A Step Forward: Implementation of Hourly Rounding, Step Tracking, Staff Perceptions of Barriers, and Solutions

Monday, 30 October 2017: 1:15 PM

Aimee L. Burch, MS
Nursing Administration, CHI Health St. Francis, Grand Island, NE, USA

Purpose: This session will discuss a Midwest community hospital’s journey to determine nursing staff

perceptions of barriers and solutions to hourly rounding; while also discussing implementation of an

electronic hourly rounding system and it's effect on patient falls, call lights, and nursing work in steps.

Leadership and nursing staff investment in patient safety research is essential to successful

implementation and sustainability of changes (Brosey & March, 2014; Kessler et al., 2012; Krepper et

al., 2012; Olrich, Kalman & Nigolian, 2012). Hourly rounding is employed in many hospitals to improve

patient safety, and patient and nurse satisfaction, and when implemented successfully, can decrease

call lights and patient falls (Brosey & March, 2014; Kessler et al., 2012; Olrich, Kalman & Nigolian,

2012). Little data is available regarding nursing perceptions, barriers, and solutions surrounding hourly

rounding (Fabray, 2015; Krepper, et al., 2012). Informal interviews with nursing staff showed a

perception that hourly rounding increased work and steps.

Methods: A multi-year, IRB-approved, qualitative pre- and post- implementation research study was

used to establish nursing staff perceptions surrounding hourly rounding, including convenience,

compliance, and support; while determining verbatim barriers and solutions. Additionally, nursing staff

steps were monitored using electronic step trackers; while simultaneously assessing on-time rounds

versus patient falls and call light use. Study interventions included education on hourly rounding

purpose and benefits, and implementation of an electronic hourly rounding tool.

Results: Statistical analysis showed significant (p<0.001) improvements in staff ownership of the hourly

rounding process, as well as all categories surrounding the electronic hourly rounding tool. Staff

described fewer issues with acuity and staffing as barriers to hourly rounding, self-identifying that hourly

rounding caused no increase in work; while also reporting increased knowledge about hourly rounding.

Analysis also showed higher on-time hourly rounding correlates to fewer patient call lights, and strongly

correlates to fewer patient falls. Hourly rounding does not significantly increase day-shift nursing staff

steps (staff work), but does strongly correlate to increased night shift steps.

Conclusion: Hourly rounding is essential to help maintain patient safety, and patient and staff

satisfaction. Patients suffer fewer falls, while staff experience decreased alarm fatigue with fewer call

lights. An electronic hourly rounding system can help monitor that hourly rounds are being completed;

however, staff buy-in is crucial for the culture change necessary for the successful implementation and

maintenance of hourly rounding.