We had an inservice yesterday. Now, they've instituted a new fall prevention policy that they basically expect every inpatient to be on. You have to reassess every 12 hours, plus reassess with every change such as a new narcotic or BP med, or transfer to another unit. They want the nursing staff to do hourly rounding, and have a sheet up in each room to check off that this was done, along with what the pt was doing at the time. They expect the nursing staff to ask "Is there anything else I can do for you? I have the time."
I told the woman that I wasn't going to say any canned comments like that, that it would seriously annoy many patients to be repetitivly asked the same question. I also told her that I basically already do this, but I don't want to follow a formula. She replied that many people, especially the CNAs aren't doing this, that probably most nursing staff was, and that this was more to get the CNAs to interact better, and that they would be the ones to do the check sheet. She said that they don't expect you to say the same thing each time, just use that as a guideline.
Well, since I already do this I don't have a big problem, except that the charting will be totally obnoxious and meaningless because I'll most likely hurry through it. Since I work in the ICU, it won't be to bad, but when I float to Med/Surg it will be a PITA to complete all this extra charting. The check off sheet will not be a part of the permanant chart, but will be collected each day and reviewed by the unit managers. I feel sorry for them, that sounds like a dreary task.
Honestly, there are nurses on our Med/Surg unit who sit at the nurse's station quite a bit, so I do think there is a problem that this is trying to rectify. But it's making a lot more charting for everyone. :angryfire
i don't think nurses are fighting the idea of rounding on their patients. i think what they're fighting is the idea of filling out a checklist on each of their hourly checks and uttering the canned spiel: "is there anything i can do for you? i have the time," when most of the time we've got all we can do to keep our heads above water. the "i have the time" part of that canned spiel is a damned lie, and i think nurses are fighting that.
gotcha. i do understand that scripting is difficult for most of us to accept. i always ask "is there anything else i can do for you", but the "i have the time" part does sound a little weird. i do have some scripts that i use, such as "how can i help you", "i'm going to give you some privacy" etc, but if it doesn't sound natural and genuine, we end up sounding a little stupid.
it seemed like some were saying that they don't approve of hourly rounding because patients need to rest, they don't have time, etc. it just worries me that some nurses think it's ok not to check on patients hourly.
Maybe the hourly checking & documentation has something to do with the new Medicare policy on reimbursement (lack thereof) for "preventable", "nursing-sensitive" inpatient mishaps:
Maybe the hourly checking & documentation has something to do with the new Medicare policy on reimbursement (lack thereof) for "preventable", "nursing-sensitive" inpatient mishaps:
Although addressing too-high ratios would seem to be a more sensible approach.
I do think part of it has to do with this change, but the hospital should really go over these changes with the nursing staff if that is the case.
It also sounds like the script comes from Press Gainey. They do patient surveys and this appears to be one of their typical tools. I'm in pre-reqs right now and I can assure all the nurses out there that I'd rather they be normal and genuine then forced and robotic. I bet many others would feel the same way.
I am a traveler at a hospital that does hourly rounding. The managment states it has dropped call lights significantly. However, there are those pt that you can round on every 15 mins and they would still put on the call light. we are suppose to ask about pain, if they need the bathroom or to be repositioned. We have 1nurse to 5-6 pts. The cna's do not round.
Specializes in cardiac/critical care/ informatics.
Our staffing ratios didn't change. Nurses make rounds on even and na's on odd hours. the literature says call lights drop and patients arent' as anxious. I havent' actually seen that but the nurse manager on our floor doesn't enforce anything so who can tell.
LOL. HOURLY rounding? We have a little 2-3 second thing that goes overhead in the ENTIRE hospital that sounds like a little musical "chime" sequence... every 30 MINUTES... reminding us to check on our patients. Yee-haw!
OMG!!! That's insane! Did anyone ever read that book a long time ago as a kid "A Wrinkle in Time"? Well, that is what that reminds me of. I can picture the chime sounding and then like programmed drones, all the nurses stop whatever they are doing at the same time and begin going door to door, scripting and such, in sequence.
Good idea but sometimes difficult to actually do. Make sure if you are off of the floor when your hourly round is due you have it covered. Sometimes a facility uses this to show how overstaffed they are. I know one facility did and then cut a nurse on day shift. Hope it works for you.
yeah, sit down in that chair with the MRSA and God knows what else is all over it
im glad someone else thought of it, no way am i gonna sit in a room ive seen what get slinged all over. and on to the topic im a travel nurse havent seen this rounding yet thank goodness but we did have a doc ask a patient if she thought she was at the hilton, i about fell out.
We too started the 'hourly rounding' checklists about 2 weeks ago.
I was good for about 3 days doing it - and now im boycotting it.
Not to sound like im bragging, but my charting is pretty darn good. I write usually every 2 hours, or when im in the room, or when I gave a PRN pain pill, etc. We have charting by exception, but I just cant do that. So, if you look at my charting - you'll know that I've been with the patient and checking on them.
If I have to take the time to fill out 3-5 books hourly, it will take away from my charting. So then when get sued can I say "I know I did that, but I didnt chart it because my hospital makes us fill out an hourly rounding sheet that isnt even part of the patients hospital chart - but its charted on there!"
We had a staff meeting last night that reminded us about them, and that they are being collected weekly and to make sure we fill them out. Its to raise pt satisfaction scores. Ugh.
I felt slightly bad that I filled out only..oh..0/5 yesterday. Hehe. I was busy! I didnt finish charting til 1855 - I wasnt staying later to work on them. Plus, I was in the busy pod with 5 patients, 3 of which were babies with no parents that were either g-tube fed or PO fed every 3 hours (love holding baby in one arm feeding him, and charting with the other hand), and I had a kiddo go to urgent surgery to fix a Quinton Cath that he had 'kicked' out.
So sorry hospital, if I didnt fill out your little sheets. I was busy caring for patients and making sure nobody staved to death or died.
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nursemaa
259 Posts
gotcha. i do understand that scripting is difficult for most of us to accept. i always ask "is there anything else i can do for you", but the "i have the time" part does sound a little weird. i do have some scripts that i use, such as "how can i help you", "i'm going to give you some privacy" etc, but if it doesn't sound natural and genuine, we end up sounding a little stupid.
it seemed like some were saying that they don't approve of hourly rounding because patients need to rest, they don't have time, etc. it just worries me that some nurses think it's ok not to check on patients hourly.