Hourly rounding is a fundamental patient safety and quality improvement strategy used in modern inpatient care settings. This proactive approach is rooted in evidence-based practice and is designed to anticipate patient needs rather than merely reacting to them. By establishing a structured routine of frequent patient contact, healthcare facilities create a safer, more comfortable environment for those receiving care, enhancing patient well-being and satisfaction.
Defining the Practice
Hourly rounding, sometimes called purposeful or intentional rounding, is a structured process where nursing staff check on patients at fixed, scheduled intervals. This systematic intervention is typically performed every hour during the day and often every two hours overnight. It is a nurse-led proactive approach designed to anticipate patient needs before they become urgent issues.
This method signifies a fundamental shift from reactive to proactive care. Historically, patients relied heavily on the call bell system to summon staff, leading to potential delays and frustration. With hourly rounding, a nurse or patient care technician assesses the patient’s status regardless of whether a call light has been used. The goal is to ensure small needs are met consistently, preventing them from escalating into safety risks or major discomfort.
The Core Protocol
The core of hourly rounding is a systematic assessment that staff must complete during each visit. This structured approach often centers around a framework known as the “4 Ps,” which serves as a checklist for the caregiver. The “4 Ps” stand for Pain, Position, Potty, and Possessions (or Placement).
During the round, the staff member first inquires about the patient’s comfort, asking about pain and using a pain scale to assess its severity. If pain is present, staff can administer or schedule medication. The second P, Position, involves checking if the patient is comfortable and repositioning them as needed to prevent skin breakdown, especially for those at high risk for pressure ulcers.
The Potty check addresses the patient’s toileting needs, as the urge to use the restroom is a common reason patients attempt to get out of bed unassisted, leading to falls. Staff assist the patient to the bathroom or provide a bedpan or urinal.
Finally, Possessions or Placement focuses on ensuring that the patient’s personal items and the call light are within easy reach. This includes placing items like water, tissues, the phone, and the call bell close to the patient, eliminating the need for them to strain or reach.
After completing these steps, the staff member must clearly communicate when the next round will occur. Documentation of the time and actions taken is mandatory, often completed with a sign-off on a physical or electronic log to ensure accountability and track compliance. This consistent documentation helps the care team monitor adherence to the protocol and provides a record of the proactive care delivered.
Goals and Measured Outcomes
The consistent application of hourly rounding is linked to several measurable improvements in care quality and patient safety. One primary goal is the significant reduction of patient falls, which are a major safety concern in hospitals. By proactively addressing toileting needs and ensuring items are within reach, the practice reduces the circumstances that prompt patients to attempt risky unassisted movements.
A direct outcome of meeting patient needs proactively is a decrease in the use of the call light system. Studies have shown that call light usage can be reduced substantially, sometimes between 23% and 70%, when nurses consistently conduct hourly rounds. This reduction improves the workflow for the nursing staff, allowing them to cluster care activities and spend more focused time with patients.
Beyond falls and call lights, hourly rounding also contributes to a reduction in hospital-acquired pressure ulcers, sometimes called bedsores, because of the frequent repositioning checks. The practice has a strong positive correlation with overall improvement in patient satisfaction scores. The predictable contact and responsiveness to needs are directly reflected in higher patient experience metrics, offering a sense of security and attentiveness that improves the quality of their hospital stay.