Nursing News

Rounding Cuts Call-Light Use

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By Debra Wood, RN, contributor

Hourly rounding, following a carefully developed protocol, can significantly reduce patients’ use of call lights, saving nurses time and energy, according to a new study sponsored by the Studer Group.

“This takes control over the workflow from the patient and gives it back to the nurse,” said lead investigator Lyn Ketelsen, RN, MBA, a coach with the Studer Group, Gulf Breeze, Florida. “And we saw a nice increase in patient satisfaction across the board.”

Ketelsen developed a blueprint for hourly rounding and in 14 hospitals tested its effectiveness in anticipating patient needs. The study found a 40 percent reduction in call-light volume during the first four weeks of implementation.

When rounding, the nurse enters the room and tells the patient, “I am here to do my rounds.” Ketelsen explained that this begins to frame the encounter for patients, so they know what to expect.

“Patients start to know the drill, and they become even more efficient in helping us get done what we need to do while we are there,” Ketelsen said.

Once in the room, nurses complete any scheduled task, such as changing a dressing or giving a medication. Rounding is not an additional undertaking, just a different way of organizing existing work.

“It was a change in practice, a change in mindset,” said Stephanie Doncevic, RN, BSN, clinical nurse manager of a surgical unit at Euclid Hospital-Cleveland Clinic Health System-East, Ohio, one of the units that participated in the study.

Euclid is now implementing hourly rounds throughout the hospital. The surgical unit decreased its call volume by 75 percent, leading to a less hectic environment.

“Nurses have more time to do things they need to do,” Doncevic said. “It’s [being] proactive instead of reactive to the call lights.”

Doncevic said nurses with long tenure did not consider the program new. They felt it formalized how they already provided care. Now, however, everyone, float staff included, round.

Before leaving the room, the nurse checks on the three Ps: pain, potty and positioning, which Ketelsen found were the three most frequent reasons for a patient to press the call bell. By catching pain early, before it becomes too severe, relief comes easier.

“People feel well cared for,” Doncevic said. One Euclid patient told her doctor how she received the best care ever.

The nurse also completes an environmental assessment. Is the phone and call light within reach? Does the patient have water? Is the trashcan and over-bed table next to the bed? The nurse then asks the patient if there is anything else he or she can do for the patient.

Nurses leave when everything is done and tell the patient they will return in about an hour. It allows the patient to cluster requests.

“It leaves the call-light system to be what it was designed to be, which is left for urgent and emergent requests,” Ketelsen said. “When a call light does go off, we are in a drop-and-run situation, and we will respond as such.”

Hourly rounding worked equally well with different staffing systems. Nurses and nursing assistants can alternate rounds, with nurses doing even hours and CNAs odd or vice versa.

Ketelsen met with some resistance from nurses when she initially suggested the concept, but once nurses tried it, most seemed to like it.

Bette Dructor, RN, nurse manager at Northeastern Hospital-Temple University Health System, in Philadelphia, Pennsylvania, admits she was skeptical at first. But she was willing to give it a chance, since the nurses on her unit were “running crazy.”

Within a few weeks, nurses reported more free time and patient satisfaction scores shot up. Call light volume decreased by 65 percent, and the entire hospital converted to hourly rounding.

“Everyone wins from this,” Dructor said. “The staff has really bought into it.”

Nurses throughout the study hospitals told Ketelsen that they did not feel as busy, even though the number and acuity of patients remained the same.

“It’s so much fun to see staff respond well to this,” Ketelsen said. “It’s my little part of how we can help in this [nursing] shortage. Anything we can do to give back time to nurses, we ought to be doing it. This is a significant way.”

Fall rates and the number of patients developing decubitus ulcers also fell. Dructor said length of stay decreased at her hospital. One unit wore pedometers and found during a 12-hour shift that walking decreased from 5.2 miles before rounding to 4.3 miles after implementing it.

“I’d like to see this happen in every hospital in the country,” Ketelsen said. “This is Nursing 101.”

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