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Nurses Round on the Hour at Hopkins Children's

April 16, 2009
Rounding Nurse

Nurse George Aulson checks in on Sinoria Williams.

Dawn Luzetsky, nurse manager of Hopkins Children’s inpatient adolescent unit, is the first to concede that it’s a struggle to improve patient satisfaction. She should know – she and her staff created a customer satisfaction task force on their unit that resulted in a host of initiatives, including one in which staff acknowledge and reward colleagues who consistently perform good customer service. Staff appreciate the positive feedback, Luzetsky notes, yet despite multiple initiatives the unit’s patient satisfaction scores from Press Ganey, which measures health-care customer service, are still not where Luzetsky wants them: “We felt we needed to identify an intervention that would give us 100 percent control to make improvements.”

Now nursing staff on the unit are moving ahead with another initiative that Luzetsky and nurse clinician III Tricia Willis learned about at a recent Press Ganey conference – hourly rounds – which they believe will not only improve patient satisfaction but also mean more control and less stress for nurses. Traditionally, Luzetsky explains, hospital nurses operate in a reactive mode, responding to calls from a patient or parent, which often results in a loss of control in managing the delivery of care. Under hourly rounds they schedule scripted visits on the hour with each of their patients, focusing on the three P’s – pain, or asking patients to describe their pain level; positioning, or making sure the patient is comfortable; and potty, or asking whether the patient has to go to the bathroom, as well as ensuring personal items are in patients’ reach and all needs have been met. Confident that their nurse will be back at the bedside at a certain time, patients and parents feel less inclined to call the nurse.

“First and foremost we’re proactively caring for the patient,” Luzetsky says. “The nurses will have more control over their time management by blocking quality individualized time for each patient, rather than only reacting to call bells.”

Other hospitals that have implemented hourly rounds, Luzetsky notes, have seen up to a 50 percent decrease in patient falls and approximately a 30 percent decrease in patient calls. Also, parents perceive hourly rounding nurses as being more responsive to patient needs, like pain relief, in a timely manner.

Luzetsky concedes that the first reaction by some nurses to the hourly rounding protocol was, “As busy as we are, how will we meet this expectation?” But she adds that the nurses in the unit, who have been participating in the pilot project since it rolled out March 1, are seeing the value of hourly rounds as an evidence-based best practice.

“I was hesitant at first,” says nurse George Aulson, “but from what I’ve seen, hourly rounding is improving both patient safety and patient satisfaction on our unit. And it’s definitely helping to de-stress the parents.”