Hourly Rounding: A systematic approach to patient safety
Paula Anton, MS. RN, CRRN, ACNS-BC, Michelle Fernamberg, MHA, BSN, RN, CRRN, Leah Shever, PhD, RN,
Mary L. Parker, MS, RN, 6A Professional Practice Council
6A Acute Rehabilitation Nursing, University of Michigan, Ann Arbor, MI
Purpose
Hourly rounding has been demonstrated to improve outcomes in
acute care. Over the past 4 years, various units at University of
Michigan Hospitals have implemented hourly rounding processes.
Units have had varied results and difficulty sustaining those results
and Hourly Rounding in practice. The purpose of this project was to
standardize an evidence-based, patient-focused intentional
surveillance of the patient that contributes to:
• optimal patient outcomes
• improved patient satisfaction
• decreased call light use
• decreased falls
Synthesis
Studies describe Hourly Rounding as a group of interventions that
improves call light use, patient satisfaction, and safety.2, 5, 6
Recent studies describe these results in multiple settings. 3, 4, 5, 9.
Activities of the nurse during rounds vary by study, but some reviews
are beginning to identify common trends in activities that make the
most impact. 4, 9
Toileting at specific times is known to decrease falls in elderly and
patients on diuretics. 1, 7, 10
Implementation Strategies
The Professional Practice Council was involved in the decision to
implement Hourly Rounding. They participated in education of peers
on the process, and were embedded in planning the strategy for
implementation. Staff were educated on the process for rounding
and how the process and outcomes would be measured. 4, 6
Leaders provided feedback to staff regularly.
To determine how well the process is implemented on the unit,
following data sources were monitored:
• Leader Rounding in which unit leaders round on staff and patients
to ask them directly about the Hourly Rounding process. 2, 8
• Chart audits for documentation of pain/comfort, toileting and
activity/positioning.
Evaluation
Outcome measures included call light data, falls and patient
satisfaction with nursing care and response to call lights. Findings
were mixed. Call light use did not change in response to rounding. The
patients reported process was well adhered to, with nurses providing
the interventions as prescribed. Patient satisfaction improved.
Evaluation
Initially falls decreased, but later an increase in falls prompted
additional chart audits. Results suggested that toileting may not have
been being done pro-actively, in spite of patient comments that it
was.
Significance
While Hourly Rounding is well established as a helpful set of
interventions for improving patient outcomes, it is clear that
leadership commitment to monitoring staff compliance with the
process is needed to hardwire the practice.3, 4, 8 It is possible that the
complexity of such a grouping of interventions results in difficulty
keeping the practice going, and evidence from this project indicate
that pro-active toileting may be the most important intervention.
References
Change
A pilot was conducted on 6A in which, at prescribed intervals, the
nursing staff performed activities that focus on four basic areas of
nursing care:
• Pain and comfort
• Safety and environment
• Positioning and activity
• Pro-active toileting
Specific language was used to systematically convey activities to the
patients.
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