Walking rounds

[SCRN1]

Do you have them? We recently went to doing this and was told this is how all hospitals will eventually be doing it. I don't know if it's a JACHO thing or not.

First, we get verbal & written report from the nurse we're relieving. During that, we are to go over the past 12 hours of orders to make sure they've all been done or ordered. After that, we are to go together to each patient's room and be introduced. While there, we are supposed to look together at things such as IV sites, IV fluids/meds, dressings, etc.

I can understand how this would help decrease orders being missed and hold the nurse more accountable for ensuring orders were done that were ordered during her/his shift. Also that one nurse who's ready to get out of there and go home will be less likely to leave an IV bag almost empty, a patient lying in a urine soaked diaper, etc. BUT, the way it has been going so far, most nurses giving the report want to rush through the orders so fast that the oncoming nurse doesn't really have time to eyeball that it really was done/entered in computer/added to MAR even though the other one says it was. Some nurses try to avoid this part completely. Some not only try to avoid this, but also avoid going to the patient's rooms.

If you are doing reports this way, how is it going where you are?

[meandragonbrett]

We have walking rounds in our ICU. It works really well.

[SCRN1]

How many patients do you have each? I work on a PCU floor and we may have up to 8 patients/nurse. That usually also means we don't get all our patients from just one nurse. Because of having to wait until one nurse is finished giving report to someone else, it could mean that over an hour has gone by before you finish getting report on all your patients that shift. THEN, the nurse manager has the gall to fuss at nurses for overtime!

[rita359]

Have been supposed to be doing some of this for years(doing walking rounds not as extensively as you describe). You notice "supposed to". In my experience it doesn't work well.

[SCRN1]

Have been supposed to be doing some of this for years(doing walking rounds not as extensively as you describe). You notice "supposed to". In my experience it doesn't work well.

I don't see this continuing at our hospital either. It's not working well there either and each day, I see less & less nurses actually even doing it.

[P_RN, ADN, RN]

Maybe before HIPAA, but with semi-private rooms still being used, it's not confidential. I can see just a look over at the patient, but not a whole discussion over each patient.

BTW I was in a semi-private room recently, and I think they're the work of the devil. Screaming roommate, her talking on the phone at all hours, her family calling my phone to tell her to hang up. I spent most of my short stay sitting on the floor in the hall. Maybe we could start a campaign to end this madness. We could report X nunmber of HIPAA infractions for every semi- every day.....hmmmmm.

[BrnEyedGirl, BSN, MSN, RN, APRN]

We tried this,..didn't go over real well for many of the reasons you have mentioned. It is very time consuming,.when I get there at 1830 I may take 8 pt's from 4 different nurses,..standing at bedside for report also brings up so many question from pt's and family members,...they are valid questions that should be answered,.but not durring report,

...we've ran into things like,.."I just heard you talking to my roomate,...he has CHF just like me,.but I'm not taking even half those medicines you were talking about w/him,..shouldn't I be trying some of those too??",OR,.."My Dr hasn't checked for such in such,..but sounds just like what I have, how can I have that test run on me?" Family members also choose that time to ask about how a family member has eaten today, when will he be albe to come home, why is he taking Zocor instead of Lipitor, at home he always takes Lipitor?,..the list goes on and on

Sometimes we were still doing report at 8pm because of all the distractions,.not to mention there are somethings said in report that you might not want to say to your pt or his roomate!

I liked walking rounds in CCU when we had only one or two pt's and we closed the unit to visitors durring that hour,.if you have many more pt's than that it just doesn't work.

[meandragonbrett]

I think walking rounds are more easily implemented in an ICU setting. As you only have 1-2 patients (maybe three if one is being d/c'd to step down) and you take report from one person. I don't see how walking rounds would be very beneficial or time efficient when you have 5-9 patients.

[Agent99]

It's a JCAHO thing. They are harping on communication lately, how things are missed during report (shift to shift, ER to unit, RR to unit etc.). Our unit is going to start this too, by the end of the year.

[jjjoy, LPN]

I like the idea of more complete shift reports but that requires more time. A good amount of overlap between shifts would allow for that but of course no one would want to pay for such an overlap!

[SCRN1]

It's a JCAHO thing. They are harping on communication lately, how things are missed during report (shift to shift, ER to unit, RR to unit etc.). Our unit is going to start this too, by the end of the year.

Don't get me wrong...I am all for making improvements for the safety of patients and the safety of our lisences. But how much patient care does JACHO actually expect us to do during a shift when most of a shift is spent giving report and then documenting everything in about 3 different places. The more time that has to be spent on all these different types of things, the less I see of patients being properly cared for and more false documentation. I've seen nurses notes stating they did certain things for a patient when I know for a fact the patient was seen maybe 10 minutes out of the whole shift and the things they charted weren't actually done.

[SCRN1]

I like the idea of more complete shift reports but that requires more time. A good amount of overlap between shifts would allow for that but of course no one would want to pay for such an overlap!

So true! We only have a 15 minute overlap. So how are we to get report the way they're expecting now in that little bit of time...especially when it's 8 different patients and 3-4 different nurses to wait in line to talk to? And of course, there's still charting to do that you didn't have time for during the regular part of the shift!