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B E S T P R A C T I C E :
S A C R E D H E A R T H O S P I TA L
P E N S A C O L A , F L O R I D A
B E S T P R A C T I C E :
S A C R E D H E A R T H O S P I TA L
P E N S A C O L A , F L O R I D A
HOURLY ROUNDINGHOURLY ROUNDINGS U P P L E M E N T
© 2007 Studer Group
2© 2007 Studer Group
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
Today, due to organizations around the country that have implemented hourly rounding, patient falls are
down. If every hospital in the country were rounding on inpatients hourly, the cost savings would be two
billion dollars, and most importantly patients would receive better care. Skin breakdown is decreasing
and call lights are down 37.8 percent so staff can do what they want to do, take better care of patients. In
addition to patient care issues, Medicare just announced they would no longer be paying for patients who
fall and have skin breakdown that are acquired while in the hospital.
The hourly rounding tools just got better. We spent hundreds of hours in research, clinical and operational
trials, preparing teaching kits and use of user groups to make sure the material works. With all of that,
we find when more organizations implement the tools and techniques - people like you make the material
better. In their work, Sacred Heart Hospital in Pensacola, Florida, created a best practice to focus on truly
hardwiring the hourly rounds. We have found that organizations that use this tool, combined with the other
methods recommended in hourly rounding, achieve better clinical results than those that do not use this
tool. Due to our mission of making health care better, which we know is also your mission, we wanted to
get this enhancement to you right away.
Thank you for your dedication to doing work with such great purpose, it’s worthwhile and makes
a difference.
Yours in Service
Quint Studer
© 2007 Studer Group3
A. Overview of Organization
Sacred Heart is a 476-bed acute care facility located in Pensacola, Fla., which includes Sacred Heart Hospital, Sacred
Heart Children’s Hospital and Sacred Heart Women’s Hospital. In addition, Sacred Heart Health System, a member of
Ascension Health, includes a 50-bed hospital – Sacred Heart Hospital on the Emerald Coast located in Walton County,
east of Destin, Fla.
B. Hourly Rounding Outcomes and Results
Five months after implementation with 10 nursing units on board, Sacred Heart is seeing the following results on the
units that are practicing hourly rounding:
Call lights reduced by 40-50 percent
Patient falls were reduced by 33 percent
Hospital-acquired pressure ulcer cases were reduced by 56 percent
Overall patient satisfaction has increased 71 percentile points
QUALITY: PATIENT FALLS REDUCED
Patient falls were reduced by 33 percent for the units practicing hourly rounding.
FALLS100
90
80
70
60
50
40
30
20
10
0
Before Hourly Rounding After Hourly Rounding
Patient Falls
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N THOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
4© 2007 Studer Group
QUALITY: SKIN BREAKDOWN REDUCED
Hospital-acquired pressure ulcer cases were reduced by 56 percent on the units practicing hourly rounding.
In addition to hourly rounding, Sacred Heart Hospital is part of an Ascension system-wide goal to eliminate facility-
acquired pressure ulcers as part of the ministry’s “HealthcareThat Is Safe” initiative. In collaboration with the Institute for
Healthcare Improvement, a comprehensive plan was developed which included participation in an International Pressure
Ulcer Prevalence Study sponsored by Hill-Rom, purchase of new bed surfaces and implementation of a
nursing driven “SKIN” bundle.
SERVICE: PATIENT SATISFACTION INCREASED
Overall patient satisfaction has increased 71 percentile points.
DECUBUTI
20
15
10
5
0
Before Hourly Rounding
NosocomialDecubuti
After Hourly Rounding
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group5
C. Hourly Rounding Implementation
Sacred Heart Hospital in Pensacola, Fla., began training nurses in hourly rounding in November 2006. The hospital
began with six pilot nursing units and now has 10 nursing units rounding hourly. Successful implementation of hourly
rounding requires participation of all staff on the unit as well as consistent leader rounding. Variance in practices that
are not addressed will produce inconsistent results and dissatisfaction including staff complaints. Call lights will not see
significant decreases and patient satisfaction results will trend up then down.
Sacred Heart credits their excellent outcomes to the hardwired accountability that they have placed into their
implementation process. They have focused on ways to reduce individual variance from the start. The Hourly Rounding
Dashboard Report (see Tool B) and the Competency Checklist (see Tool F) are key tools to hardwire in the process. One
of the best hardwired tactics implemented has been the weekly hourly rounding meeting led by the CNO or director. This
meeting includes leaders from all units currently participating in hourly rounding as well as those coming on soon. The
meeting allows those involved an opportunity to understand the challenges, transfer learning and best practices and
foster accountability. (See Tool A to review a sample agenda of this critical meeting.)
Consistently connect to purpose by sharing patient or staff feedback about the impact hourly rounding serves. This will
serve as the fuel that ignites the flame which in turn kindles the staff’s passion. The Healthcare Flywheel® turns as staff
feel they have purpose, do worthwhile work and make a difference.
Patient Satisfaction Response: Nursing Breakdown:There were significant increases in the perception of nursing care specifically in promptness to call lights and pain control.
NURSING QUESTIONS
BASELINE CURRENT
Nurses Overall 31 98
Friendliness / courtesy of the nurses 25 94
Promptness response to call 10 95
Nurses’ attitude toward requests 34 98
Attention to special / personal needs 50 99
Nurses kept you informed 42 98
Skill of the nurses 49 96
How well your pain was controlled 42 99
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group6
Tool A: Hourly Rounding Standardized
Meeting Agenda
Tool B: Hourly Rounding Dashboard Report
Tool C: Hourly Rounding Welcome Cards
Tool D: Hourly Rounding Pocket Cards
Tool E: Hourly Rounding Pillow Cards
Tool F: Hourly Rounding Competency Checklist
Tool G: Hourly Rounding Flyer – The 3 P’s
Cultivating Patient Care Excellence
Tool H: Hourly Rounding Flyer – The 4 P’s
Cultivating Patient Care Excellence
Tool I: Hourly Rounding Flyer – OB Unit
Tool J: Hourly Rounding – Call Light Log
Tool K: Hourly Rounding – Hourly Rounding
Documentation Log
Tool L: Sacred Heart Hourly Rounding
Implementation Tips and Guidelines
D. Hardwiring Hourly Rounding: Sacred Heart Tools and Examples
The following tools were created by Sacred Heart to hardwire accountability into their hourly rounding
implementation process. They are provided as resources and examples to you.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
D: ONGONING
Hourly Rounding Conducted
A Leader Rounding Conducted
Positive Wins are Shared and Communicated
B
C
Prior Oct2006
Nov2006
Dec2006
Jan2007
Feb2007
Mar2007
Apr2007
May2007
C F G
• Foundationtactics in place
• Benefits ofhourly roundingcommunicated
• Leaders round with purpose using specific questions• Rounding questions posted in the staff lounge• Leaders sign the rounding logs when rounding on patients• Hourly rounding logs placed inside the rooms
• Read positive patient letters to the staff• Share results with the staff• Review call light logs and recognize the nures and the unit secretary with the least call
lights recorded• E-round or send out a broadcast note weekly to associates to keep the positive impact
of hourly rounding top of mind
Hourlyroundingbegins 6
pilot units
• Staff trainingconducted
• Competencychecklist andcheckoffs conducted
• Related toolsdistributed(pocket, welcome andpillow cardsdistributed)
Weeklyhourly
roundingmeetings
begin
Hourlyrounding
dashboardreportcreated
Fouradditionalunits begin
hourlyrounding
© 2007 Studer Group7
TOOL A: HOURLY ROUNDING STANDARDIZED MEETING AGENDA
Purpose: A weekly hourly rounding meeting led by the CNO or director to drive accountability works well to accelerate
and hardwire the process. The meeting goals include: understanding challenges, transferring learning
and best practices, rewarding and recognizing success and holding leaders accountable for their results.
Target: The meeting includes leaders from all units currently participating in hourly rounding as well as those
coming on soon.
HOURLY ROUNDING WEEKLY MEETING AGENDA
I What is working well?
II What are the barriers?
III Reward and recognize success
IV Patient letters, stories and staff feedback
V What are the tough questions staff asks?
VI Leader reports on unit patient satisfaction results and reviews the percentage of
“competency checklists” completed for the week
VII What actions will nurse leaders take to improve their hourly rounding results?
VIII Leaders exchange 24 hours worth of completed call light and rounding log to
review and give each other feedback
IX What have they learned at the meeting that they want to implement?
X Next steps are discussed and agreed upon
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group8
TOOL B: HOURLY ROUNDING DASHBOARD REPORT
Purpose: Utilize a dashboard report to measure your unit’s return on investment of their time and effort. Reporting
includes (a) fall rate, (b) pressure ulcers, (c) call light volumes, (d) patient satisfaction, (e) pain question, (f) response to
call light, (g) staff worked together as a team, (h) attitude toward personal requests, (i) attention to personal needs and
(j) overall rating of care.
Target: Leaders from all units currently participating in hourly rounding.
BASELINE
Dec-06
Jan-07
Feb-07
Mar-07
Apr-07
May-07
Jun-07
Jul-07
Aug-07
Sep-07
Oct-07
Nov-07
Dec-07
SAFETY PATIENT SATISFACTION
FALL RATE
PRESSUREULCERS
CALL LIGHT
VOLUME
N SIZE
PAINCONTROLLED
RESPONSE TO CALL
LIGHT
STAFF WORKEDTOGETHER AS
A TEAM
ATTITUDE TOWARD YOUR
REQUESTS
ATTENTION TO PERSONAL
NEEDS
OVERALLRATING OF CARE
OVERALLPERCENTILE 5 EAST
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group9
TOOL C: HOURLY ROUNDING WELCOME CARDS
Purpose: The welcome card given to every patient upon admission provides the key words meant to set expectations
by “contracting” with the patient and educating the patient/family regarding hourly rounding. These cards, signed by the
admitting nurse, are left in the patient’s room to explain why we round hourly, and also to provide an access number if
anything is needed during the patient’s stay.
Target: Welcome cards are provided to all staff involved in hourly rounding.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group10
TOOL D: HOURLY ROUNDING POCKET CARDS
Purpose: Issue pocket cards to unit staff, float staff and new staff during orientation.
Target: All staff performing hourly rounding.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group11
TOOL E: HOURLY ROUNDING PILLOW CARD
Purpose: Pillow cards are used to place on the pillow when patients are out of the room for tests. They communicate to
the patient that staff came by to check on them during hourly rounds.
Target: All staff performing hourly rounding.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group12
TOOL F: HOURLY ROUNDING COMPETENCY CHECKLIST
Purpose: This tool provides a competency checklist which documents the demonstration of hourly rounding
competencies and behaviors. This competency checklist can be customized and adapted for any unit.
Target: All staff involved in hourly rounding.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
DATE
NAME
DEPARTMENT
EVALUATOR
Knock on door prior to entering – ask permissionManage up your skill or that of your co-workerUse good eye contact
Explain the purpose of hourly rounding (initial visit)Use key words “very good” careDescribe rounding schedule (6am-10pm q1hr. 10pm-6am q2hr.)
Place name on white boardUpdate nursing plan of care/goals for patient
How is your pain?Are you comfortable?Do you need to go to the bathroom?
Complete MD ordered treatments, proceduresComplete nursing care as neededAdminister scheduled medications
We will round again in about an hourIs there anything else that I can do for you? I have the timeDocument your rounding on rounding log
Give Welcome Cards to introduce hourly rounding to all patients (new admissions and transfers)We round hourly on our patients to ensure that you receive “Very Good” care. We round every hour between 6am - 10pm & every two hoursbetween 10pm - 6am. We will not wake you if you are sleeping unless we need to. If anytime during your stay, you feel you are not receiving“Very Good” care, please let us know immediately so that we can address your concerns.
Complete Self Assessment, practice and then have a Leader observe you
Move items within reach (table, call bell, phone, water)
INTRODUCTIONS
SELF ASSESSYES NO YES NO
EVALUATOR COMMENTS
EXPLAIN HOURLY ROUNDING UPON ADMISSION
UPDATE WHITE BOARDS
ADDRESS 3P’S PAIN...POSITION...POTTY
PERFORM SCHEDULED TASKS
CLOSING
ASSESS ENVIRONMENT
HOURLY ROUNDING COMPETENCY CHECKLIST
© 2007 Studer Group13
TOOL G: HOURLY ROUNDING FLYER – THE 3 P’S CULTIVATING PATIENT CARE EXCELLENCE
Purpose: This tool serves as a training tool and reminder of the 3 P’s of Pain, Position and Potty.
Target: Posted and provided to all units involved in hourly rounding using the 3 P’s.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group14
TOOL H: HOURLY ROUNDING FLYER – THE 4 P’S CULTIVATING PATIENT CARE EXCELLENCE
Purpose: This flyer provides a training tool and reminder of the 4 P’s of Pain, Position, Potty and Possessions. It
allows you to see how the hourly rounding behaviors can be customized depending on the patient needs. The 4th P
“Possessions” reminds the staff to perform an environmental check and move items within the reach of the patient.
Sacred Heart has adapted and used the 4 P’s throughout most units.
Target: Posted and provided to all units involved in hourly rounding using the 4 P’s.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group15
TOOL I: HOURLY ROUNDING FLYER – OB UNIT
Purpose: This tool provides an example of how hourly rounding can be adapted for an OB unit. In the OB unit, they
determined their patients’ needs to include Pain, Position, Questions and Supplies. These indicators were chosen
because they addressed the reasons the call lights ring.
Target: Posted and provided to OB units involved in hourly rounding using the 4 P’s.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group16
TOOL J: HOURLY ROUNDING – CALL LIGHT LOG
Purpose: This log documents detailed information regarding the call lights by allowing the tracking of the reasons the
call lights ring. This call light log is customized for use in an adult unit and is filled out by the unit secretary. The adult
unit customization includes tracking pain, position, potty, possession, pumps, error and other. Note – this log may be
customized to any unit’s needs. For example, the OB unit might add questions or supplies and a pediatric unit may
include safety and supplies. Daily review by the manager will help to identify variances by a nurse enabling real time
feedback and improvements to occur. Health unit coordinators take ownership by paging out messages to the nurses
when the call light volume begins to increase.
Target: Adult units implementing hourly rounding.
Unit ______________________________________
Shift _____________________________________
Date _____________________________________
HUC _____________________________________
Coordinator _______________________________
Day M T W Th F Sat Sun
No# Pain Position Potty Possessions Pumps Error Other Room # RN Initials
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Check box each time the call light rings indicating reason, RN assigned to patient and the room number
Please turn these logs into your coordinator at the end of your shiftRev. 12.28.06
ADULT HOURLY ROUNDING CALL LIGHT LOG
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group17
TOOL K: HOURLY ROUNDING – DOCUMENTATION LOG
Purpose: This log is used for the staff to document hourly rounds. Staff are instructed to inquire about the “P” behaviors
and document on the log the specific ones that they addressed. The logs are collected at the end of 24 hours and given
to the charge nurse, reviewed and forwarded to the nurse manager for compiling data. This log is designed for an adult
unit and can be customized and revised for any specialty unit.
Target: Adult unit implementing hourly rounding.
HOURLY ROUNDING LOG Stamp Patient Information
RN Name _____________________
RN Name _____________________
Tech Name ___________________
Other Name ___________________
In ______
In ______
In ______
In ______
RN Name _____________________
RN Name _____________________
Tech Name ___________________
Other Name ___________________
In ______
In ______
In ______
In ______
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
Rm # _____________Date: _____________ Bed # ____________ Day M T W Th F Sat Sun
TIME PERIOD STAFFINITIALS
TIMEROUNDING
PAIN POSITION POTTY POSSESSIONS COMMENTSIn chart by exception, note patient need
EVERY 1 HOUR ROUNDS 6 AM - 10 PM
6 AM
7 AM
8 AM
9 AM
10 AM
11 AM
12 PM
1 PM
2 PM
3 PM
4 PM
5 PM
6 PM
7 PM
8 PM
9 PMEVERY 2 HOUR ROUNDS 10 PM - 6 AM
10 PM
12 AM
2 AM
4 AM
This is not part of the permanent medical record
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group18
TOOL L: SACRED HEART HOURLY ROUNDING TIPS AND GUIDELINES
Purpose: This document provides details of the implementation steps used at Sacred Heart. A sample overall timeline
is provided and the detailed elements including foundational elements, training and hardwiring tools and tactics are
included in the table below.
Target: Organization and all nursing units.
RN Name _____________________
RN Name _____________________
Tech Name ___________________
Other Name ___________________
In ______
In ______
In ______
In ______
RN Name _____________________
RN Name _____________________
Tech Name ___________________
Other Name ___________________
In ______
In ______
In ______
In ______
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
(Please Print)
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
D: ONGONING
Hourly Rounding Conducted
A Leader Rounding Conducted
Positive Wins are Shared and Communicated
B
C
Prior Oct2006
Nov2006
Dec2006
Jan2007
Feb2007
Mar2007
Apr2007
May2007
C F G
• Foundationtactics in place
• Benefits ofhourly roundingcommunicated
• Leaders round with purpose using specific questions• Rounding questions posted in the staff lounge• Leaders sign the rounding logs when rounding on patients• Hourly rounding logs placed inside the rooms
• Read positive patient letters to the staff• Share results with the staff• Review call light logs and recognize the nures and the unit secretary with the least call
lights recorded• E-round or send out a broadcast note weekly to associates to keep the positive impact
of hourly rounding top of mind
Hourlyroundingbegins 6
pilot units
• Staff trainingconducted
• Competencychecklist andcheckoffs conducted
• Related toolsdistributed(pocket, welcome andpillow cardsdistributed)
Weeklyhourly
roundingmeetings
begin
Hourlyrounding
dashboardreportcreated
Fouradditionalunits begin
hourlyrounding
© 2007 Studer Group19
IMPLEMENTATIONTIMEFRAME:
IMPLEMENTATION STEPS:
Several months
prior to
implementation
Round on staff, send and manage up thank you notes, implement key words
These are foundational tactics to the successful implementation of
hourly rounding
o When the staff feels valued and has the tools and
equipment to do their job, they are more likely to be
open to working on new behaviors
o The success of hourly rounding is enhanced when all
team members are participating
Discuss the benefits of hourly rounding
Designed to promote high quality patient care
o Increases patient satisfaction by average of 12 raw points
Provides health care that is safe
o Reduces falls up to 50%
o Reduces pressure ulcers up to 16%
Increases efficiency for staff
o Anticipates reasons why the call lights ring
o Reduces call lights up to 38%
o Saves nurses from 150 – 300 hours per month
Item A:
Item B:
IMPLEMENTATIONTIMEFRAME:
IMPLEMENTATION STEPS:
Two weeks prior to
implementation
Get a team together to discuss the pilot
o Use this group to make decisions, plan and
monitor processes
Discuss hourly rounding in staff meetings
o Share the results of the Studer Group research in the
September 09, 2006 AJN Article
o Solicit input from staff in the planning and
implementation stages to encourage empowerment
and a sense of pride in the process
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group20
Conduct Training
o Select nursing units with strong leaders who have good
communication skills for your pilot units
o Make training mandatory
o Train nurses, techs and unit secretaries
o Train day and night shift
Give staff a Competency Checklist and Hourly Rounding Pocket Cards
o Competency checklist specific behaviors necessary
to master hourly rounding
o Pocket cards are quick reminders of the “P” behaviors
o Have staff perform a self assessment
o Staff then practice for one week prior to leader evaluating
the staff’s competency during hourly rounding
Distribute Hourly Rounding Welcome Cards
o The nurse admitting the patient uses the card to explain
hourly rounding to the patient and describe what the patient
can expect from the staff
o Staff signs their name on the welcome card “contracting”
with the patient to round hourly and address
prescribed behaviors
Distribute Hourly Rounding Pillow Cards
o Use cards when patients are out of the room for tests
o Card states “Sorry I Missed You! We perform hourly
rounding to ensure that you receive Very Good Care.
Let us know if you need anything when you return. I will be
back in about an hour.”
o Staff indicates time of round, signs their name and leaves
the card and a mint [sugar free or regular] on the
patient’s pillow
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group21
Item C:
IMPLEMENTATIONTIMEFRAME:
IMPLEMENTATION STEPS:
Implementation Date
IMPLEMENTATIONTIMEFRAME:
IMPLEMENTATION STEPS:
Ongoing Leaders round with purpose
Round daily to determine if patients are receiving “Very Good Care”
and monitor to see if staff is prompting for the 3P behaviors.
o If logs are complete but call lights are not reduced, staff are
likely “checking on patients” or rounding hourly and asking,
“how is everything?” Patients will commonly respond
“fine”. The patient will then use the call light because the
behaviors (3P’s) were not addressed.
Ensure that rounds occur on night shift and weekends
Leader questions during rounding
o Our goal is to round on patients every hour; did you
receive our hourly rounding welcome card?
o How are we doing with rounding? Are we offering
assistance in positioning, pain and taking you to the
bathroom? How about on night shift and on weekends?
Post rounding questions in the staff lounge communicating that this
is an open book test. Staff will go the extra mile when they know
what is expected.
Item D:
One week after
implementation date
Leaders complete Competency Checklists
o Give staff an opportunity to complete a self assessment
o Staff successfully completing check-offs receive a
special retractable badge holder
o Badge holder is a quick visual indicator at shift change
of who has been trained on hourly rounding
o Manager should not delegate this important function
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
Implementation begins
© 2007 Studer Group22
Ongoing Sign the rounding logs when making leader rounds to demonstrate
to the staff that you are reviewing their logs and communicate the
importance of the staff signing the logs.
Place the hourly rounding logs inside the rooms vs. on the outside
of the room door allowing families to visualize the staff signing the
log. Use of key words when signing will provide an opportunity to
engage the family, enhance trust and promote care and concern.
Hardwiring
Have unit secretary send out pages or reminders immediately if call
lights begin to increase
Review call light logs daily to spot trends.
Indicate room number and nurse’s name on call light logs so training
can be focused on the appropriate staff nurse.
Develop a float packet with tools including a pocket card
Include hourly rounding in nursing and tech unit
coordinator orientation
Incorporate hourly rounding competency goals into job evaluations
Develop a plan up front to address shift change, breaks and
confused patients
o Decide who will change out logs every 24 hours
o Adjust staff to cover call lights during shift change
o Have staff round before going to lunch and when returning
letting patients know that they will be at lunch and that
someone will be back in about an hour
o Automatically get confused patients up to the bathroom.
Often, they will tell you they do not need to use the
bathroom and then will immediately use the call light for the
same request.
Ongoing Reward and recognize success
Share results with the staff. The more the positive results are shared
with the staff, the quicker understanding will come and behaviors will
be reinforced.
Review call light logs and reward and recognize both the nurse and the
unit secretary with the least call lights recorded.
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group23
IMPLEMENTATIONTIMEFRAME:
IMPLEMENTATION STEPS:
Weekly Hourly Rounding Meeting
o Initially schedule meeting weekly
o Change to bi-weekly when patient’s perception of care is
indicating consistent practices
The meeting should be led by CNO or Director (someone the leaders
report to) to foster accountability and support cross learning.
Include units currently doing hourly rounding and those planning to
come up in the future.
Agenda
o What is going well? Share wins, letters, stories,
staff feedback
o What are barriers identified? Problem solve solutions
o What are the tough questions?
o Review the % of competency check sheets completed
o Review the call light logs and daily rounding logs for the
past 24-hour period
o Review patient satisfaction results by unit for the week
Item E:
E-round or send out a broadcast note weekly to associates addressing
one of the following topics to keep the positive impact of hourly
rounding top of mind
o Comments you are hearing from the patients
o Positive staff comments and feedback
o Call light percentage reduced
o Hourly rounding stars of the week and why
o Patient’s perception of care – patient satisfaction results
Read positive patient’s letters to the staff which will encourage them
by reminding them why they went into health care
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
© 2007 Studer Group24
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
o Leaders trade logs and give each other feedback based
on what they are seeing
o Leaders discuss actions for improving results
o Next steps are discussed and agreed upon
IMPLEMENTATIONTIMEFRAME:
IMPLEMENTATION STEPS:
Monthly Hourly Rounding Metrics
Create an Hourly Rounding Dashboard Report to
measure your unit’s
return on investment for their time and effort
o Fall rate
o Pressure Ulcers
o Call light volumes
o Patient Satisfaction
• Pain Question
• Response to call light
• Staff worked together as a team
• Attitude toward personal requests
• Attention to personal needs
• Overall rating of care
Item F:
Item G:
IMPLEMENTATIONTIMEFRAME:
IMPLEMENTATION STEPS:
After process is
hardwired
Expand to other units in the hospital and begin same process.
© 2007 Studer Group25
HOURLY ROUNDING HOURLY ROUNDING S U P P L E M E N T
The implementation steps identified are the keys to hardwiring this important tactic. The
nursing leaders at Sacred Heart have worked diligently to stay focused on the results that
this can achieve for the patients and the staff. Here are examples of the key learnings and
results we have experienced.
Key Learnings
Pilots do not have to be perfect, perseverance is key
Allow units to revise logs, handouts etc. as long as main objectives can be met
Communicate target dates and time lines
Offer to discontinue keeping rounding logs when unit reaches and maintains
greater than 95% patient satisfaction results for three months
Celebrate successes often for winners and most improved
Results
Staff indicated less chaos, more control over their day and an
uncanny feeling of calmness during a time of increased census.
Now when call lights ring, the staff encourage each other by
offering each other suggestions for a quick fix. As a result, their
nursing patient satisfaction results have increased.
Staff report stories of picking up clinical changes in patients during
hourly rounds allowing in some cases to transfer the
patient to higher level of care resulting in positive
outcomes for the patient.
Patient satisfaction early results: Nursing scores have increased
31% since baseline in two quarters; overall satisfaction has
increased 45% since baseline in two quarters.
Patient satisfaction current results: Overall satisfaction has
increased 71% from baseline in six months.
A patient recently stated the following in a letter:
“I wanted to take this opportunity to tell you how much I appreciate the wonderful compassionate care from the staff at Sacred
Heart. I had to have a colon resection on 12/19/06, which needless to say, had me scared to death from the beginning. The fear
remained, but, the kindness which I was shown and the excellent care that I received there far exceeded any expectations that I may
have had. These nurses were so good and so attentive that I do not believe that I ever had to call for anything, because they would
be in my room to check on me to see if I needed anything before I ever had time to ask.”
SUMMARY:
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