Hourly R u OK?

A. Overview of Organization
Apollo Speciality Hospitals, Madurai was founded in 1997. The 230-bedded hospital
provides affordable and quality critical care to all communities in South Tamil Nadu. State-ofthe-art bio-medical equipment complemented by highly-skilled staff ensures high standards of
care at Apollo Specialty Hospitals, Madurai. The hospital places special emphasis on quality time
between patients and doctors and nurses. The hospital has an overall success rate of 98% and sees
an average of 15,000 patients a year. A 24-hour panel of super-specialists is present at the
hospital. This panel is equipped to tackle any emergency and honor the hospital's commitment to
providing all services under one roof.
B. Intentional Rounding: HOURLY ROUNDS
Hourly rounding is the process in which every hour, a staff nurse enters a patients room
to assess the persons needs. Intentional Rounding has been developed as an evidence-based
structured process in the United States (US) by the Studer Group. Generally, rounding occurs
every hour during the day shift and every two hours on the night shift. As the staff make their
hourly rounds, they focus their assessment on five key concepts pain, position, personal
needs, placement of items and peaceful environment. Staff members use a checklist to ensure
everyone asks the same questions.
C. The need for HOURLY ROUNDS
For many years nurses working in Apollo hospitals undertook task based rounds
e.g., two hourly rounds to check on the position of patients, prevent pressure sores, or
monitor mouth care or toiletry needs. Many nurses felt regularly checking on patients
helped them to feel reassured and Cared for.
Following a number of critical reports, concern had been expressed about the need
to ensure essential aspects of nursing care are consistently delivered. One of the strategy we
adapted is to implement hourly nursing rounds, to check on patients and ensure their
fundamental care needs are met.

D. The key elements of intentional rounding?

The key aspects that are usually checked during intentional rounds include the Five Ps

Positioning: Making sure the patient is comfortable

and change the position and

assessing the risk of pressure ulcers

Personal needs: asking and offering water, giving a feed, bed pans and urinals and even
assisting the patient to the bath rooms to avoid the risks of falls.

Pain: Asking patients to describe their pain level on a scale of 0 10 and taking
necessary actions.

Placement: Making sure other items a patient needs are within easy reach. Checking
tubings, invasive lines, IV access and urinary catheters.

Peaceful Environment: Checking for the right temperature in the room. Switching of
lights if not needed. Switching on fans if needed etc..

During each round the following behaviors are undertaken by the nurse:
Use an opening phrase to introduce themselves and put the patient at ease
Perform scheduled tasks
Ask about the Five Ps (described above)
Assess the care environment (e.g. fall hazards, temperature of the room)
Use closing key words e.g. is there anything else I can do for you before I go? Don t
hesitate to call in emergency and explain the use of call bells.
Explain when the patient will be checked on again
Document the round

The Hourly Rounding Tool

NURSING HOURLY ROUNDS

TiME
7AM
8AM
9AM
10AM
11AM
12N
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
12MN
2AM
4AM
6AM

PAIN

ACTION
SIGN

POSITION

ACTION
SIGN

PLACEMENT

ACTION
SIGN

PERSONAL
NEED

ACTION
SIGN

PEACEFUL
ENVIRONMENT

ACTION
SIGN

E. Hourly Rounding Outcomes and Results

Ten months after implementation with nursing units on board, Apollo Speciality Hospital, Madurai is
seeing the following results on the units that are practicing hourly rounding:

Call bell use reduced by 28.5%

Patient falls were reduced by 38.8%

Hospital-acquired pressure ulcer cases were reduced by 41.6%

Overall patient satisfaction has increased by 25.5%.

QUALITY: PATIENT FALLS REDUCED

Patient falls were reduced by 38.8% percent for the units practicing hourly rounding.

14

12

10

Before Houly
Rounding, 18

38.8
%

patient falls

After Hourly
rounding; 11

QUALITY: SKIN BREAKDOWN REDUCED

Hospital-acquired pressure ulcer cases were reduced by 37.5 percent on the units practicing
hourly rounding.
9
8
7

41.6%
6
5
4

Before Houly
Rounding, 12

After Hourly rounding,

7

2
1
0

Bed sore

SERVICE: PATIENT SATISFACTION INCREASED

Overall patient satisfaction has increased 25.5 percentile points.

100
90
80

25.5 %

70
60
50
40

Before Hourly
Rounds, 64
After Hourly Rounds,
86

30
20
10
0

Patient satisfaction

Call bell frequency

Conclusions
The available evidence suggests that intentional rounding can help staff to organize their
workload and provide more systematic reliable care. However, nurse leadership, staff
training and accountability structures are essential to ensure intentional rounding supports
improved patient outcomes and experiences of care.
Patients are reported to generally like intentional rounding because they feel less isolated,
less anxious, more important and more homely and know they will be checked regularly
and frequently.