Hourly Rounding
Hourly rounding is a structured nursing practice aimed at enhancing patient care and safety by conducting regular assessments of a patient's needs, typically on an hourly basis. This practice involves a nurse or nursing assistant checking in on patients to evaluate their pain levels, comfort, bathroom needs, and accessibility to personal items—often referred to as the "4 Ps": pain, position, potty, and possessions. During each round, the healthcare professional introduces themselves, performs the necessary assessments, and provides assistance as required.
Additionally, nurses update a whiteboard in the patient's room with their name, the name of the next nurse, and relevant information about medication schedules and additional care plans. While hourly rounding is ideally conducted every hour, it is often adjusted to every other hour during nighttime, recognizing that many patients may be asleep. This practice is widely regarded as a best practice within nursing for promoting patient safety and comfort, ultimately contributing to improved healthcare outcomes.
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Hourly Rounding
Hourly rounding is a nursing practice in which a nurse (or a nursing assistant) evaluates a patient's needs on an hourly basis, or every other hour during the overnight hours. The nurse typically assesses the patient's pain level, position in bed, need to use the bathroom, and ability to reach possessions. The nurse also usually updates the patient's whiteboard with relevant information.
How It Works
A nurse typically begins hourly rounding by introducing him- or herself to the patient and explaining the reason for the visit. The nurse then performs tasks that are focused on what are commonly called the 4 Ps—pain, position, potty, and possessions.
For pain, the nurse asks the patient about his or her level of pain. If necessary, the nurse provides the patient with medication or schedules medication to be administered during a later round.
With regard to position, the nurse assesses the patient's comfort, as well as the patient's risk of developing pressure ulcers. If the patient is uncomfortable or at risk for pressure ulcers, the nurse repositions the patient in bed, adjusts the patient's pillows, and asks the patient if he or she would like extra blankets.
As for potty, the nurse asks the patient if he or she needs to use the bathroom. If the patient does need to use the bathroom, the nurse helps the patient get to and from the bathroom.
Possessions involves the positioning of the patient's possessions. The nurse determines whether or not the patient can reach items such as the bedside table, the call bell (which the patient can use to summon a nurse), the TV remote, the phone, a water glass, tissues, and the trash can. If any of these items are out of the patient's reach, the nurse repositions them, so the patient can reach them.
Besides performing tasks related to the 4 Ps, the nurse also typically updates the whiteboard that is in the patient's room. The nurse writes down his or her name on the whiteboard, as well as the name of the nurse who will make the next round. The nurse may also write down the time the next round is scheduled, the time the patient will be given his or her next dose of medication, and any other pertinent information.
Once the nurse performs all these tasks, he or she usually ends the round with a closing. The nurse asks the patient if he or she needs further help with anything and also tells the patient that a nurse will return in an hour.
Although hourly rounding is meant to occur every hour, it generally occurs every other hour during the overnight hours because the patient is likely to be asleep.
Bibliography
Allari, Rabia S. and Khaldoun, Hamdan. "Caring Behavior and Hourly Rounding: Nurses’ Perception." The Open Nursing Journal, 21 Feb. 2023, opennursingjournal.com/VOLUME/17/ELOCATOR/e187443462301270/. Accessed 13 Dec. 2024.
Brosinski, Carmen and Autumn Riddell. "Incorporating Hourly Rounding to Increase Emergency Department Patient Satisfaction: A Quality Improvement Approach." Journal of Emergency Nursing, vol. 46, no. 4, July 2020, https://www.jenonline.org/article/S0099-1767(19)30451-9/abstract. Accessed 13 Dec. 2024.
Leamy, Mary et al. "Intentional Rounding: A Realist Evaluation Using Case Studies in Acute and Care of Older People Hospital Wards." BMC Health Services Research, vol. 23, no. 1341, 2 Dec. 2023, doi.org/10.1186/s12913-023-10358-1. Accessed 13 Dec. 2024.