of call lights on the unit. When patients are rounding on every hour by nursing staff, they quickly build a trust relationship with the nurse, which in turn raises patient satisfaction scores. Checking on patients continuously will assure all of the patients needs are met in a timely manner and are up to par. This will leave the patient satisfied that they got the care they deserved and in turn will lead the patient to fill out a positive survey about their stay. Patient satisfaction scores are very important to the hospitals that are surveyed. The survey plays a large part in whether hospital employees get a raise during the year, how much budget is given to the hospital, and gives great insight on what the hospital can change to better satisfy their patients. Perhaps the largest context in which patient satisfaction is currently measured involves hospitals using patient satisfaction is currently measured involves hospitals using patient surveys to assess and improve their "hotel-motel" functions and do a better service job to maintain a competitive posture in their market (Nash). Hourly rounding played a large role in a 650 bed hospital in Mississippi where their patient satisfaction scores sky rocketed from 79.9% to 90.6% (Neal). Baptist Hospital in Miami is a 577 bed hospital, and they also had patient satisfaction scores fly through the rood from 79% and jumping up to 98% (Guignard). Checking on your patients' needs and comfort hourly has a large impact on patient satisfaction scores. Hospitals have a large amount of falls for various reasons, but by rounding on patients hourly will keep falls to a minimum. There are numerous reasons why patients fall, and because of this many hospitals take those risks into consideration and calculate a "fall risk" score from one to fifteen. A fall risk of one is considered to be least risk for falling and fifteen being an extremely high risk for falls. Interventions are made for patients that are at higher risk for falling. Usually when a fall risk is calculated to be a nine or above, an alarm is set on the bed or chair so that if the patient was to get up by themselves, the alarm would beep loudly to alert nursing staff. Other interventions are also put into place such as moving a patient closer to the main nursing desk, or possibly placing a one to one observation order in the computer so that a nursing staff member sits with the patient at all times. The fall risk is calculated using many different questions for example, but not limited to: age, medications the patient is currently taking, if they have recently fallen, whether they live at home or a nursing home, mental status, and mobility. Granted you may have a very confused twenty-one year old that you would nee to use the same interventions as an alert and orientated unsteady eighty-eight year old, depending on the circumstances. “Units that adopted hourly rounding cut their patient fall rates in half and reduced the number of decubitus ulcers developed by patents. Many times we can intervene before a fall occurs. Once the nurses understand how to function in the system, they can see the ways it helps keep patients safe” (Ketelsen).The Oncology unit at the Saint Cloud Hospital in Minnesota implemented hourly rounding to hopefully decrease the amount of falls that had been occurring. On average, the fall rate was about ten falls per quarter. After hourly rounding was implemented, falls dropped to four falls per quarter. Out of the ten falls, eight had elimination needs, as well as two out of four from quarter two (Mertes). This shows that if nursing staff were to round on their patients every hour and ask about elimination needs, there could have been eight less falls that first quarter. Hourly rounding can be a very difficult thing to establish with nursing staff that do not believe they have enough time in the day to do the actual rounding every single hour. A major difficulty is how to establish a work-day design that actually makes the hourly rounding possible. There is an interactive video that was made available to show nurses that had doubts about the change, to prove that it actually does improve efficiencies and satisfaction rates to give nurses more time back during their shift. So next time you feel like you have been running all day, ahd have probably walked 5.2 miles for your shift as mentioned above; try rounding on your patients by covering potty, pain, position, and personal belongings every hour to minimize the amount of call lights, raise your patient satisfaction scores, and reduce the amount of falls on the unit.

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