hourly rounding

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I want to know how different hospitals do hourly rounding. I currently work on a telemetry unit and manage 6-7 patients a day, doing am care, dressing changes, wound care, medications ( which each patient usually have 10-20 pills and IV's), patient teaching (medication, discharge instructions and anything else they need), computer charting, written charting and speak with various departments and md's. I also need to accompany any patient that goes off the floor for testing. This is in an acute care hospital. We are expected to do rounding on 16-17 patients, not our own, we are scheduled once a day. I know this doesn't sound like a lot but take into consideration all the other things that you are doing and the fact that you still do rounds on your own patients all day and the fact that it can take close to an 1 1/2 to do those daily hourly rounds. How does your hospital want you to do hourly rounds?

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Specializes in critical care, PCU, PACU, LTC, HHC, AFC.

In my facility we are expected to fill out a hourly rounding sheet, checking with the time we enter the room, assess for pain, noise, make sure the call light is in place, etc.

I personally feel this sheets are a waste of time, just because I sign a sheet, and put a couple checks on it, doesn't mean I provided good patient care. Good patient care in my eyes is safe nurse to patient ratio. I believe any nurse who works in a busy hospital setting or any setting for that matter wants to provide good care, and does their best. Together we try to find that happy balance between patient care and charting. Patient care is top priority, but charting is just as important, cause if you don't chart it you didn't do it.

Why give us another thing to chart on? Because it looks good to the public's eye? I believe happy nurses make happy patients, not a hourly rounding sheet.

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Specializes in Home Health.

We also have hourly rounding logs. Some staff member is supposed to be in each room once per hour. This usually happens at the top of the hour. Usually the nurses take the odd hours and the aides take the even hours. More times than not, the CNA will actually sign off on EVERY single hour all day long. I cannot imagine how our CNAs really do this with up to 15pts each.

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Specializes in Emergency.

Ohh I don't even want to get started on this but here I go anyhow. OP, I could have written your post, and now they have us started on the ridiculous task of hourly rounding for the entire floor. First of all..if every RN is supposedly responsible for his or her own patients and should therefore be rounding on them, why is it necessary to assign every nurse thewhole floor on an hourly basis? It is a colossal waste of time, and one more meaningless piece of paper. The idea very obviously was not created by a bedside nurse, but by management in yet another of their brilliant brainstorms to make the "customer" happy. Now I've never been a hospital patient but it only takes some common sense to recognize that what would make a patient happy is not a new and unfamilar face interrupting them every hour meaninglessly, but a hospital stay with nursing care that happens in a timely manner. Now we are so busy running around the floor for no reason, my patient has to wait 20 minutes to see me instead of 10. In theory..cause unlike management, I have my priorities straight. But of course to fix this management would have to actually shell out for another nurse so maybe I could have 5 or 6 patients instead of 8. Which will of course never happen. So give me more paperwork and call it patient satisfaction. Maybe I'm bitter cause of the new management on my floor, coming in out of nowhere and trying to fix problems with answers that have nothing to do with anything and make new problems. Okay..I'm off my soapbox now. Thanx for letting me vent!!

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Where I worked nurses were on even hours CNA's on odd hours. Basically anyone that went in the room asked if the patient was in any pain, needed help to the washroom, or anything at all. After that we would sign our initials and the time that we were in the room. Most of the time the RN's would just sign their name at the end of the shift for the hourly rounding throughout the day because they did not want to check on the pts.

In my opinion, it helped keep call lights down when everyone was working together.

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We have an hourly rounding check in the computer. However, if anything pertinent is charted every hour: vs, pain, ambulation etc. that counts as hourly rounding. When we had a pt fall out of bed, DOH insisted in seeing documentation of hourly rounding!!! I could show them (I am a NM) that the patient had been seen every hour for one reason or another, they accepted this. It is not always "Management decies that..)

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Specializes in CMSRN.

We are the same as Noregrets. That is why I chart in the rooms. Shows I was in the room. But since I work nights I do not wake the pt. I just check to see they are breathing rhythmically and that the call bell is within reach.

Saved me one night. A/Ox3 lady decided she was going to get up to go pee, even though she knew she was unsteady at times. She was advised (and charted) to call. Well I went to see her and charted I saw her. Exactly 17 minutes later she fell (couldn't hold it and slipped in her own pee). Of course I had to do an incident report. But it was the computerized hourly rounding that saved me. Never felt more confident when it came to a fall.

I am very supportive of the computerized hourly rounding. Could cya.

We used to have the paper. Did us no good. Not even a part of the permanent charting. Very happy with the computerized way.

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Hourly rounding is a good idea only if it can actually be executed!!

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As a directive from above, we started hourly rounding two years ago on the inpatient area. Each unit came up with ways that would work best for them. I am a manager but worked this unit many years on both shifts and we had 2-3 times more patients that the last few years. Nevertheless, any change or any added work to the floor nurse never goes over well. We are an adult acute med/surg/telemetry unit. We had already gone to EHR and BCMA and have a computer in every room to make charting real time much more convenient (though the computers always seem to have a problem).

Hourly rounds....that didn't go well with me to start, especially since I had to implement it. I didn't like adding another paper on the clipboard. The purpose of EHR is to decrease the paperwork....hahaha that didn't work out so well. Anyway, since all nurses should involve the patient and family in the care, we decided to try something a bit different.

We took the paper idea and made large poster size laminated charts (we have 7Ps). On this poster, we have an area at top to update the date, day, doctor, nurse and CNA. Then we list the 7Ps. Below that is a round chart (we filled this area with something related to this culture of patients). Around this circle are the hourly times like a clock and a short line beside it. Because it's laminated, we can use dry-erase markers, so no papers to gather and replace every day or every patient. It's just erased and updated with each day/patient. The poster is place on the wall across from the patient, so they can also see it and read most of it from that distance.

There are actually good evidence-based reasons for the hourly rounding so I was open to trying it. By having the poster on the wall that the staff initial, the patient, as well as the family, can see when they were checked on. If the patient is asleep, they are not awakened to answer 7 questions, that's a bit overboard. But for those patients who need assistance and tend to get up to the bathroom and fall, this could be beneficial.

This isn't limited to just the RNs, but any nursing personnel, physical or respiratory therapists, physician, etc. If they are in the room, they may be addressing some of these 7Ps and initial at that time slot. As long as someone did confirm that patient was safe and the needs were met, it is a good thing. Pain in the you-no-what? Of course. But instead of shuffling through clipboards and papers, if you're in the room with the patient, you are walking by that poster and just initial it. The beginning of each shift the CNA is responsible for updating the top portion. As a guideline, we had the CNAs on even hours and RNs on odd hours, but that's definitely not how we care for the patients so it's to be a team effort. Overall, it should decrease the number of falls, call light use, and the patient doesn't feel abandoned and ignored, waiting for pain meds or someone to help them to the bathroom. This is in theory of course. I believe it is effective, though it's still a work in progress until we come up with a better way. If we stick with this, the replacement posters will also have a place for the updated pain goal and activity level.

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