How to Get and Give the Most from Hourly Rounding

Hourly rounding is the process of intentionally checking on patients on a very regular basis, as a means of addressing patient needs, as well as improving their safety and overall care experience. The rationale for what has been relatively standard practice since the mid-1970s is “When patients are unable to comprehend nursing workflow and cannot predict when a nurse will be available for physical and emotional assistance, they worry that no one will be available to respond to immediate needs (i.e., they experience “help uncertainty”), anxiety levels rise, and inappropriate coping mechanisms may come into play (e.g., getting up to go to the bathroom alone shortly after receiving a pain medication). By taking the initiative to address basic needs such as use of the bathroom (“potty”), positioning, pain control, and proximity of personal items using a structured format, nurses can decrease patient anxiety and minimize help uncertainty” (Mitchell et al, 2014).

Improving Hourly Rounding

Whereas purposeful rounding was a mechanical process in its early days, typically relying on rigid requirements and a strict set of questions, nurses have recently become more practical and flexible in achieving it. A Cleveland Clinic article discusses efforts to improve the process, offering that “utilizing data and anecdotal evidence from caregivers, med-surg nurses began to consider what hourly rounding should look like and how to remove barriers. ‘No matter what, every single hour, 24 hours a day, someone should be rounding,’ says [Nurse Manager Katie] Galvan. ‘That doesn’t mean we’re going to use the same language, ask the same questions or wake people up. Nurses now are empowered to round using the ‘observe vs. ask’ guidelines’” (Cleveland Clinic, 2018). The process was able to incorporate patient circumstances more effectively and get past some of the barriers that had prevented effective rounding in the past.

One Size of Hourly Rounding Does NOT Fit All

Despite its intention, hourly rounding may not always achieve its goals. A King’s College London study found that hourly rounding may unintentionally “focus on completion of the rounding documentation rather than on the relational aspects of care delivery” (Townsend, 2019). Here are some situations where intentional rounding can be customized to the patient condition and preferences:

1. Use digital notes with access to real-time information so that subsequent rounders can stay abreast of patient condition and concerns. Nothing destroys the patient experience faster than having to repeat what’s going on to a new clinician.
2. Patients who are asleep should be allowed to continue resting. Sleep is very important for healing. A rounding nurse may simply observe the quality of the sleep with disturbing the patient.
3. In some cases a patient may appreciate conversational banter during hourly rounding. The clinician should tailor interactions and engagement to what patients prefer. Even non-verbal interactions can occur in a way that expresses warmth and caring.

References

Cleveland Clinic, “Finding the Way to Purposeful Hourly Rounding: Continuous Improvement project breaks down barriers,” clevelandclinic.org, May 25, 2018, Retrieved at https://consultqd.clevelandclinic.org/finding-the-way-to-purposeful-hourly-rounding/.

Mitchell, M., et al, “Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review (Abstract),” Journal of Nursing Administration, 2014 September 44 (9): 462-472. Retrieved at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547690/.

Townsend, L., “Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients,” NursingNotes, 09/10/19, Retrieved at https://nursingnotes.co.uk/news/acute-care/hourly-rounding-may-nurses-deliver-carefinds-study/.