Hourly Rounds Reduce Rate of Patient Falls and Bedsores

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By Megan M. Krischke, contributor

Patient satisfaction is up, nurses are walking nearly a mile less per shift and patient falls and bedsores have been reduced at Crestwood Medical Center in Huntsville, Alabama. What is their secret? The answer—hourly rounds.

Crestwood instituted hourly rounds in October 2007 as part of the “Crestwood Cares” Initiative which was mandated in all of the parent company’s (Community Health Systems) 119 hospitals. The initiative, which was designed to reduce common problems associated with hospital stays, has resulted in a 58 percent decline in accidental patient falls and a 39 percent decline in bedsores.

“When hourly rounding was first introduced, the nurses didn’t exactly embrace it because they felt it would interfere with their other work duties,” said Martha Walls, RN, BSN, MSN, chief nursing officer at Crestwood. “Despite the initial trepidation, nurses are now encouraged as they see how their HCAHPS (Hospital Consumer Assessment of Healthcare Providers & Systems—a publicly reported data source) scores are improving.”

All hospital staff who enter a patient’s room are to introduce themselves, explain why they are there, how long their task will take and thank the patient when they leave. On rounds, nurses are to address the “Four Ps”: potty, pain, position and possessions.

“Rounds are focused to attend to the top reasons patients press their call button. When the nurse or tech enters a room they are to inquire whether the patient needs to use the bathroom, to check the patient’s pain level, to help the patient change positions if need be, and to make sure that all their needed possessions are within arms reach such as the call button, water, glasses, book, etc.,” Walls explained. “Overall, we have fewer call lights now because patients’ needs have already been met or they know a nurse will be there shortly.

“When the patient is admitted they are given a brochure that tells them about the hourly rounding. People can have a lot of anxiety about being in the hospital and knowing that someone will check on you regularly can relieve some of that fear.”

One ongoing challenge for hourly rounding is that when a smaller unit experiences an emergency it can make meeting the hourly deadline impossible.

“We are working to train our other clinical staff to be able to help with rounding during these emergencies,” explained Walls. “They may not be able to administer pain medication, but even the housekeeping staff can make sure that a patient’s possessions are in reach and then communicate to a nurse if there is an unmet need.”

“One patient we had who was a retired nurse, urged us not to tell patients that their nurses would check on them hourly—she simply didn’t believe it could be done,” said Lori Light, spokeswoman for Crestwood. “When we looked at the records after she checked out, we saw that she had, indeed been attended to hourly.”

It is clear that Crestwood patients notice the difference in care. Crestwood has seen a nine percentage point increase in the HCAHPS score related to “willingness to recommend our hospital.” The percentage of patients who would definitely recommend Crestwood to their family or friends has jumped from 73 percent to 82 percent since hourly rounds were introduced.

Inspiration for Community Health Systems to institute hourly rounding in all their hospitals came from the book, Hardwiring Excellence, by Quint Studer and related Studer Group, an outcome-based health care consulting firm.

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