Do you round on your patients every one hour?

  1. 0
    I work on a tele floor where it is not uncommon at all to have nine patients. Seven or eight is usually the number I have. We also usually have only two techs on nights, so one tech to fourteen patients. It's a very busy floor.

    They are going to incorporate a program where every one hour, you go into each room and say "I am here to check on you; is there anything you want or need?" (You have to actually say something like that, otherwise the patient might not be aware that they are being "checked on".)

    That's going to be a lot for nine patients - I will just be finishing rounds when it is starting again. The patients will know that we will be rounding on them Q 1 hour, so if we are caught up in a code or something, I am not sure what will happen.

    Does anyone work somethere that employs this? I am a frequent presence in my patients' rooms, to be sure, but it's probably more like every two hours for some patients - and more often than every one hour on more critical patients. I am worried as to how to make this work with such a high patient/nurse ratio.

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  2. 35 Comments...

  3. 0
    They just started this on our med/surg floors. They came up with these little posters with a doughnut called "Riki the Rounder" to promote it. Most of the floor nurses that I talked to were so insulted that it was implemented in this way....were they trying to appeal to them because they liked doughnuts? It reminded me of the movie "office space". And I really felt like tearing the posters off the wall.
  4. 0
    My Hospital started this program last year. Here it is hourly rounding till 2400. Than Q2 hrs till 0600. Do the nurses here actually wake pts. up at 0200 and 0400 to ask them questions? Some might, but most use common sense and reasoning.
  5. 0
    I feel a little insulted, too. And especially that they are wanting us to say "Is there anything you want or need?" I can understand a quick round to assess breathing quality, skin color, pain scale. But to ask them if they want anything every one hour? It's like being a waitress.
  6. 0

    Yes, my unit has implemented hourly rounding...apparently there are studies that indicate this improves pt satisfaction, reduces call lights etc..
    But we only have 4 pts...I cannot imagine hourly rounding working with up to 9!

    It sounds like you work nights? Our unit only rounds q2 hours on night shift.

    When a nurse is in a code/emegent situation...coworkers always take over the other pts..this is not policy, just part of unit culture...

    Can't believe you have such a high pt load...esp if they are critical/busy...I often don't get more than 5 minute break even with 4 acute pts!

    Best of luck to you...and let us know how rounding goes?
  7. 0
    Our problem is, when a patient is going down the tubes, it usually takes several nurses to assist - so in essence, all the nurses on that floor. Of course we would send one out for serious issues, but not for cokes or "can I have more tissues" requests.

    I sometimes struggle to get all my patients medicated at a primetime medpass within the hour's timeframe - I can't imagine if I am also the one asking them if they want or need anything that hour! Bedpans, pain meds, sodas, blankets, new gowns....I'm overwhelmed just thinking about it!
  8. 0
    On my floor, which is a post-op floor, we do hourly rounding until 2200 and then every two hours after that. I do not wake my patient and ask anything if they are asleep. I quietly walk in the room, check to make sure everything is right, breathing, IV bags going, PCA number for my charting (if they have one) and then I walk back out. Most of the time the patient does not even hear me. I would think, waking them up every 1 hour to ask about pain or to let them know you are rounding especially at night would make patient satisfaction go down, not up.....

    We have up to 7 patients per nurse on my floor. I can't imagine having 9 and trying to round every one hour. It is hard enough to do every two hours and do charting.
  9. 0
    Like anything else in life, it will probably depend on the patient's diagnosis and personality as to whether they enjoy the every one hour visits or not. I have only been a hospital patient when I had a baby, and I would have been very annoyed at every one hour visits.

    I have had patients tell me that too many people come into their room before, and I've actually planned to "cluster care" to go into their room less.
  10. 4
    A program like this was piloted on my unit late last year. We are a telemetry floor/cardiac stepdown with 64 beds. On nights, we have 16-18 RNs and 2-4 techs.
    We were supposed to inquire about:
    environmental comfort (temp, lights, etc)
    and any other desires that the pt had.
    We objected STRONGLY to the instruction that we wake pts to ask these questions, and this was altered prior to implementation.

    The results were presented [internally] last week.
    Generally speaking, the results were:
    Staff thought it was annoying and generally ineffective.
    Pts knew they were being checked on frequently, but it had no appreciable effect on pt satisfaction.
    Call light use did not change.
    Fall frequency did not change.

    There has been no movement to make this a lasting policy, though several of us do make an effort to check on people at least once per hour. Often, that's just me tiptoeing in with my little flashlight, listening for breathing, checking the IV fluids and IV site, checking urinals and foleys, squirting some hand scrub and sneaking back out.

    Quote from LilyBlue
    I am a frequent presence in my patients' rooms, to be sure, but it's probably more like every two hours for some patients - and more often than every one hour on more critical patients.
    See, this sounds like professional competence. A "policy" that requires q1 rounds impairs professional competence; it's what an ancient teacher of mine called "monkey medicine" where you just do what the paper (hospital policy) tells you to do, and try to remove the capacity for a professional to make individualized judgments.
    Last edit by masonRN on Feb 16, '09
    leslie :-D, HM2VikingRN, Altra, and 1 other like this.
  11. 0
    I'm sorry, but as a nightshift worker it really BUGS me when the powers that be come up with these ideas about having to wake people up to ask them if they need anything. Whatever happened to the importance of sleep in a pt's healing? This seems to be the most forgotten aspect of pt care. I've got no objection to rounding on pts, I do it anyway even though there's no strict rounding paperwork to be filled out (yet). I sneak in quietly, check they're breathing etc...But waking them up? I don't think so......!

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