Call lights are often frustrating for nurses, but are essential features in most hospital units. Although the lights are invaluable for alerting staff to patient needs, those needs often are not emergencies, and constantly answering the calls can tie up a workday. A recent study shows that when nurses conducted hourly rounds, the call light use was reduced by 38%, and the nature of those calls were more important to the patient’s well-being. The change freed up time for staff to complete their tasks without constant interruptions and improved patient safety.

Lyn Ketelsen, RN, MBA, is a coach for the Studer Group, which conducted the study. She says the idea came after the group’s visits to hospitals for consulting work. The consultants noticed that most nursing units are constantly reacting to events after they happen, which kept staff harried and under stress. It led to call lights that weren’t answered, which would anger patients.

“You could see which units functioned proactively and which ones did not,” says Ketelsen. “There’s a disparate difference, and patients feel that difference.” Ketelsen says the group devised a program of hourly rounding, including required key language and points for nurses to cover during rounds for clients to try. They noticed a positive change and decided to study the concept.

In the study, units that adopted hourly rounding cut their patient fall rates in half and reduced the number of decubitus ulcers developed by patents. “Many times we can intervene before a fall occurs,” says Ketelsen.

The rounds lead to better care because they build trust between patients and caregivers. “The communication is better, so there’s freer information flow from the patient,” says Ketelsen.

Ketelsen says staffers in med-surg units address the “three Ps” during their rounds–pain, position, and potty. These are the most common reasons why patients in med-surg units use a call light, she says. Once patients understand that the nurse will round consistently to address these issues, they stop using the call light.

Next, the nurse should check for environmental concerns that could lead to a patient using the call light. They should check for tissues, a pitcher of water, and other comforts for the patient.

Before the nurse leaves, he or she should ask whether the patient needs anything else and then tell the patient when to expect another round.

Ketelsen says the system is customizable for different units and facilities, so nurses can design the rounds to address their most common or urgent needs.

Ketelsen says nurses themselves are largely to blame for the overuse of call lights. Generations of nurses have told patients to use the light “if they need anything,” so it shouldn’t be a surprise when the patient does just that.

“We created this slippery slope for ourselves,” she says. “We have to get back to what used to be a ‘drop and run’ mentality for call lights. Now, the nonurgent needs are met in the context of the hourly rounds.”

Once the rounds take hold and the smaller needs are addressed regularly, the call light regains its traditional importance, says Ketelsen. In the study, units that performed rounds and reduced call light use found that when the lights did go off, it was for an urgent reason.

“Patients begin to know what to expect as well as staff,” she says.

The study included 64 nursing units in 22 hospitals nationwide. The units were a mix of different services, says Ketelsen, and included both Studer Group client and nonclient hospitals.

A year after the study concluded, the group contacted the units involved to see whether they were still using the rounds. Nearly 90% were, and many had decided to expand the system to other units in the hospital.

Editor’s note: This article is from Briefings on Patient Safety, HCPro, Inc., April 2007