nursing team on TWH’s 3B Fell
Since implementing Intentional (or hourly) rounding 18 months ago, the nursing team on Toronto Western Hospital’s 3B Fell (pictured) have seen a decrease in patient falls and pressure injuries as well as benefits to their team communication. (Photo: UHN)

It's 8 a.m. on Toronto Western Hospital's (TW) General Internal Medicine (GIM) in-patient unit on 3B Fell, when nurse Deb Desveaux collects the rounding sheet from the nursing station.

At the start of that day's shift, Deb signed up for the 8 a.m. and 1 p.m. time slots on the intentional rounding schedule – where nurses on the unit assign themselves to proactively check on each patient every hour outside of their scheduled times for care.

"How are you doing today?" Deb says to the patient in the first room on her round. "Is there anything I can do for you?"

Started by a 2016 Krembil Nursing Award idea proposed by then 4B Fell nurses Marcella Chung and Pearl Lau, intentional – or hourly – rounding has been in place on 3B for the past 18 months, and has made a positive difference to patient care on 3B Fell, a mixed GIM/Cardiology unit.

 

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"Hourly rounding has enhanced patient safety, fostered a team-based approach to care, and provided reassurance to both patients and staff that everyone's needs are being taken care of," says Deb, who has been with the team for more than four years.

The 5Ps

On any given day, each nurse on the unit is assigned four to five patients on average. Before hourly rounding was adopted, nurses mostly focused on the patients they were responsible for. As such, checks on patients outside of medication or other point of care times could occasionally be inconsistent if a nurse became busy with an unstable patient or other duties.

All nurses would respond to call bells, but patients and their families would sometimes not understand why they hadn't seen their assigned nurse in a while during the shift. 

Hourly rounding has helped to change that. Each 12-hour shift, nurses sign up for one or two slots of rounding. They visit every patient and check in with what's called The 5 Ps: pain, promotion of continence, position, physical environment, and promise – where the nurse promises the patient to come back with what they requested whether it be information, help or something else. 

On the rounding sheet, the nurse will check off having seen each patient and note any changes in their condition or if any care was provided.

"Hourly rounding has helped to promote a change in mindset for nurses because it is providing care based on what the patient identifies as a need and not the care schedule," says Sandra Li-James, Director, Professional Practice at TW.

Offers nurses peace of mind

The team on 3B has seen many benefits from this proactive method such as a decrease in falls and pressure injuries, as well as promoting a team approach to patient care where everyone feels accountable for all patients.

Now nurses are familiar with all the patients on the unit as well as those patients' baselines, allowing them to be more in tune to recognize when something is off.

"This system gets us to address all the patients' needs together as a team," says Deb. "If I get very busy with one patient who needs my attention, I have peace of mind knowing that one of my colleagues will check in on my other patients during rounding."

In addition to its benefits for day-to-day work, the team also credits hourly rounding for helping to quickly locate a patient who had gone missing. Because of the documented checks, staff were able to pinpoint exactly when the patient was last seen which helped focus the TW Security team in their search. The patient was soon located unharmed.

"I'm very proud of my team for embracing this idea and helping each other to make it work," says Velma Bailey, Nurse Manager, 3B Fell. "It has helped with team communication, trust between staff and patients' families, and made things much more personable for everyone.

"I'm very fortunate to work with such a positive team that is willing to try new things."​

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