hourly rounding

karenrussell_rn · Jun 10, 2009

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.

snuggles49 · Jun 10, 2009

We do rounding .( Hospital 80 beds)

1. Rounding is done every 2 hours on day shift (12 hrs) and every 1 hour on noc(12).

2. Day shift nurse rounds at 8am, 10am on own patients then one nurse rounds on all patients at 2p. CNA rounds 12p, 4p, 6p on all patients

3. Noc shift round on own as well as assign some hours to the aide.

4. Pt. to staff ratios on days is up to 7:1 same on Noc on a 26 bed med-surg unit. All Units are expected to round (OB and CICU)

5. A rounding documentation sheet was devoloped to incorporate the IV sheet and Turning log.

There has been no resistance to this new policy from nursing or the aides.

By incorporating rounding/IVdocumentation/turning documentation on one form you should get better compliance to IV checks and Pt. turning as well as having neccessary documentation if someone is not failing to do the work esp in the case of skin breakdown.

Rounding has been proven to reduce the number of call lights going on, patient saftey. patient satisfaction. Two articles to read re this issue are "Ring for the Nurse" www.medscape.com, and "Effects of Nursing Rounds" www.nursingcenter.com

We also emphasized with our staff to follow the The 4 P's : Pain, Position, Potty, and Possessions (call light within reach, phone water etc)

sparta802 · Jun 14, 2009

We just started this and it's not a part of the pt's record. We just have to go into the pt's room and make sure they're ok, see if they need anything, etc. If they're sleeping, we let them sleep. We have to initial a paper hanging in the room each hour. I like the idea b/c (on night shift especially), pts might not be checked on for hours since the nurses/aides assume if they're quiet, they're asleep or content. There could be a pt on the floor, dead, anything and no one would know for hours! I think this also makes the pts happier since they know we're there more- to get water, empty urinals, get pain meds, etc and they don't have to ring the bell and "bother us."

suni, BSN, RN · Jun 15, 2009

I would like to read the article on medscape but cannot find it.

snuggles49 · Jun 19, 2009

suni, sorry the link did'nt work. The article was from Medscape. I got it on line at their site. It actually was a CE offering. The title again is Ring for the Nurse! Improving Call Light Management The author of the article is Laura A. Stokowski, RN, MS Try this link: http://www.medscape.com/viewprogram/8786_pnt

Good Luck

suni, BSN, RN · Jun 19, 2009

Thank you! found the article, read it and printed it to do an educational offering as we move forward with hourly rounding.

mama_d, BSN, RN · Jun 20, 2009

We do hourly rounding as well, and initial a sheet in the patient's room. Which means, realistically, that at about 0500 techs and nurses initial for the whole shift at one shot.

I did keep actual track one night and initialed every time I entered a patient's room, and discovered that I round, on average, much more than once an hour on my patients.

Since it's one of the things that our NM asks about when she does patient rounds, I tell my patients at the beginning of the shift "We're supposed to check on you every hour to ensure that you are comfortable, safe, and all of your needs are met...but since it's night time, I usually just poke my head in and quietly check on you without waking you unless I really need to."

I<3H2O, BSN, RN · Jun 29, 2009

We are doing it where I work. We have about 5:1 nurse ratio with a 10-12:1 CNA ratio. Each of us are required to be in there every 2 hours. CNAs take even hours and nurses the odd. We were just told we had to do it. Director hung a hourly log by the door and we all sign each time we go in. Simple, easy and call lights have reduced DRASTICALLY! We've probably been using it a year or so and it is one of the best things our floor as implemented.

nursecher · Jul 6, 2009

Hourly rounding is being piloted on my unit (Med/Surg/Ortho/Peds/Tele) ......Pure and simple I just don't have time to mark the paper every time I am in the room. Yes, I am so busy that I do not have time. I have between 6-10 patients and it doesn't get done. LPN's/CNA are able to do this as well and don't. I am in my patients rooms as much as possible and as much as needed and that is it.

I think we should eliminate as much paperwork as possible so we have time to see our patients once an hour. Sad that we have to write it down to "prove it".

It's not working well on my unit. :down:

snuggles49 · Jul 7, 2009

I get tired of the excuse "just don't have time" do you say that about meds, assessments, dressing changes, noting orders, calling doctors ? What does one eliminate because they "just don't have time" If you are an RN your role is to delegate tasks to CNA/LPN so you can do task that require an RN. Why don't the LPN/CNA do rounding ? You say they can but just don"t Why? As far as "paperwork" that is the "prove" . You will be glad you have that "paperwork" if you have to defend yourself in a court of law or even to your supervisor. Remember if it isn't documented then it is considered not done"

Hope your Rounding gets better. Sounds like your facility has some work to do by defining who should be rounding and when. We started Rounding aprox 1 month ago. It has went well. Our Rounding sheet incorporates the IV documentation as well as the turning documentation. Our aides, lpn, and Rn's are expected to round every 2 hours day shift every 1 hour noc shift. They are expected to address the 3 P's position, potty, possessions (call light, h2o etc). Our aides do not check IV's so the nurse still goes back in to do IV check. It all gets done. The nurses have a pt. ratio up to 7:1 with many times 2-3 discharges and as many back in. In some of my earlier post on this thread I mentioned some articles re to rounding . They may be helpful.

rnss05 · Dec 12, 2009

We tried it and administration wanted it done. Please...We have 43 pt's on our medsurg floor/ two modules/ one RN to each module...You do the math..One aide per side but often have to share the aide. Same with one LPN.

More paperwork on a really busy floor can sometimes mean less patient care. You are constantly reprioritizing and this type of nonsense just makes for more confusion. They can't keep RN's and can't figure out why. People driving to work with 10 yrs experience on the floor drinkin maloxx on the way in to work each day.

crystalcnd · Dec 24, 2009

At the hospital where I work we (nurses & PCAs) do hourly rounding. The PCAs round on odd hours and do ADL/Safety checks. The nurses round on even hours and do the same. We chart each time we round. The PCAs also do vitals checks at different times (Q2, Q4, Q6, or Q8). So really there is someone checking on a patient every hour and sometimes more often. If the patient is a total/complete, the PCAs will go in on the odd hours and turn the patient. You also have respiratory and lab coming in throughout the night doing breathing treatments and drawing blood. We do not have to sign anything in the room whenever we go in a pts room but we do chart when we do our rounds. This has really cut down on the use of call lights and on patient falls. On night shift if a patient is sleeping we do not wake them up, although it seems that most of our patients do not sleep at night!