Originally Submitted November 23, 2008
Revised and Resubmitted January 10, 2009
Hourly rounding is a strategy involving nurses and other health care staff to regularly “check in” on patients every hour. Because nursing staff is not reacting to call lights, patients are more content and happy; therefore nurses feel they are doing a better job helping their patients (Studer, 2007). Research has shown that rounding every hour lowers patient’s use of call lights and resultantly decreases the workload of the nurse (Leighty, 2007; Meade, Bursell, & Ketelsen, 2006; & Tipton, 2008). Performing hourly rounds has contributed to 20% less walking per shift worked (Studer, 2007, & Leighty, 2006). By using this proactive approach, nurses can better manage their time and fell they are more attentive to their patient’s needs. Leighty (2006) states, “nurses involved in a hourly rounding protocol are finding their shifts less stressful and their time more productive” (¶ 1). Activity
The project will consist of instructing nurses and certified nursing assistants (CNA’s) on the benefits of hourly rounding and how to perform hourly rounds appropriately. Pre-instruction, a survey was administered related to the nurse’s/CNA’s feelings/ attitudes on the current odd-hour rounding system and the effects of odd-hour rounding on their time management and the daily routine. Time management and increased productivity is proven to be a benefit of hourly rounding. Performing hourly rounds has contributed to 20% less walking per shift worked (Studer, 2007, & Leighty, 2006). Four staff members will wear pedometers for a specified time prior to the implementation of hourly rounding and will again at the end of the project after hourly rounds have been put into operation for at least 2 weeks (see APPENDIX B). The teaching is planned after each nurse has used the pedometer for at least three 12-hour shifts. Instruction will include a poster to present material including statistics and evidence based literature to validate the success of hourly rounding, especially the advantages for nurses. A laminated card with be produced outlining the specific actions to be performed: positioning, offer assistance with elimination, assess for pain and offer pain medication if timely, and place all essential items within reach, i.e. call bell, phone, tissues (Tea, Ellison, & Feghali, 2008). More importantly, the nurses and CNA’s will be instructed to ask, “Is there SOMEthing else I can do for you?” This scripted question relays the message that the nurse is dedicated to the patient and wants “to anticipate the patient’s needs” (Stokowski, 2008). Following this statement with “I (or another nurse/CNA) will return in one-hour to do rounds again,” is another way to be proactive and thus allow the nurse to be more productive due to better time management (Stokowski, 2008). This instruction will be reinforced by including role-play in which proper rounding is demonstrated.
Quality control for hourly rounds will be determined if the rounding chart is initialed every hour to indicate rounds are performed (see APPENDIX A). Although initialing a chart does not prove that rounds were performed, the post-implementation survey questions will assist in validation. To ensure compliance with the project, rewards will be distributed throughout the implementation period. Increased productivity and better time management will be bonuses for the nurse/CNA toward the end of project implementation; material rewards may not be necessary due to this (Studer, 2007). The team approach will be helpful, especially with those patients that need additional assistance with toileting or positioning. Having two nurses/CNAs round together on those patients needing the extra care will save time and energy in the long run. Outcomes
The focus of the practicum project is to assess if hourly rounding does indeed...