Hourly Nursing Rounding

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Introduction
• Purposeful and timely rounding is a best practice
intervention to routinely meet patient care needs,
ensure patient safety, decrease the occurrence of
patient preventable events, and proactively address
problems before they occur.
• The Institute for Healthcare Improvement (IHI) endorsed
hourly rounding as the best way to reduce call lights and
fall injuries, and increase both quality of care and
patient satisfaction.
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Introduction
• Nurse knowledge regarding purposeful rounding and
infrastructure supporting timeliness are essential components
for consistency with this patient centred practice.
• Published reports have suggested that systematic and
purposeful rounding by nursing results in improved patient
satisfaction

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Definition
Hourly rounding is the process in which every hour, a nurse
enters a patient's room to assess the person's needs.

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Purpose
 

•The primary purpose of hourly rounding is to improve patient outcomes by

enhancing patient safety and patient satisfaction. 

•To address the patient needs in a proactive manner.

•To improve time management. 

•Establishes caring through presence and partnering with patients.

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Scope:

• Nursing responsiveness is an important factor in a patient’s

experience of care during hospitalization and is captured in
most patient satisfaction surveys.

• The goals of rounding are to create approachable

management, strengthen relationships, find improvement
opportunities, and show appreciation to employees

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Scope:

When consistently and effectively applied, Hourly Rounding will:

• Reduce patient falls
• Reduce call lights for increased nurse efficiency and satisfaction
• Reduce all nursing causes for increase of LOS
• Improve patient perceptions of their care
• Improve patient experience scores
• Give nurses more time for patient care tasks – you are more in
control of your time by being proactive rather than reactive.

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Responsibilities:

• Nurses assigned to the patients are responsible for adhering

the hourly nursing rounds policy
• Issues or complaints identified will be escalated to the Ward
Incharge & Floor Incharge and further to Nursing Head/Ops
manager and to the Centre Head.

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 Process:

• Issues/Complaints identified in every shift should be reported

to Shift Incharge. Issues related to Pain, Potty, Position and
Possessions can be categorized as Nursing, Delay in Service,
House Keeping, Room (Infra Structure)
• Shift Incharge will report to Ward Incharge during the shift
huddle.
• Ward Incharge shall report to Nursing Head and Ops Manager
• Nursing Head will report to Centre Head in the huddle
meetings. In absence of the Nursing Head, Ops Manager shall
report to the Centre Head.

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Responsibilities:

• Hourly log sheets should be a part of all nursing

charts, Opportunities identified in hourly rounding
should be documented every shift in Nursing Rounding
Registers, the data should be collated at the end of the
month and shared to Nursing Head.
• Competencies required should be clearly identified
and trainings should be conducted to all nurses.
• Rounds should be documented in the presence of the
patient.

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Policy:

Four Key Actions to Remember for Hourly Rounding

• Pain
• Potty
• Position
• Possessions

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Policy:

- Four Key Actions to Remember for Hourly Rounding

• Pain
• Potty
• Position
• Possessions
- Frequency of hourly nursing rounding is,
• 6am - 10pm every hour
• 10pm - 2am every two hours
• 2am to 6am - One visit

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Barriers to Hourly Rounding:

1. Buy-in: One potential strategy for gaining buy-in from seasoned

nurses is to show the evidence of proven success.
2. Acuity levels: An important factor is to ensure a tool is used to
adequately measure acuity levels, which will help appropriately
distribute workloads.
3. Time management is an essential skill required by nurses to be
successful in any work setting.
4. Unexpected interruption

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Breaking Down Barriers:

1. Patients were sleeping

2. Lack of an acuity system for nursing assignments
3. Unit emergencies

4. Contradictions in policies
5. Lack of communication

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Breaking Down Barriers

Barrier: Unit emergencies

Solution: Nursing staff created a unit workflow that clearly
describes staff roles during times of emergency. It identifies the
caregivers needed at the bedside during rapid response and code
blue situations. It also details caregiver duties that can be
dismissed after the emergency medical team arrives. The
workflow places emphasis on rounding on other patients during
emergencies.

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Breaking Down Barriers

Barrier: Full compliance with rounding decreases from 7 p.m. to

11 p.m.
Solution: The late evening timeframe coincides with high
admissions, high-volume medication administration and staffing
level changes from day to night shift. Med-surg unit nursing
teams are striving to increase communication and accountability
between peers during traditionally busy times.
Teams have utilized role playing and brainstorming in small
groups to help staff approach sensitive conversations, such as
when a nurse needs to ask an Incharge for help with rounding.
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Breaking Down Barriers

Barrier: Missed documentation of rounding in the electronic

medical record (EMR).
Solution: During staff meetings, huddles and practice council
meetings, unit leaders placed educational emphasis on accurate
documentation. All staff received education on the rounding
documentation feature within the EMR. In addition, staff perform
random real-time feedback audits related to hourly rounds
documentation.

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Measuring Outcomes
• Review quarterly patient fall rates
• Review quarterly pressure ulcer rates
• Review/discuss hourly safety rounds regularly at staff meeting
• Review NPS scores/patient comments
• Fewer call bells
• Less steps taken by nurses over each shift
• The reports will be forwarded to analysed in the Quality
Improvement, Patient experience and Patient Safety
Committees.
•  

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19
Competency Checklist

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Scripts

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Pocket Card

Purpose: Issue pocket cards to unit staff and

new staff during orientation.

Target: All staff performing hourly rounding.

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Research Articles

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 Evidence Based Practices
 Meade, CM., Bursell, AL., & Ketelsen, L. Effects of Nursing Rounds on Patients’
Call Light Use, Satisfaction and Safety. American Journal of Nursing. 2006;
106(9):58-70.
• Found that a protocol which incorporates specific actions into nursing
rounds either hourly or once every two hours: – decreased patient falls by
50%
– Decreased skin breakdown by 14%
– Increased patient satisfaction scores by 8.9 points
– Decreased call light use by 38%
– Reduced distance walked each day by nursing staff by 20%

• http://
www.iosrjournals.org/iosr-jnhs/papers/vol7-issue4/Version-2/I0704026573.pdf
• https://
www.mc.vanderbilt.edu/root/pdfs/nursing/hourly_rounding_supplement-stude
r_group.pdf
• http://www.theinstituteforinnovation.org/docs/default-source/annotated-biblio
graphies/hourly-rounds_oct-2016.pdf?sfvrsn=2 24
Improving Call Bell Response

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Introduction

• Every patient has a right to expect the safest

care and the best possible experience.

• The call bell is a vital communication link

during a patient’s hospital stay.

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 Definition

A nurse call button is a button or cord found in hospitals, at

places where patients are at their most vulnerable, such as
beside their bed and in the bathroom.
It allows patients in health care settings to alert a nurse or
other health care staff member remotely of their need for
help.
When the button is pressed, a signal alerts staff at the
nurse's station, and usually, a nurse or nurse assistant
responds to such a call.

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 Definition
• A nurse call button is a button or cord found in hospitals, at places
where patients are at their most vulnerable, such as beside their
bed and in the bathroom.
• It allows patients in health care settings to alert a nurse or other
health care staff member remotely of their need for help.
• When the button is pressed, a signal alerts staff at the nurse's
station, and usually, a nurse or nurse assistant responds to such a
call.

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 Purpose

• Enables a patient who is confined to bed and has no other way of

communicating with staff to alert a nurse of the need for any type
of assistance
• Enables a patient who is able to get out of bed, but for whom this
may be hazardous, exhausting, or otherwise difficult to alert a
nurse of the need for any type of assistance
• Provides the patient an increased sense of security

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 Purpose

• Enables a patient who is confined to bed and has no other way of

communicating with staff to alert a nurse of the need for any type
of assistance
• Enables a patient who is able to get out of bed, but for whom this
may be hazardous, exhausting, or otherwise difficult to alert a
nurse of the need for any type of assistance
• Provides the patient an increased sense of security

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 Scope

• The call bell speaks for patients who can’t talk.

• It connects the immobile or disabled patient to the nursing
station.
• It is the difference between life and death for some patients, and
it is the source of relief to a vulnerable person that a nurse is
coming to help.

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 Responsibilities:

• All the Nurses working on the floors are responsible for answering
the call bells.
• Nurse working near to the patient’s room should be attending the
patient upon call bell.
• Strong leadership is necessary from the nurse unit managers to
stress the importance of prompt call bell response.
• A team approach should be emphasized to spread the load among
all staff.
• Initiatives should be introduced to keep nurses at the bedside and
improve patient surveillance.

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 Policy

• Timely response to patient calls is important to monitor from

many perspectives including customer satisfaction and patient
safety.
• Visual surveillance of high-risk fallers is important as they are
generally unable to ring for assistance when required.

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Team based approach for response to needs?

With patients
Before call bell rings
Call bell rings
Involve family members as partners
Goal: Stop call bell before they
happen Goal: Answer call bell within 1
Check in with patients and family their needs
minutes
have been met
 Schedule hourly rounding
 Frequent informal check in With staff  Everyone responds
by nurse regardless of position
Tell each other when you helped out their  Enquire about needs
patients
Thank each other for helping out

If patient request for the nurse

Call bell dialogue  “Find out what patient want and let patient know if
you can handle
 Incase the request can not be handled by you,
 “May I help you?”
 inform assigned staff or the team leader/Charge
“Please share with me what you need so that I can
nurse
right person for you
 Communicate back action taken to the patient and
 “I will take care of that right now”
care giver
If more than 5 min delay is anticipated in resolutions,
inform the patient If more than 5 min delay is anticipated in resolutions,
inform the patient
 Measuring Outcomes of Hourly Rounding

• Reduction in the number of call bells for non-clinical reasons as

these needs were met in a proactive manner.
• Active patient monitoring
• Review quarterly patient fall rates
• Review quarterly pressure ulcer rates
• Review/discuss hourly safety rounds regularly at staff meeting
• Review NPS scores/patient comments
• The reports will be forwarded to analysed in the Quality
Improvement, Patient experience and Patient Safety Committees.

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Evidence Based Practices:

• Call bell response times were discussed at every opportunity,

for example, clinical handover, team meetings and ward
meetings to increase awareness.
• Nursing meal breaks were rescheduled so that only two were
absent from the ward at any one time.
• The nurses work in teams so that another nurse is responsible
for the patient calls when they are on a break
• A bedside model of nursing handover replaced the previous
lengthy ‘meeting room’ model, resulting in a greater nursing
presence on the ward.

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Evidence Based Practices:

• After a 15-minute group handover from the nurse in charge of

the previous shift, the handover between one shift and the
next was then conducted at the bedside with the discussion
involving the patient.
• The patient and the charts were visually checked at the time
and any shortfalls addressed.
• Physiotherapy assistants were rostered for ward duty during
the morning peak time (8am-9.30am) to help answer call bells,
and assist patients who required the toilet or set up for
breakfast.
 
 

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T

Thank You

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