Hourly Intentional Rounding
Worth the Time?
Brandy Everson
COHP 450
November 30, 2014
Purpose/Introduction
I am a nurse at Saint Mary’s hospital in Grand Rapids. They require
nurses and personal care technicians to do hourly rounding. Hourly
intentional rounding addresses
•Toileting
•Environment
•Hunger/thirst
•Pain
•End with “Can I do anything for you before I leave? I will be back in
another hour but use your call light if you need someone before?”
The purpose of this presentation was to decide if intentional hourly
rounding is worth the time it takes staff from other tasks.
Finding Research
Keywords I used were:
• intentional rounding
• hourly rounding
• call lights
Search engines I used were:
• General one file info trac
• Primo by Ex Libris
• LexisNexis
Search results were right on target
with what I was looking for with the
key words “hourly intentional
rounding.” A couple of articles I did
not spend time on were not what I
considered credible sources.
References
Harrington, A., Bradley., Jeffers, L., Linedale, E., Kelman, S., &
Killington, G. (2013). The implementation of intentional
rounding using participatory action research. Intentional
Journal of Nursing Practice, 19(5), 523-529.
Mason, Mary-Claire. (2012). More than a checklist. With the
governement calling for hourly patient checks, intentional
rounding could soon be widespread in hospitals. Nursing
standard, 26(20), 20.
Study #1
• The first study was the implementation of intentional
rounding using participatory action research, used a
qualitative approach called PAR or participatory approach
research. This study is a patient cohort and consisted of four
cycles which could be revised throughout.
• The population was patients in the hospital. Variables are
their limited decision making.
• In the first phase “assessment, "they found most call lights
were placed for non urgent reasons and underlying reason
was emotional or anxiety.
• Feedback from surveys after discharge in regards to
intentional rounding were inconclusive.
• There was a reduction in call light usage and safety was
improved.
(Harrington, A., Bradley., Jeffers, L., Linedale, E., Kelman, S., & Killington, G., 2013).
Study #2
• The next study was also a qualitative study.
• They did a static group comparison where a few were selected
to participate in intentional rounding were compared to those
who did not participate.
• Study was done by creating a checklist of what each patient
was asked then trialed on the floor. They kept track of results.
The subjects were selected patients on the floor.
• The study tracked the amount call lights that went off before
and after intentional rounding. They also did two hour checks
and one hour for dementia/acute care patients.
• They found that pressure sores were reduced with intentional
rounding.
(Mason, Mary-Claire, 2012).
Ethical Considerations
Study #1
Study #2
• The first study took the proposal
to the institutional review board
who approved prior to the study.
• Information was distributed to the
staff and permission from staff
was given.
• Permission was verbal and written
was obtained.
• The second study does not discuss
ethical consideration. They do
claim while participating in the
study patients receive care that is
equal versus more vocal patients
receiving care.
(Harrington, A., Bradley.,Jeffers, L., Linedale, E.,
Kelman, S., & Killington, G., 2013).
(Mason, Mary-Claire, 2012).
Strength
Study #1
Study #2
• Chose to do the study
because they felt nurses were
reacting to the patients needs
rather than preventing them.
They felt this study could
improve patient satisfaction
and productivity.
• Chose to do the study because
they were doing many of the
intentional rounding things
already and thought the
checklist would provide a
systematic way of doing
things
Harrington, A., Bradley., Jeffers, L., Linedale, E.,
Kelman, S., & Killington, G. (2013).
(Mason, Mary-Claire, 2012).
Quality
Study #1
Study #2
• Used a small amount of
patients and staff to test
intentional rounding. They
used 86 patients and 138
staff.
• Discusses how evidence is
low because patients suffer
from cognitive deficits
making it hard for them to
participate in intentional
rounding.
• Does not give the amount of
staff or patients that
participated. They say that
their was 78% percent
decrease of call lights which
in turn improved patient
care but do not state out of
how many patients.
• They do not have a section
where they discuss
reliability of their evidence.
(Harrington, A., Bradley., Jeffers, L., Linedale, E.,
Kelman, S., & Killington, G., 2013).
(Mason, Mary-Claire, 2012).
Credibility
• Both articles were peer reviewed.
• Both articles have findings that match other literature out on
intentional rounding.
(Mason, Mary-Claire, 2012).
(Harrington, A., Bradley., Jeffers, L., Linedale, E., Kelman, S., & Killington, G., 2013).
Incorporating into practice
• You would want to develop a policy and structure for what
charting is necessary for rounding as well as questions they
should ask.
• You then would roll it out department by department. This
allows you to work out the kinks before it is hospital wide.
• Intentional rounding would be an expectation of all staff and
would be communicated as a policy change. It would be
educated in large groups to reduce time spent on it. New hires
would be on an individual basis if needed.
How it affects practice
• These studies have the potential to improve practice
everywhere. Safety is improved, pressure ulcers are reduced
and overall patient satisfaction is increased. That not only
improves the practices of the individual nurse but nursing
practice as a whole. In my opinion we were moving away from
the 1:1 attention we gave patients to sitting behind a computer
and waiting to be summoned.
• Based on the two articles giving the same outcome, I think
you can generalize the results and assume that if every
hospital did this same study, they would have the same results
(Mason, Mary-Claire, 2012).
(Harrington, A., Bradley., Jeffers, L., Linedale, E., Kelman, S., & Killington, G., 2013).
Barriers to Intentional Rounding
• Additional time spent charting what you did during rounds
• Additional time spent with patient takes time away from
required charting
• Staffing may not accommodate rounds. While one staff
member is rounding other patients may need help.
• Additional training which would add costs to payroll. This
may even itself out with decreased falls and pressure sores.
Additional PICO questions
• Does intentional rounding in comparison to waiting for
patients to use their call light reduce the amount of falls in the
hospital?
• Does intentional rounding in comparison to waiting for
patients to use their call light reduce anxiety and emotional
distress experienced by patients in the hospital?
Conclusion
• I stand by intentional rounding after researching this topic. I
do feel that hospitals should understand the additional time
spent and keep charting to a minimum.
• In my opinion I should be charting on the exceptions and not
the expectations. I should be expected to toilet my patient, so
why do I need to document that I asked? Our time should be
spent with patients and not behind a computer.
• Lastly, I was unable to find any evidence that pointed to
intentional rounding as a hindrance to patient care. I even
researched sleep disturbance but because most institutions
require staff to allow patients to sleep this did not apply.