Policy context

In terms of policy context the practice of rounding in nursing care delivery gained a high profile in January 2012 when the then Prime Minister participated in rounding on a visit to a large NHS Trust. He then announced a package of measures to improve standards of care in hospitals one of these being a requirement to introduce rounding nationally in all hospitals (DH 2012a). An emphasis on rounding was placed in the document ‘Patients First and Foremost’ (DH 2013a: p68) and the initial government response to the Francis Report (Francis 2013) stating ‘that the majority of hospitals had introduced hour by hour nursing rounds on their wards’ and urged remaining hospitals to do so within a year.

Rounding was included in the work of the Nursing and Care Quality Forum (DH 2012b) a body of senior nurses set up by the Prime Minister to tackle issues of improving nursing care. Rounding was also embedded within the vision and strategy for compassion in practice, ‘The 6 C’s’ promoted the values of care, compassion, competence, communication,

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courage and commitment published by the Chief Nursing Officer (DH 2012c). Two further initiatives which connect up with potential outcomes of rounding related to patient safety are Harm Free Care (DH 2011a). These included a drive to reduce patient harm from falls and pressure ulcers; and the NHS Safety Thermometer (Health and Social Care Information Centre, HSCIC 2015) which provided methods for surveying and analysing the results from patient harm associated with falls and pressure ulcers (Lowe and Hodgson 2012; McDonagh 2013).

Nineteen NHS Trusts have published anecdotal information about the benefits of rounding (table 4) and 50 hospitals in England have implemented rounding (Bartley 2011). However, there was an acknowledgement that there was still no robust research evidence in the NHS to suggest rounding improved nursing care (Bartley 2011; Mason 2012; Snelling 2012). I collated evidence in table 4 in an attempt to demonstrate a lack of consistent approaches to rounding leading to different types of rounding being implemented. I would suggest that this diversity of approaches hinders comparable large scale evaluation of patient outcomes, which leads to a poor and fragmented rounding practice, resulting in prospective patient benefits being lost and standards of nursing care failing to improve.

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Table 4: Diverse approaches to rounding

Hospital Published Information Reported Outcomes

1. Aintree University Hospital

2 hourly rounding on 30 wards

Acute provider Nursing and Care Quality Forum Demonstrator Site

Gillen (2012), Levenson (2013)

Reduced call bells

2. Blackpool Victoria Hospital

Acute provider Nursing and Care Quality Forum Buddy Site

Levenson (2013)

Reduction in falls 3. Croyden University

Hospital

Hourly Rounding, Implemented summer 2010

Duffin (2010)

Nil reported 4. East Sussex

Healthcare Trust

Intentional rounding, Pilot 2 stages on 6 wards initially 2nd stage full implementation across two hospitals, covered 6 months

Dewing and Lynes O’Meara (2013)

Staff satisfaction questionnaire, increased visibility and patient contact time, Improved patient experience, Improved staff experience 5. Forth Valley, NHS,

Sterling, Scotland

2 Hourly care and comfort rounds implemented June 2011, 29 bed ward

Stoddart et al (2014)

Staff satisfaction increased, positive feedback from patients

6. Hommerton University Hospital, London

Comfort Rounds 4 hourly, Piloted one ward for 2 weeks 2010, being rolled out across the Trust

Negus (2010)

Reduction in falls 7. Imperial College

Healthcare Trust, London

Hourly rounding implemented 2012, review of the process on 4 wards

Kenny and Norton (2015)

Staff and patient views on rounding, patients unaware of the process and staff do not value the process

8. Leeds Teaching Hospital

Hourly rounding in a high dependency unit Lowe and Hodgson (2012)

Compliance of rounding log documentation. Difficulty in comparing data

9. Lewisham

University Hospital, London

2 Hourly Rounds, All adult in patient wards 2011

Burke (2011)

Positive feedback from patients and relatives 10. Musgrove Park

Hospital, Taunton

Intentional Rounds 2 Hourly, Piloted 2010 on the Acute Medical Unit, implemented a third of hospital wards 2012, improvement methodology

Dix et al. (2012), Mason (2012), Braide (2013)

Reduced call bell usage, improved detection of pressure ulcers, reduced falls and reduced complaints

33 11. Nottingham

University Hospital

Caring Round the Clock, three types of round: Patient Rounding, Senior Leadership Rounding, Leadership Rounding on Patients

Piloted 10 wards 2011, roll out to 79 wards 2012

Hutchings (2012), Hutchings et al. (2013)

Reduced call bell usage, falls reduction but concurrent falls prevention campaign, positive patient feedback

12. Queen Elizabeth Hospital,

Birmingham

Hourly Care Rounds

Rolled out across all wards 2011, use of DH rapid spread methodology

Crossfield and Pitt (2012) Mason (2012)

Falls reduction, improved patient feedback

13. Salford Royal Hospital

Intentional Rounds, Piloted April 2011, organisational policy Nov 2011 Acute provider Nursing and Care Quality Forum Buddy Site

DH (2012;2012a;2012b), Gillen (2012), West (2012), Levenson (2013)

Reduced falls and pressures but one of several interventions noted

14. Tameside Hospital, Manchester

Acute provider Nursing and Care Quality Forum Demonstrator Site

Levenson (2013)

Quality account data 15. University College

Hospitals, London

Acute provider Nursing and Care Quality Forum Buddy Site

Levenson (2013)

Plans to measure patient feedback, falls and pressure ulcer prevalence

16. University Hospitals Coventry and Warwickshire

Intentional Rounds, Across Trust March 2012, focus on Pressure Ulcers and Skin Assessment

McDonagh (2013)

Reduced incidence of pressure ulcers but several interventions noted

17. Wansbeck Hospital, Northumbria

Intentional Rounds Hourly, Trialled number of wards

Fitzsimmons et al. (2011)

Reduced call bell usage, improvements in patient experience data

18. Whipps Cross Hospital, London

Proactive Patient Rounds 2 Hourly, Oct 2009

Duffin (2010)

Reduced falls but one of several interventions, patient survey patients more satisfied

19. Wrightington, Wigan and Leigh Hospital, Greater Manchester

Intentional Rounds

All wards since May 2012, initial resistance from nursing staff Acute provider Nursing and Care Quality Forum Buddy Site

Gillen (2012) Levenson (2013)

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