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CE Article: Hourly rounding improves patient safety; Structured visits with patients reduce call light use, saves nurses time

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Learning objectives: After reading this article, you will be able to
1. describe the benefits hourly rounding has on call light reduction and patient safety
2. explain two points nurses should address during their rounding

Call lights are both frustrating and essential features in most hospital units. Although the lights are invaluable for alerting staff to patient needs, those needs often are not emergencies, and constantly answering the calls can tie up a workday. A recent study shows that using hourly rounding reduced call light use by 38%, and the nature of those calls were more important to the patient's well-being. The change both freed up time for staff to complete their tasks without constant interruptions and improved patient safety.

Proactive care saves time
Lyn Ketelsen, RN, MBA, is a coach for the Studer Group, which conducted the study. She says the idea came after the group would go to hospitals for consulting work. They would notice that most nursing units are constantly reacting to events after they happen, which kept staff harried and under stress. It led to call lights that weren't answered, which would anger patients.

"You could see which units functioned proactively and which ones did not," says Ketelsen. "There's a disparate difference, and patients feel that difference." Ketelsen says the group devised the program of hourly rounding, along with required key language and points to cover during rounds for clients to try. They noticed a positive change and decided to study the concept.

It may seem counterintuitive, but asking nurses to commit to rounding every one or two hours actually saves them time overall. Some managers use a log to help stay on top of the rounding. Click here and click on the rounding log link for more information.

That is because patients used their call lights less frequently, which led to less running back and forth for nurses, says Ketelsen.

"They felt they had control of the day," she says. "Now the standard of care is consistent."

Patient safety benefits
Units that adopted hourly rounding cut their patient fall rates in half and reduced the number of decubitus ulcers developed by patents.

"Many times we can intervene before a fall occurs," says Ketelsen.

Once the nurses understand how to function in the system, they can see the ways it helps keep patients safe, says Ketelsen. The rounds lead to better care because they build trust between patients and caregivers. Read more about patient satisfaction here.

"The communication is better, so there's freer information flow from the patient," says Ketelsen.

Points to address in the round
Ketelsen says staffers in medical-surgical units address the "three Ps" during their rounds--pain, position, and potty. These are the most common reasons why patients in medical-surgical units use a call light, she says. Once patients understand that the nurse will round consistently to address these issues, they stop using the call light.

Next, the nurse should check for environmental concerns that could lead to a patient using the call light. They should check for tissues, a pitcher of water, and other comforts for the patient.

Before the nurse leaves, he or she should ask whether the patient needs anything else and then tell the patient when to expect another round.

Ketelsen says the system is customizable for different units and facilities, so nurses can design the rounds to address their most common or urgent needs.

"These behaviors are tweaked for the different kinds of units. [Although] the three Ps may work for a med-surg unit, you may need other behaviors for an [intensive care unit] or mother-child unit," she says.

Retrain patients as you retrain staff
Ketelsen says nurses themselves are largely to blame for the overuse of call lights. Generations of nurses have told patients to use the light "if they need anything," so it shouldn't be a surprise when the patient does just that.

"We created this slippery slope for ourselves," she says. "We have to get back to what used to be a 'drop and run' mentality for call lights. Now, the nonurgent needs are met in the context of the hourly rounds."

Once the rounds take hold and the smaller needs are addressed regularly, the call light regains its traditional importance, says Ketelsen. Units that rounded and reduced call light use found that when the lights did go off, it was for an urgent reason.

"Patients begin to know what to expect as well as staff," she says. The study included 64 nursing units in 22 hospitals nationwide. The units were a mix of different services, says Ketelsen.

There were both Studer Group client and nonclient hospitals included. The final results took information from hospitals that met a high confidence interval in their results, she adds.

A year after the study concluded, the group contacted the units involved to see whether they were still using the rounds.

Nearly 90% were, and many had decided to expand the system to other units in the hospital. Read about another successful patient rounding study here.

Source: Briefings on Patient Safety, HCPro, Inc., April 2007

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