Nursing rounds: A 'win-win situation' for quality care

Simple, low-cost practice is having a dramatic impact

Would you like to decrease falls and nosocomial skin breakdown, reduce the frequency of patients' call light use, and increase satisfaction of both patients and nursing staff? After a 2006 study linked these and other benefits to nursing rounds, a growing number of organizations are implementing this practice.1

"Since the article was published, I have had 1,143 requests from hospitals and nursing managers from all over the U.S.," reports Christine Meade, PhD, the study's lead author and researcher with the Studer Group, of Gulf Breeze, FL,

At Sharp Memorial Hospital in San Diego, hourly rounding was implemented for 800 nurses and nursing assistants in all inpatient units. Nurses ask patients about the four "Ps:" pain, position, need to go to the bathroom (potty); and proximity (convenient location of everything the patient needs). Before nurses leave, patients are asked: "Is there anything else I can do for you before I go?"

"Since patient falls are often related to unexpected trips to the bathroom, these rounds anticipate the need and help prevent falls," says Jennifer Jacoby, RN, chief nursing officer. Nurses were given one-on-one instruction on what to do during hourly rounding, with follow-up meetings with managers to validate their progress.

A second contributor to falls is reaching for something too far from the bed, so assuring needed items are in proximity assists this. "Position helps prevent skin breakdown, and pain inquiry assures we are managing pain ahead of the curve," says Jacoby.

At St. Rose Dominican Hospital- Siena Campus in Henderson, NV, nurses do hourly rounding to check for pain, potty, and position, and document pain levels on a white tracking board in the patient's room. "We have had some excellent results and have decreased our falls," says Teressa Conley, vice president and chief operations officer.

After nursing rounds were implemented on the med/surg units at Northeastern Hospital-Temple East in Philadelphia, safety and satisfaction improved. "Initially we were only looking to improve patient and employee satisfaction," says Elizabeth Dructor, RN, nurse manager. "But when our Press Ganey scores soared from 68-72% to 98% in all areas of the questionnaire, we realized the impact rounding produces. We soon realized as well we were having a tremendous impact on pain control."

Because of toileting every hour during the rounds, fall rates decreased "a whopping 65%" and injuries related to falls dropped as well, says Dructor. "We came to understand how far reaching rounding really is and the impact it has on so many other areas of care," she says. "Weekly comparison of unit scores prior to rounding told the story. Rounding is absolutely best practice."

Nursing rounds are a "win-win situation" for everyone — patients, staff and the hospital, says Dructor. "The patients love knowing someone will be returning to see them in a scheduled timeframe," she says.

Since patient needs are met during each period of rounding, unless it's something emergent, patients refrain from using the call bell. "Nursing staff have less interruptions, less distractions, and less running around," says Dructor. "The nursing assistants do the bulk of the rounding, and even they find that patient care time is less interrupted, because they don't have to stop what they are doing to constantly answer bells."

The hospital has markedly decreased the number of falls with injuries. "Hopefully, litigation costs are lowered, not only because of decreased falls, but also because having a better experience makes it less likely that someone will sue for other issues," says Dructor.

At Medical University of South Carolina in Charleston, nursing rounds have resulted in a 15% to 70% decrease in call lights, with marked improvement of patient satisfaction scores on many units. "It is worth the effort!" says Marilyn J. Schaffner, PhD, RN, administrator for clinical services and chief nursing executive. "There are many reasons to do it, and no reason not to do it."

After rounding was implemented at St. Rose Hospitals—deLima Campus, there was a dramatic decrease in call light use. "On my 20-bed intermediate care unit, call lights used to be constantly going off," says Wendy Lincoln, RN, MSN, director of critical care services. "Now, the call lights go off five or 10 times in a 12-hour shift. They are the exception rather than the norm." White boards were customized to include a space where the patient/family can write down "questions for my doctor" to increase patient participation in care.

Collect data to show impact

As for what data are needed to demonstrate the impact of nursing rounds on safety, Meade suggests the following: a record of call lights, rounding logs that nursing staff must sign, the number of falls, the number of medication errors (both dosage and wrong medication), decubitus ulcers, surgical wound site infections, peripheral and central line site infections, and a number of other infections.

At Sharp Memorial, fall rates are compared to other hospitals in California through data from the California Nursing Outcomes Coalition. "Overall, the fall rate and number of pressure ulcers is lower than 90% of other hospitals in the state," says Jacoby.

Fall rates and pressure ulcer rates are measured, along with questions from the hospital's patient satisfaction survey about response to call light and management of pain.

At Medical University of South Carolina, the patient's overall satisfaction with discharge is tracked, with current scores compared to baseline scores prior to implementing hourly rounding. "I believe we can positively impact the discharge process if the nurses and clinical associates continue hourly rounding even after the discharge order is written," says Schaffner. "I sense the patient's dissatisfaction with discharge is about a lack of effective communication with the patient and their family members." A number of other metrics were measured before and after implementing hourly rounding, including staff satisfaction, steps walked by nurses, and patient falls.

Northeastern's fall rates were compared before and after the rounding program was implemented, and include every fall and near fall incident report, comparison of injury vs. no injury, where the fall, occurred and other details of the event.

"Had I realized the far-reaching impact rounding has, I would have liked to have data comparing medication errors prior to rounding and since rounding was initiated," says Dructor. "I believe it has decreased errors, simply because the nurses are not interrupted and distracted while dispensing medications, but I have no hard data to back it up," she says. "I would encourage someone who has yet to begin rounding to keep that piece in mind."

Reference

  1. Meade CM, Bursell AL, Ketelsen L. Effects of nursing rounds on patients' call light use, satisfaction, and safety. Am J Nursing 2006: 106(9);58-70.

[For more information, contact:

Teressa Connelly, Vice President and Chief Operating Officer, St. Rose Dominican Hospitals-Siena Campus, 3001 Saint Rose Pkwy, Henderson, NV 89052. Phone: (702) 616-5578. E-mail: Teressa.Conley@chw.edu.

Elizabeth Druchtor, RN, Nurse Manager, Medical/Surgical Units, Northeastern Hospital Temple East, 2301 E. Allegheny Ave., Philadelphia, PA 19134. Phone: (215) 291-3269. E-mail: dructoe@te.temple.edu

Wendy Lincoln, RN, MSN, Director of Critical Care Services, St. Rose Hospital-deLima Campus, 102 East Lake Mead Pkwy, Henderson, NV 89015. Phone: (702) 616-4887. E-mail: Wendy.Lincoln@chw.edu

Jennifer Jacoby, RN, Chief Nursing Officer, Sharp HealthCare, 8695 Spectrum Center Blvd., San Diego, CA 92123. Phone: (858) 499-4117, Fax (858) 499-4140. E-mail: jennifer.jacoby@sharp.com

Christine Meade, PhD. Alliance for Health Care Research, Studer Group. Phone: (540) 942-9143. Fax: (540) 942-1563. E-mail: chris.meade@studergroup.com. Web: www.studergroup.com.

Marilyn J. Schaffner, PhD, RN, Administrator for Clinical Services and Chief Nursing Executive, Medical University of South Carolina, 205 Main Hospital, Charleston, SC 29425. Phone: (843) 792-7545. Fax: (843) 792-6682. E-mail: schaffnm@musc.edu]