Hourly Rounding: A Replication Study

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

Safety is an essential factor in the creation of the healing environment and this is dependent on the role of the caregiver and the patient when it is possible. “Safety is a basic component of professional nursing and Caritas Processes. Safety concerns affect all of the nurse’s activities related to supporting, protecting, and correcting the environment for healing at all levels, To feel safe and protected is a basic need” (Watson, 2008, p. 13). Many factors impede the safety of patients in a healing environment such as Risk of falls, Pressure ulcers, and close calls. Ford’s literature (as cited in Woolley et al, 2012) found that “hourly rounding resulted in a 52% reduction in call light use, giving nurses more time to provide patient care and prevent patient calls” and in Bourgault et al.’s study conducted in 2006 (as cited in Woolley et al, 2012) “expected outcomes of hourly rounding included increase

Method. Through interviews and surveys with staff, the barriers to obtaining patient weights in the mornings, rather than that of the afternoon or evenings, are

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

The hourly rounding log is designed in accordance with the hospital’s policies and procedures. A clinical committee is consulted in designing the documentation log to suit the needs of the patients and the staff. It is composed of four columns. The first column is the time period, the second is the actual time that the staff rounded the patient, the third is the staff’s initials who make the rounds, and the last one is for comments (any significant patient needs that were addressed or that patient is asleep).

If there is a fall with injury, the manager has the ability to go back and check how long the call light was on prior to a fall. However, this information is not used to prevent and emphasize the relationship between the length of time a call light is on and the rate of fall. Most nurses and patient care technicians are not aware that the manager can back-track the call light and find out this information. To measure the rate of falls to the length of time a call light is answered, the nurse working on the project choose the histogram. This illustrates the length of time in the Y axis and the rate of falls in the X axis during the period of study (time frame). The histogram itself will include a control group, average answers, and delay answers to call light. This example was imported and modified from a previous study done comparing the numbers of call lights and nursing rounds by (Meade et al. 2006).

Rounding allows nurses to gather information in a structured way. It’s proactive, not reactive like call light responses. It’s a great way to get a handle on patient problems before they occur. It’s all about providing the best patient-driven health care… The great thing about hourly rounding is that it doesn’t benefit only the patients. (¶ 4).

For some nurses, mandatory overtime can be an advantage due to financial instability but mostly mandatory overtime can cause fatigue, burnout, injuries, errors, inadequate sleep and deficits in performance. According to research working long hours which consists more than 40 hours a week or over 12 hours a day leads to an increased medication errors and patient mortality. The probability of making medication errors increases tremendously when nurses work longer than 12.5 hours a day. During surveys regarding reasons of overtime, 60 % of nurses stated that overtime was obligatory as part of their job, 29 % of nurses stated that they volunteered and 41% of nurses stated that they were “on call hours” (Bae, 2012)

Hourly rounding also known as intentional rounding or comfort rounding is an initiative that hospitals nationwide are beginning to implement. Hourly rounding should be purposeful. “Hourly rounding is a systematic proactive nurse-driven evidence based intervention to anticipate and address needs in hospitalized patients” (Deitrick, Baker, Paxton, Flores, & Swavely, 2012, p.13). “Purposeful nurse rounds encompass a practice where nurses attend to and document scheduled patient reviews at pre-determined and regular intervals (hourly or second hourly)” (Lyons, Biunero, & Lamont, 2015, p.31).

The purpose of the study was to identify the effect of regular nurse rounding on patient fall rate, call light usage and patient satisfaction in a medical surgical unit. A literature review using three studies from Medline and

Tzeng and Yin (2009) identified the main reasons for call light use and the impact that hourly rounds have in decreasing the call light use rate and patient falls. This study was done in a community hospital located in Michigan and used archived hospital data for analyses. The archives involved were from four adult acute care units during February 2007- June 2008: one surgical unit with 53 beds, two medical units with both totaling 87 beds and one medical-surgical combined unit with 58 beds (Tzeng, & Yin, 2009).

The authors recommend that the findings originating from this study can be used as a basis to initiate protocols for implementation of bedside nursing

Patients in a hospital and/or healthcare facilities have to be cared for all day and all night, everyday of the week by nurses. The usual way to fulfill this need is to divide up the day into three 8-hour shifts. Different shifts have been put into place to help improve nurse satisfaction, decrease the nursing shortage and save the hospital money. The 24-hour day is made up of two 12-hour shifts; 12 hours in the day and 12 hours at night. There has been quite an ongoing debate over the years regarding this issue of nurses working over 8 hours in a single day. Many people, such as hospital nursing administrators, have reason to believe that working long hour shifts causes more errors in

Limited attention has been paid to the hours worked by nurses, or the effects of these hours on patient safety (Rogers, 2008). Even though most nurses favor 12- hour shifts and overtime, it is associated with difficulties staying awake during times of duty, reduced sleep times, and triple the risk of making an error (Rogers, 2008). The most significant risk of making an error occurred when nurses were scheduled to work 12.5 hours or more.

Hourly rounding contributes in several key areas to achievement of high levels of patient satisfaction, including quality of care and patient safety. This puts patients at the center of care by building on the fundamental aspects of care, which are so important. Thus by checking in on patients in wards regularly to see whether they are comfortable and have everything they need can produce a number of positive results. Nurses