Dear Editor,

Over the past ten years, new policies supporting “hourly rounding” were implemented in the inpatient setting and transitioned into nursing homes and rehabilitation facilities. The goal is to improve the patient’s perception of nursing staff responsiveness, reduce falls, reduce skin breakdown, and assist patients who may “sundown.” Evidence showed low to moderate strength with intermittent complaints and concerns stemming from patients and patients’ families regarding persistent non-responsiveness to call light requests. The recommendation for using the four “P’s” consistently has shown to have a positive impact on hourly rounding by nurses (Mitchell et al., 2014). With the rise of fall injuries, skin breakdown, and patient’s non-satisfaction, hourly rounding remains necessary to promote patient safety. Patients must be assessed every hour to determine ongoing needs and assistance. All staff is well engaged in the application of this policy. Every hour somebody, either a nursing assistant, a personal activity, or a nurse, must safety check on the patient’s need. A teamwork effort was also developed to maintain that hourly round to protect patients and promote patient safety. With this new policy, it may be possible to reduce the risk of falls, pressure ulcer development, and an improvement in the patient’s satisfaction and care. Studies showed that hourly round increased patient satisfaction and drastically reduced patient falls (Saleh et al., 2011). Staff needs to have proper communication to work effectively together to provide a correct implementation of this policy. Only through successful communication staff could demonstrate confidence and good coordination to follow new change during a trial program period.

A study performed at Baltimore Medical Center where hourly rounding was guided for three weeks showed a 52% decline in call light use after introducing hourly rounding; No falls were registered, and pressure ulcer rates were reduced by up to 56% (Ford, 2010). Doctor nurse practice (DNP), as a leader, could implement strategies to promote patient-centered communication in a healthcare setting between staff, patients, and their loved ones to ensure the best outcomes. Those strategies were to focus hourly rounding on the 4 P’s: Pain, Potty, Positioning, and Possessions. For that, a trial program was developed for four weeks, and everyone in this facility was followed. During the trial, patients were checked every hour by staff or a family member. Patients were assessed for pain, need to go to the bathroom, need to reposition, and call light within reach. If there were needs, they were assisted correctly to maintain patient safety. Every hour, they were asked if they are having pain or need any assistance with ADLs. They were often repositioning every hour to enhance skin integrity by preventing any pressure sores. Post-surgical patients were encouraged to ambulate or change positions very often. If patients have any discomfort, they will be potentially at risk of falling. With the consistent and practical application of the hourly rounding policy, the facility has reduced patient falls, skin breakdown, reduced call lights for increased nurse efficiency and satisfaction, and improved patient perception of care. With great success, the trial program was accomplished in the facility. Data were collected by selected staff, which was trained to provide proactive, successful results. The program’s success was well demonstrated; therefore, other facilities are welcome to be involved in this policy.

The policy of hourly rounding was a successful program trial. It showed that continually monitoring the patients can often decrease the patient’s anxiety and promote their safety. The correct implementation of the hourly rounding policy can be very beneficial for nurses, patients, and patients’ families. The standard of hourly rounds is a crucial opportunity to involve patients and families in fall prevention strategies and enhance the communication of interventions between nursing staff (Tucker et al., 2012). Long-term care patients do not often have proper balance because they are most likely confused about time and place. Therefore, they can easily have a terrible fall if nurses cannot address basic needs such as the use of the bathroom, positioning, pain control, the proximity of personal items, and call lights. Hourly round is a beautiful, helpful approach that nurses can use to avoid fall injury and improve patient satisfaction and decrease care costs. Medical costs have resulted from falls range of about $19.2 billion annually in the United States (Bohl et al., 2012). Hourly rounding can be a challenge for nurses, but it can significantly reduce patient risks for falls and prevent bedsores.

References

Bohl, A. A., Phelan, E. A., Fishman, P. A., & Harris, J. R. (2012). How are the costs of care for medical falls distributed? The costs of medical falls by component of cost, timing, and injury severity. Gerontologist, 52(5), 664-675. doi:10.1093/geront/gnr151

Ford, B. (2010). Hourly rounding: A strategy to improve patient satisfaction scores. MEDSURG Nursing, 19(3), 188-191.

Mitchell, M. D., Lavenberg, J. G., Trotta, R. L., & Umscheid, C. A. (2014). Hourly rounding to improve nursing responsiveness: A systematic review. The Journal of nursing administration, 44(9), 462–472. https://doi.org/10.1097/NNA.0000000000000101

Saleh, B., Nusair, H., AL Zubadi, N., Al Shloul, S., & Saleh, U. (2011). The nursing rounds system: Effect of patient’s call light use, bed sores, fall and satisfaction level. International Journal of Nursing Practice, 17(3), 299-303. doi:10.1111/j.1440-172X.2011.01938.x

Tucker, S. J., Bieber, P. L., Attlesey-Pries, J. M., Olson, M. E., & Dierkhising, R. A. (2012). Outcomes and challenges in implementing hourly rounds to reduce fall in orthopedic units. Worldviews on Evidence-Based Nursing, 9(1), 18-29. doi:10.1111/j.1741-6787.2011.00227.x