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).
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.
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:
Learn more from the HealthStream blog post, Five Guidelines for Purposeful Rounding in Healthcare.
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