We’ve all witnessed the hospital stay from hell. Whether the patient was you, yourself, a family member or a friend, we’ve seen what happens when patient contact with medical staff is spotty: Pain management can become rife with anxiety. Patient cleanliness declines. The potential for falls — often while going to the toilet — increases. Patient discomfort becomes a point of obsessive focus. Patients’ use of call lights can become so frequent as to lose its intended meaning.
Such conditions are supposed to be addressed by the centuries-old practice of medical staff making bedside rounds to every patient at some regularly recurring interval. The rounding staff could be lead doctors; multidisciplinary teams that may include social workers, respiratory therapists, even pharmacists; or (most frequently) nurses.
According to a white paper produced by Vocera Communications using information provided by University of Chicago Medicine, evidence suggests that integrating rounding into clinical workflow not only can reduce nurses’ steps, time, and interruptions to the care team, it also improves patient outcomes, satisfaction, and HCAHPS scores.
So if effective rounding can do all that…
How can rounding itself be improved?
Despite the fact that rounding, “a passing parade of white coats,” has been a ubiquitous practice in hospital wards for hundreds of years, research on rounding is a fairly recent phenomenon. Some have noted that rounding was “hardly mentioned in textbooks” (O’Hare 309).
With traditional rounding, teams often arrived at patients’ bedsides unannounced when patients could be asleep or indisposed. Conversations — often of a technical nature — might have taken place amid the sounds of televisions, cleaning services or beeping machinery. No wonder that the multidisciplinary entourage may be disappearing. That means that input now recorded by individual professionals may not be shared efficiently. Handwritten notes, once the standard, can further hamper communication and clarity.
A current best practice for nurse rounding, often codified as the “Four Ps,” shows some variation in its essential themes, but they basically come down to these: Nurses paying attention to
- Pain (“Are you feeling better or worse?”),
- Potty (“Are you able to visit the restroom on your own?”),
- Positioning (“How can I help you to rest more comfortably?”), and
- either Possessions (“Can you reach everything you need?”) or Preventing falls (“How steady on your feet do you feel?”).
Nurse rounding looms large in patient care because it improves engagement, provides real-time feedback to nurses and other clinical staff, and communicates the concerns of patients directly to nurses and sometimes through the mediation of other medical leaders. Rounding helps to connect managerial staff with nursing floor staff. Important questions raised in the Vocera white paper include whether technology is being leveraged to rid rounding of stale methods like paper rounding sheets, and whether nurses are linking data to particular caregivers via rounding.
While hourly rounding is a recommended, proactive approach to improving patient and hospital outcomes, by itself, it is insufficient (Mitchell et al. 2014; Lee et al. 2016). The Vocera white paper asserts that the most successful multi-pronged rounding programs should strive proactively to
- address patient and family concerns;
- reduce call-light utilization and increase responsiveness;
- address patient pain, cleanliness, and safety issues;
- improve nursing communication;
- elevate quality of care; and
- build patient, family, and staff relationships.
Vocera goes on to say, “Optimally, the organization will integrate its rounding practice by incorporating technology solutions for capturing rounding information in real time” on mobile devices.
Such tech solutions for improving rounding don’t have to be rocket science. When you step back for a broader view of nurse rounding, you’ll notice that most of the skills making the greatest difference in patients’ lives are non-technical skills (NTS). These include such skills as teamwork, communication, situational awareness, and responsiveness to patients. These NTS categories were all identified as important to influencing patient outcomes (Murray et al. 2016). They lend themselves all to technology solutions that are social in nature, collaborative and iterative.
Precisely how technology can optimize nurse rounding is a concern of great magnitude for us at tekMountain. Join the EngagedNurse social community today on the following platforms:
Lee, T. L., Crause, M., Gipson, K. (2016). “No-pass zone: Multidisciplinary approach to responding to patient needs.” Journal of nursing care quality. Vol. 31, No. 4, pp. 327–334.
O’Hare, James A. (2008). “Anatomy of the ward round.” European Journal of Internal Medicine 19: 309–313.
Mitchell, M. D., Lavenberg, J. G., Trotta, R., Umscheid, C. A. (2014). “Hourly rounding to improve nursing responsiveness: A systematic review.” Journal of Nursing Administration, 44(9), 462–472.
Murray, K., McKenzie, K., Kelleher, M. (2016). “The evaluation of a framework for measuring the non-technical ward round skills of final year nursing students: An observational study.” Nurse Education Today 45, pp. 87-90.
Vocera Communications, Inc. (June 2014). “Take rounding to the next level to improve patient satisfaction, outcomes and loyalty. www.vocera.com