Hourly Intentional Rounding Worth the Time Brandy Everson

Hourly Intentional Rounding Worth the Time? Brandy Everson COHP 450 November 30, 2014

Purpose/Introduction I am a nurse at Saint Mary’s hospital in Grand Rapids. They require nurses and personal care technicians to do hourly rounding. Hourly intentional rounding addresses • Toileting • Environment • Hunger/thirst • Pain • End with “Can I do anything for you before I leave? I will be back in another hour but use your call light if you need someone before? ” The purpose of this presentation was to decide if intentional hourly rounding is worth the time it takes staff from other tasks.

Finding Research Keywords I used were: • intentional rounding • hourly rounding • call lights Search engines I used were: • General one file info trac • Primo by Ex Libris • Lexis. Nexis Search results were right on target with what I was looking for with the key words “hourly intentional rounding. ” A couple of articles I did not spend time on were not what I considered credible sources.

References Harrington, A. , Bradley. , Jeffers, L. , Linedale, E. , Kelman, S. , & Killington, G. (2013). The implementation of intentional rounding using participatory action research. Intentional Journal of Nursing Practice, 19(5), 523 -529. Mason, Mary-Claire. (2012). More than a checklist. With the governement calling for hourly patient checks, intentional rounding could soon be widespread in hospitals. Nursing standard, 26(20), 20.

Study #1 • The first study was the implementation of intentional rounding using participatory action research, used a qualitative approach called PAR or participatory approach research. This study is a patient cohort and consisted of four cycles which could be revised throughout. • The population was patients in the hospital. Variables are their limited decision making. • In the first phase “assessment, "they found most call lights were placed for non urgent reasons and underlying reason was emotional or anxiety. • Feedback from surveys after discharge in regards to intentional rounding were inconclusive. • There was a reduction in call light usage and safety was improved. (Harrington, A. , Bradley. , Jeffers, L. , Linedale, E. , Kelman, S. , & Killington, G. , 2013).

Study #2 • The next study was also a qualitative study. • They did a static group comparison where a few were selected to participate in intentional rounding were compared to those who did not participate. • Study was done by creating a checklist of what each patient was asked then trialed on the floor. They kept track of results. The subjects were selected patients on the floor. • The study tracked the amount call lights that went off before and after intentional rounding. They also did two hour checks and one hour for dementia/acute care patients. • They found that pressure sores were reduced with intentional rounding. (Mason, Mary-Claire, 2012).

Ethical Considerations Study #1 Study #2 • The first study took the proposal to the institutional review board who approved prior to the study. • Information was distributed to the staff and permission from staff was given. • Permission was verbal and written was obtained. • The second study does not discuss ethical consideration. They do claim while participating in the study patients receive care that is equal versus more vocal patients receiving care. (Harrington, A. , Bradley. , Jeffers, L. , Linedale, E. , Kelman, S. , & Killington, G. , 2013). (Mason, Mary-Claire, 2012).

Strength Study #1 Study #2 • Chose to do the study because they felt nurses were reacting to the patients needs rather than preventing them. They felt this study could improve patient satisfaction and productivity. • Chose to do the study because they were doing many of the intentional rounding things already and thought the checklist would provide a systematic way of doing things Harrington, A. , Bradley. , Jeffers, L. , Linedale, E. , Kelman, S. , & Killington, G. (2013). (Mason, Mary-Claire, 2012).

Quality Study #1 Study #2 • Used a small amount of patients and staff to test intentional rounding. They used 86 patients and 138 staff. • Discusses how evidence is low because patients suffer from cognitive deficits making it hard for them to participate in intentional rounding. • Does not give the amount of staff or patients that participated. They say that their was 78% percent decrease of call lights which in turn improved patient care but do not state out of how many patients. • They do not have a section where they discuss reliability of their evidence. (Harrington, A. , Bradley. , Jeffers, L. , Linedale, E. , Kelman, S. , & Killington, G. , 2013). (Mason, Mary-Claire, 2012).

Credibility • Both articles were peer reviewed. • Both articles have findings that match other literature out on intentional rounding. (Mason, Mary-Claire, 2012). (Harrington, A. , Bradley. , Jeffers, L. , Linedale, E. , Kelman, S. , & Killington, G. , 2013).

Incorporating into practice • You would want to develop a policy and structure for what charting is necessary for rounding as well as questions they should ask. • You then would roll it out department by department. This allows you to work out the kinks before it is hospital wide. • Intentional rounding would be an expectation of all staff and would be communicated as a policy change. It would be educated in large groups to reduce time spent on it. New hires would be on an individual basis if needed.

How it affects practice • These studies have the potential to improve practice everywhere. Safety is improved, pressure ulcers are reduced and overall patient satisfaction is increased. That not only improves the practices of the individual nurse but nursing practice as a whole. In my opinion we were moving away from the 1: 1 attention we gave patients to sitting behind a computer and waiting to be summoned. • Based on the two articles giving the same outcome, I think you can generalize the results and assume that if every hospital did this same study, they would have the same results (Mason, Mary-Claire, 2012). (Harrington, A. , Bradley. , Jeffers, L. , Linedale, E. , Kelman, S. , & Killington, G. , 2013).

Barriers to Intentional Rounding • Additional time spent charting what you did during rounds • Additional time spent with patient takes time away from required charting • Staffing may not accommodate rounds. While one staff member is rounding other patients may need help. • Additional training which would add costs to payroll. This may even itself out with decreased falls and pressure sores.

Additional PICO questions • Does intentional rounding in comparison to waiting for patients to use their call light reduce the amount of falls in the hospital? • Does intentional rounding in comparison to waiting for patients to use their call light reduce anxiety and emotional distress experienced by patients in the hospital?

Conclusion • I stand by intentional rounding after researching this topic. I do feel that hospitals should understand the additional time spent and keep charting to a minimum. • In my opinion I should be charting on the exceptions and not the expectations. I should be expected to toilet my patient, so why do I need to document that I asked? Our time should be spent with patients and not behind a computer. • Lastly, I was unable to find any evidence that pointed to intentional rounding as a hindrance to patient care. I even researched sleep disturbance but because most institutions require staff to allow patients to sleep this did not apply.