Hourly Rounding/pain management?

[locolorenzo22, BSN, RN]

Hey, all...just curious about how the following items have worked for other hospitals and staff....

I had a work meeting yesterday....and we had quite a few items brought up.

1. Apparently the new DON has decided that we all need to be doing some sort of "hourly" rounding, between CNAs and nurses....How has this worked for others? I personally feel rushed sometimes trying to get charting done, med passing, and talking to doctors and signing off charts. Our ratios are usually 7,8 to 1 for nurses, and 13-15 per 1 CNA......I would agree to more of a 2 hour system, but I could see why the hospital would think that hourly rounding would be better.....

2. Another thing that was brought up was a length of call light issue....The thing that gets me is that a CNA brought up "hey, if I'm going to be in a room for a while, how can I make sure that lights are being answered?" My boss took it as a personal attack and started in on that CNA about how they need to ask for help, etc....well they do, but 95% of the nurses won't answer lights. If I'm going by and it's one of my patients, I certainly do....but if I'm in the middle of meds, or with a doctor, etc...I can't stop and go get it. Also, we have a emergency light system, but when it goes off....almost everyone else sits there....I was the only one out of 7!!! people at the nurses station to get up and go check it out.

3. For pain management, our unit team has decided to put these dry erase clocks in every room. After we give pain meds, we are to make a hour/minute hand for when the next dose of pain medicine is due...as well as write when they got it and when they can get it again.....I think that's ok. But I think it's going to backfire if the pain is unrelieved, and patients don't ask for anything else.....maybe we just need to do a better job of explaining when patients can get pain meds again.

Any advice about these issues?

Also, I'm talking to the CNAs about how they would feel if I was a "liason" between management and them...many of the CNAs gripe silently because they know that mentioning issues won't change anything. And when they do, they are belittled and made to feel like it's their fault for bringing it up. As a former CNA to RN...I think the aides would be more understanding and willing to bring up issues, if it's to me versus my manager. I'm planning to bring up the idea as more of a "time-saver". My boss goes to many meetings throughout the day, and maybe a every 2-3 week meeting about aide issues would be easier than having to hunt her down, or have a CNA call her, or have CNAs come in on their day off, etc. I understand that budget and staffing issues are ones she can't solve...but the other ones could be.

Thanks all for reading this LOONNNG post.

[nurseshepherd]

Our new DON must have read the same new managment article yours did; we are now supposed to do hourly rounds, all departments. What will happen is folks will chart they did to satisfy the latest mandate and still do what they have been doing, seen it happen. Not sure where this request comes from, must have been some new research that suggests this may help with patient outcomes or satisfaction with care, but our med/surg folks are going to have a tough time actually doing it with 8 - 12 patients. Does any know where this concept came from?

[sammy75]

We have been doing hourly rounding for about a year now....HATE IT! The CNAs do odd hours, RNs/LPNs do even hours. We have a bedside flowsheet hanging on the wall of the pts room to document on every time you do your rounds. However, I work nights and most pts don't want to be bothered if they are trying to sleep (no n/v, pain, etc) and every time the door opens it ususally creeekkkksss and the pts wake up p***ed off! There is really no time to do hourly rounding since I have 7 pts per night and 1 CNA for 40 pts! Oh and another thing about this flowsheet business.....there is a column on it to mark how the person is positioned (in a chair, l/r/b in bed, etc) and if they have been on one side for longer than 2hrs then we are to wake them up and tell them to turn over! (These are not the q2 turns, they are walkie talkies with no skin issues.) Now, if I'm EVER in hospital as a pt and someone wakes me to tell me to turn over they had better move because I'm gonna deck 'em!!!

[uscstu4lfe]

i work in med-surg and we have the hourly rounding rule. i have not seen any of the RNs actually do hourly rounding. they would never get anything done! at the end of their shift they just sign off as though they did. hourly rounding is just another way the hospital is looking to cover their butt and blame you if something goes wrong with a patient because you were not checking on them frequently enough.

[ICRN2008, BSN, RN]

In peds we were required to document hourly: Patient alertness, position and activity (ie calm, crying, etc). We had to do hourly pain assessments on all patients in pain, especially sickle cell patients on PCAs. We had to document IV VTBI and PCA injections attemps hourly as well. It was difficult to say the least, especially when we only had one CNA for the entire unit, and he/she was assigned one patient with each nurse.

[ICRN2008, BSN, RN]

Oh, and we had to document the IV site assessment hourly as well. This came after a few lawsuits for infiltrated IVs. We managed to do our hourly rounding, but we usually only had four patients. Even then, we were running around the entire shift and often didn't get any breaks.

[medsurgrnco, BSN, RN]

Sounds like you work at the last hospital I worked at!

Hourly rounding is a subject that has been covered by several threads in the last few months. Suggest you do a search and read what has been posted on the topic. According to research, hourly rounding reduces the number of falls and ulcers, reduces use of the call light so that it reduces the number of interruptions that nurses deal with, and increases patient satisfaction. It also reportedly improves nursing efficiency so that nurses have more time, but I couldn't find any stats on how much time is supposedly saved. Seems like most nurses think it takes extra time, which was my experience. IMO they need to hire an extra CNA to do the rounding, as most of pt needs (according to the research) are tasks that can be done by CNAs. In my experience, hourly rounding sheets were used by management as another way to track what staff does during the shift and so blame nurses for any untoward events.

I don't like putting pain med info on the board as you described. That turns PRN pain meds into scheduled ones, which is not what the doc ordered. That also leads the pt to think they have to suffer with pain until the next dose is "due" (not due, but available - it's a PRN med). Writing this info on the board also takes up precious time that is better spent elsewhere.

Suggest you not attempt to be a liaison between CNAs and management. Sounds nice of you, but quite likely could turn into a nasty situation for you.

[classicdame, MSN, EdD]

we initiated hourly rounding and our call lights have decreased 300%!!!!! That alone saves a lot of walking and interruptions. Also, number of falls and complaints in general are way down. Nurses, PT/OT, Educators, CNA --- a lot of people are able to do the hourly rounding. Nurses bucked it at first but now most say they have MORE time because they are not being interrupted as often.

[queenjean]

I have always rounded hourly (myself or the aide, if I have one). No big deal. I tell pts that I or the aide will be checking on them every hour during the noc to make sure they appear comfortable, but that we will still depend upon them to call us with their needs. There is no documentation at our facility, though, outside of the peds department.

In our facility, the nurse either has an aide or doesn't. So, if she has an aide, the aide responds to the call light. If the aide is busy or the nurse doesn't have one, the nurse responds. If she is busy, another nurse or aide takes care of it. In terms of answering the light, we have a central call light system, so whoever is up at the desk answers it and is responsible for relaying the message or just taking care of it themselves. Again, no big deal.

A department I once worked at used a similar method for pain management. I really liked it. First of all, it decreased those "Is it time for my pain meds" calls. It completely eliminated the family complaints that "I don't think my {loved one} has gotten any pain medication all night." I thought you would have more clock watchers, too, but that didn't seem to happen, any more than usual. I think pts felt like they were more in control of their pain management. I really don't see how it is much different than giving a pt 2mg of po dilaudid and saying "You can have this up to every four hours if you need it." It's not like that info should be a secret.

It doesn't sound like these changes are bad. Maybe how they are implemented is the problem. In the pain management issue, it was the nurses who decided to do it that way. Not every department in the hospital does it like that. We don't have white boards in the rooms where I work, but if we did, I'd certainly use it. Maybe instead of mandating all these things and how they are done, your director would have been better off saying, we are going to be doing these things, how do you think we should best implement them? Is that maybe bothering you more?

[jzkfel]

I think that posting when pain medicine was given might be a good idea, and frequent evaluations are definitely a good idea, but posting when medications are "due" is a bad practice. If a patient is in pain and their medicine isn't due for another hour, do you want them to sit there in pain and wait, or call you so you can deal with the problem (maybe by calling for an early dose, by icing, repositioning, or whatever might be needed). If they are comfortable, maybe the trade off of sedation, constipation, etc isn't worh it and you want to hold off on giving the medication. Managing pain takes a lot of nursing judgement - posting schedules really undermines that. I am much more comfortable telling my patients to tell me about the pain (thats their job) and let me worry about the schedule (thats my job).

[morte, LPN, LVN]

We have been doing hourly rounding for about a year now....HATE IT! The CNAs do odd hours, RNs/LPNs do even hours. We have a bedside flowsheet hanging on the wall of the pts room to document on every time you do your rounds. However, I work nights and most pts don't want to be bothered if they are trying to sleep (no n/v, pain, etc) and every time the door opens it ususally creeekkkksss and the pts wake up p***ed off! There is really no time to do hourly rounding since I have 7 pts per night and 1 CNA for 40 pts! Oh and another thing about this flowsheet business.....there is a column on it to mark how the person is positioned (in a chair, l/r/b in bed, etc) and if they have been on one side for longer than 2hrs then we are to wake them up and tell them to turn over! (These are not the q2 turns, they are walkie talkies with no skin issues.) Now, if I'm EVER in hospital as a pt and someone wakes me to tell me to turn over they had better move because I'm gonna deck 'em!!![/quote]you can ad me to that list!!!!