As a retired RN who was certified in medical-surgical nursing, I remember the goals of the hourly rounding policy. Our patients were reassured to find out that staff would check on them every hour at a minimum for any needs they might have, and families could rest easy knowing their loved ones would not be ignored. Hourly rounding also helped prevent a patient from falling through the cracks on a busy shift—always my biggest fear, and one that would keep me up at night.

Obstacles to hourly rounding in acute care.

I also remember the challenges to this policy. Because in hospitals we are dealing with humans and not machines, unlike in factories, there are countless variables to sabotage our best efforts. Everyone has heard the line from the Robert Burns poem, “The best-laid plans of mice and men often go awry.”

The patient variables are unique to each primary nurse and her patient care technician (PCT) who have a plan to alternate rounding on those in their care: the patient who codes, the hemorrhaging post-op patient, the incontinent patient, and the cancer patient with intractable pain. The list is endless—situations that keep the primary nurse or PCT tied up in a room during their turn to do hourly rounds.

Some hospitals may have instituted tracking systems that can show proof of a caregiver’s entrance into a patient’s room. While these may be helpful, legally, to prove the caregiver’s presence, tracking systems may be perceived as punitive—and how do they help caregivers in the scenarios above? Timed hourly rounding alerts on a nurse’s cell phone may be helpful, unless both caregivers are simultaneously in challenging patient situations. Communication breakdowns do happen.

One nurse’s modest proposal.

I am quite sure that the methodology of hourly rounds will continue to inspire new ideas, but an idea I had while working has been stubbornly popping into my mind ever since I retired. It’s not a solution to the challenges of proactive hourly rounds. I’d call it more of a backup safety net for the patient.

The idea is to create a visual that would alert staff that a patient has not been seen for 60 minutes. Imagine that next to the red cancel call button on the wall above the patient’s bed there is a purple button with a 60-minute timer and a silent audible purple light above the patient’s door, next to the red call light.

Oh no, you’re thinking—not another call light! Another setup for failure!

But bear with me. While the patient’s nurse and PCT often return to the same rooms multiple times in a shift, there is always another room with the “stable” patient who never rings his bell and is about to code, or a dying cancer patient on a morphine drip who cannot ring her bell. When the primary nurse and PCT are both involved with patients whose imminent needs take priority, it’s easy to lose track of time.

A visual alert as safety net?

But here is the safety net: whenever a caregiver—be it a nurse, a PCT, a physical therapist, or social worker—fulfilled a function in the room, they would ask the patient if they had any other needs, and then restart the timer by pushing the purple button above the bed before they left. A purple light above the doorframe (which goes on after 60 minutes) would be a visual that alerted all available staff walking by the room that someone needed to go in—whether it be the staff nurse, the nurse manager, or ancillary medical personnel.

With this visual alert and team effort, my guess is that purple lights would be few. Besides preserving a patient’s trust, it would contribute to every nurse’s peace of mind by keeping patients from falling through the cracks on a busy day.

Of course there would be abuses of the system, as there are with any system. And if the timer were placed above a patient’s bed, restarting it in the doorway wouldn’t be an option. We wouldn’t want to disturb a sleeping patient, but walking to the head of the bed would ensure that we had assessed that they were truly sleeping and not in distress.

I have always felt that nurses are by nature conscientious and would welcome any help to ensure the safety of those in their care. Keeping patients from falling through the cracks is more necessary than ever in this time of high patient acuity, staffing challenges, and mental strain on the primary nurse.

What’s your take?

Whether this idea seems workable to you or not, I’d love to hear your thoughts and ideas about how best to address the challenge of hourly rounding.

Mary Ann Hoyt is a retired medical-surgical nurse.