MPSC 2010 Annual Conference Solution Submission
Hourly Rounding – The 4 P’s
Organization Name: Peninsula Regional
Medical Center
Janet Mercer & Cherita Fagan
Contact Person:
janet.mercer@peninsula.org
E-Mail:
Type:
Title:
Phone:
Acute Care Hospital
Clinical Manager- 5WB/5EB
410.543.7570
IDENTIFICATION:
What was the problem to be solved?
• Increase patient satisfaction scores
• Decrease falls
• Decrease skin breakdowns
• Increase staff satisfaction
How was the problem identified?
• Patient satisfaction survey (NRC Picker) results
• Hospital survey identified opportunity to increase patient satisfaction
• Skin breakdown rates
• Fall rates
What baseline data existed?
• NRC Picker Overall Rating of Care score- 53.2% (April 09)
• Average Skin rate 3.217% per one thousand (1000) pt. days (January thru April 09)
• Average Fall rate 4.059% per one thousand (1000) pt. days (January thru April 09)
PROCESS:
Evidence-based research indicated implementation of hourly rounding would increase pt.
satisfaction, decrease fall rates, decrease skin breakdown rates, and increase staff satisfaction.
All patient care staff in clinical areas was educated utilizing the Studer Group Hourly Rounding
Module. A one-hour class was developed introducing staff to the concepts of “Hourly
Rounding”. Peninsula Regional’s decision was to focus hourly rounding on the 4 P’s: Pain,
Potty, Positioning, and Possessions (see attachment #1). Several vignettes were shown during
the class to reinforce the rounding behaviors. Each staff member left the class with a competency
(see attachment #2) to take back to their area and practice/ role-play with another staff member.
Once comfortable they had to complete the competency with a Clinical Resource Nurse. Hourly
Rounding was rolled out hospital wide on April 15, 2009.
To ensure successful implementation, it was critical for nurse managers to validate with each
patient the performance of hourly rounding.
MPSC 2010 Annual Conference Solution Submission
SOLUTION:
What solution was developed?
• Competency based (return demonstration) education for all employees on clinical areas.
• Management rounding to verify performance of hourly rounding by staff.
• Rounding Log for documentation (Attachment #3)
How was this solution implemented?
• Classroom setting for one hour.
• Return demonstration of competence.
What are the results of this implementation?
• Patient satisfaction scores trending upward for overall rating of care.
• Fall rate trending down
• Skin breakdown trending down
What measures are being taken to assure the results are sustained over time?
• Hourly rounding logs are monitored for completion and to ensure documentation of
rounding is being performed.
• During the managers daily rounding process verification of hourly rounding is verified
with the patient.
• If inconsistencies are noted between the patients’ experience and the rounding log
documentation, coaching and mentoring is provided to each individual staff.
OUTCOMES:
•
•
•
NRC Picker patient satisfaction scores- 64.4% (September 09) (Attachment #4)
Average Fall rate-2.693% per 1000 pt days (May-December 09) (Attachment #5)
Average Skin rate-1.543% per 1000 pt days (May-December 09) (Attachment #6)
MPSC 2010 Annual Conference Solution Submission
Hourly Rounding – The Four Ps
P
ain
P
osition
P
otty
P
ossessions
Introduce Yourself
Address the Four Ps
For example:
“Mrs. Smith, my name is Sarah, and I will
be your nurse today. I will take excellent
care of you. I have discussed your care with
your nurse from the last shift and I have the
plan for the day.”

Pain – “How is your pain?” Medicate
patient or schedule during upcoming rounds.

Position – “Are you comfortable?”
Move the patient up in bad. Rearrange
pillows. Offer extra blankets. Turn patients
who are at high-risk for skin breakdown.

Potty – “Do you need to use the bathroom?”
Assist the patient to the bathroom.

Possessions – “Do you need me to move the
phone, call light, trash can, water or your
bedside table within reach?” Arrange bedside
table. Refill water pitcher.
Describe Hourly Rounding
“Because we want you to receive
excellent care, we are going to round
every hour from 6 a.m to 10 p.m. and
every 2 hours from 10 p.m. to 6 a.m. We
will not wake you if you are sleeping,
unless your physician has asked us to do
so. During this time, we will check on
your pain, your comfort and if you need
to use the bathroom. We will also be
asking if you need anything moved
within easier reach, or have any
questions about your care.”
Use White Boards
Write today’s date, the patient’s nurse’s
name and his/her assistant/PCT. Also
write the charge nurse’s name and
extension.
In addition:
 Perform scheduled tasks:
- MD ordered procedures
- Give scheduled treatment and/or
medication
Closing

Communicate when you will return.
“I, or someone from my team, will be back
in about an hour.”
 Close with Key Words. “Is there anything
else that I can do for you? I have time.”
 Document your round on the Rounding
Log in the patient’s room.
MPSC 2010 Annual Conference Solution Submission
Name:__________________________ Badge #:____________ Unit:____________
Hourly Rounding Competency Skills Checklist
Directions: Use this tool as a competency checklist to document the demonstration of hourly rounding
competencies and behaviors. There are two parts to this competency – the learner’s self evaluation and the
manager/supervisor/or designee’s evaluation of the learner which must both be signed-off to complete this
competency. All information reviewed/skills assessed are based on the 2006 StuderGroup, Patient Care Strategies:
Achieving Nursing & Patient Care Excellence (Hourly Rounding). Successful completion of this competency will
be documented in NetLearning, 0.5 ECH.
Competence Statements
Introductions
 Knocks on patient’s door prior to entering, asks permission
 Uses good eye contact
 Explains the purpose of hourly rounding (initial visit)
 Uses key words “excellent” care
 Describes rounding schedule (7am-10pm q 1 hour; midnight-6am q 2 hours)
Update White Boards
 Places name on white board
 Updates information as per unit practice.
Addresses 4P’s Pain . . . Position . . . Potty . . . Possessions. Asks:
 “How is your pain?”
 “Are you comfortable?”
 “Do you need to go to the bathroom?”
 “Is everything you need within your reach?” (move items as needed table, call
bell, phone, tissues, water)
Performs and Explains Scheduled Tasks, Treatments, Care and Medication Use
 Completes MD ordered treatments, procedures
 Completes nursing care as needed
 Administers scheduled medications
Closing
 Explains to patient, “We will be rounding again in about an hour.”
 Asks “Is there anything else that I can do for you? I have the time.”
 Documents rounding on the rounding log in the patient’s room
Successfully
Demonstrated
Self Evaluation
(learner’s
initials)
Successfully
Demonstrate
d
(initialed by
evaluator)
MPSC 2010 Annual Conference Solution Submission
My signature below indicates that the above information/skills have been reviewed and that I have successfully
demonstrated understanding/competence.
_______________________________________
__________________
Employee Signature
Date
Initials Validation of evaluator:
________
__________________________________________
Initials
Signature
_________________
Date
MPSC 2010 Annual Conference Solution Submission
Hourly Rounding Log
This log is to be completed every hour from 7 am to 10 pm and every 2 hours from midnight to 6
am.
I have assessed my patient for all of the above comfort measures as indicated by my signature
below:
Time Period
7:00 AM
8:00 AM
9:00 AM
10:00 AM
11:00 AM
12:00 PM
1:00 PM
2:00 PM
3:00 PM
4:00 PM
5:00 PM
6:00 PM
7:00 PM
8:00 PM
9:00 PM
10:00 PM
12:00 AM
2:00 AM
4:00 AM
Initials of Person Rounding
Comments (*note if pt. sleeping)
MPSC 2010 Annual Conference Solution Submission
6:00 AM
Rounding includes: Asking about pain, voiding/elimination, positioning, ensuring everything
within reach, asking if there is anything else you can do, and telling the patient when someone
will be back.
MPSC 2010 Annual Conference Solution Submission
MPSC 2010 Annual Conference Solution Submission
MPSC 2010 Annual Conference Solution Submission