2. 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.
2
3. The Facts
Proactively 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
3
4. Goals:
Reduce call lights
Improve patient perceptions of care
Increase nursing satisfaction and efficiency
Reduce patient falls
Reduce skin breakdown
4
6. 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.
6
7. 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.”
7
8. PEDIATRIC ROUNDING
P = parents/plan/pain
E = eating (bottles, meals, etc.)
D = diapers (supplies, towels, etc.)
I = interaction/ID bands
8
9. Rounding Behaviors that
Reduce Call Lights
Use opening key words to reduce anxiety.
Perform scheduled tasks
Address the 4 P’s of pain, position and potty, proximity
Assess additional comfort needs (to decrease call
lights & increase patient satisfaction)
Conduct an environmental assessment to assure safety
Prior 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
9
10. 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.
10
11. 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.
11
12. 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
12
13. Findings One Year After the Study
Quantitative Measures Before One Year
Rounding
Patient satisfaction 79.9 88.8
38.2%
Percentage of “excellent” 80.1%
ratings
Reduction in falls* — 60%
Resource: Studer Group 2007 13
14. Top Five Changes In Patient Requests
Rounding affected the 4 P’s:
3000 Pain (-35%)
2,379 Potty (-40%)
2500
Position (-29%)
2000 Proximity 1,628
1,424 1,420
1500 1,142
984
868
1000 744
507
361
500
0
Bathroom Pain Positioning IV/Alarms Misc
Pre-Round End Round
Resource: Studer Group 2007
14
15. North Mississippi Medical Center
Tupelo, Mississippi
Tupelo, MS
650 beds – largest hospital in Mississippi
Serves 650,000 people in 22 counties
40 medical specialties
Level II Trauma Center
Hospitalist program
3,900 employees
Malcolm Baldrige Quality Award in 2006
15
16. North Mississippi Medical Center
Tupelo, Mississippi
100
80
60 Pre-One Hour Rounding
One Hour Rounding
40
20
0
Patient Satisfaction
16
17. FREQUENCIES OF PATIENT FALLS
ON EXPERIMENTAL AND CONTROL UNITS
Number of falls Number of falls
Group in the four weeks during the four weeks
prior to rounding of rounding
One-hour rounding 25 12
group
Two-hour rounding 19 13
group
17
18. Skin Breakdown Reduced
One Hour Rounding
14% reduction
7
6
5
4
3
2
1
0
Pre-One Hour Rounding During One Hour
Rounding
18
19. King’s Daughter’s Hospital
Yazoo City, Mississippi
Yazoo City, Mississippi since 1930.
25-bed acute and swing bed unit
10-bed geriatric psychiatric unit
Twenty-four hour Emergency Department.
Outpatient Services: Wound Care Clinic , Foot
Specialist Clinic, Diability, Urology, Ophthalmology ,
Otolaryngology, Cardiology, Orthopedic Surgery,
Gastroenterologist, General Surgery
19
20. King’s Daughter’s Hospital
Yazoo City, Mississippi
Goals of implementation: Educating Staff:
Decrease hospital acquired Explained WHY we were
pressure ulcers implementing
Decrease falls Reviewed evidence-based data
Improve pain control Defined actual process
Improve patient satisfaction Scripting:
Decrease call lights 4 P’s – Positioning, Potty,
Implementation timeline: Pain, and Proximity
Education “Is there anything else I can
Go-Live
do for you while I’m in the
room?”
20
21. 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
21
22. Benefits of Hourly Patient Rounds
Leads to better care: Builds trust between patients and
caregivers.
Reduces patient anxiety by more frequent encounters
Reduces call lights which minimizes interruptions and
other distractions faced by the nursing staff
Improves the patient’s perception of staff communication,
staff responsiveness, pain management and a safe
environment
Increases overall patient and employee satisfaction
Mead, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing rounds on patient call light use, satisfaction, and safety.
AJN, 106(9),59-69.
22
23. Conclusion
The 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.
23
24. Conclusion
Available evidence
indicates hourly rounds
are appropriate, safe,
and useful for practice
24
25. 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.
25
26. 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.
26
Editor's Notes
1 use the word round, explain during rounds you will be checking pain, comfort, position and bathroom, reduces anxiety2. meds, treatments, procedures, feedings. • Pain - Evaluate pain level.3. Prn meds recommended to be given at the earliest fequency so that pt doesn’t need to call.4. Fluff pillows, straighten sheets, fill water pitchers, call light, remote in reach, Telephone light switch, garbage can, bedside table, comfortable and covered. 5.Respond to questions. Ask if there anything else the patient needs.6.Reassure - Express care and concern. Let the patient the next rounding time.7.”Is there anything else I can do for you? I have time.” 8.Mrs. H, it looks as if you have everything you need. I or CNA will be back in an hour to round on you again”
• Please say to each patient: "I am here to do my rounds to check on your comfort because I care."• Check PAIN-ask level, and if medication is needed.• Offer TOILETING assistance, empty urinal/bedpan• Assess COMFORT/POSITIONING-is any help needed, is it time to turn the patient.• ENVIRONMENTAL check (peace of mind):• Check that call light, telephone, TV control and bed light switch are in reach.• Bedside table, Kleenex and water are in reach.• Garbage can is next to bed, not full, with bag.• Does patient need refreshment?• Prior to Leaving Room:– "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.
Often, nurses make rounds on even hours and support staff make rounds on odd hours. While making rounds, staff engage patients by checking on the “4 P’s”: pain, positioning, potty (elimination), and proximity of personal items. Patients are told that staff will check on them frequently, so hourly rounds help manage patients’ expectations. Patients become less anxious about getting their needs met as they learn to trust the process of hourly rounds. Attending to patients’ comfort, safety, and environmental needs may also prevent adverse events like falls, pressure ulcers, or unrelieved pain; and contribute to patients’ satisfaction with nursing care. Proponents also attest that hourly rounds organize work flow, offering efficiencies by giving nurses time back as they proactively (rather than reactively) anticipate and attend to patients’ needs.
To help you remember, successful pediatric patient rounding , use pneumonic PEDI
Success TipsEnsure buy-in of nursesEnlist others to roundHold nurses accountableModify and utilize in additional areas (ED, OB)Present and promote as evidence-basedRecognize and reward those that do it well
Hospitals Baylor univ.< 2750, St eliz.400 Tmple univ, PA 617 sharp memorial hospital San diego 1870
To communicate the results of the project solution and allow workplace feedback a multi-approach should be taken, to include group e-mails, staff meetings and nursing surveys. Each of these approaches allows for staff members to receive critique, ask questions and submit suggestions or comments anonymous. By publishing success and failures within the hospital other individuals awareness of the need for increasing patient satisfaction is increased and similar or alternative initiatives can be developed in different care settings.
