The Happy Hospitalist is a board certified internist who works in the hospital and writes regularly on several blogs, including The Happy Hospitalist.
More from The Happy Hospitalist
I recently learned that Happy’s hospital is initiating hourly rounding by nurses. Apparently there is research behind hourly rounding to show it is effective in increasing patient satisfaction, increasing nursing satisfaction, increasing quality by reducing fall rates as much as 60 percent and decreasing the number of call lights by 40 percent.
How does this magical hourly rounding work? It’s based on the 4 P’s of nursing: Pain, Potty, Position and Periphery. This is not to be confused with the 4 P’s of marketing: Product, Price, Place and Promotion.
I read now that there is actually a script for which nurses should memorize when introducing themselves in the hourly rounding role: “I am here to do rounds. How is your pain? Do you need to use the restroom? Do you need help to reposition (or get up, or get back to bed, or whatever the activity is)?” Once all that is complete, the nurse should make sure the call light, telephone, TV remote, bed light, bedside table and tissues are within the patient’s reach. Then tell the patient, “Is there anything else I can do for you? I have time now while I am in the room. Also, someone will be back in about an hour.”
Then they mark the hourly rounding checklist. This process will be a group effort, apparently including RNs, techs, clinical assistants, nurse managers, assistant nurse managers, and even the unit secretary. At some point other departments, such as PT, OT, RT, etc may assist in the endeavors.
I think hourly rounds sounds like an excellent idea for nurses. If it decreases their call lights, I don’t know how they couldn’t agree. But I also think the concept holds promise for improving the efficiency of communication between nurses and physicians as well, which can also improve the efficiency of the nurse’s daily work flow. I think I am going to work on adding a fifth P to the hourly rounding. It’s called paging.
Here’s how it works. All floors will page their hospitalist once after the hourly rounds first thing in the morning to notify the hospitalist of any needs related to pain, potty, position or periphery. All necessary prn orders will be obtained at this time and no further pages will be made until the following day’s hourly rounding regarding pain, potty, position or periphery.
After the daily call, the pager will only be available for critical issues which don’t include low calcium levels or decreased urine output. Turning hourly rounding 4Ps into hourly rounding with 5Ps has the ability to take this concept to the next level and reduce the number of pages to physicians by 99.99999 percent while simultaneously increase nursing and physician satisfaction by 99.99999999999 percent.
If the nurses are happy and the physicians are happy and the patients are happy, then daily rounding with the 5 P’s should be established as the standard by which all hospitals strive to meet. This is a natural extension of the dialysis spa and the hospitel phenomenon and I’m all for any policy that improves quality and satisfaction with one giant magical wand.
Hourly rounds done by 8am. Pages done by Nine. Let’s get movin’ people.