Hourly rounding for positive patient and staff outcomes: fairy tale or success story?
The lay and professional literature seems to be inundated with stories of medical errors and staff nurse job dissatisfaction. As the nursing shortage intensifies, many Nurse Managers are searching for ways to fully utilize the professional nurses' expertise and knowledge base while enhancing patient safety and satisfaction. Hourly patient rounding proposes to be one answer to both patient and RN satisfaction.
A recent article in the June issue of Nurse Executive Watch summarized the process and positive outcomes derived from hourly rounding. The process was described more fully by Meade and colleagues (AJN, 2006). According to these authors, positive outcomes comprise increased patient and RN satisfaction. Positive outcomes from such a seemingly simple intervention makes one wonder, "Is this a fairy tale or a success story?" Many nurses reading Meade's work might notice the authors' credentials (2 PhD-prepared nurses) and the fact that the study has the backing of the Studer Consulting Group and decide that for them and their Unit, the intervention is a fairy tale.
The purpose of this article is to share the success story of one Nurse Manager (Neil) as he partnered with the Medical Surgical Clinical Nurse Specialist (Kristi) and his staff to implement hourly patient rounding on his Medical Surgical Unit at Hillcrest Medical Center, Tulsa. Neil first learned of the strategy from the Nurse Executive Watch article. As he read the article, he pondered, "How can I implement patient rounding and scripting on my Unit? What are some of the barriers and facilitators need to consider to assure that I am successful?" Several planning strategies with Kristi and his nursing staff later, the Unit piloted hourly patient rounding and scripting. Procedure, barriers, facilitators, and outcomes are bulleted below to encourage other Managers to implement this strategy on their units.
* Unit was divided into two sides: on one side the nurses and techs would perform q 1 hour rounding, on the other side, the nurses would give nursing care in their usual manner.
* A small white board was mounted in each room for the RNs name who was caring for the patient that day
* The secretaries at the desk would tally the total number of patient calls for each side.
* Nurses and techs had a clipboard in each room with a time chart where they noted that each hour's round was made. Nurses made rounds on odd hours and techs made rounds on even hours.
* The totals for each side were compared to see if the intervention could reduce the number of call lights.
* Patient satisfaction with quality of care was also analyzed through daily managerial rounds. Neil asked the patients if they knew their nurses name and if their needs were being met.
* Educating all the staff about the program and gaining "buy-in"
* Keeping up with the charting
* Consistency of staff in performing checks
* Varied patient population, diagnoses, and co-morbidities
* Staffing and acuity levels, number of admits and discharges for each team
* Secretaries very willing to participate in a plan that would reduce call lights: Responding to patient calls can consume a large part of their time
* Professional staff nurses wanted to improve quality of the care delivered on the Unit
* Teamwork by the techs and nurses
* Support of Dr. Kupperschmidt.
* Daily rounding by Manager affirmed to the staff that hourly rounding is an important patient intervention
* Zero customer complaints (increased satisfaction?) on the Unit during this informal pilot test
* Reduced the total number of call lights
* Staff on non-rounding side noticed the positive outcomes: They started to do q1 hour rounding as well!
* Managerial rounds noted: Patients reported they were "highly satisfied" with their care and felt "very well cared for at this hospital"
Undoubtedly, frequent call light use can impose monumental demands on a nurse's time and energy. Multiple interruptions in the cognitive work of nursing can cause omissions in care and potentiate medical errors (Potter, et al. 2005). One hour rounding is a care model that effectively decreased call light use and increased satisfaction among our patient population. When asked if she would continue the practice of hourly rounding if Neil stopped checking, one professional staff nurse, Ruby Thomas, replied, " It was definitely beneficial. At first, I had to get used to the structure. After I became more comfortable with the intervention, I realized how much better I knew my patients and saw how the number of calls I received decreased."
Readers are encouraged to access the full project from the Studer Group and read all the details. Neil implemented many of the strategies and reaped the benefits. However, not all the details of the pilot are shared in this short article. In addition, Managers are encouraged to pilot the program even if they do not have the services of PhD- or masters-prepared nurses. Rounding for positive patient and staff outcomes is not a fairy tale: it is a success story waiting to happen on your Unit.
Advisory Committee News in Review. (2006) Hourly rounding decreases call light frequency, may ultimately improve care quality. Nurse Executive Watch. Advisory.com
Meade, C.; Bursell, A.; & Ketersen, L. (2006) Effects of nursing rounds on patients' call light use, satisfaction and safety. American Journal of Nursing, 106 (9); 58-71.
Potter, P. & Wolf, L.& Boxerman, S. Grayson, & D. et al. Understanding the cognitive work of nursing in the acute care environment. Journal of Nursing Administration. 35(7-8):327-335.
Neil Orr, BS, RN, Nurse Manager & Kristi
Tranum, MS, RN; Clinical Nurse Specialist;
Hillcrest Medical Center & Betty
Kupperschmidt, EdD, RN, OU-Tulsa Nursing