Introduction
Rounding entails routine observation of patients and their surroundings to identify potential dangers, increase the chance of noticing the hazards, and take corrective action before they happen. It is frequently defined as hourly or purposeful in nursing. The deliberate checking of inpatient every hour throughout the day and every two hours at night is known as hourly rounding. On the contrary, purposeful interval rounding involves making proactive rounds at intervals to meet all patient health needs before they are urgent.
The clinic management at Atlantic Health System recently implemented purposeful rounding to avert inpatient accidents. Research has shown that both techniques have improved patient satisfaction and wellbeing outcomes, better communication, and staff responsiveness (Gliner et al., 2021). Purposeful interval rounding is worth the time and effort applied over hourly rounding to minimize falls and proactively increase interaction between healthcare employees and patients.
PICO: In adult patients at Atlantic Health System(P), is purposeful interval rounding (I), compared to hourly rounding (C), more effective in preventing patient falls(O)?
The hospital had been applying the hourly round before the management opted for the purposeful interval rounding. Health workers in the organization had become accustomed to the previous approach. For instance, nurses favored the approach because it was structured and easier to follow. Nevertheless, an internal evaluation by the hospital’s management discovered shortcoming with the method, such as low patient satisfaction and increased risks of accidents due to longer rounding interval.
In addition, there were reported incidence of patient injuries attributed to inability to initiate a call and nurses taking longer to attend to the situation. In as little as 30 minutes, a patient can have a significant change that requires acute intervention. The institution cited emerging studies showing purposeful rounding can enhance staff productivity by encouraging teamwork, improving patient supervision efficiency, and promoting patient welfare when adopting purposeful interval rounding (Di Massimo et al.,2022; Spano-Szekely et al., 2019).
However, nurses’ frustrations with the approach are a genuine concern that the institution should contemplate while attempting to apply it. Purposeful rounding entails asking employees to rearrange and handle their jobs differently to suit the rounding schedule, which is more challenging to adhere to than hourly rounding. Currently, it appears that the hospital is struggling with change-management since the novel technique was enforced.
Purposeful Interval Rounding vs. Hourly Rounding
A literature evaluation of evidence-based research on applying both approaches was used to assess their effectiveness. Table 1 displays a comparison of four peer-reviewed articles on the subject. Studies that investigate purposeful rounding indicated higher decline rates for recorded falls. According to Di Massimo et al. (2022), the fall were lowered by 50% in a randomized study that evaluated 1822 patients. Spano-Szekely et al. (2019) studied the effectiveness of the intervention in a 245-bed hospital, where falls reduced from 2.51 to 1.15 (equivalent to a 54.1% drop) per 1000 patient days.
Additionally, studies on hourly rounding demonstrate a substantial decrease in patient fall rates. For instance, Anu (2021) found a 36% reduction in a 41-bed unit in prolonged hospitalization, while results by Gliner et al. (2021) present a more than 21% drop. Accordingly, purposeful interval approaches are more effective than hourly rounding based on the findings from the four studies. Although the evidence is compelling, more clinical analysis is required to reinforce the existing studies.
Table 1: Comparison of the effectiveness of purposeful and hourly rounding.
Purposeful interval and hourly inventions do not necessarily focus on improving patient experience or happiness but go beyond these outcomes. For instance, both cover how to provide organized plan nursing attendance for patients and better safety defined by the 5Ps (potty, pain, position, possessions, and personalization). When rounding is done hourly or at intervals, there is as much as a 60% drop in call utilization or disruption in nursing workflow and proactive illness management (Di Massimo et al., 2022; Spano-Szekely et al., 2019). Therefore, there are multiple reasons to do purposeful interval rounding, including advancing patient contentment, nursing experience, and interruptions in care provision.
Purposeful interval rounding differs from hourly rounding regarding consistency and usage of an organized checklist since it requires nurses to check up on patients at intervals. Interval rounding is perfect for effectively interacting with patients by applying the 5Ps and anticipating their nursing requirements, circumstances, and environment to solve their concerns (Shin & Park, 2018). Nevertheless, research has shown that hourly rounding is more effective at reducing patient anxiety and enhancing contentment through trust-building (Shin & Park, 2018). Patients are conditioned to expect visits by nurses to monitor their basic requests at a specific time, which lessens patient calls and reduces the working pressure for caregivers.
Ideas for Future
Level of Evidence and Nursing Implications
The number of researchers that have addressed intentional rounding is less than in hourly rounding. Nevertheless, few studies have reported its positive link to patient fulfillment and reduced fall rates. Possible explanations for its limited implementation include difficulty standardizing nursing rounds due to patient situations, greater stress on nurses from proactively reacting to patient needs, and nurse shortage (Shin & Park, 2018).
However, considering its value, it is necessary to implement it in hospitals through a change-management process. The hospital should actively engage caregivers in the fore-front in implementing the purposeful interval system to eliminate misunderstanding and leverage its effectiveness to the benefit of staff and patients. Future direction of nursing is that purposeful interval rounding is an effective strategy that will improve performance for health workers while improving level of patient satisfaction and reducing cost for the institution.
Future Research
The organization should reevaluate its choices for using technology to support the new practice. Additionally, it is essential to deliberate how purposeful interval rounding will integrate with the hospital’s nursing model (Shin & Park, 2018). For instance, the implementation team must conduct an extensive investigation how to customize the purposeful rounding to each unit by developing a checklist of activities and frequency. It includes getting feedback from caregivers as part of the research while considering how to incorporate technology into the purposeful rounding strategy.
Conclusion
The two rounding techniques have been shown in studies to advance patient fulfillment, medication outcomes, communication, and staff response. According to a literature assessment comparing evidence-based studies, purposeful interval techniques are more successful than hourly rounding in curtailing falls. For example, two studies using interval rounding found a 50% and 54.1% plunge in falls, respectively, whereas the other two on hourly rounding found a 36% and more than 21% drop.
More clinical testing, however, is required to supplement existing data. Hourly or interval rounding can reduce call initiation and interferences in nursing workflow while increasing proactive discomfort treatment; nonetheless, the latter is ideal for patient involvement and pleasure. The organization should appraise new technology solutions and add purposeful interval rounding into the hospital’s nursing paradigm. Customization of rounding to each unit and follow-up studies and adjustments, including caregiver feedback, are crucial for process improvement.
References
Anu, J. (2021). Hourly rounding and fall prevention among the elderly in long term care: A change process. Journal of Geriatric Medicine, 3(1), 1–5. Web.
Di Massimo, D. S., Catania, G., Crespi, A., Fontanella, A., Manfellotto, D., La Regina, et al. (2022). Intentional rounding versus standard of care for patients hospitalised in internal medicine wards: Results from a cluster-randomised nation-based study. Journal of Clinical Medicine, 11(14). Web.
Gliner, M., Dorris, J., Aiyelawo, K., Morris, E., Hurdle-Rabb, D., & Frazier, C. (2021). Patient falls, nurse communication, and nurse hourly rounding in acute care. Journal of Public Health Management and Practice, 28(2), 467–470. Web.
Shin, N., & Park, J. (2018). The effect of intentional nursing rounds based on the care model on patients’ perceived nursing quality and their satisfaction with nursing services. Asian Nursing Research, 12(3), 203–208. Web.
Spano-Szekely, L., Winkler, A., Waters, C., Dealmeida, S., Brandt, K., Williamson, M., Blum, C., Gasper, L., & Wright, F. (2019). Individualized fall prevention program in an acute care setting. Journal of Nursing Care Quality, 34(2), 127–132. Web.