Walking rounds

mcknis · Mar 16, 2009

we have instituted this at our facility as well and i am totoally against it! the other day we had a question posed to us about getting pts available to have a private conversation on the phone/in the room and the only answer was to get the other pt out of the room. i thought you have got to be kidding me! You want us to get the other pt out of the room for a conversation,but we will stand here and talk about them in front of everyone during rounds. how big of a double standard is that!!!!! argh....

Daytonite, BSN, RN · Mar 16, 2009

the word is hipaa and it stands for the health insurance portability and accountability act. we did walking rounds at many of the facilities where i worked and i often had to explain why to lazy nurses who would rather sit on their rumps in the report room drinking coffee and gossiping. if a visitor is in the room politely ask them to leave for a few minutes or ask the patient, who is a part of this reporting process (hipaa is very clear about telling everyone that the patient owns their healthcare information), if they would like the visitor to remain or leave for a few minutes. walking rounds include going into the patient and doing a quick inspection of the patient's wounds/dressings/tubes, discussing what treatments/tests were done/are to be done and how the patient faired/will need to be prepped, any concerns the patient or nurses have, noting them so they can be taken care of--and moving on. the patient's history isn't reviewed unless one of the parties has a question about it and brings it up. if other administrative info needs discussion it is done at the nurse's station. when walking rounds are done correctly, hipaa is not a problem.

pharmgirl · Mar 16, 2009

Sorry, typo, I'm well aware of its mneumonic being HIPAA. I guess maybe walking rounds aren't done properly where I am. All pts have a roommate and the rooms are very small. Roommates cannot help but overhear a conversation. Most of these people are immobile, so taking the roommate out of the room for report is just not feasible. It would take all day to move pts out and in, by that time it would be time for report again lol. Visitors obviously are addressed but what about the roommates? This is both of the occupants "homes".

I am not bringing this up because I would rather leave my lazy rump in a chair and drink coffee. I do plenty of walking during the day and another 30 minutes isn't going to kill me, but I have a hard time discussing a patients bowel habits in front of people (roommates and/or people milling the hallways) who are not involved. Maybe I am lazy, but I wouldn't want my diarrhea discussed in front of Mary Contrary in the next bed. Call me crazy, or lazy...one of the two LOL

Daytonite, BSN, RN · Mar 16, 2009

I've been a patient a number of times in semi-private rooms. It really is a lot harder to hear what is going on when the privacy curtains are pulled, voices are low and doors are partially closed than people think. Roommates, unless they are nasty people to begin with, actually look out for and are respectful of each other. And, voices can be kept low enough when talking about BMs so the roommate can't hear. In fact, talking during rounds can be kept to a minimum. People need to be a patient themselves to understand what it is like on the other side of the siderails.

And, yes, I am very aware that most people do not perform walking rounds correctly. I was a manager and on a QA/QI committee that surveyed the way they were done. One of my staffs complained bitterly about them and wanted nothing more than to sit around in the report room and gossip. They were missing the assessments of basic things like saline lock sites and dressings on femoral punctures from angiograms and lumbar punctures because they weren't taking time to listen to patients. Drove me nuts. I loved walking rounds because I saw them as an opportunity to multitask and get some important assessment done right off the bat. You will find that not everyone you work with prioritizes like that or wants to be prepared for potential problems. They are content to take crisis as it hits. If I have seen and spoken with every patient in my charge right off the bat I feel a lot better.

I followed a nurse once who left me a dead patient. The patient was lying cold and dead in her bed when I made my first rounds. The nurse's report to me was the patient had a good day. I think what she meant to say was that she, the nurse, had a good day. And that is another reason why I like walking rounds. Trust your own observations.

pharmgirl · Mar 16, 2009

Good advice! Thx Daytonite! Maybe they just aren't being done appropriately which is why I got a bitter taste in my mouth. I, too, enjoy the multitasking part of it since I've been thrown to the wolves and basically take on 14 pts by myself for the most part and need all the time savers I can get. I can understand the benefits of it. Maybe at my facility the actually guidelines for walking rounds will hit the floor at some point and things will tighten up, hopefully. It is a fairly new procedure here and maybe the kinks need to be worked out. As for when I give walking report, I will keep trying my best to provide for privacy, which is my biggest problem with it. I honestly feel like I'm violating the patient, I'll work on that.

Thanks for the advice

Daytonite, BSN, RN · Mar 16, 2009

I've been trying to find online guidelines for walking rounds and finding nothing. I'm sure there are written policies and procedures on this. Perhaps your facility actually has them--somewhere. A literature search may find some.