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Hourly rounding reduces falls, increases patient satisfactionRounding – or regularly checking in – on patients in the hospital setting is nothing new. However, beginning July 25, New Ulm Medical Center nurses have implemented a very specific form of rounding that has been piloted at other facilities around the nation and is specifically aimed at reducing patient falls. “Hourly rounding” is an evidence-based practice where nurses and other care staff work together to check in on patients each hour and carry out specific tasks during those visits. “For years, nurses have been taught to check on their patients on a regular basis, but the difference between checking and hourly rounding is we are very intentional about the questions we ask and the specific things we check,” said Dennis Salter, Director of Patient Care at NUMC. During hourly rounding, staff members ask patients about their pain level, make sure they are comfortable in their position in bed and see if they need to get up and use the bathroom. Not only does this result in increased patient satisfaction, but more importantly it results in reduced falls in the hospital setting. “One of the things that interested us the most about hourly rounding is the effect on patient safety,” said Inpatient Manager Marilyn Swan, RN. “Although we have improved our fall rate through other steps we’ve taken, national studies have shown that hourly rounding can reduce falls up to 60 percent. It has so many side benefits, but the main focus for us is patient safety.” An integral part of hourly rounding is something called “environmental rounding,” Salter said. This includes checking to make sure that everything is within reach – the tissue box, the telephone, drinking water, any reading material the patient may be looking at, etc. If a patient has everything in reach, they are less likely to get out of bed to get something and therefore less likely to fall. Anyone, including members of housekeeping staff and dietary staff, can do environmental rounding when they stop in a patient’s room. Pre-data collection and education with staff and nurses began early this summer with the help of Terri Malecek, RN – a clinical nurse specialist student from Mankato State University, who completed a summer internship at NUMC. Malecek conducted a call-light study (patients ring their call light when they need a nurse or some kind of assistance) on the med/surg units in May that showed the unit had many more call lights than expected – 2,500 in May alone. In addition to the call-light study, Malecek conducted information about patient satisfaction and falls data. “Call lights are very important and we want patients to use them when necessary,” Swan said. “But, studies have shown that when patients know and trust that a nurse will be checking in on them in an hour, they will save their concerns and needs for that time.” Trust is a key element in hourly rounding, Malecek said. “The big things with this is building trust, communication and consistency – it is important for the patients to know that all their nurses will be doing hourly rounding and that the routine doesn’t change just because there is a shift change,” she said. “As a patient, it is so reassuring to know when the nurse is coming back,” said patient Deb Steinke. “Sometimes they walk out the door and you think, ‘Oh, I forgot to ask them something,’ but you know they will be back, so you can save your question for next time.” Inpatient Assistant Nurse Manager Shari Novak, RN, said hourly rounding results in increased nursing satisfaction. “Research showed that initially this feels like an added task for the nurses, but what happens is there are fewer call lights to answer and it actually saves the nurses time,” Novak said. To prepare for the hourly rounding implementation, nurses and other staff participated in training that was focused on teaching specific behaviors such as asking very exact questions rather than “do you need anything?” Hospital leadership is also making a commitment to this initiative, Swan said. “When hourly rounding is done, staff will mark it on a log to show that it has been done. Managers will be rounding on patients at least once during their stay to assess how well the hourly rounding is meeting the patient’s needs and what the patient’s experience has been.” Specialty units like OB and Behavioral Health will do a modified rounding process, Salter said. “Studies have shown that hourly rounding was most effective when piloted on medical/surgical units,” he said. When hourly rounding was implemented, there was a kick-off celebration with a “road-trip” theme, Swan said. “We likened it to taking your family on a vacation and making sure that you have taken the necessary steps to make it a smooth ride,” she said. “Similar to that, hourly rounding is all about being proactive, taking care of our patient’s needs in advance, which improved both patient safety and satisfaction.” |
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New Ulm Medical Center
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