1. Hourly Rounding:
Obtaining Results
Evidence-Based Practice
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2. Objectives
 Why hourly rounding is effective and powerful
 Results from two facilities of implemented hourly
rounding and results
 Motivate nursing staff to become hourly rounding
advocates
 Staff involvement and accountability for patient
satisfaction.
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3. The Facts
 Proactively address patient needs
 Improve staff workflow and satisfaction
 Improve service quality and patient-centered care
 Decrease risk for pressure ulcers, falls, etc.
 Safety and clinical quality
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4. Goals:
 Reduce call lights
 Improve patient perceptions of care
 Increase nursing satisfaction and efficiency
 Reduce patient falls
 Reduce skin breakdown
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5. 4 P’s
 Pain
Potty
Position
Proximity
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6. Scripted Rounding
 "I am here to do my rounds to check on your
comfort because I care.“
 4P’s
 "Is there anything else I can do for you before I
leave? I have time while I am here.
 I will be back in one hour to round on you again".
 Document the rounds.
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7. Explain Goals of Hourly Rounding
“We round every hour on our patients to ensure that you
receive ‘QUALITY’ care. We will not wake you if you
are sleeping unless we need to. If anytime during your
stay, you feel you are not receiving ‘QUALITY’ care,
please let us know immediately so that we can address
your concerns.”
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8. PEDIATRIC ROUNDING
P = parents/plan/pain
E = eating (bottles, meals, etc.)
D = diapers (supplies, towels, etc.)
I = interaction/ID bands
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9. Rounding Behaviors that
Reduce Call Lights
 Use opening key words to reduce anxiety.
 Perform scheduled tasks
 Address the 4 P’s of pain, position and potty, proximity
 Assess additional comfort needs (to decrease call
lights & increase patient satisfaction)
 Conduct an environmental assessment to assure safety
 Prior to leaving the room ask, “Is there anything else I
can do for you?”
 Tell each patient when you will be back (to decrease
call lights and decrease anxiety)
 Document the round
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10. Studer group
 Largest study to show that certain nursing staff behaviors
reduce call light and allow nursing staff to respond more
efficiently to patient requests.
 27 units in 14 hospitals.
 Call light usage decreased by 38%
 Patient satisfaction went up from 79.9-88.8%
 Meade, C.M., Bursell, A.L., Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use,
satisfaction and safety. American Journal of Nursing, 106(9), 58-70.
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11. Studer group
 50% decrease in patient falls.
 Patient AND employee satisfaction increased.
 Nurse reported more time to attend to other task because
they were answering call lights less often.
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12. Findings One Year After the Study
 85.7% of the units continued the rounding.
 92.8% of the hospitals expanded the rounding.
 Patient Satisfaction scores maintained a strong
increase over the early results.
 Falls continued to decrease over the year.
 Resource: Studer Group 2007
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13. Findings One Year After the Study
Quantitative Measures Before One Year
Rounding
Patient satisfaction 79.9 88.8
38.2%
Percentage of “excellent” 80.1%
ratings
Reduction in falls* — 60%
Resource: Studer Group 2007 13

14. Top Five Changes In Patient Requests
Rounding affected the 4 P’s:
3000 Pain (-35%)
2,379 Potty (-40%)
2500
Position (-29%)
2000 Proximity 1,628
1,424 1,420
1500 1,142
984
868
1000 744
507
361
500
0
Bathroom Pain Positioning IV/Alarms Misc
Pre-Round End Round
Resource: Studer Group 2007
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15. North Mississippi Medical Center
Tupelo, Mississippi
 Tupelo, MS
 650 beds – largest hospital in Mississippi
 Serves 650,000 people in 22 counties
 40 medical specialties
 Level II Trauma Center
 Hospitalist program
 3,900 employees
 Malcolm Baldrige Quality Award in 2006
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16. North Mississippi Medical Center
Tupelo, Mississippi
100
80
60 Pre-One Hour Rounding
One Hour Rounding
40
20
0
Patient Satisfaction
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17. FREQUENCIES OF PATIENT FALLS
ON EXPERIMENTAL AND CONTROL UNITS
Number of falls Number of falls
Group in the four weeks during the four weeks
prior to rounding of rounding
One-hour rounding 25 12
group
Two-hour rounding 19 13
group
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18. Skin Breakdown Reduced
One Hour Rounding
14% reduction
7
6
5
4
3
2
1
0
Pre-One Hour Rounding During One Hour
Rounding
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19. King’s Daughter’s Hospital
Yazoo City, Mississippi
 Yazoo City, Mississippi since 1930.
 25-bed acute and swing bed unit
 10-bed geriatric psychiatric unit
 Twenty-four hour Emergency Department.
 Outpatient Services: Wound Care Clinic , Foot
Specialist Clinic, Diability, Urology, Ophthalmology ,
Otolaryngology, Cardiology, Orthopedic Surgery,
Gastroenterologist, General Surgery
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20. King’s Daughter’s Hospital
Yazoo City, Mississippi
Goals of implementation: Educating Staff:
 Decrease hospital acquired  Explained WHY we were
pressure ulcers implementing
 Decrease falls  Reviewed evidence-based data
 Improve pain control  Defined actual process
 Improve patient satisfaction  Scripting:
 Decrease call lights  4 P’s – Positioning, Potty,
 Implementation timeline: Pain, and Proximity
 Education  “Is there anything else I can
 Go-Live
do for you while I’m in the
room?”
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21. King’s Daughter’s Hospital
Yazoo City, Mississippi
Results:
 Patients perception of nurses checking on them more
frequently
 Heightened awareness of repositioning to decrease
pressure ulcers, of assisting to the bathroom to decrease
falls, and assessing pain to achieve better control
 Decrease in call lights
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22. Benefits of Hourly Patient Rounds
 Leads to better care: Builds trust between patients and
caregivers.
 Reduces patient anxiety by more frequent encounters
 Reduces call lights which minimizes interruptions and
other distractions faced by the nursing staff
 Improves the patient’s perception of staff communication,
staff responsiveness, pain management and a safe
environment
 Increases overall patient and employee satisfaction
Mead, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing rounds on patient call light use, satisfaction, and safety.
AJN, 106(9),59-69.
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23. Conclusion
 The implications of these findings for nurses would
certainly be a more organized workflow, less burnout
and fatigue and greater job satisfaction as well as
improved patient care and comfort.
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24. Conclusion
Available evidence
indicates hourly rounds
are appropriate, safe,
and useful for practice
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25. References
 Assi M, Wilson P, Bodino J, et al. (2008). Why making the rounds makes sense. Am Nurse Today. 2008;3(2):12.
 Bulechek G, Butcher H, Dochterman J. (2008). Nursing Intervention Classification. St Louis, MO: Mosby; 2008.
 Coombs, M. A. (2004). Power & Conflict between Doctors and Nurses: Breaking through the Inner Circle in Clinical
Care. New York: Routledge.
 Culley T. (2008). Reduce call light frequency with hourly rounds. Nurs Manag. 39(3):50-52.
 Galanti, G. (1997). Caring for Patients from Different Cultures: Case Studies from American Hospitals (2nd ed.).
Philadelphia: University of Pennsylvania Press.
 Haack W. (2007). Care rounding: a process to improve patient satisfaction, pain management and safety. Proceedings
of American Nurses Credentialing Center (Virginia Henderson Library), 2007.
http://www.nursinglibrary.org/Portal/main .aspx?pageid=4024&pid=19623.
 Hourly rounding decreases call light frequency, may ultimately improve care quality. (2006). Nurse Executive Watch.
www.advisory.com. 2006.
 Johnson L, Topham D. (2007). Reducing falls through RN rounding. Clin Nurs Spec. 2007;21(2):114.
 Kalman M. (2008). Getting back to basics: hourly nursing rounds to decrease patient falls and call light usage and
increase patient satisfaction. Proc Sigma Theta Tau Int (Virginia Henderson Library), 2008.
http://www.nursinglibrary.org/Portal/main.aspx?pageid=4024&pid=20449.
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26. References
 Kennedy, J. and Frick, B. (2008). Boot Camp: Develop Nurse Leadership Skills in a Supportive Group Environment.
What’s Right in Health Care: Evidence to Outcomes. www.studergroup.com.
 Leighty J.(2006). Hourly rounding dims call lights.
http://www.studergroup.com/dotCMS/knowledgeAssetDetail?inode=319742
 Meade, C.M., Bursell, A.L. & Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use, satisfaction, and
safety. AJN, 106, 58-70.
 Schroder, Jack. (2003) Identifying medical malpractice. (2nd Ed.) Oakland, CA: Catalpa Press.
 Studer Group (2006). AHC Research Call Light Study. Hourly Rounding, developed by Studer Group, the largest study
ever focused on the impact of rounding. www.studergroup.com.
 Weisgram B, Raymond S.(2008). Using evidence-based nursing rounds to improve patient outcomes. Medsurg
Nurs.2008;17(6):429-430.
 Woodard J. (2009). Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Clin Nurs
Spec.2009;23(4):200-206.
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