Six Practical Peas of Hourly Rounding
Although I do think the vegetable is under rated, I will not be dedicating a whole blog post to the tiny round green veggies. I am however speaking of the process often taught to clinical workers in health care facilities across the country. You probably have seen or will see the training at some point in your nursing career. I have seen a few variations of this process, “the peas” I personally call it. Many institutions adopt their own official way of doing the peas, but quality nurses often include these steps anyway in their daily routine. Some workplaces may train you to memorize certain questions or vocabulary with patients. Either way, the science and theories behind this process allow us nurses to stay organized, be effective, be productive, be proactive and ultimately get our work time back, 100%. A nurse only has a certain amount of time in the shift to get many tasks done. Effectiveness is key to success. Let us look at it with more intention.
I definitely include this hourly rounding process in my personal workflow and routine. The idea is to address all "the peas" with the patient every time you see them and simultaneously set up a plan for the future. These checks or rounds on the patients, normally are every 2-4hrs depending on what is going on with the patient, what shift you are working and also whom you are sharing the workload with on the floor. Not only are you being purposeful and proactive with your patients, but the knowledge you will gain from working hands on with them will help tremendously, later in documenting. Correct documentation, in my mind, directly correlates to money. It is very important to document the true burden of care for the shift, every current shift, not the day before not the shift before. I also suggest perfecting your observation skills and getting in the habit of thoroughly scanning the patient's room when you are in there. When done correctly, this rounding process really does ensure quality care for the patients, helps in the prevention of falls, improves personal time management with less interruptions and improves patient satisfaction scores. Money, Money, Moneyyyyy!
What are the six peas might you ask?!
Pain - Potty - Position - Possessions - Privacy - Plan
How would this look in real time?!
Pain - Assess, advocate and address the patient's pain to the best of your abilities, all of the time. Pain management is huge in rehabilitation. The patients need to get up out of bed and participate in therapy every day in order to stay in rehab with the ultimate goal of going home. Refusals of therapy due to pain happen on occasion but it just won't do. Pain is whatever the patient says it is, it is subjective information, but you can also observe for signs and symptoms of pain. It should match but sometimes it doesn't. Do not be the kind of nurse to delay or withhold medications if the patient asked and the medication was ordered. Part of this is getting ahead of their pain. Depending on your shift you may be medicating the patient prior to therapy to ensure the best participation or medicating at night before bedtime to ensure the best sleep and rejuvenation. Always follow your orders and ask for clarification if needed. Our job is to administer, document and monitor for effectiveness. When the medication is not always effective, we may also need to get creative with other methods of relief like ice or heat. You could potentially alternate PRNs, use as needed orders to breakthrough scheduled orders, guided imagery or even simple Tylenol takes the edge off just enough. Make sure you look at all your orders and pay attention to any directions for the pain scale noted inside the details of the order. Get in the habit of addressing pain early and frequently in the shift. To avoid interruptions or breakthrough pain, talk with your patient and set up a plan of action for the future. This creates trust and builds confidence of your abilities with the patient. As soon as you get report, do walking rounds with the off going nurse, lay eyes on all of your patients and assess the patient for pain and orientation, then repeat this frequently in the shift.
Potty - Assess and address the patient's continence and/or need to go to the bathroom. Mobility is the top goal for our patients in rehabilitation. You want to keep your patient's continent to the best of your ability. No you cannot work miracles, some patients do come in low level or incontinent and discharge incontinent, but the point is, we still must try. You very well may be surprised at the continence level of the patient helps paint the picture of care for reimbursement of services. Remind the patient when you're in the room, that you have the time to take them to the bathroom or help them with a device in order to prevent a delay in getting back to them later if they may need you. Check the patient at the beginning of the shift with the CNA if it's a lower-level incontinent patient. Make time for these things. You can assess the patient's skin plus set up a plan with the patient for the rest of the shift. You can assess their cognitive abilities to follow directions and call for assistance. Get in the habit of multitasking. Get in the habit of charting intake and output in real time. It is so easy to forget and so important to document correctly. Take credit for the things you do plus if it's not documented, it did not happen. Period.
Position - Often times a slight position change can ease pain and discomfort. Make sure you offer to help change position of the patient if they cannot do it themselves or they need the encouragement. Most patients will lay in one spot if you allow them too. It's not good for your skin or muscles to be in one spot for too long. If a patient declines my offer to turn and reposition, I educate the patient, chart it and move on. Most patients are either interested in hearing and understand what you tell them, others however may but up barriers and not want to comply with best nursing practices. Either way it shouldn’t make a difference to you. As in don't take things personal. You may need to be a little flexible with the patient. Document, Document, Document. In this case you can visualize how the patient was when you started your shift. Even if you're still getting report. Pay attention to things in the room, to equipment the patient may need to put on when in the bed or when getting out of the bed. The good thing also about this position task is you can delegate to the nursing assistants but it also is your job to ensure it is being done.
Plan - Setting up a plan with the patient helps you with time management as well as limits the number of interruptions. You can discuss options and availability of you or their treatments early on in the shift. Again be flexible but often this saves time and questions with the patient.
Privacy - HIPAA violations are a thing. Being aware of maintaining the patient's privacy, it is very important. The manner in which you enter and exit a patient's room should promote comfort and consideration for the patient. The last thing you want when entering or exiting a patient's room is to forget to knock, forget to announce yourself, or forget to pull the curtain or close the door. Little things may be BIG things to them, patient perception has weight in our field.
Possessions - Make sure the patient has everything they need close by them; this promotes independence and provides a feeling of security. Also it will lesson your interruptions because they are looking for glasses or a cell phone.
Thank you for reading and I hope you try to use new tactics in your work! Let me know on YouTube or SnapChat how it's going for you. Use the 💊 emoji on all socials to let me know you got this far!
XOXO,
Zen RN
