By Lauretta Ihonor
Well-executed purposeful nurse rounding – nurse-led patient checks performed consistently, using a standardized protocol – has been shown to significantly increase patient safety alongside patient and staff satisfaction.
Yet despite evidence demonstrating its benefits, and validated protocols – like the Studer Group’s International Rounding Protocol – that provide clear instructions on how to perform these rounds, well-executed purposeful nurse rounding remains the exception, rather than the rule in hospitals.
Research suggests that this disconnect exists because of numerous barriers to consistent and effective implementation of purposeful nurse rounding in hospital settings.
To ensure that purposeful nurse rounding is properly executed, we must first identify these barriers and then look to tackle them.
The Barriers to Effective Purposeful Nurse Rounding
Findings from a systematic review published in the Journal of Nursing Management revealed that the key barriers to nurse-compliance with purposeful rounding include:
Lack of time – heavy existing workloads make it nearly impossible for nurses to conduct thorough hourly checks on all their patients, and also find the time to carry out their other duties.
Lack of understanding – contradictions between nurse rounding protocols and existing policies can create confusion. For example, should nurses respect policies on undisturbed sleep and meal times, or should they interrupt patients eating and sleeping to carry out the checks? Must rounding be performed when emergencies occur elsewhere on a ward?
Lack of belief in the system – nurses who don’t buy into the idea that purposeful nurse rounding will bring benefits for their patients and themselves are less compliant.
How to Best Tackle Nurse Rounding Barriers
The identified barriers indicate that nurses undoubtedly need more support to effectively implement purposeful rounding. This can be achieved as follows:
The lack of time barrier can be addressed in several ways. First, adding just one extra nurse to wards with large numbers of high-acuity patients can make a world of difference when it comes to reviewing all patients. Where staff and budget constraints make this unfeasible, it is worth adopting the equally acceptable bi-hourly purposeful round instead.
It is also important to allocate patients to nurses according to acuity levels. As high-acuity patients take more time to assess during each round, ensuring nurses have an equal number of high-needs patients will help to make sure time demands on each nurse are more uniform.
Before rolling out the protocol, hospitals should trial purposeful rounding on their wards and identify areas that could lead to confusion for staff. Once identified, these can be proactively addressed.
Contradictions between existing policies on sleep and mealtimes can be resolved by adding a degree of flexibility to the protocol. Nurses could be advised to adopt an ‘observe,’ rather than ‘ask’ approach when patients are sleeping, eating or otherwise engaged.
Alternatively, hospitals adopting hourly checks could reduce the frequency of checks to bi-hourly at night time.
A clear protocol should be agreed upon for nurse rounding during medical emergencies. Is it acceptable for nurses to forgo all purposeful rounding during an emergency or should they delegate their rounds?
If nurses understand exactly how to act in these situations, they will be more likely to comply with the strategy in the long term.
As the nursing staff are integral to the success of a purposeful nurse rounding approach, thorough education before implementation is vital, and this education must be collaborative.
Nurses need to understand why this protocol is important and be given a chance to see how it could transform their workflow, time management and patient outcomes. This can be achieved by exposing them to patients and nurses from other hospitals who have experienced the benefits of purposeful nurse rounding first hand.
Finally, nurses should be given a chance to air their doubts and fears, be listened to, reassured and given practical solutions before introducing purposeful rounding.
The Uniting Piece
Once these key barriers to compliance have been addressed, attention can turn to the execution of the program. For purposeful nurse rounding to be truly successful, hospitals will need a system that can monitor the process and alert nurses to perform their checks. And this system will need to do so in a manner so seamless that compliance becomes effortless and habitual.
Automation of this monitoring process is likely to be most effective, as this is hands-down the best way to prompt nurses to take action with precise regularity. An automated monitoring system can also prove invaluable for overcoming some of the aforementioned barriers to the proper execution of purposeful rounds.
For example, nurse alerts can be programmed to be automatically issued hourly during the daytime and bi-hourly at night time – ensuring that disruption to sleeping patients is minimized.
Notifications can be further customized to match the degree of patient risk, with alerts for high-risk patients set more frequently.
Such systems will also allow nurses to digitally log their checks and receive feedback on their performance over the day, week or month.
Having a graphically documented report that shows nurses how well they have performed to date is more likely to motivate them to maintain performance or improve in areas where they feel they are falling short. This, in turn, fosters the type of compliance with purposeful rounding that many hospitals are currently struggling to achieve.
Lauretta Ihonor is a medical doctor and a health journalist. She is based in London, UK and specializes in writing about medical technology and general medicine. She has worked for CNN International, BBC and Sky News.
ReferencesMitchell MD, Lavenberg JG, Trotta R. Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review. J Nurs Adm. 2014 Sep; 44(9): 462–472.Sims S, Leamy M, Davies NI, et al. Realist synthesis of intentional rounding in hospital wards: exploring the evidence of what works, for whom, in what circumstances and why. BMJ Qual Saf. 2018 Sep; 27(9): 743–757.Toole N, Meluskey T, Hall N. A systematic review: barriers to hourly rounding. J Nurs Manag. 2016 Apr;24(3):283-90.