Hourly rounding in LTC????

racing-mom4, BSN, RN · Mar 13, 2008

Yes hourly rounding is GREAT in theory. But with 46 patients you would start at bed 1 and it would take you an hour to be at bed 46!

I have no solution. My only thought is change need to take place, but it must start at the top, with STAFFING.

I did my 1st clinical at a nursing home that I was impressed with. Granted I was only there during the day, but the thing I loved the most was at meal times. Every person in the facility from the cleaning crew to the head administrators helped feed. For 1 hour basically every employee was either in the dining hall or gathering patients to take to the dining hall or returning patients from the dining hall back to their rooms. It was incredible. The residents actually ate full hot meals because the feeding ratio was no more than 3:1. Mostly 2 feeders to a staff.

The nursing home I worked at, I would have to feed 6 people at a time. Do you know how cold their food got? Or how little they would eat because they basically got tired from waiting for the next bite.

Blackcat99 · Mar 13, 2008

I use to work LTC-never again I hope. Yes, it would be nice to be able to do hourly rounds but when you're so short-staffed how can you possibly do it? I left LTC for good because I got sick and tired of being verbally abused by family members.:argue: I was told that the nurse who replaced me spends all of her time outside having "smoke breaks." I worked so very hard at LTC and all I got was abuse from both management and family members. :nono:LTC is a no-win situation for any nurse.

tatgirl · Mar 13, 2008

That is the key word "Staffing". When they worked us short all last month, the head honchos never gave us a thought as they left at 5pm to go home. The study worked well because it was done in the hospital where the nurses dont have the pt load that ltc nurses do. I have 24 residents on my front end alone, and 2 cnas that have 12 people apiece. Most of these folks are total care that can not do a thing for themselves. Add to that the frequent fallers who manage to take off their bed alarms, and crawl over their side-bolsters!!! Most nights I feel like I am working in chaos, and no matter how hard I work, I cant do enough....

Wendy

LPN

RN1989 · Mar 13, 2008

Guess what? LTC has as many horrid problems as every other kind of nursing. They ask you to do ridiculous things without the proper tools. All you can do is the best you can or get out of nursing altogether.

Midwest4me · Mar 14, 2008

I use to work LTC-never again I hope.... :nono:LTC is a no-win situation for any nurse.

My sentiments exactly!!!! It always felt to me like I was beating my head against the wall for 8-10 hours.

ltcconsultant · Mar 15, 2008

I actually addressed this in my blog back in 2007

The basic premise behind hourly rounding in the nursing home is that you check in on each resident about every hour (every two hours during nocs) and check on 3 things: Position, potty, and pain. You see if they need to be repositioned, you take them to the toilet or change them, if necessary, and you ask them if they are in pain. These 3 things are contributing factors to quite a few falls, and so if you check on these things frequently you thereby lessen the risk of a resident falling. Since there is a good chance that a good number of people aren't going to need anything when you check on them, this can actually be a more efficient way to accomplish dry rounds, by spreading it out, so to speak. You could take the lean approach and only use this for people who hog the call light or are at high risk for falls. I have worked with a facility to implement hourly rounding and it wasn't as bad as they initially thought. It really isn't as demanding on staff as one might imagine.

CoffeeRTC, BSN, RN · Mar 17, 2008

I actually addressed this in my blog back in 2007
The basic premise behind hourly rounding in the nursing home is that you check in on each resident about every hour (every two hours during nocs) and check on 3 things: Position, potty, and pain. You see if they need to be repositioned, you take them to the toilet or change them, if necessary, and you ask them if they are in pain. These 3 things are contributing factors to quite a few falls, and so if you check on these things frequently you thereby lessen the risk of a resident falling. Since there is a good chance that a good number of people aren't going to need anything when you check on them, this can actually be a more efficient way to accomplish dry rounds, by spreading it out, so to speak. You could take the lean approach and only use this for people who hog the call light or are at high risk for falls. I have worked with a facility to implement hourly rounding and it wasn't as bad as they initially thought. It really isn't as demanding on staff as one might imagine.

I work on a 48 bed unit...Me and an LPN with 3-4 CNAs (would love to have the 4, but most times it is 3) Hourly rounding is done in my facility. Might not be the check everything type of round, but me or the CNAs really do see all of the residents just about every hour. No, I'm not physically touching or assessing every resident every hour, but in between the running up and down the halls, answering the phones, med pass...etc they are getting checked on my me or the CNAs down my hall.

I do notice a decrease in accidents/ incidents when this is done. Some nurses that I have worked with don't spend as much time down the hall as I do(I'm not sure what they are doing)...that hall does have a bit more accidents, complaints or call bells going off all the time and not answered.

So yes....it does work, just might not be done the way "they" are saying it should be done.

nightmare, RN · Mar 17, 2008

In your facility do you have to keep the room doors closed all the time? We have been told we have to keep the doors closed because of fire safety.This means that to physically see a resident you have to open the door,in days gone by a quick glance through an open door as you were passing told you if the resident was safe or not.At night they also close all the corridor fire doors so that you can't hear movement as well.This has contributed to several major falls which might have been stopped if movement had been heard.

ltcconsultant · Mar 17, 2008

I've never of heard of this before. It seems that requiring bedroom doors to be shut at all times could potentially be a violation of resident rights. I'm curious as to how your facility has done on its last life safety code inspection?

nightmare, RN · Mar 17, 2008

I am in Scotland,IT so probably things are different. Our inspection teams will look for closed doors because of fire safety!( This is all because of a bad nursing home fire some years ago)I do agree with you that it goes against some of the residents wishes.A lot of them hate having the doors closed and will wedge them open! this is even worse if there is a fire!We do had door closers on some of the doors which are activated by the fire alarm but these are not on every door.

withasmilelpn · Mar 18, 2008

I spend a lot of time down my hall, helping meet my residents needs during my med pass, treatments, etc. With 2 CNAs to 30 patients, someone always needs something. It makes my med pass very long, so that I am never in compliance. I would say that I do generaly have very happy patients and family members though. But, as I never really sit down until my shift is over, I never get out on time-still have chartng to do. For hourly rounds to really work, and not make us break the other regs we must follow, we need to be staffed by acuity. An increase in falls on a unit should result in increased staff, or behaviors, IVs etc. Right now we have a patient getting IV push benadryl! We should not be doing this. LTC/Rehab is becoming increasingly complicated. (Of course, then insurance companies will start to demand that ALFs provide more assistance with less nursing, right?)