Six months after the telemetry unit at Sts. Mary & Elizabeth Hospital in Louisville, KY, implemented hourly nurse rounding, the number of patient falls decreased, patient satisfaction increased, and call light use dropped by more than 3,000 per month.
"The managers round on all of the patients every day," says Amy Robinson, RN, a nurse manager at the 200-bed facility. "One of the questions we ask the patient is, ‘Does someone always come in as soon as you use your call light?’ And we often hear, ‘Oh, I never use my call light because they’re in here all the time.’ "
The hospital began hourly rounding on Robinson’s 25-bed telemetry unit in March 2007 to reduce patient falls. In February 2007, the unit had five falls. That number dropped to one in April, although it took six months before the program was really hardwired. The director of patient care excellence, Lisa Benner, organized the project.
"We have a high population of elderly patients, so [telemetry] seemed like a good place to start, and, indeed, we did find that our falls went way down," Robinson says. "Patient satisfaction went up, which we saw as a bonus. But the biggest thing was patient safety."
Some nurses initially feared that it would add to their workload. "One of the things that we tried to really get across to the staff is that this isn’t something extra; you’re already doing this," Robinson says. "All we’re doing is giving you the verbal tools for what you’re already doing to help your patients feel more comfortable."
Before mandating hourly rounding, nurses were most likely in the patient’s room every hour anyway. But instead of asking patients about specific needs, nurses would most likely ask, "How are you doing? Is there anything you need? Okay, I’ll check on you in a little bit."
Now, staff members ask patients whether they’re in pain, whether they need to use the restroom, whether they are in a comfortable position, and whether they have everything they need within arm’s reach. Staff members also tell patients, for example, that they’re moving the call button or wastebasket closer to them because they’re concerned about their safety and they don’t want them to fall getting out of bed. That message has led to increased patient satisfaction, Robinson says. Many patients who were in the hospital several years ago now tell her how much the facility has changed.
Robinson says, "I had a lady this morning who said, ‘I had been in here before and I liked the hospital, but I really feel that you all care this time. You come in every hour. You ask me how I’m feeling and if I’m in pain. It just really makes me feel good that you all actually care.’ "
The success of hourly rounding on the telemetry unit prompted administrators to roll it out hospitalwide. The facility began rounding in the ED and the ED waiting room. "We found it really reduced anxiety for patients and for their families," Robinson says. "Patient satisfaction in our emergency room has dramatically increased with that."
The hospital has nurses round on the even hours, and aides check in with patients on the odd hours. The hospital has sheets in all patient rooms, which nurses or aides initial every hour.
"The family can see someone was frequently checking on them," Robinson says, adding that the sharp reduction in call light use and patient falls has led to nurse buy-in. "They seem to have a little more time in their day. It seems like they’re a little more relaxed and they’re not running quite as much."
Source: This article was adapted from Quality Improvement Report, an HCPro, Inc., publication.
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