PATIENT HOURLY ROUNDING

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• PATIENT HOURLY ROUNDING
• Yale-New Haven Hospital
• 2010

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Objectives

• Nursing staff will
• Verbalize an increased understanding about
  patient hourly rounding goals.
• List the 8 specific rounding behaviors.

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The Facts

• Nursing staff devote a lot of time responding to
  unscheduled patient requests so they have less
  time for more critical duties.
• Patient falls and pressure ulcers are concerns to
  staff , patients and families.
• How nursing staff respond to call lights plays a
  major role in how patient perceive the quality of
  healthcare.

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Goals

• Reduce call lights
• Improve patient perceptions of care
• Increase nursing satisfaction and efficiency
• Reduce patient falls
• Reduce skin breakdown
• The Studer Group (2006). Hourly rounding. Fire
  Starter Publishing.

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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

• Success in other areas.
• Hospitals saw 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.
• The Studer Group (2006). Hourly rounding. Fire
  Starter Publishing.

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Studer says

• Rounding allows nurses to gather information,
• it is proactive not reactive.
• Handle patient problems before they occur.

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Specific Behaviors

• Use opening words and/actions to introduce
  yourself, your skill set, your experience.
• Perform scheduled tasks.
• Assess and address the
• Adult 4Ps - pain, personal needs, position
  and placement
• Pediatrics P.E.D.I.
• Pparents/plan/pain
• Eeating (bottles, meals, etc)
• Ddiapers (supplies, towels, etc)
• Iinteraction/ID bands
• The Studer Group (2006). Hourly rounding. Fire
  Starter Publishing.

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Specific Behaviors

• Assess comfort needs.
• Conduct an environmental assessment of the room.
• Use closing key words or actions.
• Explain when you or others will return.
• Document the rounding in Sunrise Clinical Manager
• The Studer Group (2006). Hourly rounding. Fire
  Starter Publishing.

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Explain Purpose of Hourly RoundingUpon
Admission/Transfer/Change in Caregiver

• We round every hour on our patients to ensure
  that you receive Very Good 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 Very Good care, please let us know
  immediately so that we can address your concerns.

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Key Words - Adult

• Hello Mr/Mrs ____ My name is___ I will be your
  (Nurse/PCA) today
• What is your pain level right now?
• Can I assist you to the bathroom?
• (incontinence care, empty urinal, etc)
• Would you like to be repositioned?

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Key Words - Adult

• Are you comfortable?
• I want to place these items (call bell,
  telephone, tissues) in front of you, so that they
  are within your reach.
• Is there anything else I can do for you before I
  leave? I have the time.
• I (or other staff member) will be back within
  the hour to round on you again.

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Key Words - Pediatrics

• Hello (patient/parents) ____ My name is___
  I will be your (Nurse/PCA) today
• Are you aware of the plan for today?
• What is your pain level right now? or Do you
  feel that your child is comfortable?
• Can I assist you to the bathroom? (check
  diaper, supplies, empty urinal/hats)

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Key Words - Pediatrics

• Are you comfortable? (for younger children -
  comfort items- pacifier, toy, book, etc.)
• I want to place these items (call bell,
  telephone, tissues, trash) in front of you, so
  that they are within your reach. (age
  appropriate)
• Is there anything else I can do for you before I
  leave? I have the time.
• I (or other staff member) will be back within
  the hour to round on you again.

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SUCCESSFUL ADULT ROUNDING

• The 4 Ps, vital for successful rounding
  consists of
• Pain asking patients to describe their pain
  level on scale of zero to 10
• Positioning making sure the patient is
  comfortable and assessing the risk of pressure
  ulcers
• Placement making sure the items a patient needs
  are within easy reach (call bell, phone, water)
• Personal Needs scheduling patient trips to
  bathroom to avoid unsafe conditions

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SUCCESSFUL PEDIATRIC ROUNDING

• To help you remember, successful pediatric
  patient rounding includes
• P parents/plan/pain
• E eating (bottles, meals, etc.)
• D diapers (supplies, towels, etc.)
• I interaction/ID bands

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Procedure
Responsible Time Frame
1. Use opening key words to introduce yourself and explain your role. Nurse , PCA,BA Initial Introduction
2. Write names and phone numbers of caregiver staff on whiteboard. Nurse and PCA Each Shift
3. Address the 4 Ps for adult areas Nurse and PCA Hourly Minimum
4. Address the PEDI list for pediatric areas Nurse and PCA Hourly Minimum
5. Assess additional comfort needs Nurse and PCA Hourly Minimum
6. Conduct an environmental assessment Nurse and PCA Hourly Minimum
7. Prior to leaving the room ask Is there anything else I can do for you? I have the time. Nurse and PCA Hourly minimum
8. Tell each patient when you and others will return. Nurse and PCA Every time you exit the room
9. Nurses will round on the even hours Nurse Even Hours
10. PCAs will round on the odd hours PCA Odd Hours
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Procedure- Continued
Responsible Time Frame
11. Rounding will be documented at the end of the shift on SCM Flowsheet Vital Signs Adult or Pedi (Non-ICU) (See next slide) Nurse and PCA Hourly
12. Rounds will continue throughout the night patients do not need to be awakened. Nurse and PCA Hourly



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Document at end of shift
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• EVERY PATIENT
• EVERY TIME
• EVERY HOUR