hourly rounding

We call it Empower Rounding at our hospital; 4 P's and an E: PAIN, POSITION, POTTY, POs, ENVIRONMENT. Basically we go in every hour, PCAs on odd hours, nurses on even hours. Sometimes we flip, but the nurses must always agree to which hour they'll round. The nurses take 5 pts each on a hall of 10 pts, but the PCA has all 10 pts. This eliminates the PCA from spending their entire shift just rounding on pts! (In the event you can't do your round, let the PCA/nurse know and they'll do it for you: communication!!) The nightshift gets the day's initial vital signs at 0600 so the dayshift PCAs can get quickly get started with their 0700 round.

The most important step, we've found, is communication between the staff. PCAs get report from each other, then they immediately get report from the Nurses. It really makes the morning go by so much better when everybody knows who is who and what pts require what.

When the PCA does the initial round, they put the names of the caregivers on the dry erase board and ask the pt if they have a goal for the day (if pt is confused or unable to communicate, we give them a goal: skin care, turning Q 2hrs, etc). They also explain the rounds for new pts.

As far as the actual round itself, we ask if they are having any pain and if so where & how bad. (After I give pain medicine, I write on the board the next time the pt can get more medicine. I've had so many pts tell me that it relieved them to know when they could get the next dose of something). We suggest going to the potty rather than ask because we've found that asking a pt only gives them the idea that they've got to go after you leave the room. We ask if they are comfortable in their current position and if not, we help them get comfortable. Environment and POs usually go hand-in-hand, where we straighten up the room, make sure the trashcans are within reach of the pt, move the bedside table back to the bed, make sure the water pitcher and cups are within reach, and place the call bell and telephone where the pt can get to it. All of this can be done within a few minutes. Before leaving the room, we explain that we "will be back in to check on you in about an hour" and ask if they need anything else before we go (the video suggested adding "I have time" to that question, but I think that's too cheesy). We no longer say to the pt and/or their family, "call me if you need anything" because that defeats the purpose of doing the round in the first place.

So far, we've seen a tremendous decrease in the number of call outs and if we get them, the pts states that they hit the button by mistake. It only takes a few minutes to do and it increases pt satisfaction overall. For me, I actually have time to take the 15 minute break that is being taken out of my paycheck regardless, I can complete my assessments in the computer, catch up on work emails and any staff education. Even our secretary talks about how bored she is!!

Karen, I am curious - what is your nurse : patient and PCA : patient ratio?

Our unit is broken down into 5 halls for nurses. The nurse-to-patient ratio is 1:5 on 4 halls and 1:6 on the other. There are 3 halls that the PCAs are responsible for. The PCA-to-patient ratio is 1:9 on 2 halls and 1:8 on the other. We have a 26-bed unit and typically our needs are 6 nurses and 3 PCAs unless our census is low.

We do rounding .( Hospital 80 beds)
1. Rounding is done every 2 hours on day shift (12 hrs) and every 1 hour on noc(12).
2. Day shift nurse rounds at 8am, 10am on own patients then one nurse rounds on all patients at 2p. CNA rounds 12p, 4p, 6p on all patients
3. Noc shift round on own as well as assign some hours to the aide.
4. Pt. to staff ratios on days is up to 7:1 same on Noc on a 26 bed med-surg unit. All Units are expected to round (OB and CICU)
5. A rounding documentation sheet was devoloped to incorporate the IV sheet and Turning log.
There has been no resistance to this new policy from nursing or the aides.
By incorporating rounding/IVdocumentation/turning documentation on one form you should get better compliance to IV checks and Pt. turning as well as having neccessary documentation if someone is not failing to do the work esp in the case of skin breakdown.
Rounding has been proven to reduce the number of call lights going on, patient saftey. patient satisfaction. Two articles to read re this issue are "Ring for the Nurse" www.medscape.com, and "Effects of Nursing Rounds" www.nursingcenter.com
We also emphasized with our staff to follow the The 4 P's : Pain, Position, Potty, and Possessions (call light within reach, phone water etc)

We just started this and it's not a part of the pt's record. We just have to go into the pt's room and make sure they're ok, see if they need anything, etc. If they're sleeping, we let them sleep. We have to initial a paper hanging in the room each hour. I like the idea b/c (on night shift especially), pts might not be checked on for hours since the nurses/aides assume if they're quiet, they're asleep or content. There could be a pt on the floor, dead, anything and no one would know for hours! I think this also makes the pts happier since they know we're there more- to get water, empty urinals, get pain meds, etc and they don't have to ring the bell and "bother us."

suni, sorry the link did'nt work. The article was from Medscape. I got it on line at their site. It actually was a CE offering. The title again is Ring for the Nurse! Improving Call Light Management The author of the article is Laura A. Stokowski, RN, MS Try this link: http://www.medscape.com/viewprogram/8786_pnt
Good Luck

We do hourly rounding as well, and initial a sheet in the patient's room. Which means, realistically, that at about 0500 techs and nurses initial for the whole shift at one shot.

I did keep actual track one night and initialed every time I entered a patient's room, and discovered that I round, on average, much more than once an hour on my patients.

Since it's one of the things that our NM asks about when she does patient rounds, I tell my patients at the beginning of the shift "We're supposed to check on you every hour to ensure that you are comfortable, safe, and all of your needs are met...but since it's night time, I usually just poke my head in and quietly check on you without waking you unless I really need to."

We are doing it where I work. We have about 5:1 nurse ratio with a 10-12:1 CNA ratio. Each of us are required to be in there every 2 hours. CNAs take even hours and nurses the odd. We were just told we had to do it. Director hung a hourly log by the door and we all sign each time we go in. Simple, easy and call lights have reduced DRASTICALLY! We've probably been using it a year or so and it is one of the best things our floor as implemented.