Hourly Rounding / Walking Reports

VegRN · Jun 3, 2007

I am a new grad that is on a unit that is trialing hourly rounding by CNAs. I am finding that they tell the CNA that everything is great, and then call me, even for water....

Just how are the CNA's wording things when they go in the room, is it:

"You don't need anything, do you?" or "You look like you're doing ok"

or is it,

"Hi, it's me again, Mary, the nursing assistant, do you need anything right now such as water, a blanket, help to the bathroom or do you have any questions?"

Makes a BIG difference.

patwil73 · Jun 3, 2007

Thanks for all the responses!

For those who do hourly rounding how many patients are a typical load? Do you notice any difference in rounding if you have a primary team (no aid) or a larger team with an aid?

Also for walking reports, does anyone have a form they use for it? How much do you include in your walking report? Do those hospitals that use it primarily have private rooms or double rooms and how do you provide for the privacy necessary when in a double room?

Thanks again everyone,

Pat

fetch33 · Jun 3, 2007

I work 12 hr nights on a busy ortho unit. A couple of units in the hospital are trialing hourly/q2hr rounding. We are in the q 2 hr group. Supposedly, it will reduce call light usage. I say it may on days, but won't have any affect on nights... the reason? The patient is asleep many times when you check on them.. they don't know you have just been in 10 minutes ago, so they will push their call light. Another problem I have is that we have extra paperwork to fill out to 'prove' we are rounding. It is not a part of the patient's permanent record and it is rediculous. I say make it a part of the patient's chart and put it on the computer where I am charting already. Also, the nurse manager wants all shifts, including night shift to physically go into the room to the bulletin board at the foot of the bed and chart on the paper there. First, I am short and pens don't write uphill. Second, walking to the patient's bedside many times will awaken them and I'll need a flashlight or light to see by to chart. I always check to see that my patient's are breathing, but walking next to the bed with tennis shoes on that always squeak with the darn wax they put on the floors is just overkill. It will awaken patients and piss them off. Are there any other hospitals who insist on added paperwork just to 'prove' that they checked on the patient properly?

GreenEyedNurse · Jul 20, 2007

Hi, I'm new to these boards and found it while doing a search about hourly rounding. I'm a patient care coordinator of a 30 bed med-surg unit. I mostly function as a floating charge nurse, but often due to staffing issues, I take a full 5 patient assignment. We work 5-1 and out pct's have 10-1. Hourly rounding is a big hot button issue in our hospital right now. We initiated this on our unit in May and our fall rate dropped significantly. We originally had staff buy-in, but now we're noticing a drop off of the rounding behaviors (using the rounding verbage, etc) We have a tool that everyone hates where, yes, we're documenting every hour that we have asked the 3 P's (Pain, Position, Potty), checked the environment of the room and we also have a column for bed exit alarm check. People HATE the tool! I recently attended the Studor Group "What's Right in Healthcare" conference and it was a very empowering and one of the main focuses of the conference was hourly rounding. I'm trying to figure out how to 'hardwire' this with the staff. We're trying to alternate, pct on the odd hours, nurse on the even. Q2 hour checks on midnights (not waking them up of course). Since I'm in staffing a lot, I have the perspective of being the staff nurse who is swamped and trying to get in to check on everyone. What I've found is that it's not necessarily doing the "Hi, everything OK?" type of rounds, but really just using the verbage..."do you need to go to the bathroom, do you need a drink, are you warm enough, etc." Anyone with any input on this?

lynaheat · Jul 20, 2007

That has been our complaint all along. I work on a med-surg/cardiac icu step down unit. Primary nursing is 3-1, team nursing is 6-2. A lot of the time we have ICU appropriate patients, so even making sure that I see everyone every 2 hours is sometimes hard esp. with the team nursing.[/quote
Is there any way you could all sit down and talk about the pro and con of this arrangement and maybe get ti to a point. where it would be less stressful. I know Doctors have all the answers. But maybe a different approach focusing on the care of the patient is not fully meet.

EmmaG, RN · Jul 20, 2007

I recently attended the Studor Group "What's Right in Healthcare" conference and it was a very empowering and one of the main focuses of the conference was hourly rounding.

I figured it must have come from something like this.

I worked a unit with "hourly" rounding. It was supposed to alternate between CNAs and nurses. There were sheets in each room we had to fill out and initial (and they were part of the patients' medical record). The CNAs would sign and initial their portion at the beginning of their shift. I'm not sure if the nurses did so, I never checked. I simply signed the sheet when I went into the room, whatever time it happened to be--- beyond the fact that's how I was taught oh so many years ago, I tend to get rather paranoid about 'future' charting.

In addition to charting in our notes and on the nursing flowsheets if a patient had gone for surgery or a test or procedure, we were still required to "round" on them, and fill out those hourly sheets in the room that the patient was not in the room, but noting that we made rounds anyway. So I wasted a good deal of my time rounding on phantom patients.

If the sheets were not completely filled in, the manager hunted you down and made you sign them. There were a few times she came to me, insisting that I fill in the blanks and continued to do so even when I explained that during that time frame I had NOT been in that patient's room. I saw her do this with others too. I can't blame her entirely, because medical records would send back all rounds sheets not signed every hour with instructions for the nurses to complete. I have a REAL problem with this.

So accuracy in charting certainly wasn't the least bit important. Patient safety and comfort wasn't the goal. It was another BS idea combined with more BS charting designed to give the patients and visitors the illusion that the hospital "cared".

jenny_rn · Jan 19, 2008

We have a tool that everyone hates where, yes, we're documenting every hour that we have asked the 3 P's (Pain, Position, Potty), checked the environment of the room and we also have a column for bed exit alarm check. People HATE the tool!

Our hospital recently installed a new web-based software for nurse rounding as well, it's actually well received... It's not as complicated as the package you have to use. We have a rounding schedule we try to stick to, but about once a day we use this tool to survey the patient on a series of questions (usually four, sometimes five) that are specific to our floor. The software tracks all the responses and apparently has some sort of weekly report that gets sent up to management. We document our corrective actions, etc. We have also seen a drop in call lights.

BrokenRNheart · Aug 17, 2008

There was an article on hourly rounding in September 06 issue of the American Journal of Nursing. The research proved that hourly rounding significantly cut down on call light use. I must have thrown away that particular issue, but the February 07 issue has a letter from Tiffini Mericle, the DON at Wright Medical Center in Iowa. She initiated a similar call-light reduction program that was outlined in the Sept 06 issue that resulted in a decrease in the number of call light calls by 72%! She states that the hospital's satisfaction surveys also went up. Even if your hospital doesn't have an hourly rounding policy it is still a good idea that every nurse can implement. The patients feel better cared for if they know they are going to be seeing their nurse again at least every hour.

I have been thinking about this topic again. Rather than start a new one, I searched and thought I would kick this up.

A recent shift that I worked made me think about this again.

We started our shift with call lights going off non-stop for about 5 hours and it started back up in the last 3 hours of our shift (night-twelve).

Had 16 wound dressings to do, give blood and all of the patients had been pooping non-stop from receiving laxatives for days.

When it came down to charting, the hourly rounding was a joke. There was no way you could have "rounded" and charted in any kind of hourly manner.

Hourly rounding is the hospitals way to

1) force you to be accountable for something that they created a road block on and

2) cover their butts because they know it is impossible.

When minutes are flying past you faster than the speed of light as you are trying to pass meds, chart, do wound care - READ wound care orders, answer call lights, clean butts, tend to multiple requests of a patient that can keep you in the room for a half hour to an hour, get orders, check charts, draw labs, follow up on orders, find and correct errors.....60 minutes feels like FIVE. Before you know it, it is time to "round" again. I am seeing my patients non-stop but some times a patient or two might not be seen for an unreasonable amount of time.....so....

DO I LIE? Do I chart that I couldn't?

Seriously, any one have the guts to admit that their hourly rounding charting isn't truthful?

Also, I notice that aides are supposed to do the same and chart turns. I know my patient is not getting turned....not getting the things they chart, but they chart it. We are all struggling to stay on top of call lights for mor than half the shift. When it takes 4 staff members to tend to the care of an obese patient and you are all in there for a half an hour or an hour.....???

Not charting - or charting the truth will get you reprimanded or fired.

Are you all getting your hourly rounding done?

jlmb214rn, BSN, RN · Aug 17, 2008

In my facility, we use both hourly rounding and bedside report. The term "bedside report" can be confusing, so make sure what your facility expects of you. On my floor, we give a complete verbal report and then go around to each room. In the room we do the following:

Introduce the oncoming nurse.

Visualize the IV site, tubes, drains, or any complicated dressings.

Ask if they need anything. (This is where you have to have a backbone and call in your support staff for requests that they can accomodate. If you go fill pitchers and get people to the bathroom, you'll be there all day and the next nurse will get started late)

This works... really. It is beneficial in many ways.

It lets your patients know that his nurses are communicating. You'd be suprised how many of them think that we don't!

If you are oncoming, you can make sure you aren't left with an infiltrated IV or a bone dry bag of fluids, or any other mess, for that matter.

And it gives you an opportunity to "lay eyes" on all your patients at the very beginning. We are always taught to "prioritize" care, which is important. Without the walking rounds, most nurses would just go and assess and pass meds to their patients based on their acuity. (ie: my fresh post op bowel resection before my lap chole thats gonna leave today.)

With the walking rounds, I still prioritize care, but I can "see" all my patients at the very start of the shift, then go get my stuff together and start my assessments and meds.

As far as hourly rounding goes, it is beneficial too. But you need support staff. You can't do it all on your own. My load consists of between 6-9 post op patients. The techs and nurses rotate hourly rounds. We aren't on an "even hour, odd hour" schedule, per say, but we communicate to make sure that someone has rounded that hour.

For the most part, our patients enjoy the hourly round EXCEPT at night. I am a huge fan of letting my people rest when I can. There are some patients who can't sleep through someone "peeking" in on them. Some can. The ones who sleep heavy don't mind, obviously, but I have had complaints from those who are light sleepers and have "adjusted" my rounding to accomodate their rest. (I didn't round hourly on them, shhhh)

Patti 2nd gen RN · Aug 17, 2008

Walking report was awful!!! I work 11-7, and used to work 7-7 nights--both in hospital and sub-acute settings---it became impossible to NOT violate HIPPA, got patients upset because the professional language intimidated them, we have very few private rooms, and visitors are all over--listening and interrupting because they saw staff in the hall talking and wasn't it more important that we drop everything and get their loved one ice water?? and did mom's roomate have something contagious, they wanted mom moved immediately, and on and on---Hourly rounds are nice, but do wake people...and really, in my setting, don't prevent falls at all--they fall 5 minutes after you leave the room, BECAUSE you were there and woke them!!! Especially the dementia patients. Most of our falls are dementia patients with no sense of time, or alert and oriented patients who either don't want to 'bother' us, or don't want to wait 5-15minutes--we have one nurse and one GNA to 17-20 patients---there is no way around it, people have to wait. And the person who said the paperwork and policies are just to cover the administration's butt --YES!!!!! I truly believe that no one should have the right to tell me how to do my job unless they can come in and do it better than me--ivory tower nurses and admin folks need a reality check!!!

FireStarterRN, BSN, RN · Aug 17, 2008

I love the idea of walking reports. I wouldn't want to discuss everything in front of the patient, such as their overbearing family, their past drug history, or the fact that they are over the top emotionally needy and call you in the room every 15 minutes for extremely trivial requests. But I like the idea of visually laying eyes on the patient with the other nurse while giving part of my report.

medsurgrnco, BSN, RN · Aug 17, 2008

I didn't like walking rounds as I found it was inefficient. Patients often had questions so that it took too long. The offgoing nurse usually would give me a very brief report leaving out important info, while the ongoing nurse would grill me extensively instead of reading the Kardex which had pertinent info listed and which they were expected to review before the walking rounds.

Also didn't like hourly rounding. The CNAs could not be trusted to do their assigned rounds, so I had to do extra. It was an unnecessary interruption when I was trying to get other work done, and I didn't see any advantage to it. I saw my patients at least every 1-2 hours anyway, just didn't have to obsess over when I did it and spend the extra time to write down the time and initial on the hourly rounding sheet as was expected with hourly rounding.