Intentional Rounding
Classification: Clinical Policy
Lead Author: Pete Murphy
Additional author(s): Dylan Edwards / Fiona Morris
Authors Division: Corporate
Unique ID: TWGOP1(12)
Issue number: 3
Expiry Date: April 2018
Contents
Section
Page
Who should read this document
Key practice points
Background/ Scope/ Definitions
What is new in this version
Policy
Standards
Explanation of terms
References and Supporting Documents
Roles and Responsibilities
2
2
2
2
3
3
4
4
5
Appendices
Audit Document
Staff Guidance
Intentional Rounding Document
Document control information (Published as separate document)
Document Control
Policy Implementation Plan
Monitoring and Review
Endorsement
Equality analysis
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Who should read this document?
All clinical staff, including allied health professionals
Key Practice Points
This policy outlines the Trusts expectations in respect of nursing staff
undertaking Intentional Rounding. Intentional Rounding is a structured
process where nursing staff carry out regular checks with individual patients at
set intervals, typically hourly. The hourly check of patients follows a
prescriptive format and should finish with closing key words, most commonly
“Is there anything else I can do for you?” It is anticipated that this approach
will provide a platform for addressing the needs and concerns of patients.
Research by the Alliance for Health Care Research (Meade et al, 2006)
reported a 38% reduction in call bell use, a 12 point mean increase in patient
satisfaction, a 50% reduction in patient falls and a 14% reduction in pressure
ulcers.
Background/ Scope/ Definitions
It is expected that all nursing staff will understand and adhere to the policy.
Intentional Rounding practice within Salford Royal NHS Foundation Trust will
be the regular checking of patients’ needs utilising the 4 P’s




Pain (“How is your pain?”)
Personal needs (“Would you like help getting to the bathroom?”)
Position (“Are you comfortable?”)
Possessions (Help with a drink, moving items to within reach)
At each Intentional Round a formal written checklist will be completed and the
patient will be asked specific questions (appendix 3)
This could lead to the patient expressing other concerns which may need to
be acted upon.
What is new in this version?
Change in nursing titles from Deputy Directors of Nursing to Divisional
Directors of Nursing
Simon Featherstone/Christine Pearson/Julie Molyneaux – previous authors of
the policy have been removed as they have left the Trust
Removal of QI quarterly auditing the Intentional Rounding documentation
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Policy
Patients will be asked on an hourly basis, between 8am and 10pm and 2
hourly between 10pm and 8am is there anything that they need utilising the 4
P’s. Patients who are sleeping will not be disturbed, unless their care
requirements to support this.
The Trust’s Nursing Assessment and Accreditation System will monitor
standards and adherence to Intentional Rounding.
Staff guidance on how to complete the Intentional Rounding document is
available (appendix 2). Ward Managers/Matrons should ensure that all staff
are aware and understand the guidance.
Standards
1. A welcome leaflet will be given to every patient on admission explaining
Intentional Rounding.
2. In addition to the welcome leaflet, a verbal explanation should be given
on admission and the patients’ understanding of the process
ascertained using the teach-back method.
3. Patients will be asked on an hourly basis between 8am and 10pm and
2 hourly between 10pm and 8am is there anything that they need.
Should patients require hourly or more frequent cares this should be
provided as required regardless of the time. (Appendix 3)
4. Intentional Rounding for patients who have a tracheostomy should take
place every hour, regardless of day or night.
5. Patients who are unable to move without assistance should not be left
for more than 2 hours without being assisted to change position.
Patients at risk who are able to move themselves should be
encouraged to change their position at least every 2 hours. Pressure
relieving mattresses/devices DO NOT NEGATE the need to change
the position of the patient.
Mattress Escalation – appropriateness and escalation of mattresses to
be discussed with the tissue viability link nurse in the first instance and
escalated to the tissue viability specialist nursing team for advice where
required.
6. Patients refusing to either change their position or be assisted to
change position their position should have the risks fully explained to
them by the responsible nurse and escalated to the shift co-ordinator,
ward matron or lead nurse where necessary. This should be clearly
documented in the patient’s health record.
7. Registered nurses must complete the document at set times as
indicated to provide an overview of the process and ensure that
patients’ care needs are met at all times
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8. Planning of care delivery – nursing teams should ensure that the care
delivery is planned at the beginning of shifts in order to facilitate a
minimum hourly contact with individual patients (cover for staff breaks,
escorting patients for investigations etc).This should be done using a
team approach and failure to achieve hourly patient contact should be
escalated to the shift co-ordinator.
9. Fluid balance charts should be supported with a 24 hour cumulative
chart to aid accurate monitoring.
10. Where appropriate, food charts must be completed fully to provide a
complete record of the patients’ dietary intake for a 24 hour period
11. In cases, whereby the fluid balance and / or flood chart is not used, this
must be clearly indicated by applying a cross to the N/A box situated at
the top of the chart.
12. The allocated Registered Nurse must enter their initial and printed
surname at the top of the Intentional Rounding document for each shift
and each entry made in the document must be fully legible in
accordance with NHSLA.
Explanation of terms
Terms explained in the policy
References and Supporting Documents
Meade et al (2006) Alliance for Health Care Research.
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Roles and responsibilities
The Executive Director of Nursing
Will ensure that all Senior Nurse Leaders take ownership of the policy
The Divisional Directors of Nursing
On behalf of the Executive Director of Nursing will be responsible for ensuring
the policy is reliably implemented in all wards and departments
Assistant Directors of Nursing, Lead Nurses, Corporate Matrons and
Ward Matrons/Managers
Will be responsible for ensuring that the policy is operationalised and adhered
to within their wards and departments. They must ensure that all staff are
aware of their accountability and responsibility in complying with the policy.
They must ensure guidance is given to staff in order for them to complete
(Appendix 2)
Regular audit of compliance will be undertaken by the Corporate Matron or
Ward Matron which will include observations of an intentional round
(Appendix 1)
Appendices
Appendix 1 – Audit Document
Appendix 2 – Staff Guidance/Intentional Rounding Document
Appendix 3 – Intentional Rounding Document
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Appendix 1
Intentional Rounding Audit Ward :
Hospital
number
demographics
Date:
Are there any gaps in
the intentional rounding
document?
Have the correct
codes been used?
Is the body map
completed accurately and
corresponds to the
patient?
Has the correct personal
completed the intentional
rounding at the correct
time?
Time:
Has the fluid
balance
completed
accurately?
Has the Food
chart
completed
accurately?
1
2
3
4
5
6
7
8
9
10
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Does the patient
know about
Intentional
rounding?
Observing of
intentional
rounding. Has this
been carried out
appropriately
Comment of observations
Actions and Feedback
Auditor
……………………………………………………………………………………..
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Appendix 2



Information cards should be given and explained to all patients on arrival to the ward, this includes detailed information on intentional rounding that should be communicated to patients and their families
All documentation must be completed using black ink.
Intentional rounding can be performed by several members of the ward team however certain grades of staff have different responsibilities as will be discussed within the document.
Fig: 1
-
Please ensure all patient information is accurate and completed
o i.e. Patient name, hospital number, NHS number, ward and date.
See Fig 1
- At the beginning of every shift the nurse must ensure they complete the
section who is responsible for the care of the patient. This must be completed
with your full professional title. (For example Sr Hill, or SN Hill first names and
initials can be included.)
Fig 2:
See Fig 2
- Each chart lasts 24 hours and needs to be replaced between midnight and
2am every day.
o Hourly rounding needs to be performed between 8am to 8 pm
o 2 hourly rounding at a minimum between 8 pm and 8am (this is
shaded in grey).
o The red columns are to identify times when the intentional rounding
MUST be completed by a Registered Nurse (RN) however this is a
MINIMUM standard and assessments could take place between these
times – agreed at divisional level.
Fig 3:
See Fig 3
- Every hour the nurse or CSW must firstly introduce themselves to the patient
and ask a range of questions otherwise known as the 4 p's PAIN, PERSONAL
CARES, POSITION, and POSSESSIONS.
- Healthcare workers must ensure thorough assessments are carried out and
that all their patient’s needs are addressed.
- All sections must be documented with YES or No
Fig 4:
Pain:
If patient able to communicate they must be asked if they are in pain and appropriate
response must be acted upon.
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Staff need to assess both verbal and non-verbal signs for pain. If a patient is in pain
this must be escalated to the necessary individuals who can rectify the situation.
Things to consider.
Have you made a thorough assessment?
Have you thought about moving the patient’s position?
If Pain is established and analgesia required and you are not in the position to deliver
this please ensure that this is escalated to the relevant personal, and that you revisit
the patient at the earliest opportunity to ensure the patient is pain free and
comfortable.
Fig 4:
Personal Cares
Things to consider
Ensure all patients are asked re elimination and continence needs are met.
Do patients need support with hygiene and dressing needs?
Ensure our patient’s dignity is maintained.
Are they too hot or too cold?
Position
This could range from simple encouragement to supporting or performing pressure
area care. (i.e. if a patient had been noted to be sitting in a chair for some length of
time try to encourage the patient to move position.)
Possession:
Ensure the patient has all necessary possessions accessible to them, i.e. spectacles,
hearing aid, jug and glass, call bell to hand and ensure the area is clear safe and decluttered.
See Fig 4
Fig 5:
Falls Risk section
Please ensure the falls risk symbol for all patients is documented every hour as
patients status can alter this should be regularly reviewed.
G= Green
A= Amber
R= Red
Ensure the appropriate abbreviation is used for psychological status i.e. A for alert, C
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for confused
Is footwear appropriate? Please complete with a Yes or No answer
Things to consider
Are Slippers available?
Are they the correct fitting?
Does the patient require Non slip socks?
See Fig 5
Fig 6:
Skin bundle section
-
Please ensure reference is made to the correct mattress been used or cushion
for the patient needs this needs to answered with a Yes or No
Skin condition
Fig 6.1
-
Please ensure all skin codes are documented accurately and in the free text
space to be more specific.
Change position
-
Please ensure all positional changes are documented with the appropriate
codes. Numerous codes can be used if required.
See Fig 6 & 6.1
Fig 7:
-
Please ensure after performing the intentional rounding assessment you
complete the signature section and state your designation
-
RNs to complete the red columns
See Fig 7
Fig 8:
-
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At the end of your assessment please ensure you ask Is there anything else I
can do for you?
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See Fig 7
Fig 9:
Skin integrity
X
Devices
-
Please ensure every section is completed accurately and that all necessary
information provided.
-
On the body map please ensure all skin integrity is clearly marked and the
correct code used.
-
For devices please see selection provided. There is an area to add other
devices that may be pertinent to your patient. Please ensure the location of
the device is marked on the body map and a relevant number documented.
-
Please see diagram for example.
15
See Fig 9
Fig 10:
Fluid balance chart
-
Please ensure all patient identity information is correct.
Please ensure accurate fluid balance recording by all staff.
Fluid balance will commence from midnight for the 24 hour period. This
needs to be then calculated and acted upon appropriately.
Results must be imputed on the cumulative fluid balance chart.
The red sections highlighted on the fluid balance charts are times when the
RN must complete.
See Fig 10
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Fig 11:
Food Chart
-
To complete as necessary. To tick N/A box if not required
Enter dietary code as necessary
To include supper time food on new section at the bottom of the page if
applicable
See Fig 11
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Appendix 3
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