© 2018 OnCourse Learning Corp. All rights reserved
20225 Water Tower Blvd. Brookfield, WI 53045
Patients are fans of hourly rounding
EDITOR’S NOTE: OnCourse Learning guarantees this educational activity is free from bias. Lynn Deitrick, PhD, RN, is a nurse-anthropologist who has worked in the field of patient satisfaction and patient experience for more than 13 years. She has published more than 25 articles in peer-reviewed journals on topics, including call bells, patient satisfaction, and hourly rounding, and has presented on these topics at numerous professional conferences.
Alice is a new nurse employee on a busy medical/surgical unit at General Hospital. During her first week, she noticed how often she heard call lights beeping. The unit was noisy from all the call lights, and the nurses seemed to be constantly scurrying around in and out of patient rooms. She asked Anne, her preceptor, why they weren’t doing hourly rounds. Anne said she was unfamiliar with hourly rounding.
Alice explained that where she had worked before, nurses had rounded hourly on their patients. Because the unit was quiet, patients weren’t ringing their call lights, the number of patient falls had been reduced by half, and nurses had more time to get their work done because they weren’t constantly interrupted to go in and out of patient rooms. Anne was intrigued by what Alice was telling her and wanted to learn more about rounding and whether it would work on their unit at General Hospital.

Hourly rounding is a systematic, proactive, nurse-driven evidence-based process designed to anticipate and address needs of hospital patients.1-9 Rounding has been shown to increase patient satisfaction with the hospital experience because of regular attention from nurses. In addition, research indicates that on inpatient units where rounding has been “hardwired,” patient falls have decreased by 50%, skin breakdown has been reduced by 14%, and the number of patient calls via call lights has dropped by 38%.1,2 (Level B),4-9 The concept of hourly rounding was developed in the late 1980s at a medical center in Birmingham, Ala. That hospital introduced the role of a unit “hostess,” who rounded on every patient four times each shift. The hostess answered call lights within five minutes and addressed all patient requests that did not require a licensed staff member.

Tasks that the hostess took care of included adjusting room temperatures and providing patients with juice, water, or pillows. The change brought about by the hostess was dramatic: Within two weeks, there was a noticeable decline in patient and physician complaints together with many positive comments about the hostess from nurses. Nurses appreciated having someone available to answer call bells quickly, and patients felt that their needs were being met promptly.10 Hourly rounding developed from these roots.
One of the key drivers of hourly rounding is patient satisfaction. The unit hostess role described above indicates that patient satisfaction can be affected by things such as prompt response to call lights and attention to other patient needs and concerns. Patient satisfaction can be defined as “the consumer’s fulfillment response; the degree to which the level of fulfillment is pleasant or unpleasant.”11

One author suggests that “satisfaction is a short-term attitude that is encounter specific.” He adds that “service quality is often judged by patients based on their perceptions of performance relative to expectations.”12 These perceptions about a patient’s hospital experience are measured by the Hospital Consumer Assessment of Healthcare Providers and Systems survey. The HCAHPS survey measures experiences of patients during their hospital stays and is used by hospitals throughout the United States.13 Hospital patients often need help with basic tasks, such as using the restroom, eating, bathing, and ambulating. Nurses’ responsiveness to their needs is a key factor that patients often consider when making judgments about the quality of their care. Other factors that can influence opinions about satisfaction can include patient and family perceptions of things such as prompt response to call lights, timely assistance to the restroom, timeliness and appropriateness of pain control, the friendliness of the nurses, and an effective exchange of information with nurses.

When a patient’s need for assistance isn’t met promptly, it can result in patient falls and increased pain, as well as complaints from patients and families.1-3,4,13-15 (Level B) It should be noted that the HCAHPS survey includes questions about pain control and assistance to the restroom.13 As noted, patients often measure their satisfaction with hospital care based on factors such as staff responsiveness to their needs and prompt answering of the call bell. The call bell is a “lifeline” for a hospital patient.15 It is how the patient summons the nurse for assistance or information. Patients expect that when they push the call bell, the nurse will come promptly. But busy caregivers may find it time-consuming to answer call bells. Also, every time a nurse tells a patient, “Call me if you need anything,” she or he seems to be giving up control of her time to the patient.15

Because of the expectations of patients for assistance and attention as well as the need for nurses to have some control over their activities, it became important to find a way to satisfy both patients and nurses while meeting the legitimate needs of both. Rounding fills this need in the inpatient setting. Rounding allows the nurse to focus on the needs of each patient so he or she gets the full attention of the nurse. During the round, the nurse will address all patient needs, including pain, restroom, comfort and position, information, treatments, and medications so that when the round is complete, all the patient’s needs have been met.1
How to earn continuing education
THIS COURSE IS 1 CONTACT HOUR
Read the Continuing Education article.
This continuing education course is FREE ONLINE until December 21, 2018, courtesy of Nurse.com. To take the test for FREE, go to https://www.nurse.com/ce/no-way-around-it. After that date, you can take the course for $12 at the same link. If you have a CE Direct login and password (generally provided by your employer), please login as you normally would at https://cedirect.continuingeducation.com and complete the course on that system.
1.
2.
3.
If the course you have chosen to take includes a clinical vignette, you will be asked to review the vignette and answer 3 or 4 questions. You must answer all questions correctly to proceed. If you answer a question incorrectly, we will provide a clue to the correct answer.
4.
Once you successfully complete the short test associated with the clinical vignette (if there is one), proceed to the course posttest. To earn contact hours, you must achieve a score of 75%. You may retake the test as many times as necessary to pass the test.
5.
All users must complete the evaluation process to complete the course. You will be able to view a certificate on screen and print or save it for your records.
In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
OnCourse Learning is also an approved provider by the Florida Board of Nursing, the District of Columbia Board of Nursing, and the South Carolina Board of Nursing (provider # 50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider #CEP16588.
You can take this test online or select from the list of courses available. Prices subject to change.
ONLINE
QUESTIONS
T | 800-866-0919
No Way Around It: Rounding Means Satisfied Patients and Nurses
Lynn Deitrick, PhD, RN
puzzle-icon-white
This course is 1 contact hour
Course must be completed by January 31, 2019.
Goals and objectives: The goal of this continuing education program is to provide nurses and nurse leaders with an understanding of hourly rounding’s purpose and process and offer tips for implementation success. After studying the information presented here, you will be able to: 1. Define purposeful hourly rounding 2. Discuss the different types of rounding: introductory rounds, initial rounds, and hourly rounds, and the key behaviors in each 3. Explain how to measure the success of hourly rounding in the clinical setting
Nurse.com educational activities are provided by OnCourse Learning. For further information and accreditation statements, please visit Nurse.com/Accreditation. The planners and authors have declared no relevant conflicts of interest that relate to this educational activity. OnCourse Learning guarantees this educational activity is free from bias. See “How to Earn Continuing Education” to learn how to earn CE credit for this module or visit http://ce.nurse.com/instructions.aspx.
Complete course and take the test
CE Direct subscriber? Complete course here
Purposeful hourly rounding
Hourly rounding means visiting patients every hour to proactively take care of their needs, with rounding modified to every two hours overnight.1 Often the word “purposeful” is used along with hourly rounding to indicate that rounding requires specific actions and words, or scripting, on the part of the nurse who is rounding. Rounding is different from just checking to see if a patient needs anything. Instead, rounding is purposeful. By asking the patient about specific things during each round, nurses can anticipate patient needs instead of reacting to patient needs by waiting for the patient to use the call bell.1-4,14-18 The tasks of rounding are organized using the letter P. The three basic P’s of rounding are pain, potty, and position, which are the three basic needs common to most patients. These three P’s are universal and used in most hospitals that use hourly rounding as their patient care model. Other P’s can be added, based on the preferences of each hospital.11,13,16

Other P’s for rounding include “pump, periphery, plan of the day, possessions.” Using words beginning with P makes the tasks of rounding easy to remember. When rounding, it is best to limit the number of P’s so it is easier for staff to remember the tasks associated with rounding. Most hospitals choose four or five P’s as their focus for rounds and incorporate all patient care tasks, including medication passes and treatments, into those P’s.8,16-21
Three types of rounds occur during each shift: introductory (which can include bedside shift report), initial, and hourly. Let’s examine each type. The introductory round is just what it says, a round to introduce the oncoming nurse by the outgoing nurse. The process allows the oncoming nurse to be “managed up” by her colleague who is leaving and increases the patient’s confidence in the oncoming nurse. Managing up means that the outgoing nurse introduces the oncoming nurse by highlighting the nurse’s strengths.

An example of this is: “Hello, Mrs. Jones, I’m going home now, but I wanted to introduce Kelly, who will be taking care of you today. She has worked here for three years and is an excellent nurse, one of our best. She will take very good care of you today.” A statement like this from the outgoing nurse sets up the oncoming nurse as competent and lets patients feel they are in good hands.13,18,19 The introductory round can be included as part of the bedside shift report or can take the form of the outgoing and incoming nurse’s visiting each patient together at change of shift for introductions and a quick check of the patient’s well-being. As part of the introductory round, the outgoing and oncoming nurse visit all their patients together at shift change and give shift change report. The outgoing nurse can then leave, and the oncoming nurse can begin his or her initial rounds.13,16,18,19 The initial round is the first hourly round of each shift, and it is done after the outgoing and oncoming nurses complete the introductory rounds. The initial round includes all the dialogue and actions that are part of a regular hourly round with the addition of two important elements. First, the initial round should include an explanation to the patient of what hourly rounding is. This way, the patient understands rounding and knows that it is purposeful.

Second, during this initial round that the nurse should ask each patient, “What is the most important thing that I can do for you today?” The MIT may be something as simple as making a phone call to check on the status of a patient’s pet or checking with the physician to see if the patient can have regular instead of decaf coffee. Asking for the MIT shows patients that their priorities are important and will be addressed along with their medical treatment.

The MIT is usually written on the patient’s communication board so the nurse can focus on ensuring the MIT is carried out. Each oncoming nurse should ask about the MIT as part of the initial round, as the patient’s MIT likely will change shift to shift.13,16-19 The regular hourly round is done every hour for the remainder of the shift. The hourly round is performed in the same way at most hospitals although the P’s used may vary. The hourly round is performed every hour addressing the P’s from 0600 to 2200.

At night, the nurse can set up the overnight expectation for rounding by telling the patient that he or she will round every two hours from 2200 until 0600. The nurse will come into rooms quietly and check that patients are safe, but will not waken them if they are sleeping. The nurse will sign the rounding log at each round so the patient can see that the round happened during the night. Rounds return to every hour beginning at 0600.13,16-21
Patient satisfaction
Types of rounding
Because of the expectations of patients for assistance and attention as well as the need for nurses to have some control over their activities, it became important to find a way to satisfy both patients and nurses while meeting the legitimate needs of both.
The P’s of rounding1,8,17-21
PAIN: Address patient’s pain at every round; use scale of 1-10; document medication given and when next dose is due on the room communication board. Explain pain medication, adverse effects, dose. Tell patient, “I will round on you every hour to make sure your pain is under control.”
POTTY: Offer patient assistance with restroom needs. Caution not to get out of bed alone. Ask, “Do you need to use the restroom now? May I help you to the restroom?”
POSITION: Assess patient position and reposition as needed for comfort. Help patient into or out of bed, into or out of chair, and turn. Ask, “Is there anything I can do to make you more comfortable?”
PUMP: Check IV and other pumps to ensure that everything is working correctly so alarms do not go off.
PERIPHERY: Assess patient room: tidy up, clear clutter, straighten bed, fluff pillows, remove used linen. Ensure that telephone, call light, TV control, and wastebasket are within reach.
PLAN: Review patient agenda or plan of care with patient. Update on tests and treatments; discuss needs at home; plan for discharge. Ask patient, “What is the most important thing I can do for you today?” and update the communication board.
POSSESSIONS: Make sure the patient’s belongings are within reach. Make sure that items, such as dentures and hearing aids, have labeled containers for safekeeping when patient isn’t using these items. Secure patient valuables.
PARTING: Before leaving room ask the patient, “Is there anything else I can do for you before I leave? I have the time.” Explain that you will be back again in an hour and that during the night you will round on them every two hours, even if they are sleeping. Document the round on the rounding log in the room.
Other P’s that can be used:
Basic P’s of rounding:
Earn 1 credit hour with this free continuing education course
article-down-arrowshare-dots-shadowleft-arrowright-arrowright-arrow-3
How to Navigate
Nurse-logo
Subscribe
X
How to Navigate
BROWSE
FIND
right-arrowleft-arrow
hamburguer-icon-shadow
MENU
Move forward or backward between articles by clicking the arrows.
Click or tap to bring up the Table of Contents.
READ
share-dots-shadow
facebooktwitterLinkedingoogle-pluspinterest
SHARE
scroll
Share articles by clicking on one of the social media icons in the upper right corner of the page.
Use your mouse wheel, keyboard arrow keys, or scroll bar to move up and down in an article.
Don't miss our next edition!
Get free tips and nursing content delivered right to your inbox