Hourly Rounding in the ED

[biker momma]

The ED I work in has instituted a "policy" of hourly rounding. I understand that this is an ideal on a medical/surgical type floor and agree with the concept in the ED but......am wondering about in the ED. Do any of you work where hourly rounding in the ED is the norm. I make a point of checking my patients frequently (usually more often that q hour) and charting the interaction. Part of this new policy is an effort to improve our patient satisfaction scores. A second suggestion that is floating around is doing walking rounds at change of shift. Again I see the value but am wondering about how well it works in the ED. Any thoughts? What is your ED's policy on charting and patient rounds.

[BEDPAN76]

Haven't worked ER in YEARS! However, from being a patient myself and being with loved ones in the ER, let me tell you that 15 minutes can seem like an hour when you're in pain, worried and afraid. I always felt better when someone at least poked their head in the door to check.....:nuke:

[pererau]

I do walking rounds as my standard because I think it is just good patient care to say goodbye to your patients, and it eliminates the awkwardness for the oncoming nurse to have to introduce themselves.

As for hourly rounding, I think that is a load of horse poo. I try to get vital signs every hour or so if I can and pop in whenever I have the chance, but there's no way I'm leaving my septic patient to stop by and visit abdominal pain Willy one more time only to hear a complaint about the water not being cold enough for him. Rounding is a great idea, but when artificial time tables get forced on you by people who haven't put on a set of scrubs in 15 years because they want to save their jobs by making yours tougher, then it's pitchfork and torch time.

I'm just saying.

[Triage24]

We have hourly rounding in the ER were I work. This is a waste of paper and time. While this may be a good idea on a floor setting this is not pratical or smart inm a ER setting. This is the kind of things the folks who live behind a desk with fancy degrees think of. While they would struggle to identify a blood pressure cuff from a stethescope it is intresting how they always seem to know what me and you need to be doing at the bedside. Think about it, would you want them working beside you in a busy ER.

[PICNICRN, BSN, RN]

Another example of Press-Gainey/JACHO maddness!! We have this policy also and I work in PICU and pretty much never leave my pts bedside in 12 hours! I chart at least Q1 v/s in the chart with assessment but somehow that does not take the place of putting my initials on the stupid hourly rounding form to prove to someone somewhere behind a desk that I actually saw my pt that hour.... PLEASE!!! I can see the point on the floors but in ICU/ED areas??? Whats next the OR??

It reminds me of the bathroom cleaning schedule at McDonalds!

[RN BSN 2009]

While not a bad idea, it's not always applicable. Use your best judgement!

[Iam46yearsold]

We hourly round and document our roundings also. The new way of life in the ER. I think its for the better.

[TraumaNurseRN]

We hourly round and document our roundings also. The new way of life in the ER. I think its for the better.

Hourly round?...not certain the concept is good for the over all lack of nursing care presenting in most ERs. I haven't read any other posts regarding this, but unless I totally misunderstand....there are actually nurses leaving their post to chitchat briefly about current patients needing care in the ER at the time they are walking around rounding. I would think that is poor time management during a time when things need to be done. It is an emergency room after all. My 2 cents....and like I said I did not read the multi posts...but rounds in the ER actually made me literally laugh out loud.

[TraumaNurseRN]

Haven't worked ER in YEARS! However, from being a patient myself and being with loved ones in the ER, let me tell you that 15 minutes can seem like an hour when you're in pain, worried and afraid. I always felt better when someone at least poked their head in the door to check.....:nuke:

While I know what you are saying....poking your head in is never just poking your head in anymore. Patients sometimes have this entitlement mentality that cannot be met in the ER setting, nor should it ever be a part of the philosophy of care. Sure, nurses need to be nice and meet the needs of the patient. But unless it's an emergency...then patient's and their families need to either be educated that a warm blanket or a cup of water or pillow fluff realy isn't in the plan of the nurse coding her patient next to your family member, or the sick patient on the other side of your family member, or the push of management to discharge the other to make room for the new patient, or the admitted patient the nurse has to take up to their ICU room. 15 minutes is 15 minutes....and in those 15 minutes....sometimes the nurse is trying to empty their bladder while organizing her next plan of action, or she is giving an acute patient the proper care they need. Sure 15 minutes can seem like an hour if you are in pain, worried or afraid....but sheesh...15 minutes of pain, worry or fear is nothing in the whole scope of things. Immediate emergency care needs to go to immediate emergency care and as old ER worker....I would think you would remember how the whole process unfolds. 15 minutes is nothing....I'll say it again...15 minutes is nothing.

[RNcDreams]

I work in an ER that has "instituted" hourly rounding but hasn't mandated any additional paperwork to verify that it's being done.

It was, as stated above, put in place to increase satisfaction scores.

My thought is that I am not going to pull myself away from a critically ill patient so that I can check on a stable patient that just might still be having pain. I can't make your pain disappear, and me stepping in to your room hourly to remind you of that does not help things.. especially when your pain isn't caused by something we can fix in the ED... and ESPECIALLY if it's a day where I'm getting slammed with ambulances, there's multiple codes, and we're short staffed.

I'd say maybe techs could do it, but they need to be doing EKGs, etc.-- tasks that are instrumental in patient care.

I'm not sure what it's like in other places, but you can never just step in to say hello and check in... they always need something, or have a question, or want to talk, or WHATEVER ... and then poof, you're way behind.

Seems to me it's better to go with the flow, medicate you as needed, and keep up with charting and testing. Mooooove things along, instead of repeatedly stopping to verify that I am in fact caring for you.

Bleh.

It's a nice idea in theory, but not practical in emergency settings.

[NativeSundance, LPN]

We have hourly "comfort rounds" and also walking rounds at shift change. They are Nazi's about it too. No excuse...like I had another pt circling the drain...was busy tubing in another room, doing bilat chest tubes... etc, etc. If I have time, fine. When I don't then so be it. Meeting unrealistic patient expectations is a hopeless adventure. My hospital expects us to have the patient experience a "5 star hotel" type er visit. No kidding...that was literally in the memo. Just no way to please all the folks all the time. It is an ER, not a hotel. Yes, we have blood, vomit, stool, spit, screaming, cursing, and so forth going on at all times. Bet that doesn't happen in a 5 star hotel.

[Iam46yearsold]

Hourly round?...not certain the concept is good for the over all lack of nursing care presenting in most ERs. I haven't read any other posts regarding this, but unless I totally misunderstand....there are actually nurses leaving their post to chitchat briefly about current patients needing care in the ER at the time they are walking around rounding. I would think that is poor time management during a time when things need to be done. It is an emergency room after all. My 2 cents....and like I said I did not read the multi posts...but rounds in the ER actually made me literally laugh out loud.

It is the shape of things to come