Hourly rounding logs

Specialties Geriatric

Published

Is anyone utilizing the practice of hourly rounding to assess the 4 Ps (position, pain, personal needs and potty) and if so do you have a log up in the room for staff to document it? This practice has been found by research to decrease falls, calllights and improve patient satisfaction. How is it working in your facility?

Specializes in L&D, OR, ICU, Management, QA-UR, HHC.

Whoa, at the LTC where I work I have 50 (count 'em 50) residents at night with the supposed staffing of me, and three STNA's, though usually only two. Since I'm the only RN in the building I also cover IV's and such on the other 50 bed wing for the LPN over there. After a med pass to my residents which takes almost 2 hours, all the tube feeds, routine checks of the glucometers, medication returns, etc. not including charting, neuro checks on any falls, V/S's on any resident receiving antibiotics, incidents reports, preparing transport reports for our many dialysis patients, then my second med pass. Oh, I forgot treatments, drsg changes, wound vac checks, I'm lucky to get a potty break. If they add another form to check off, say, hourly check marks on 50 patients that's 400 meaningless check marks that will take even more time, I will then GIVE UP.

Specializes in ER.

I wonder if you are working where I work, since we just implemented this within the last week.

It stinks and it's stupid. Let me explain why:

You can sign the sheet off and not actually do it. Seriously, not all patients need to be offered diet needs q 1 hour. Not every patient needs turning q 1 hour. It can just be initialed without ever addressing these points. I agree pain is to be assessed, but my nursing notes/SOC address these, not some silly hourly rounding sheet used for audit purposes (mainly). What decreases falls and increases patient satisfaction is the actual work of the nurse. If we truly want a good representation of patient care, have a monitor check when each nurse enters a room. Have each patient submit a review of their nurses/cna's and how adequately they addressed their needs regarding toileting/pain/diet/safety. It's just ridiculous that anyone even thought of this as a means of accounting for patient satisfaction/safety.

In my environment (ER), it is insulting. I check on my patients probably every 15 minutes, sometimes just a walk by, peeking into the room to see if they're asleep. All of my patients are within maybe 20 feet of me ALL NIGHT. I am at their beck and call. Hourly rounding is not the best method to evaluate the problems/reduce problems in the ER, anyway.

Specializes in LTC, assisted living, med-surg, psych.

I can't imagine how this could be done in LTC with the ratios we have, e.g. 1 nurse and 4 CNAs for 60 patients on night shift.

I'm shocked at the staffing ratios I hear on here-1 nurse and 4 aides for 60 patients. HMMM, if you do 12 hour shifts that comes to about 1 NHPPD. That sure doesn't come close to the 3.2 NHPPD that I believe I read somewhere was legislated (somewhere)to be the minimum. I think you're right about the piece of paper not being the tool to getting hrly rounding done.

I'm DON in a Critical Access hospital where we have 18 residents (they are considered unskilled swing patients, not LTC patients). The 18 are cared for by an LPN and 3 CNAs on days/2 at night. There also is an RN in house 24/7. I'm making some adjustments so the LPNs will now also have to care for 2 skilled swing patients along with their 18 unskilled swingers. One of them said to me today "Don't you understand, I have 18 patients to take care of, I can't possibly take care of two more". They should go do a shift with some of you. I think they might then appreciate the job they have.

Specializes in family practice.
I'm shocked at the staffing ratios I hear on here-1 nurse and 4 aides for 60 patients. HMMM, if you do 12 hour shifts that comes to about 1 NHPPD. That sure doesn't come close to the 3.2 NHPPD that I believe I read somewhere was legislated (somewhere)to be the minimum. I think you're right about the piece of paper not being the tool to getting hrly rounding done.

I'm DON in a Critical Access hospital where we have 18 residents (they are considered unskilled swing patients, not LTC patients). The 18 are cared for by an LPN and 3 CNAs on days/2 at night. There also is an RN in house 24/7. I'm making some adjustments so the LPNs will now also have to care for 2 skilled swing patients along with their 18 unskilled swingers. One of them said to me today "Don't you understand, I have 18 patients to take care of, I can't possibly take care of two more". They should go do a shift with some of you. I think they might then appreciate the job they have.

Dont you think 18 patients are too much to take care of by 1 person. Acute, sub-acute, rehab whatever.

I'm not at a facility so i cant contribute to the OP

Specializes in Public Health, TB.

We are just starting hourly rounding that focuses on the 4 Ps. However, instead of an hourly checkoff sheet, we are going to assess patient satisfaction scores in 6 months, to see if there is an improvement.

Those rounding sheets remind me of the ones you see on the door of public restrooms.

When I was doing a clinical rotation a couple of years ago, some staff got in deep do-do for pre-charting on the rounding sheet. Apparently they documented rounding on an expired patient for 3 hours after his death.

We have hourly rounding and what is suppose to happen is that nurses check one hour and CNA check the other hour. How is this suppose to happen when you are giving medications. At best you may see the patient every hour as you pass by their rooms but it is almost impossible to stop in the middle of a medication pass and document hourly rounding on some one else. We use EMR's and this would involve opening a whole new screen to document on another patient.

Specializes in Gerontology, Med surg, Home Health.

First off I find the p that stands for potty demeaning and undignified. They are not children and they do not 'go potty'. Secondly, to those of you who think you wouldn't be able to handle hourly rounding because you have 8 (:eek:) residents, in long term care, even on a skilled/sub acute unit, the nurses quite often have 20 or 30 or on 11-7 40 patients. It is impossible.

Specializes in Geriatrics, Ambulatory Care.
First off I find the p that stands for potty demeaning and undignified. They are not children and they do not 'go potty'. Secondly, to those of you who think you wouldn't be able to handle hourly rounding because you have 8 (:eek:) residents, in long term care, even on a skilled/sub acute unit, the nurses quite often have 20 or 30 or on 11-7 40 patients. It is impossible.

I thought the same thing about "potty"

I think rounding sheets hourly sounds like is a great idea. Unfortunately, there is no way possible to do it. They barely have time to the minimal documentation. CNA's and nurses became CNA's and nurses to care for people not to do paperwork. I know it is a necessary evil. I never add more documentation for documentation sake. What would be awesome is if we had the scan cards like they have in the movies so you just scan your card every time you walk in and put of a room. Then we would know where everyone is all the time and could track how often someone goes in and out of a room :)

I don't know how people would find time to do it. Our ratio isn't bad 20 patients to 1 nurse at a skilled facility but depending on our census and how sick or confused the patients are it can be crazy busy. Often you don't have time to do your documentation until after your shift ends particularly if there is an admit or two or patients fall, or people you have to send to the hospital. Nice thought, but not possible at most places.

:rolleyes:Wow! I am surprised by the numbers I hear on these ratios of nurse to patient. I am introducing hourly rounding as a new concept this week to my staff. I want to see the results of increased patient satisfaction, decreased falls, and increased staff satisfaction. Our HCAP numbers have been very disheartening to the staff who I know take good care of their patients. So far, the staff that have seen the logs agree they are a good tool for family to see that we are caring for "momma". I agree "potty" is demeaning and I am presenting it as only a pneumonic for memory; not a word we use with an adult patient. My nurses have a ratio of 5:1, give or take one patient, in an acute care setting of a rural community hospital. I think the log needs to be revisited for some areas and obviously it is not for a setting such as the NH.

Specializes in ABMT.

OP, are you asking about implementing hourly rounding in a long-term care facility? I don't see how it would be humanly possible. The bits of evidence I've read about it were specific to hospital settings, so I don't know how well it translates into LTC with vastly different acuity & staffing.

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