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Does intentional rounding mean better patient care?

New research shows hourly ward rounds may not be the best way for nurses to deliver care.

Intentional Rounding was introduced in 2012 following the government’s response to care failures at Mid Staffordshire NHS Trust.  The then Prime Minister David Cameron announced that all nurses were to carry out hourly rounds to “systematically and routinely checking that each of their patients is comfortable, properly fed and hydrated, and treated with the dignity and respect they deserve.” [1] At regular intervals, nurses will carry out observations with patients, as well as asking about their pain level, if they are comfortable or need anything.

Following the introduction of intentional rounding, it was unclear how it would be rolled out and implemented in hospitals. In 2014 a study was funded by the National Institute for Health Research, Health Services and Delivery Research programme (NIHR HS&DR) in 2014 to investigate the impact of intentional rounding in hospital wards on the organisation, delivery and experience of care.  Professor Ruth Harris from the Florence Nightingale Factually of nursing, Midwifery & Palliative Care is leading the study.

An initial summary of the research has raised questions as to whether it is the best way for nurses to deliver fundamental patient care. The report also suggests a national discussion be had about whether intentional rounding is the most effective way of delivering nursing care in a complex health system.

The study is the first of its kind - a theory-informed, large-scale mixed methods evaluation of intentional rounding worldwide. This research offers unique perspectives on the effectiveness of intentional rounding, in particular what works, for whom and in what circumstances. The research involves a national survey of all NHS acute Trusts in England; in-depth case studies of six wards in three NHS acute Trusts (involving interviews with healthcare staff, patients and carers; observations of IR and nurse shadowing) and the retrieval of routinely collected ward outcome data and an analysis of costs.

The study suggests that, whilst patients were observed as having regular contact with registered nurses and were generally positive about their experience with nursing care, intentional rounding is not the optimum way to support the delivery of fundamental nursing care to patients. Nurses themselves were unsure at best about the value of intentional rounding, and that a tick box approach was not helpful to upholding patient dignity and respect. Whilst the documented evidence showed that nursing care had been delivered, there was some concern that this evidence was not always sufficient or reliable, and that it was difficult for nursing staff to maintain the documentation when faced with competing demands upon their time.

 Professor Ruth Harris said:
“Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery. Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

Whilst intentional rounding has widespread use – 97% of NHS acute Trusts in England were implementing it in some way, and 81% had a structured protocol, script or procedure in place – there was a lack of understanding in why intentional rounding was being carried out, and a lack of education and preparation of staff to undertake it.

The study suggests the development of intentional rounding needed a period of piloting, evaluation and refinement instead of importing an untested model in a quick response to a crisis.