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Hourly Rounding: Obtaining Results

Evidence-Based Practice

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Objectives Why hourly rounding is effective and powerful

Results from two facilities of implemented hourly rounding and results

Motivate nursing staff to become hourly rounding advocates

Staff involvement and accountability for patient satisfaction.

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The FactsProactively address patient needs

Improve staff workflow and satisfaction

Improve service quality and patient-centered care

Decrease risk for pressure ulcers, falls, etc.

Safety and clinical quality

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Goals: Reduce call lights

Improve patient perceptions of care

Increase nursing satisfaction and efficiency

Reduce patient falls

Reduce skin breakdown

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4 P’s PainPotty PositionProximity

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Scripted Rounding"I am here to do my rounds to check on

your comfort because I care.“4P’s

"Is there anything else I can do for you before I leave? I have time while I am here.

I will be back in one hour to round on you again".Document the rounds.

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Explain Goals of Hourly Rounding

“We round every hour on our patients to ensure that you receive ‘QUALITY’ care. We will not wake you if you are sleeping unless we need to. If anytime during your stay, you feel you are not receiving ‘QUALITY’ care, please let us know immediately so that we can address your concerns.”

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PEDIATRIC ROUNDING

P = parents/plan/painE = eating (bottles, meals, etc.)D = diapers (supplies, towels, etc.)I = interaction/ID bands

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Rounding Behaviors thatReduce Call LightsUse opening key words to reduce anxiety.Perform scheduled tasksAddress the 4 P’s of pain, position and potty,

proximityAssess additional comfort needs (to decrease

call lights & increase patient satisfaction)Conduct an environmental assessment to assure

safetyPrior to leaving the room ask, “Is there anything

else I can do for you?”Tell each patient when you will be back (to

decrease call lights and decrease anxiety)Document the round

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Studer group

Largest study to show that certain nursing staff

behaviors reduce call light and allow nursing

staff to respond more efficiently to patient

requests.

27 units in 14 hospitals.

Call light usage decreased by 38%

Patient satisfaction went up from 79.9-88.8%

Meade, C.M., Bursell, A.L., Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use, satisfaction and safety. American Journal of Nursing, 106(9), 58-70.

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Studer group 50% decrease in patient falls.

Patient AND employee satisfaction increased.

Nurse reported more time to attend to other task

because they were answering call lights less

often.

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Findings One Year After the Study

85.7% of the units continued the rounding.

92.8% of the hospitals expanded the

rounding.

Patient Satisfaction scores maintained a

strong increase over the early results.

Falls continued to decrease over the year.

Resource: Studer Group 2007

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Findings One Year After the StudyQuantitative

MeasuresBefore

Rounding One Year

Patient satisfaction 79.9 88.8

Percentage of “excellent” ratings

38.2%80.1%

Reduction in falls* — 60%

Resource: Studer Group 2007

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Top Five Changes In Patient Requests

2,379

1,424

1,142

744507

361

1,628

984

1,420

868

0

500

1000

1500

2000

2500

3000

Bathroom Pain Positioning IV/Alarms Misc

Pre-Round End Round

Rounding affected the 4 P’s: Pain (-35%) Potty (-40%)

Position (-29%) Proximity

Resource: Studer Group 2007

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North Mississippi Medical Center Tupelo, MississippiTupelo, MS650 beds – largest hospital in MississippiServes 650,000 people in 22 counties40 medical specialtiesLevel II Trauma CenterHospitalist program3,900 employeesMalcolm Baldrige Quality Award in 2006

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North Mississippi Medical Center Tupelo, Mississippi

Patient Satisfaction0

102030405060708090

100

Pre-One Hour RoundingOne Hour Rounding

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FREQUENCIES OF PATIENT FALLS ON EXPERIMENTAL AND CONTROL UNITS

GroupNumber of falls

in the four weeksprior to rounding

Number of fallsduring the four

weeksof rounding

One-hour rounding group

25 12

Two-hour rounding group

19 13

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Skin Breakdown Reduced

Pre-One Hour Rounding During One Hour Rounding0

2

4

6

One Hour Rounding 14% reduction

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King’s Daughter’s Hospital Yazoo City, Mississippi

Yazoo City, Mississippi since 1930. 25-bed acute and swing bed unit10-bed geriatric psychiatric unitTwenty-four hour Emergency Department.Outpatient Services: Wound Care Clinic ,

Foot Specialist Clinic, Diability, Urology, Ophthalmology , Otolaryngology, Cardiology, Orthopedic Surgery, Gastroenterologist, General Surgery

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King’s Daughter’s Hospital Yazoo City, Mississippi

Goals of implementation:

Educating Staff:

Decrease hospital acquired pressure ulcers

Decrease falls Improve pain control Improve patient

satisfactionDecrease call lights Implementation timeline:

EducationGo-Live

Explained WHY we were implementing

Reviewed evidence-based data

Defined actual processScripting:

4 P’s – Positioning, Potty, Pain, and Proximity

“Is there anything else I can do for you while I’m in the room?”

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King’s Daughter’s Hospital Yazoo City, Mississippi

Results:

Patients perception of nurses checking on them

more

frequently

Heightened awareness of repositioning to

decrease pressure ulcers, of assisting to the

bathroom to decrease falls, and assessing pain to

achieve better control

Decrease in call lights

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Benefits of Hourly Patient RoundsLeads to better care: Builds trust between

patients and caregivers. Reduces patient anxiety by more frequent

encountersReduces call lights which minimizes interruptions

and other distractions faced by the nursing staffImproves the patient’s perception of staff

communication, staff responsiveness, pain management and a safe environment

Increases overall patient and employee satisfactionMead, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing rounds on patient call light use, satisfaction, and safety.

AJN, 106(9),59-69.

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ConclusionThe implications of these findings for nurses

would certainly be a more organized workflow, less burnout and fatigue and greater job satisfaction as well as improved patient care and comfort.

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Conclusion

Available evidence indicates hourly

rounds are appropriate, safe,

and useful for practice

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References Assi M, Wilson P, Bodino J, et al. (2008). Why making the rounds makes sense. Am Nurse Today.

2008;3(2):12.

Bulechek G, Butcher H, Dochterman J. (2008). Nursing Intervention Classification. St Louis, MO:

Mosby; 2008.

Coombs, M. A. (2004). Power & Conflict between Doctors and Nurses: Breaking through the Inner

Circle in Clinical Care. New York: Routledge.

Culley T. (2008). Reduce call light frequency with hourly rounds. Nurs Manag. 39(3):50-52.

Galanti, G. (1997). Caring for Patients from Different Cultures: Case Studies from American

Hospitals (2nd ed.). Philadelphia: University of Pennsylvania Press.

Haack W. (2007). Care rounding: a process to improve patient satisfaction, pain management and

safety. Proceedings of American Nurses Credentialing Center (Virginia Henderson Library),

2007. http://www.nursinglibrary.org/Portal/main .aspx?pageid=4024&pid=19623.

Hourly rounding decreases call light frequency, may ultimately improve care quality. (2006). Nurse

Executive Watch. www.advisory.com. 2006.

Johnson L, Topham D. (2007). Reducing falls through RN rounding. Clin Nurs Spec. 2007;21(2):114.

Kalman M. (2008). Getting back to basics: hourly nursing rounds to decrease patient falls and call

light usage and increase patient satisfaction. Proc Sigma Theta Tau Int (Virginia Henderson

Library), 2008. http://www.nursinglibrary.org/Portal/main.aspx?pageid=4024&pid=20449.

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References Kennedy, J. and Frick, B. (2008). Boot Camp: Develop Nurse Leadership Skills in a Supportive

Group Environment. What’s Right in Health Care: Evidence to Outcomes. www.studergroup.com.

Leighty J.(2006). Hourly rounding dims call lights.

http://www.studergroup.com/dotCMS/knowledgeAssetDetail?inode=319742

Meade, C.M., Bursell, A.L. & Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light

use, satisfaction, and safety. AJN, 106, 58-70.

Schroder, Jack. (2003) Identifying medical malpractice. (2nd Ed.) Oakland, CA: Catalpa Press.

Studer Group (2006). AHC Research Call Light Study. Hourly Rounding, developed by Studer

Group, the largest study ever focused on the impact of rounding. www.studergroup.com.

Weisgram B, Raymond S.(2008). Using evidence-based nursing rounds to improve patient

outcomes. Medsurg Nurs.2008;17(6):429-430.

Woodard J. (2009). Effects of rounding on patient satisfaction and patient safety on a medical-

surgical unit. Clin Nurs Spec.2009;23(4):200-206.