Get More Out of Scheduled Rounding
Boost HCAHPS and Staff Workflows by Optimizing Processes.
Regular rounding by nursing staff has long been a hospital best practice. Rounding anchors patients through their stay with a predictable routine, improves care, and helps staff. But despite its many benefits, there are barriers to using scheduled rounding well.
You may have had a scheduled rounding policy for years. You may still be considering one. In either case, you can solve problems and get the most out of your rounding process with some creative thinking.
Patient Benefits
With scheduled rounding, staff promises the patient regular check-ins — often hourly. When the team follows through, patients feel secure that their nurse will come to their room.
Research supports rounding. Rounding leads to better pain control, better staff responsiveness, and fewer preventable injuries.
[1] In one study, increased compliance with scheduled rounding led to 50% fewer patient falls.[1] With these benefits, it’s no surprise that scheduled rounding also boosts patient satisfaction scores.[2]
Staff Benefits
It’s easy to get overwhelmed as a nurse in a hospital unit. Shifts are busy. They’re worse if you spend them reacting — running from call light to call light and responding to alarms. You struggle to keep track of medications, assessments, and treatments for multiple patients, never getting organized.
Being short-staffed intensifies the problem, and staffing is at crisis levels. Almost a third of nurses surveyed recently by McKinsey and Company plan to leave their jobs next year. Finding efficiencies is more critical now than ever.
When units use scheduled rounding well, staff work proactively rather than getting trapped in a continuous reaction cycle. Research shows hourly rounds reduce call lights and alarms. They even improve patients' perception of nurse responsiveness.[3],[4] According to a survey by American Nurse, 86% of nurses believe hourly rounding helps staff, and 72% believe it decreases workload and saves time.[5]
Ways to Get the Most Benefit from Hourly Rounds
Though it has great potential, if it isn’t done well, rounding can become a valueless task to check off. Any nurse will tell you they already spend too much time checking boxes to check boxes. The process is what makes the difference. American Nurse reported that over half of nurses are not satisfied with their current rounding process. This highlights a significant opportunity.[5]
So how do you improve workflows without adding meaningless work?
Think ahead. As a nurse getting ready to complete hourly rounds, list all the medications and treatments coming up. Bring them with you. Cluster care and address as much as possible the first time you are in the room. Ask about pain. Your patients will feel better, and you will spend less time reacting to problems if you address them before they start.
Lean on the team. It’s not always realistic for a nurse with a high patient load to check in with everyone hourly. But if all share the task, it becomes a safety net. The pace of a nursing shift can be relentless or ebb and flow. If a nurse has a few extra minutes and completes hourly rounds, it’s a big help for a swamped coworker. Nurses can also delegate many rounding tasks to nursing assistants. Other disciplines, like physical and occupational therapy, may also be able to complete a round when they stop by.
Standardize. Establish standard items to cover with every round. Standardization helps the team know what tasks have been done. Often, facilities implement a rounding checklist that includes the "P's":
Pain
Position
Possessions
Potty
Pumps
These are among the most frequent reasons patients call for help.[3]
Communicate. Having a system to communicate that rounding is complete helps the whole team. Consider using an electronic checklist accessible across the unit. Some other options include a messaging system or a whiteboard in a central location. The best communication solutions notify all team members, no matter where they are.
Assess. If a patient's condition is less stable, use hourly rounds to assess it between scheduled vital signs. It only takes a minute to check a pulse or oxygen saturation. It takes seconds to note how the patient is breathing and the color of their skin. Paying attention can catch deterioration in a patient's condition fast.
Teach. Cramming teaching into a data download at discharge is not a recipe for information retention. Spreading instructions across a patient’s hospitalization has a significant effect on how well they understand and retain the information.
During some rounds, sit and use pen and paper to teach a single concept. Provide reliable printed materials patients can refer to later.
Hourly rounding can bring many benefits, including improving patient experience. When experiences get better, HCAHPS scores do too. With evidence pointing to staff benefits and improved outcomes, optimizing your rounding process is worth the effort.
References:
[1] Daniels JF. Purposeful and timely nursing rounds: a best practice implementation project. JBI Database System Rev Implement Rep. 2016;14(1):248-267. doi:10.11124/jbisrir-2016-2537
[2] Mulugeta H, Afenigus AD, Wagnew F, Haile D, Tadesse A, Kibret GD. The effect of hourly nursing rounds on patient satisfaction at Debre Markos Referral Hospital, Northwest Ethiopia: A non-randomized controlled clinical trial. Int J Afr Nurs Sci. 2020;13(100239):100239. doi:10.1016/j.ijans.2020.100239
[3] Mitchell MD, Lavenberg JG, Trotta RL, Umscheid CA. Hourly rounding to improve nursing responsiveness: a systematic review: A systematic review. J Nurs Adm. 2014;44(9):462-472. doi:10.1097/NNA.0000000000000101
[4] Johnson BC, Bryant L. Call bell usage: Tracking the effect of hourly staff rounding. Clin J Oncol Nurs. 2020;24(3):328-330. doi:10.1188/20.CJON.328-330
[5] From our readers…Hourly rounding benefits patients and staff. American Nurse. Published December 11, 2010. Accessed September 16, 2023. https://www.myamericannurse.com/from-our-readershourly-rounding-benefits-patients-and-staff/
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