Studies have shown hourly rounding decreases call light usage and unit noise levels, increases patient satisfaction, and reduces falls. Some researchers also report increased staff satisfaction and productivity, likely because staff feel they have more control over patient care. Despite these benefits, hourly rounding isn’t performed consistently according to results from a survey we completed. Engaging staff more may help improve implementation.
How rounding works
Hourly rounding is the process in which every hour, a staff member (either a nurse or nursing assistant) enters a patient’s room to assess the person’s needs. Generally, rounding occurs every hour during the day shift and every two hours on the night shift. A nurse and nursing assistant often rotate on the even and odd hours. As the staff make their hourly rounds, they focus their assessment on four key concepts — pain, position, potty, and placement of environmental items. Staff members use a checklist to ensure everyone asks the same questions. Staff place a checkmark next to the patient name at each rounding time.
Valued, but not always done
To determine nurses’ perceptions and use of hourly rounding, we distributed a 10-question to nurses on three medical surgical units (n=37) in a large urban teaching hospital; all three units have used hourly rounding for a year. Six questions were asked related to hourly rounding; if that process was valued, any barriers to performing hourly rounding, and if the process was being performed regularly.
Here are the results:
Nurse response to hourly rounding (n=37)
| Question | % of agree or strongly agree | # of agree or strongly agree |
| Hourly rounding is performed on consistently on my unit | 51% | 19 |
| Hourly rounds are performed during my shift | 81% | 30 |
| There are benefits and value to hourly rounding for patients | 94% | 35 |
| There are benefits and value to hourly rounding for staff | 86% | 32 |
| Hourly rounding decreases workload and saves time | 72% | 27 |
| I am satisfied with the current process for performing hourly rounding | 48% | 18 |
Despite the strong agreement that hourly rounding holds value for patients and staff and decreases nurse workload, only half of the nurses agreed that hourly rounding was performed consistently and were satisfied with this current process.
Path to improvement
The challenge for nurse leaders is to implement hourly rounds to improve patient outcomes while incorporating it into the already pressured workflow of today’s staff. Staff need to become engaged in hourly rounding, so they will find value in its application.
One way to improve engagement is to include staff in the planning and implementation of the program so they can learn about its benefits and help develop a workable plan. Posting patient outcome data such as falls, pressure ulcers, and patient satisfaction so nurses can see the tangible difference they are making in their patient’s hospital stay will also make hourly rounding successful. And, nursing staff will ultimately see the benefits as time is put back in their day allowing for more time for patient care. Allowing them more quality time at the bedside with their patients also promotes safe medication practice and documentation.
As staff are engaged in the hourly rounding program, it will truly be considered a success—for patients and for staff.
Leslie L. Cairns, MSN, RN, CMSRN, is the unit director of a trauma/telemetry unit. Kristine K. Wolff, MSN, RN, is the clinical director of Professional Support Services. Laurie L. Rack, MSN, RN, is the clinical director of Patient Support Services. All three work at UPMC Presbyterian-Shadyside in Pittsburgh, Pennsylvania. Linda A. Dudjak, PhD, RN is associate professor at the University of Pittsburgh School of Nursing.
References
Meade C, Bursell A, Ketelsen L. Effects of nursing rounds on patient’s call light use, satisfaction, and safety. Amer J Nurs. 2006;106 (9):57-71.
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