Frequent Nursing Rounds Decrease Call-Light Use

Emma Hitt, PhD

August 31, 2006

August 31, 2006 -- Nurses' rounds conducted regularly, every 1 or 2 hours, may help decrease patients' use of call lights, as well as increasing safety and level of patient satisfaction, according to the findings of a new study in the September issue of the American Journal of Nursing.

The study, by Christine M. Meade, PhD, executive director of the Alliance for Health Care Research, in Gulf Breeze, Florida, and colleagues, attempted to identify how often call lights are used and whether 1- or 2-hour nursing rounds would decrease the extent of call-light use. The researchers also evaluated the effect of more frequent nursing rounds on patient satisfaction and on the number of falls, an indicator of safety.

According to Dr. Meade, the practice of conducting rounds varies widely from hospital to hospital and is based on hospital policy. She stated that nurses have told her that normally "rounds are conducted on a haphazard basis at best" and usually in response to a timed interaction, such as medication administration, or in response to a patient request.

The 6-week study included 27 nursing units from 14 hospitals located across the United States. Of the units, 15 introduced the 1- or 2-hour rounding (decided by the hospital) and the remaining 12 units served as controls.

One-hour rounding was defined as nursing rounds conducted once an hour between 6 am and 10 pm and once every 2 hours between 10 pm and 6 am; alternatively, the hospital could choose 2-hour rounding, conducted once every 2 hours during the entire 24-hour period. For the first 2 weeks, "baseline" conditions were measured, and from weeks 2 to 6, the 1- or 2-hour rounding protocols were used.

During rounds, the nursing staff followed a prespecified protocol that involved a list of 12 directives. These included assessing the patient's pain level; offering toileting assistance; placing items such as the telephone, TV remote control, garbage can, and water within patient's reach; and stating that they would return within 1 or 2 hours (depending on the protocol).

Both the 1- and 2-hour rounding reduced the frequency of patients' call-light use, increased their satisfaction with nursing care, and reduced falls.

A significant reduction in call-light use for the 1-hour ( P = .007) and 2-hour ( P = .06) rounding conditions were observed across all 3 time periods and for most major-reason categories. For example, 4527 calls were made due to "serious medical concerns" during the 2-week baseline period, but after 1-hour rounding had been instituted, 3398 calls were made during weeks 3-4, and 2986 calls were made during weeks 5-6.

In addition, both the 1-hour and 2-hour rounding groups showed significant increases in patient satisfaction scores, measured on a 100-point scale, and the number of patient falls was significantly reduced ( P = .01), although only significantly so in the 1-hour rounding group.

According to the report, nurses initially expressed concern about who would perform the more intensive rounding. "However, at the end of the study...they were more satisfied with the additional time they had to care for their patients as well as to perform other tasks," the authors note.

"I was not surprised by these results," Dr. Meade told Medscape. "In my experience, patients do not believe they are checked on enough while hospitalized. The policy of hourly rounding gives patients contact on a regular basis with the staff so their needs are met," she said.

"We did find, however, that it took a strong nurse manager to plan the rounding and to enforce compliance and the teamwork necessary to accomplish the rounding," Dr. Meade added.
"The findings make intuitive sense," noted Diana J. Mason, PhD, editor-in-chief of the American Journal of Nursing. "If a patient has to use the bathroom and needs assistance getting there, we know that many will try on their own, predisposing them for falls," she told Medscape.

Dr. Mason added that she was pleasantly surprised by the nursing staff's reaction to the protocols. "One of the most frequent reasons nurses give for not changing a clinical practice or care routine is that they don't have time," she said. "This study suggests that nurses saw regular rounding as not being time-consuming."

The study was funded by the Alliance for Health Care Research, a subsidiary of the Studer Group.

Am J Nursing. 2006;106(9):744-753.

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