The benefits of hourly rounding can be very encouraging for hospitals considering implementing the program.  However, according to the Studer Group, the hospital consulting organization credited with first documenting the benefits of hourly nurse rounding, hospitals should not attempt to execute the program halfheartedly.  Having the nurses merely get “face-time” in with the patients each hour is not enough.  In order for hospitals to see real results, the Studer Group advocates that nurses follow the following eight-step rounding procedureeach time they enter a room during their hourly round:

1. Use opening Key Words.
2. Accomplish scheduled tasks.
3. Address the “Three Ps”—pain, potty, position.
4. Address additional comfort needs.
5. Conduct environmental assessment.
6. Ask, “Is there anything else I can do for you? I have time.”
7. Tell each patient when you will be back.
8. Document the round.

The most critical component, according to the Studer Group, for a successful hourly rounding implementation is maintenance.  Nurse Managers must be committed to the program, and must continually validate the program or it quickly falls apart.  Validation consists of not only making sure that nurses are consistently making hourly rounds, but also that they are faithfully following rounding procedure.

Trust but Verify

The Studer Group suggests that nurse managers execute a “trust but verify” policy.  It is important that nurses do not perceive that they are being “checked up on” by their managers because they are untrustworthy.  Instead, managers need to communicate that they are simply double checking to make sure activities do not “fall through the cracks”  and that bad habits are not formed.

Hourly Nurse Rounding Validation through Technology

Dalcon provides a solution to help hospitals implement nurse rounding as a part of its Dalcon Alert Remote Patient Monitoring system.

Dalcon Alert captures patient monitoring device alerts and sends them to wireless phones carried by hospital staff via text message.  In addition to monitoring patient device alerts, Dalcon Alert also sends periodical bed turn alerts to staff as well as rounding reminder alerts.  Nurses cancel their rounding reminder alert via Dalcon Alert’s Remote Alarm Monitor at the patient bedside.  As a result, hourly rounding is assured.  However, it is still the responsibility of the nurse managers to confirm that nurses are following rounding procedure accurately and diligently.

Hourly nurse rounding seems counter-intuitive.  At first glance, adding a major task to an already demanding job in order to decrease workload doesn’t make sense.

Yet researchers have found that adding an hourly nurse rounding program in hospitals makes a dramatic impact in two important areas:

1. Significantly increased staff productivity and satisfaction.
2. Significantly increased quality of patient care and patient satisfaction.

The fact that hourly nurse rounding actually decreases staff workload comes as a surprise to many.  Yet consideration of the impact of hourly rounding on the work environment quickly explains this phenomenon.

In a traditional acute care setting, nurses typically are conditioned to react to patient problems and requests instead of focusing on preventing them.  This strategy of inconsistency creates a high stress environment.  Because nurses are not proactively resolving patient needs, patients learn to rely heavily on their nurse call buttons to get assistance.  Due to the interrupting and distracting nature of nurse calls, as nurse calls increase, staff productivity usually goes down.

Reducing these resource-consuming nurse calls is the first area hourly rounding pays off.  As patients learn to expect nurses at specific times throughout the day, they begin to rely less on the nurse call system, using it for urgent needs only.

The effects are dramatic.  A recent study across 27 nursing units in 14 hospitals by the Studer Group, a hospital consulting organization, showed that hourly rounding decreased nurse calls by almost 40%.  In addition, patient falls were reduced by 50%. According to Christine Meade, PhD and chief researcher of the study, “It’s essentially like adding the time of one full-time RN to complement the staff for a week because of the hours not used answering call lights — and the patients love it.”

A secondary benefit of hourly rounding is the increase in the quality of patient care.  Patients feel like their needs are better cared for when patient care is provided proactively instead of as a reaction.  Also, Because hourly rounding takes care of all non-urgent patient needs, the nurse call system can regain its sense of urgency.  As a result, nurse call response times are drastically reduced.

Implementing Hourly Rounding with New Technology

Dalcon Alert, Dalcon’s Remote Patient Monitoring and Alert Management solution, has hourly rounding alerts built into the system.  Dalcon Alert captures patient monitoring device alerts and sends them via text message to wireless phones carried by facility staff.  In addition to these monitoring device alerts, Dalcon Alert also sends periodic bed turn reminder alerts and nurse rounding alerts.

Because Dalcon Alert hourly rounding alerts can only be canceled via the Remote Alarm Monitor (RAM) at the patient’s bedside, accidental staff negligence of rounding is eliminated.