Hourly Rounds: What Does the Evidence Indicate? Capstone Project Example

Introduction

Patient safety is a critical factor in supporting high quality health care at an optimal level. A variety of tools and resources are available to support this practice and instill positive and meaningful strategies that emphasize patient safety across healthcare organizations. For example, patient falls are a product of many environmental factors, yet many of these falls could be prevented with the appropriate techniques and protocols in place at the nursing level. One example is hourly rounds in order to check on patients more frequently and assist them with mobility as necessary to prevent falls and other needs. In order to determine the effectiveness of this practice, it is important to examine prior evidence that addresses this intervention and its impact on patient falls and related outcomes. Prior evidence must also be considered in order to evaluate nurse-related challenges in implementing new protocols and in the prevention of patient falls when this process is in place. It is the responsibility of nurses to be mindful of protocols with a proven degree of success and how these impact patient safety in different ways.

Body

Prior evidence indicates that it is often difficult to implement hourly patient rounds, particularly in larger organizations, due to challenges related to communication, planning, and other related concerns (Deitrick, Baker, Paxton, Flores, & Swavely, 2012). It is also evident that many nurses view hourly rounding as an additional task burden and some are less than enthusiastic regarding this practice, in spite of its potential benefits (Deitrick et.al, 2012). This reflects the importance of identifying data that will be useful in supporting the advantages of hourly rounds and in encouraging nurses to recognize its value in promoting patient safety at a higher level. Nonetheless, this practice poses considerable stress on an already challenging set of responsibilities for nurses in their daily activities.

Patient safety must be examined through the lens of hourly rounds in order to be effective in supporting an environment where nurses are able to check on patients on an hourly basis and to assist them with mobility as required, such as toileting and other tasks. Prior data regarding hourly rounds suggests that rounding may promote greater communication among the nursing staff and provide patients with a higher level of engagement by using criteria such as the four Ps: position, potty, proximity, and pain to ensure that proper attention is given to patients on a routine basis to prevent falls (Mant, Dunning, & Hutchinson, 2012). This reflects the importance of facilitating evidence-based protocols in healthcare organizations where hourly rounds are not the norm in order to expand the buy-in to this practice and its overall impact on patient safety (Mant et.al, 2012). This process is critical to the success of nursing-related interventions to support patient safety and to encourage the development of new methods to accommodate patients’ level of mobility at different stages (Mant et.al, 2012).

It is also necessary to evaluate the conditions under which barriers exist in the development of a patient rounding process, such as buy-in, disruptions, and time management, among others (Shepard, 2013). This practice requires an examination of the key variables that influence nurse-led decision-making regarding patient safety and in determining how these barriers have an impact in this regard (Shepard, 2013). Technology may have a positive impact on this process, such as computer-based scheduling, to ensure that nurses are properly coordinated to cover hourly rounds and are able to communicate in an open manner regarding this practice. Therefore, it is important to identify the specific strategies whereby nurses will share information regarding rounds to ensure that all patients are receiving the proper attention and focus in a timely manner to meet the demands and expectations of a safe and effective patient care environment (Shepard, 2013). If this is not achieved, these barriers may pose a threat to patient safety and overall quality of patient care (Shepard, 2013).

It is believed that evidence-based practice regarding hourly rounding will have a definitive impact on the decision to implement this process within a healthcare organization. Therefore, it is important for nurses to examine existing data and to determine how and if it has had a positive influence on outcomes for patients who face the highest risk of falls due to age and/or health status. These practices are likely to facilitate a successful practice environment when buy-in is supported by nurses and they are willing and able to incorporate this method into their daily practice routine. The use of technology in this process may also support the process and expand its usefulness and efficiency in supporting a patient care environment that has a positive and lasting impact on their safety.

Conclusion

Based upon the needs and expectations of the nursing environment, patient safety must serve as a critical motivator in advancing hourly rounds as a viable and practical process. It must achieve buy-in from nurse managers, who must flow down this concept to their staff nurses to encourage their full participation in this practice. In spite of the burden of the nursing workload, it is imperative to encourage patient safety and optimize protocols in this regard to facilitate successful outcomes and to minimize patient falls as often as possible. This process will encourage nurses to identify existing evidence-based data regarding hourly rounds and its degree of success, and will utilize this information to develop a protocol to incorporate into the daily routine within the practice setting. It is believed that this process will positively impact patient safety over the long term and will have a greater impact on overall quality of care within the nursing practice environment.

References

Deitrick, L. M., Baker, K., Paxton, H., Flores, M., & Swavely, D. (2012). Hourly rounding: challenges with implementation of an evidence-based process. Journal of nursing care quality, 27(1), 13-19.

Halm, M. A. (2009). Hourly rounds: what does the evidence indicate?. American Journal of Critical Care, 18(6), 581-584.

Mant, T., Dunning, T., & Hutchinson, A. (2012). The clinical effectiveness of hourly rounding on fall-related incidents involving adult patients in an acute care setting: a systematic review. The JBI Database of Systematic Reviews and Implementation Reports, 10(56 Suppl), 63-74.

Shepard, L. H. (2013). Stop going in circles! Break the barriers to hourly rounding. Nursing management, 44(2), 13-15.