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hourly rounding

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Specializes in med surg. Has 15 years experience.

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mama_d, BSN, RN

Specializes in tele, oncology. Has 10 years experience.

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

Specializes in Home Health.

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.

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:

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.

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.

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!

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.

I think the problem is that it's annoying & insulting. What do they think we do? Who doesn't round on their patient at least q1-2hrs? The call bell is not there for decoration. I know all nurses take totals into consideration...

I think when management looks at implementing plans, they look at the individual assignment. Oh cool, well all the nurse has to do is sign her name on a couple of pages...what about qthing else.

So sign a paper @ 8 to say I was in the room @ 8 although I gave a pain medication @ 8 (documented in mar & cpu) & there's a scheduled med due @ 8 and documented assessment @ 8. Well I guess they want proof...

towards the end of the shift when I'm finished charting around 8 I probably would just fill in an estimated time I was in the patient room for qhr. I guess it's okay considering that society is becoming more litigious.. That's a lot of paper to be holding on to..just in case someone may decide to sue....

diane227, LPN, RN

Specializes in Management, Emergency, Psych, Med Surg. Has 32 years experience.

We do hourly rounding, RN's and CNA's and it has really reduced the time on the call lights. We don't wake patients up. If they are sleeping, we just check and make a note on the rounding form. As charge nurse I also make rounds on as many patients as I can during the shift. I try to see all patients that have special problems, all hospice patients, patients with demanding family members, fresh post ops. If I know there is potential for a problem I try to get involved before it gets bad and I take care of it because the nurses do not have time to get tied up with a family for a hour (I don't either but sometimes I have to). It has worked great for us and our patient satisfaction scores are wonderful and we rarely have a patient fall or use restraints. We also a a great nurse patient ratio on our floor 4:1 or 5:1. This is a 34 bed med, surg, ortho unit.

I guess I don't understand that it cuts out on call lights. What is the difference in going to the room when the call light goes off and going to the room when you round, both are a visit to the room. You should count all the visits rounding just like you would count all of the call light visits. 5 patients, 12 hr shift, equals 60 visits plus call light visits. That does not sound like a time saver to me.

NJNursing, ASN, RN

Specializes in Orthopedics/Med-Surg, LDRP. Has 6 years experience.

We also are supposed to do hourly rounding. We've done a variety of things from havng sheets we had to initial every hour and we had to assess the 3P's: position, pain, potty. I'm sorry, but i'm not waking someone up every hour who is less than 70 years old who is 3-4 days post-op and AOx3. Then we get dinged for them not getting a restful night. Now the confused patients, the fall risk patients, the fresh post-ops, absolutely. We don't have those sheets anymore and us and our aids have an agreement that we each go in q 2 hours, so that someone is in there hourly. Me, them, me, them, etc. It hasn't helped much. Maybe catching a climber in the side rails, but that's about it. I had rounded on a guy at 1am and at 145 he was on the floor. And then there's nurses intuition. You just get a gut feeling when someone is just not going to do well and it behooves to listen to it.

our hospital has been working on AIDET and hourly rounding for a while now, and really, not seeing the success. it's frustrating to see yet another sheet of paper on the wall to sign now, and it's not unusual to have no CNA for the day and have 5 pt's. when you've got one confused pt, one w/c-diff well...hourly rounds are immediately challenging. i've also noticed that some patients just don't care to be bothered hourly! they find VS q4 to be annoying. feel like i'm pushing buttons and not letting a generally normal person get over a bad time in their life without interrupting b/c i don't trust that they are smart enough to inform me that they need to potty or that their pain is increasing. i'm smart enough to see when a pt appreciates my stopping in frequently or when they prefer the solitude and quiet. personally, i'd be hating the nurse coming in every hour while i'm ill. ugh.

we are lectured constantly about our lack of rounding, our need to please our pt's, and our "scores" on surveys. so btwn the sheer exhaustion of what our job takes and then hearing i'm still not doing it well enough, i'm pretty much done with it in general. i plan to finish my time and not look back. for me, hourly rounding was the beginning of my end not b/c i disagree. i'm in there every hour for the most part. it's the lack of trust and my superiors blaming me personally for what they have decided to not fund in their hospitals - more employees, and happy employees. that piece of paper is an attempt to stretch the dollar and it's only decreasing quality of care at our hospital.

NightOwl0624

Has 6 years experience.

our hospital has been working on AIDET and hourly rounding for a while now, and really, not seeing the success. it's frustrating to see yet another sheet of paper on the wall to sign now, and it's not unusual to have no CNA for the day and have 5 pt's. when you've got one confused pt, one w/c-diff well...hourly rounds are immediately challenging. i've also noticed that some patients just don't care to be bothered hourly! they find VS q4 to be annoying. feel like i'm pushing buttons and not letting a generally normal person get over a bad time in their life without interrupting b/c i don't trust that they are smart enough to inform me that they need to potty or that their pain is increasing. i'm smart enough to see when a pt appreciates my stopping in frequently or when they prefer the solitude and quiet. personally, i'd be hating the nurse coming in every hour while i'm ill. ugh.

we are lectured constantly about our lack of rounding, our need to please our pt's, and our "scores" on surveys. so btwn the sheer exhaustion of what our job takes and then hearing i'm still not doing it well enough, i'm pretty much done with it in general. i plan to finish my time and not look back. for me, hourly rounding was the beginning of my end not b/c i disagree. i'm in there every hour for the most part. it's the lack of trust and my superiors blaming me personally for what they have decided to not fund in their hospitals - more employees, and happy employees. that piece of paper is an attempt to stretch the dollar and it's only decreasing quality of care at our hospital.

I so agree.

On normal nights, (proper staffing, available equipment, stable patients, etc) I have absolutely no problem with it. I kind of like doing it, actually.

But we have been so short staffed lately, with high acuity patients, that hourly rounding is nearly impossible - you're just reacting to situations and trying to get the essential patient care in. Today we got a nasty, condescending email from our manager, talking about our noncompliance with the policy and how "research articles prove..." blah, blah... "and she'd be happy to show us the research" blah blah...

I don't doubt the research, but wonder if she has seen any research regarding nurse-patient ratios??? I'd be more than happy to show her that!

Anyone doing this and if so how is it working out and how did you get the nurses on board/

we do this at my hospital.....but share this with the nurse techs...so for the nurse it's q 2 hours .....for 3-11....i take the even starting at 4,6,8,10 and techs take the odd starting at 5,7,9,11....works out....:)

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