Hourly Rounding

Change is a hard concept for most, but change in the hospital setting can be beneficial for both staff and patients. According to Mclean (2011), “Every change begins with an ending” (p.79). How people respond to change can make the process easy or hard depending on how the change is presented.

I am well acquainted with hourly rounding. My organization has tried numerous times to implement hourly rounding and for many reasons, the effort is never hardwired. Although the implementation of hourly rounding is very effective as proactive way to prevent falls many organization struggles with sustaining rounding. Some of the barriers are lack of staff buy-in, acuity levels, staffing, and poor documentation workflows (Toole, Meluskey, & Hall, 2016). In our post-fall huddles, one of the questions asked is, when was the patient last seen. In many cases, it is more than an hour. If the patient has more contact with the staff, the risk of falling is less. One new technology that we are about to roll out is a new call system that will track

Hourly rounding also known as intentional rounding or comfort rounding is an initiative that hospitals nationwide are beginning to implement. Hourly rounding should be purposeful. “Hourly rounding is a systematic proactive nurse-driven evidence based intervention to anticipate and address needs in hospitalized patients” (Deitrick, Baker, Paxton, Flores, & Swavely, 2012, p.13). “Purposeful nurse rounds encompass a practice where nurses attend to and document scheduled patient reviews at pre-determined and regular intervals (hourly or second hourly)” (Lyons, Biunero, & Lamont, 2015, p.31).

The staff as well as students coming onto the unit for a rotation will need to be educated on this new policy of interdisciplinary team rounding. It is extremely important for the physicians and nurses to be fully educated on this change as well as the other staff members so they all can work together to decrease the amount of disturbances in the morning for the patients. In order to provide this education, the nurse manager will hold a meeting regarding the change and why it is going to happen for all staff members. The nurse manager will send out an email with different time slots that the meeting will take place to make sure every member goes to at least one meeting. For the students that will be doing a rotation on the unit, the nurse manager will provide a PowerPoint that will need to be read and a short quiz to follow in order for the students to follow the policy as well. Once every staff member completes the education, then the change can begin to be implemented on the unit. After the change was implemented I would evaluate the success of the change six months after the implementation and then again at one year. Being the unit manager, I would use two tools to evaluate the success of the change. First, I would observe morning rounds and speak to the patients during the manager rounds regarding the healthcare team’s rounding. I would also look over the discharge surveys or the past six months to see if

Hourly rounding is something that has been around for a while. One of the first things we learned in nursing school was that you should check on your patient every hour or every 2 hours (depending on nursing aid assistance). I started my research by looking at what hourly rounding entails. From there I found the majority of articles that think hourly rounding really does affect patient care and only a few opinion articles that think the opposite.

“ The ADKAR model of change includes Awareness of the need for change, the Desire to support the change campaign, Knowledge of how to make this successful, the Ability to implement new strategies, Reinforcement of change implementation, and periodic re-evaluation (Hait,2006). These four elements promote evidenced- based practice change and the commitment from nurses to participate in professional activities.”(Robert & Pape, 2011, p. 43) A APRN’s we will have to be agents of change to provide the best care for our patients. When we identify a issue or concern we must have the ability to address it

This plan will take 10 weeks to accomplish. Week 1, flyers will be made and distributed, so that all staff is aware of the changes being implemented and can plan to make this change. It will also give staff an opportunity to voice any concerns related to the changes and fill out the initial survey which is in Appendix B. This week will also be used to gather any resource materials needed to help with implementation of skills. Week 2 will be used for coordinating instruction and teaching with unit managers. Weeks 3 & 4 will be used to review the process of shift change report and how communication occurs between nurses, from nurse to patient and from nurse to physician. Staff interdisciplinary interactions will also be reviewed to find weaknesses in communication and teamwork. Week 5 will be used to review incident reports, to determine the gaps and what the staff needs to know to make incident reporting more effective and efficient. Week 6 will be used to arrange teaching times. This week will also be used to find teaching facilitators to teach the rest of the

The purpose of this paper is to describe quality improvement strategies as they relate to the nurse scheduling process. A process flow map of the six-week schedule process will be reviewed. Strategies surrounding the gap in scheduling will be the focus, as ultimately having sufficient staff affects patient quality of care.

Rounding allows nurses to gather information in a structured way. It’s proactive, not reactive like call light responses. It’s a great way to get a handle on patient problems before they occur. It’s all about providing the best patient-driven health care… The great thing about hourly rounding is that it doesn’t benefit only the patients. (¶ 4).

In this stage it focusses on sustaining the change over a long period of time. Refreezing is the final stage, once the change has been made and the structure has regained its effectiveness, every effort must be made to remain and make sure the new procedure becomes the standard. The nurse managers or charge nurses during the shift huddles can help in the reinforcement process by praising, rewarding and providing feedback to everyone for their effort to bring the change. When the goals will be met with 100% compliance of the nurses, they will be rewarded with free lunch and snacks and they will receive special appreciation in the staff meeting. The nurse managers must implement systems to ensure that changed behaviors or processes continues, measure the impact of the changes, and provide staff with progress reports and evidence of success such as let the nurses know the current patient satisfaction

The nursing staff will have the most important role in this process change. The nurses are the ones who see the patients first. The nurses will need to be onboard and understand that this process change will help us give our patients the knowledge they need as well as increasing their satisfaction. Each nurse will be responsible for maintaining the educational materials while making sure the information is accessible to our patients. An important part of this process change is to make sure the staff is onboard and the patients are receiving the information. The nurses will be able to influence and hold each other accountable for this process change. The nursing staff has the best interest of the patients and want to provide the best care they can. The nurses have the power to either bring this project along or they can hinder this

These changes are then reinforced to employees by the Charge Nurses in Morning Huddles and in special called Safety Huddles throughout the week. While management is very open to change, implementation of the changes must be carried out by the actual hands-on personnel, and this often times leads to fear of the unknown. As Yoder-Wise (2015) states, “All changes, whether perceived as positive or negative, large-scale or simply, are scary and generate fear” (p. 307). In the short time I have worked in the ED, I have seen both support and resistance among co-workers regarding change processes. While some embrace change, others resist, and are set in their ways viewing change as inconvenient and an addition of time-consuming steps to an already stressful environment. Most whom I work with, when presented with the facts and evidence behind the change, view it positively and have no problem implementing it.

The first stage is gathering data from other hospitals that have a strict feedback policy to assess what works well in terms of providing feedback in a nursing facility. The second stage is ensuring that all nurses are aware of the upcoming change and how they will be monitored. It is not designed as a punishment system and this will be made clear. The third stage is focusing on how the feedback will be delivered. I am proposing that it be delivered in the format of two positives and a negative (if there are any) so that nurses feel that their performance is not being criticized and that their positive actions in the facility are not going unnoticed. The final stage will be deciding how to gather the feedback from other staff and patients – perhaps just by observing the nurses in their

A positive force for change centers on the nurse’s strong desire to change current practices. The combination of the turnover rate, low morale, and higher percentage of new nurses, is the driving

During this stage, the educational team will meet with charge nurses and to commence the change. There will be flyers, posters, and educational opportunities during change of shift announcements for charge nurses to instruct the staff nurses about the change in protocol. The presumed budget for the education team and policy implementation have already been formulated and can be accessed in Appendix F. An application to the Internal Review Board will be submitted and reviewed for approval. This change will require system-wide recognition as a quality improvement process.