I recently learned hourly rounding was being initiated by nurses in my neck of the woods. Research about hourly rounding shows it is effective in increasing patient satisfaction, increasing nursing satisfaction, increasing quality by reducing fall rates as much as 60% and decreasing the number of call light requests by 40%.
How does this magical hourly rounding work? It's based on the 4 P's of nursing: Pain, Potty, Position and Periphery. This is not to be confused with the 4 P's of marketing: Product, Price, Place and Promotion.
I think hourly rounds sounds like an excellent idea for nurses. If it decreases their call lights, I don't know how they couldn't agree. But I also think the concept holds promise for improving the efficiency of communication between nurses and physicians as well, which can also improve the efficiency of the nurse's daily work flow. I think I am going to work on adding a fifth P to the hourly rounding. It's called paging.
I read now that there is actually a script for which nurses should memorize when introducing themselves in the hourly rounding role:
"I am here to do rounds. How is your pain? Do you need to use the restroom? Do you need help to reposition (or get up, or get back to bed, or whatever the activity is)?" Once all that is complete, the nurse should make sure the call light, telephone, TV remote, bed light, bedside table and tissues are within the patient's reach. Then tell the patient, "Is there anything else I can do for you? I have time now while I am in the room. Also, someone will be back in about an hour."
Nurses then mark the bedside checklist. This process will be a group effort, including RNs, technologists, clinical assistants, nurse managers, assistant nurse managers, and even the unit secretary. Physical, occupational and respiratory therapists may also assist in this process as well.
Here's how it works. All floors will page their hospitalist once after the hourly rounds first thing in the morning to notify the hospitalist of any needs related to pain, potty, position or periphery. All necessary prn orders will be obtained at this time and no further pages will be made until the following day's hourly rounding regarding pain, potty, position or periphery. After the daily call, the pager will only be available for critical issues. Turning the 4Ps into 5Ps has the ability to take this concept to the next level and reduce the number of pages to physicians by 99.99999% while simultaneously increase nursing and physician satisfaction by 99.99999999999%.
If the nurses are happy and the physicians are happy and the patients are happy, then daily rounding with the 5 P's should be established as the standard by which all hospitals strive to meet. This is a natural extension of the dialysis spa and the hospitel phenomenon and I'm all for any policy that improves quality and satisfaction with one giant magical wand. Hourly rounds done by 8am. Pages done by Nine. Let's get movin' people. I'm also considering adding a sixth P to hourly rounding by nurses. It's called prompting the physician and it's based on better outcomes with checklist prompting. See this study for these exciting details! These nursing someecards give perspective on the issue.