Medical-Surgical Nurse Perceptions of the Barriers to Sustainment of Hourly Rounding

Purpose:
The purpose of this study is to identify the barriers and challenges of sustaining hourly rounding from the perspective of the registered nurses from adult inpatient medical-surgical units.

Background/Significance:
Hourly rounding is a popular initiative. It has been touted to improve patient satisfaction scores and outcomes. However, a systematic review of outcomes related to the hourly rounding initiative concluded that the evidence was low to moderate strength at best. Additionally, there is a lack of evidence to show long term outcome improvements with hourly rounding which implies there are barriers to sustainability of hourly rounding.

Methods:
A quantitative descriptive study was conducted. A convenience sample of registered nurses from two different community hospital's medical-surgical units were surveyed. A Likert style survey tool was created. The content validity was established by a systematic review that identified barriers found in the literature. Two open ended questions were included to capture additional barriers and the registered nurse perceptions of what would help them perform hourly rounding more consistently. Institutional review board approval was obtained prior to the start of the study through both organization's review boards.

Results:
The response rate was 33% at one hospital and 26% at the second hospital for a total of 165 surveys returned. The nurses agreed that hourly rounding could improve patient outcomes. However, only 25% agree that rounding consistently happens on their units. The main barriers identified are: workload, competing tasks and priorities, interruptions, a lack of staff buy in, and acuity levels. Although a lack of education was found in the systematic review, this was not found to be a barrier in the survey. Ninety seven percent of nurses think that rounding frequency should be done based on assessment of individual patients and not at a prescribed rounding frequency.

Conclusions and Implications for Practice:
Knowing the barriers can help teams find creative ways to better sustain hourly rounding. Some recommendations include: advocate for adequate staffing and development of a screening tool to identify which patients would benefit most from hourly rounding to best utilize limited resources.