One or Two hour rounding

[tntrn, ASN, RN]

WE're being given yet another thing to do differently, under the guise that it will save us time, save us steps and answer all the questions to life's mysteries. One or Two hour rounding is how it's titled and I'm curious if others are doing it, what they think, is it doing what the studies say it does, and anything else you might find pertinent.

After reading the concept last night, I paid close attention on my unit. We are logging all call light calls, and our nurses are never away from a patient's room more than two hours. We have no aids, we do it all.

What I find interesting or confusing is this: Doing the rounding at 4, making sure the patient (and family) has everything it needs at 4, then telling them you'll be back at 6 isn't going to fix anything. Our puker last night certainly wasn't going to wait until 6 to puke.

Another part of this is to be offering PRN meds right on time. What? PRN means as needed, not every 3 or every 4 hours. Telling patient there are pain meds for them when they need them is far different that saying you can have pain meds now. Here take these. That is really not following the order of a PRN med, IMHO.

It will be interesting to see if this really does what they say it will. I have my doubts. Other opinions or direct experience is what I'm looking for. Thanks.

[kmoonshine, RN]

Quick idea about the pain meds: some places are utililzing the PCA concept and applying it to pain pills. Afterall, if a patient is getting percocets in the hospital, they're probably going to go home with a script for percocets too. It also gives you a good idea of how well a patient will be able to manage their pain once they are discharged home (and perhaps it will save an ED visit also; we have a fair number of patients who are discharged home, only to end up in the ED because their pain isn't being adeqately controlled). I often wonder if this would save nurses time and make patients happier because they can take their meds when they want. Here's a device marketed towards pill-PCA: http://www.avancen.com/about_the_mod.php

[tntrn, ASN, RN]

That sounds way more advanced that our place will be in, oh, say a decade or two! Some of the pumps and PCA's we're using were old when we got them and that's been over 10 years ago. But an interesting concept. I assume that if it's really, really, really too soon for another pain pill, there's a lockout dose, similar to a PCA. (I'm just thinking of a gal we had on the floor last night, who is a known addict/seeker who would be punching that pill button every 30 minutes.)

[diva_nurse]

Our hospital started 1 hour rounding a few weeks ago and the nurses hate it because with charting and other paperwork to do you have less time. Plus, a few patients complained that they were kept awake all night long because the nurse kept coming into their room. diva nurse

[kmoonshine, RN]

You could always just have one short-acting dose in a pill container with instructions to take it after a certain time (ie 3pm), with a flowsheet for them to rate their pain prior to taking the pill and to write down the time they took the med. It'll give the nurse a good 3-4 hours to reassess their pain and VS, stock the next dose, and hopefully it will let the patient feel that their pain control needs are being met. You'd probably need to have a 12-hr basal dose given by an RN (such as oxycontin), with short-acting meds that are patient administered (such as oxycodone). The patient must be cognitively aware of what is going on and able to understand the instructions though.

Like I said, what's one dose of pain meds vs. 60 pills sent home? If they're gonna divert their narcs in the hospital or abuse them, then they'll divert and abuse at home too.

Sorry, this is way off your original post. I just know that I would go crazy if I was a patient waiting for pain meds (granted, not all patients are nurses).

I'm in the ED and we've been asked to round every half hour! There's no standard as far as VS assessment goes (although its a given that if you give an IV med, that a patient should be revitaled). Also, if you're giving a med that has serious side effects (ie nitro drip -> hypotension), then its a given that you're going to be on their VS very often. I try to chart every half hour on my patients, but its pretty hard at times! However, there are some patients that I'm charting every 5 minutes on...everyone is different, and each patient needs to have a care plan individualized to their own needs. Setting an arbitrary time (such as 2 hrs) is unreasonable - some people need more coaching, some less.

I would try to find out what upsets patients the most (such as not knowing what is going on, not getting good pain control, not getting enough rest, and so forth). Then, figure out how to best meet these needs - such as oral PCA, patient-chosen "quiet time", a notepad for the patient to write down questions so they remember what they wanted to ask, or a whiteboard with "pending" written on it, followed by the care plan for the day (such as blood work to be drawn at 8am - results after 12pm, PT at 1pm-130pm, quiet-time at 3pm, etc).

[Riseupandnurse]

This is the Studer group, more of the corporate mentality. "How is your meal? Do you need anything?" "Are you ready for your check now?" And yet the boards, quite rightly, are all about prioritization and which patient do you need to go to in what order. Hospitals need to take care of medical/nursing needs and customer service with separate personnel. It would be cheaper in the long run, and everyone would be better off, patients and families as well as nurses.

[Penelope_Pitstop, BSN, RN]

like i said, what's one dose of pain meds vs. 60 pills sent home? if they're gonna divert their narcs in the hospital or abuse them, then they'll divert and abuse at home too.

yes, but "at home," they're not in my care!

anyway, i'm familiar with the one hour rounding. the way it worked on my floor was that techs took the even hours and nurses the odd hours. i tried to visit each of my patients at least once per hour anyway, and i know that several times techs and nurses didn't even enter a patient's room yet charted on the flowsheet that the rounding was complete. (just about everyone also completed charting for all rounding around 2 am...when the last round was at 6!) so although it looks nice and purty on the flowsheet...ugh.

jess

[tntrn, ASN, RN]

Thanks for all your input. I figure it will be like a lot of other things the "clipboard and high heel" types dream up: good on paper, crappy in reality.

[Xbox Live Addict]

WE're being given yet another thing to do differently, under the guise that it will save us time, save us steps and answer all the questions to life's mysteries. One or Two hour rounding is how it's titled and I'm curious if others are doing it, what they think, is it doing what the studies say it does, and anything else you might find pertinent.

After reading the concept last night, I paid close attention on my unit. We are logging all call light calls, and our nurses are never away from a patient's room more than two hours. We have no aids, we do it all.

What I find interesting or confusing is this: Doing the rounding at 4, making sure the patient (and family) has everything it needs at 4, then telling them you'll be back at 6 isn't going to fix anything. Our puker last night certainly wasn't going to wait until 6 to puke.

Another part of this is to be offering PRN meds right on time. What? PRN means as needed, not every 3 or every 4 hours. Telling patient there are pain meds for them when they need them is far different that saying you can have pain meds now. Here take these. That is really not following the order of a PRN med, IMHO.

It will be interesting to see if this really does what they say it will. I have my doubts. Other opinions or direct experience is what I'm looking for. Thanks.

`

I'm familiar with q1-2 hour rounds, as that was the policy at most places I worked. How realistic it was - that was a different matter altogether; like you said, people don't puke (or fall, get pneumonia, code, etc) on schedule. And they still expect charting to be done. I'm actually all for frequent rounding, in order to avoid tragedies like the one described in one of the news threads. It doesn't always work out though. Logging EACH and EVERY call light sounds to me suspiciously like more of this "customer service" 5-star hotel mentality that hospital administrators are obsessed with.

And it sounds like you're describing "around-the-clock" pain control too. That's something nursing schools actually preach on the basis that adequate pain control early on actually results in less need for pain medication over the long run. I've seen this done times without count. But PRN does mean "as needed"; if a medication absolutely needs to be given routinely, the physician should schedule it as such.

[Suninmyheart]

I don't mind the policy because I feel the need to check in with pt's every 1-2 hrs anyway. But I am on a cardiac PCU and we do q4 vitals and have cns'a and resource. To me it is purely an extra minute of our time to intial the rounding to provide documentation.

[mama_d, BSN, RN]

We are supposed to do rounding every hour on our patients (telemetry floor). Vitals and assessments are every four hours. Theoretically, we are supposed to ask every hour if each patient needs pain meds, reposition, to go to the bathroom, or po intake. Because I work nights, I usually just tiptoe in to see if they're awake or not. We also have forms on the bathroom doors to sign every hour...which means that at six am, the techs and the nurses are rounding to sign off alternate hours for the entire night. Statistically, it's supposed to cut down on falls and give us more time by getting to the patients before they need us....but it takes the same amount of time to go get a pitcher of water or put someone on the bedpan regardless of if you ask them or they ask you, as far as I'm concerned. Most of us have already figured out that if you put an incontinent patient on the BSC to void every hour, they're still going to wet the bed.

Just another example of looking good on paper, devised by someone who hasn't done floor nursing in the last few decades.