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.

[Vito Andolini]

"But please try to comprehend that, to someone in agonizing, brutal, unremitting pain or SOB or needing to use a toilet or being in labor or any other of life's events that are accompanied by truly ferocious pain, 15 minutes can seem an unending lifetime. Have you never experienced a fracture or the like? How can you say, essentially, that 15 minutes should be able to be endured standing on one's head? I agree that pillow fluffs for reasonably comfortable, stable patients and their clan have to wait."

But that is the entire problem with the hourly rounding. When I have to poke my head in on the reasonably comfortable patient every hour, I'm leaving the patient next door standing on his head.

What does your boss say when you tell her that?

What happens when you just don't do the hourly rounds because you are tied up with much more serious and higher priority matters?

I left out passing a gall stone or kidney stone and severe sick-making headaches.

[pererau]

Luckily in my ER we aren't required to do that yet, but they have been talking about it. Hopefully I wont have to fight that battle.

Anyway, before they ever even brought this concept up, I make it my personal goal to make sure I've seen the patients once an hour to check vital signs and see what progress is being made and update them on what is going on. I don't mind having it as a personal goal, because I understand when it can't be done, but when it is a universal law, it becomes rigid and results in poor patient care. The best answer is always less government.

[Vito Andolini]

"But please try to comprehend that, to someone in agonizing, brutal, unremitting pain or SOB or needing to use a toilet or being in labor or any other of life's events that are accompanied by truly ferocious pain, 15 minutes can seem an unending lifetime. Have you never experienced a fracture or the like? How can you say, essentially, that 15 minutes should be able to be endured standing on one's head? I agree that pillow fluffs for reasonably comfortable, stable patients and their clan have to wait."

But that is the entire problem with the hourly rounding. When I have to poke my head in on the reasonably comfortable patient every hour, I'm leaving the patient next door standing on his head.

Of course, how would you know they are still stable if you don't check on them?

[canoehead, BSN, RN]

We were just given the "word" at our ER that this mandatory hourly rounding was a big "STATE" issue and it would now be required.

Oh, bull-effing-poop!

If it was a state requirement more than one state would be enforcing it, and you'd have heard the moans and kickback on this board long ago. I bet money that they want it, they decided you're going to do it, and they get less flack if they tell you it's a state requirement. If you want to see someone shrivel up and talk in a circle just ask them to guide you to the source of that state rule. Perhaps a letter, or an internet site...or perhaps they'll just give you an internal memo and say "because I said so."

[canoehead, BSN, RN]

Of course, how would you know they are still stable if you don't check on them?

You can check on them visually, observe their activity level, signs of distress, and vitals via the moniter without actually walking in the room and saying hello. ER patients are checked on much more often than they realize, and not just by the assigned nurse, but by everyone walking by the room.

[Vito Andolini]

You can check on them visually, observe their activity level, signs of distress, and vitals via the moniter without actually walking in the room and saying hello. ER patients are checked on much more often than they realize, and not just by the assigned nurse, but by everyone walking by the room.

Yes, a visual check is often sufficient. I really never thought the OP was saying anything else was expected. All along, I thought she was referring to just a quick peek to make sure the person is still breathing, alert, not fallen off the bed, and call bell is still within reach. I did not think she was expected to talk to them, although that might be needed to be sure the pt is arousable.

[Boston-RN, RN]

I just got the email today that this is going to be starting in our ED..... I wish it was just to "check" on the pt. The responsiblity will lie with the tech and they have to check the "3 P's and 3 R's"

Personal: pee/poo and asst if necessary

Pain: and report to RN if pt states there is pain

Position: reposition the pt

Reach: ensure everything is in reach

Respond: ask if there's anything else they need and respond accordingly

Reassure: reasure them their needs will be met and someone will be back

OMG....the good news is the tech is responsible for filling out the sheet the bad news is now I will have to do all my own EKG, foleys, f/u labs and transport because the techs will be too busy playing Julie the cruise director

[Pepperlady]

So are you expected to wake a patient and ask them these things?? I mean lots of patients pass the time having a nap.

[I_LOVE_TRAUMA, RN]

We have to do this in our ER now too. The RN and the tech share the responsibility (we do evens, they do odds) and must chart it. We do the 5 P's; potty, positioning, po intake, pain, and I forget the last one right now...

[iowarn13]

Not only rounding every hour but our Dr's must have "contact" with each Pt within 10min of being typed into the system. Our hospital typically sees 40-50,000 a year and the staffing and the situations presented affect our rounding times but as one person posted -management has no clue and doesn't really give a dang as long as our "scores" are acceptable.

[Footballnut]

Please don't anyone tell my boss about this! I see my patients more frequently anyway. I just don't want any more papers flying around.

[missej2002]

I have one better some genius decide that we should do 30 minute rounding in the er, where i work at, this is crazy. most of the time someone is in the room more than 2 an hr, it maybe the aid, the nurse, lab, Dr or xray. but we can not babysit Pt's that are not sick and are just seekers. the genius we come up this crazy ideas on pt satisfaction have not dealt with the pt and families that are complaining. if you had to wait in the waiting room for 3 hours, you sickness is not an emergency, sorry you are hungry, and have not eaten anything as day and it is now PM at night, i am not feeding you, you can eat when you leave, 3 more hrs will not hurt you. These genius should come up which an idea on employee satisfaction.