hourly rounding

A. It was night shift

B. We had a 4:1 ratio

C. It worked out fine as long as there wasn't a crisis going on.

D. Unfortunately it woke some patients up in the middle of the night (light sleepers, etc). Nothing like being complained about for doing what you were told you MUST do.

E. We were supposed to say some stupid script called A.I.D.E.T. I can't remember exactly what it was, except that it was demeaning and a complete waste of time. We do all that stuff anyway - why make a fancy acronym out of it. So we can look even more subservient?

Seriously, MOST patients can call if they need something can't they? It's not like we're getting tips for our great "service."

I think if a patient scores high on a fall scale, they should get hourly rounding. Otherwise - they have a call light.

Maybe JCAHO should pitch in some funds for some "Rounders" so the nurses can actually do their jobs.

Signed,

Never Working In A Hospital Again - Mostly because of stuff like this

We have it too and AIDET as well. Guess what? patients still fall, code etc and the nurses are so tired from making nosensical visits to the patient rooms that no care can get done. also, patients complain that we are bothering them. I think management need to work a couple of shifts to see what we staff nurses really do!

"AIDET involves key words at key times for interacting with patients, visitors and others. The following generally describes the AIDET steps:

A (Acknowledge)--Establish eye contact and smile;

I (Introduce)--Name, department, self/skill set/experience, certifications, co-workers, physicians or others;

D (Duration)--How long will test/procedure/appointment take?; How long will patient need to wait?; How long before test/procedure visit/admission takes place?; How long until results are available?

E (Explanation)--Why are we doing this?; What will happen next?; What questions do you have?

T (Thank you)--Thank you for choosing MUSC.

In the course of AIDET we "manage up" ourselves and others. The intent is to make patients and visitors comfortable and to put them at ease. Every step of AIDET may not be needed, depending on the nature of the encounter. We know the consistent use of AIDET increases patient satisfaction."

I'm sorry, but I fail to see how this relates to rounding (especially during night shift). Are y'all saying that you wake up sleeping patients to make eye contact, smile, and the rest??

I don't close my patients' doors all the way and when I round I carefully open the door and take a peek to see if they're resting comfortably with eyes closed and respirations deep and even...if they're exhibiting any pain behaviors...if they're safely tucked in bed. Then I document the previous. Anybody on a cardiac monitor gets their rhythm, etc documented as well. Vital signs can be q4h or qshift and are usually timed with meds or labs to avoid waking them up multiple times.

Of course, I work on an Observation Unit and we tend to get stable patients for the most part...and those that would NOT welcome being awakened qh.

I know that AIDET is a method of managing up and not part of hourly rounding. I was just replying to the person before me that we are doing both. I like AIDET and think it is an excellent way to promote great customer service. Hourly rounding is also an excellent idea but trying to do that and care for up to 6 patients on a very busy med/surg/tele floor with poor staffing is a challenge. I do think the idea is great but it doesn't always fit in the real world.

We do rounding q 2 hours after 2000. You do not have to wake people to see how they are doing. Also, ANYONE can do the rounding, including CNA, PT, RT, etc. Some floors make deals with CNA's where they will chart rounding one time and the nurse the next, so that no one is having to do it all. The idea of course is to be sure the patient is safe. This have definitely worked for us. We started with a pilot program on one floor.

Our hospital also began AIDET and hourly rounding. As many things go, it fell away and was lost by the nurses eventually - sacrificed necessarily by our desires to actually take care of the patient medically (with our usual pt load of 8). Then they decided to have the CNA's do the rounding. The CNA's resisted, some do it, some don't.

I have patients who made fun of AIDET - those frequent flyers who not only know me by name, but name my pets, tell me which floor has the best coffee and fix their own telemetry stickers. Other patients appreciate some of it being done. I limit it to what fits them - not the entire customer service rote memorization speech. Do I want to seem real or seem like your waiter reciting the soup of the day and my dish recommendations?

The worst thing I think we came up with is a call light log. Every time you answer the call light we are supposed to write it down in a log - who, what, when, where. WHAT? I can't just go fix the beeping pump, now I need to note it first? The CNA's even resist this one. I said we just need a note pad by the light - so if you can't run fix it right this sec - make a note for the nurse they belong to and leave it posted in the open or hand it to them as you pass them.

We also are supposed to do hourly rounding. This would be fine if we had 4 pts with no problems. Unfortunately we usually have 6 (on a tele unit) and there is always the one pt who absorbs the majority of your time. Most of the nurses are in the pt rooms at least every hour, but some pts never seem to get enough attention and will literally stay on the light ALL DAY LONG! Personally I feel like we as a society have come to the point where we expect everything to happen immediately, that we are the only important person around and we as nurses are expected to cater to their every desire! Recently we got a low score because the pt said "The nurse did not give me everything I wanted to eat when I wanted it". Unbelievable-(this pt was a diabetic/renal/cardiac) Just my two cents worth:)

we do AIDET and rounding where I work, both for about a year, have 6 pts per team, and usually do okay. Sometimes there are other things going on, and you just have to be a team player and round on another nurse's pts. We were told we were going to do it, no exceptions. At first, a little grumbling from nurses (mainly older, long time nurses), but generally has calmed down, and we just do it. Hope that helps.....

As for AIDET, the way I interpret it is that we now have a model to provide BASIC communication. We do not use speeches or transcripts, but encourage everyone to use the tenets of the model so that the focus is on the patient.

Overall, the people I work with would do more for customer service if they had the time to do it in.

We call it Empower Rounding at our hospital; 4 P's and an E: PAIN, POSITION, POTTY, POs, ENVIRONMENT. Basically we go in every hour, PCAs on odd hours, nurses on even hours. Sometimes we flip, but the nurses must always agree to which hour they'll round. The nurses take 5 pts each on a hall of 10 pts, but the PCA has all 10 pts. This eliminates the PCA from spending their entire shift just rounding on pts! (In the event you can't do your round, let the PCA/nurse know and they'll do it for you: communication!!) The nightshift gets the day's initial vital signs at 0600 so the dayshift PCAs can get quickly get started with their 0700 round.

The most important step, we've found, is communication between the staff. PCAs get report from each other, then they immediately get report from the Nurses. It really makes the morning go by so much better when everybody knows who is who and what pts require what.

When the PCA does the initial round, they put the names of the caregivers on the dry erase board and ask the pt if they have a goal for the day (if pt is confused or unable to communicate, we give them a goal: skin care, turning Q 2hrs, etc). They also explain the rounds for new pts.

As far as the actual round itself, we ask if they are having any pain and if so where & how bad. (After I give pain medicine, I write on the board the next time the pt can get more medicine. I've had so many pts tell me that it relieved them to know when they could get the next dose of something). We suggest going to the potty rather than ask because we've found that asking a pt only gives them the idea that they've got to go after you leave the room. We ask if they are comfortable in their current position and if not, we help them get comfortable. Environment and POs usually go hand-in-hand, where we straighten up the room, make sure the trashcans are within reach of the pt, move the bedside table back to the bed, make sure the water pitcher and cups are within reach, and place the call bell and telephone where the pt can get to it. All of this can be done within a few minutes. Before leaving the room, we explain that we "will be back in to check on you in about an hour" and ask if they need anything else before we go (the video suggested adding "I have time" to that question, but I think that's too cheesy). We no longer say to the pt and/or their family, "call me if you need anything" because that defeats the purpose of doing the round in the first place.

So far, we've seen a tremendous decrease in the number of call outs and if we get them, the pts states that they hit the button by mistake. It only takes a few minutes to do and it increases pt satisfaction overall. For me, I actually have time to take the 15 minute break that is being taken out of my paycheck regardless, I can complete my assessments in the computer, catch up on work emails and any staff education. Even our secretary talks about how bored she is!!

Karen, I am curious - what is your nurse : patient and PCA : patient ratio?

Our unit is broken down into 5 halls for nurses. The nurse-to-patient ratio is 1:5 on 4 halls and 1:6 on the other. There are 3 halls that the PCAs are responsible for. The PCA-to-patient ratio is 1:9 on 2 halls and 1:8 on the other. We have a 26-bed unit and typically our needs are 6 nurses and 3 PCAs unless our census is low.