Tag Archives: Teaching Rounds

Hourly rounding/hourly physiologic monitoring by nurses

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This collection contains 51 articles on hourly rounding/hourly physiologic monitoring of acute care patients by nurses. It does not include articles that were specific to inpatient rehab, inpatient psychiatric patients, and epilepsy monitoring units. Many of the articles are meta-analyses or systematic reviews.

Here is one search technique that was used to find articles in PubMed: (“rounds hourly” OR “round hourly” OR “rounded hourly” OR “rounding hourly” OR “hourly rounding” OR “hourly rounds” OR “hourly physiologic” OR “physiologic monitoring hourly” OR ((“monitor hourly” OR “monitors hourly”) AND (“vital signs” OR physiologic))) AND (nurse OR nurses OR nursing)

To access the collection and to read abstracts and access full text (where available) using the Find it @ Emory button, please first open Emory’s instance of PubMed. Once you have accessed PubMed, copy/paste the following url into the same browser window: https://www.ncbi.nlm.nih.gov/sites/myncbi/1HMKnKhQm_d5i/collections/55355546/public/
If are an Emory Healthcare employee and do not have access to an article you need, send the citation(s) to Ask a Librarian.

Reducing use of call lights/bed alarms

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Here is the search technique that was used in PubMed to find articles on reducing use of call lights/bed alarms. A similar technique was used in Embase.

(“call light” OR “call lights” OR alarm OR alarms) AND (reduce OR reduces OR reduced OR reducing OR decrease OR decreases OR decreased OR decreasing) AND (use OR used OR usage OR frequency OR utilize OR utilizes OR utilized OR utilizing OR utilization) AND (patient OR patients OR inpatient OR inpatients)

Here are articles on reducing use of call lights/bed alarms. Not included are articles on automated artifact filtering, a possible technique for decreasing false alarms.

Walsh Irwin, Colleen, and Corrine YJurgens. “Proper skin preparation and electrode placement decreases alarms on a telemetry unit.” Dimensions of Critical Care Nursing 34.3 (2015):134-9.

Mitchell, Matthew D, et al. “Hourly rounding to improve nursing responsiveness: a systematic review.” The Journal of Nursing Administration 44.9 (2014):462-72.

Siebig, S, et al. “Users’ opinions on intensive care unit alarms–a survey of German intensive care units.” Anaesthesia and Intensive Care 37.1 (2009):112-6.

Culley, Tom. “Reduce call light frequency with hourly rounds.” Nursing Management 39.3 (2008):50-2.

Meade, Christine M, Amy LBursell, and LynKetelsen. “Effects of nursing rounds: on patients’ call light use, satisfaction, and safety.” American Journal of Nursing 106.9 (2006):58-70; quiz 70.

Fiterau, M, et al. “Automatic Identification of Artifacts in Monitoring Critically Ill Patients.” Intensive Care Medicine 39.2 (2013):S470.

Beep, Beep, Beep: Rescuing patients and nurses from pump alarms on an Inpatient Bone Marrow Transplant Unit. Biology of Blood and Marrow Transplantation,Volume 20, Issue 2, Supplement, February 2014, Page S306. Pamela Grant-Navarro, Marianne Wallace, Kathleen Choo, Jennifer Feustel.

Implementation of a Standardized Cardiac Monitor Care Process to Reduce Nuisance Alarms. Biology of Blood and Marrow Transplantation, Volume 20, Issue 2, Supplement, February 2014, Page S298. Kristen Coleman, Kristen Coleman, Laura Flesch, Melissa Hayward, Connie Koons, Lori Ann McKenna, Christopher Dandoy

An alarm ward round reduces the frequency of false alarms on the ICU at night. Koerber J.P., Walker J., Worsley M., Thorpe C.M. Journal of the Intensive Care Society 2011, 12:1 75-76.

Graham, Kelly C, and MariaCvach. “Monitor alarm fatigue: standardizing use of physiological monitors and decreasing nuisance alarms.” American journal of critical care 19.1 (2010):28-34; quiz 35.

Sendelbach, Sue, et al. “Stop the Noise: A Quality Improvement Project to Decrease Electrocardiographic Nuisance Alarms.” Critical Care Nurse 35.4 (2015):15-22; quiz 1p following 22.

Cvach, Maria M, et al. “Use of pagers with an alarm escalation system to reduce cardiac monitor alarm signals.” Journal of Nursing Care Quality 29.1 (2014):9-18.

Murray, Terri, et al. “Perceptions of reasons call lights are activated pre- and postintervention to decrease call light use.” Journal of Nursing Care Quality 25.4 (2010):366-72.

Are there methods that are effective at reducing nursing staff response time to patient call lights/bed alarms?

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A search of PubMed, CINAHL, and ECRI (a quality and risk management resource) for combinations of these terms:
Call lights, call buttons, intercoms, stimuli
Patients, beds, rooms
Nurses, nursing
Response time, reaction time, attention
(call lights OR call buttons OR alarms) AND (patients OR beds OR rooms) AND (nurses OR nursing) AND (response time OR reaction time)…identified many articles about reducing the rate of call light use by implementing hourly/intentional/comfort rounding, as well as the association between call light use and falls. Below are a couple of references that explore how psychological factors may be associated with response time.

Kalisch BJ, et al. Nursing teamwork and time to respond to call lights: an exploratory study. Rev Lat Am Enfermagem. 2013 Jan-Feb;21 Spec No:242-9.

Tzeng HM. Perspectives of staff nurses toward patient- and family-initiated call light usage and response time to call lights. Appl Nurs Res. 2011 Feb;24(1):59-63. doi: 10.1016/j.apnr.2009.03.003. Epub 2009 Jul 9.

A Google search for no pass zone patient call lights identified several hospitals that have rolled out campaigns with this name, but there doesn’t seem to be anything in the traditional published literature about them. Here is information from a couple of hospitals in case you want to contact them directly for additional information.

http://nursing.advanceweb.com/News/Regional-News/Bronx-NY-Montefiore-Establishes-No-Passing-Zone.aspx

http://healthleadersmedia.com/content/NRS-250810/Nurses-Find-Simple-Ways-to-Improve-Satisfaction##

http://1199seiubenefits.org/wp-content/uploads/2012/01/Mt.-Sinai-Powerpoint.pdf

This question seems to be similar to alert fatigue with use of alerts in clinical systems. After browsing some of those references in PubMed, I applied the subject headings
(“Human engineering”[mesh] OR “Hospital communication systems”[mesh]) AND (“Reaction time”[mesh] OR “time factors”[mesh]) AND nurses AND (falls OR patient satisfaction)
The most relevant reference in this search is below. It discusses use of a different technology.
Guarascio-Howard L. Examination of wireless technology to improve nurse communication, response time to bed alarms, and patient safety. HERD. 2011 Winter;4(2):109-20.

Does hourly rounding reduce the risk of accidental falls in a cardiovascular surgical unit?

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A CINAHL search for (rounds OR rounding) AND falls AND (cardiac OR coronary OR cardiovascular) did not retrieve any results.

A search for (rounds OR rounding) AND falls AND (surgical OR surgery OR postoperative) retrieved 13 references, including these studies in medical-surgical units:

Effects of rounding on patient satisfaction and patient safety on a medical-surgical unit. Woodward JL; Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 2009 Jul-Aug; 23 (4): 200-6.

Hourly Rounding: A Replication Study. Olrich, Todd; Kalman, Melanie; Nigolian, Cindy; MEDSURG Nursing, 2012 Jan-Feb; 21 (1): 23-36.

A search in PubMed found these two additional articles.

Krepper, Rebecca, et al. “Evaluation of a Standardized Hourly Rounding Process (SHaRP).” Journal for healthcare quality 36.2 (2014):62-69.
The first took place in two 32-bed cardiovascular surgery nursing units.

Ciccu Moore, Rita, et al. “Care and comfort rounds: improving standards.” Nursing management 20.9 (2014):18-23.
This study took place in an orthopaedic and surgical rehabilitation ward.

See also Does hourly or intentional rounding reduce the rate of accidental falls in acute care facilities?

See also Are inpatients with cardiac conditions or on diuretic therapy at risk for falls and is there any evidence of interventions to reduce falls in this population?
This blog entry references a couple of papers in the search  results that include patients with cardiac conditions in their populations.  You might be able to extrapolate strategies to your population.

Reviewed and updated 4/8/2014 ldt

What is the recent evidence for intentional rounds in the intensive care unit?

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Searched CINAHL and PubMed for patient rounds AND (“intensive care” OR “critical care”)  with a limit of English.

Six quasi-experimental studies in CINAHL measuring nurse satisfaction, ventilator-associated pneumonia, cental-line associated bloodstream infection, nosocomial infections, healthcare outcomes, family presence, and facilitators and barriers to patient care rounds
Adding intensive care or critical care eliminates many studies that may also be relevant.

(MH “Patient Rounds”) AND (hourly OR intentional OR proactive OR comfort)
These results include several experimental and quasi-experimental studies. If you want to look at specific outcomes, see the following searches for particular topics:

Falls – (MH “Patient Rounds”) AND (hourly OR intentional OR proactive OR comfort) AND falls

Patient satisfaction – (MH “Patient Rounds”) AND (hourly OR intentional OR proactive OR comfort) AND patient satisfaction

Patient centered care – (MH “Patient Rounds”) AND (MH “Patient centered care”)

Papers in PubMed search: (rounds OR rounding) AND (intentional OR hourly OR time factors OR proactive) AND (nurses OR nursing) AND (safety OR quality improvement OR infection OR pneumonia OR pressure ulcers OR falls OR patient satisfaction OR patient outcome assessment OR outcomes assessments) AND (“intensive care” OR “critical care”)
This search retrieves papers examining common outcomes in the intensive care unit.  Other outcomes can be included in the search.

Reviewed and updated 5/1/2014 ldt

What is the evidence-based research on the type and effectiveness of intentional rounding on inpatient psychiatry units?

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The Bottom Line: Intentional rounding can have a positive effect on call light use, patient falls, satisfaction and other criteria.

Searching PsychInfo, CINAHL and PubMed for the concepts of intentional (or hourly) rounding and patient satisfaction produced this sampling of results.

Gardner, Glenn, Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study. International Journal of Nursing Practice, Vol 15(4), Aug, 2009. pp. 287-293.

The latest evidence on hourly rounding and rapid response teams in decreasing adverse events in hospitals. Worldviews on evidence-based nursing 2007 vol:4 iss:4 pg:220

Halm, Margo Hourly rounds: what does the evidence indicate? American journal of critical care 2009 vol:18 iss:6 pg:581 -584

Baker, Stephanie. Rounding for outcomes: an evidence-based tool to improve nurse retention, patient safety, and quality of care. Journal of emergency nursing 2010 vol:36 iss:2 pg:162 -164

CHRISTINE M. MEADE, PHD, AMY L. BURSELL, PHD, LYN KETELSEN, MBA, RN Effects of Nursing Rounds on Patients’ Call Light Use, Satisfaction, and Safety