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Nottingham University Hospitals Trust

Nottingham trust launches hourly round initiative

An East Midlands trust is rolling out a new version of hourly rounding on its in-patient wards to ensure basic care needs are met.

Nottingham University Hospitals Trust will begin rolling-out its Caring Around the Clock project to approximately 78 wards this month.

Between 8am and 11pm, nurses will check on the basic care needs of patients every hour, and every two hours between midnight and 8am.

In a bid to avoid the checks becoming a tick-box exercise, staff will have to discuss with the patient their specific needs and agree a time when they will return.

Nurses will select from a list of areas what questions to ask, covering pain management, position, personal care, prevention and care planning.

The project was piloted on 10 wards earlier this year and led to a 32 per reduction in call buzzers and also a reduction in falls.

Marie Hutchings, former ward sister and now project lead for Caring Around the Clock, visited 14 US hospitals last autumn to see how they carried out checks. Her trip was supported by the Nottinghamshire Roosevelt Travelling Scholarship and funded by the League of Friends.

She said: “In 2009 we started hourly rounding but it became a bit of a tick box exercise and we weren’t getting the improvements we wanted.

“Some nurses struggled with hourly rounding. They thought it was a challenge that they weren’t doing what they should be.

“So we changed the name and now nurses have a conversation with the patients from the list of areas set by the trust and agree with the patient when they will next come and check on them.”

She added: “It is a huge cultural change but we think it will deliver real benefits to patients.”

Readers' comments (6)

  • “In 2009 we started hourly rounding but it became a bit of a tick box exercise and we weren’t getting the improvements we wanted.

    “Some nurses struggled with hourly rounding. They thought it was a challenge that they weren’t doing what they should be.

    “So we changed the name....''

    Thats where KFC got the idea from!

    There is now a revolt in my trust about these hourly 'care bundles', none of the staff now do them, and the management can finally see that the staff do have some power and that it was a pretty stupid idea in the first place.

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  • At the Battle of Ideas next Saturday in London we will discuss in a session entitled 'A crisis of Compassion: who cares?' whether initiatives like this really get to the root of the problem of poor care provision and if not what will? Details here.
    http://www.battleofideas.org.uk/index.php/2012/session_detail/6776

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  • oh for heavens sake. have folk forgotton what they came into nursing for. i am astounded that we are having to teach nurses to be compassionate and caring and now we are having to make them see their pateints hourly. what are these nurses doing if they are not checking their patients hourly. i really am beginning to think we are forgetting what nursing is about. i am astounded when i walk into ward areas and cant see a nurse. may be i have been nursing too long (i now work in the community) but when i worked in paediatrics in the ward you had your patients allocated to you and you cared for them and their parents for the 12 hour shift. they always knew who was caring for them and knew i would be back. frequently the children were on hourly or more frequent interventions but those that were not were still seen. at the end of the shift you knew what had been happening over the shift better than anyone else.

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  • Anon 4.28
    Yes, the ones that were sick were seen more than once an hour, but what of the 'walking wounded' ( for want of a better phrase)? Do they require that level of intervention ( having never worked in paeds I don't know), but an adult who can get up go to the loo, turn themselves, make their own cuppa from the urn, wash/ dress with no difficulties do they require hourly care? Taking time to see to them takes away from the more dependant patient surely?

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  • Anonymous | 14-Oct-2012 4:28 pm " what are these nurses doing if they are not checking their patients hourly. "

    I remember spending whole shifts on the ward too, but now we spend hours sitting in the office, completing onle assessments, documenting the care we have given or delegated, the conversations we have had with patients and their families, answering the phone and solving what ever problem has now arisen, documenting all that, waiting for phone calls to social services to be answered and arranging discharges with social workers, documenting the phone call and the plans, therapists, liaising,liasing, liasing and then documenting EVERYTHING.
    oh and then checking our emails [an easy way for instructions to be sent to lots of people at onece] and trying to act on the "must be done by this week" actions...
    if we could just go back to having care plans at the ends of beds, then at least we could discuss things with our patients and provide care WHILE we are documenting..... I love computers but they do have a lot to answer for in nursing

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  • Mmmm - I dont think that it is totally correct to say that call bells have dropped by 32% across the board as it has only just beencompletely rolled out across the nottingham trust in the article since 1st october.
    It comes with very variable response & there is no formal record of the hourly checks so it will not assist in complaints answering & comparitive data for patient feedback as you have just got to hope that the staff on duty have 'done the hourly checks'. Also dont forget that this should be a whole staff approach not just nurses thats not cracked yet - & is not discussed by Ms Hutchings. In theory it replaces what all us old ones did & what the papers tell the young ones to do through evidence - not rocket science. Oh & you cant have the simple things like the care plans/patient records at the end of the bed to make our lives easier & be in the clinical area just in case someone reads them or the CQC comes! That is where we are losing the plot.
    End of the day patients and families want safe & kind care - nurses & midwives just want to get on & give it as easily as possible no matter what it gets called..............

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