Intentional rounding is a structured approach to checking in with patients at set intervals. A consistent routine helps you anticipate patient needs and prevent avoidable harm.
Rounding is not an extra attendance every hour. It is a way of providing holistic care to all patients during the activities you already do, such as administering medications or taking observations. Each round becomes an opportunity to check on the patient's clinical and personal needs, plan care in partnership with the patient and their family or carer and manage your workload proactively.
Information gathered during rounding informs clinical handover.
What rounding looks like in practice
Behaviour | Why it matters |
|---|---|
Use opening greetings and introduce yourself | Builds trust and the therapeutic relationship |
Ask the patient and their family or carer what you can do for them | Improves communication and supports individualised care |
Complete and document scheduled tasks such as observations and medications | Supports safety, efficiency and delivery of planned care |
Assess against the rounding framework (P's and D's) | Care meets each patient's needs, contributing to better outcomes and reduced risk |
Update patient care boards with the patient and family or carer | Keeps care individualised |
Tell the patient when you will be back | Reassures, is proactive and improves efficiency |
Document the round | Supports quality and accountability |
Principles
- Round with each patient individually, in a way that does not make them feel they are taking up your time.
- Round with purpose, accounting for the patient's risk factors such as falls and pressure injury.
- Document every round.
- Combine rounding with scheduled tasks like administering medications and repositioning.
- If the patient is asleep, document 'asleep'. If the patient is absent, find out where they are and document this in the health record. If their whereabouts are unknown, follow your local procedure for absent or missing patients.
- If nothing further is needed, tell the patient a team member will return in an hour.
The rounding framework: P's and D's
Each round addresses the P's (personal needs, position, patient environment) and D's (discomfort, devices, documentation). Adapt the list below to your clinical specialty.
Personal needs
- Involve the patient and their family or carer in care planning, where they wish to be involved.
- Ask "What matters to you?" to address fear and anxiety.
- Provide ongoing education to the patient and their family or carer.
- Assist with toileting as required.
- Help with nutrition and hydration: positioning, opening packaging, feeding as needed.
- Support hygiene needs including showering or bathing, grooming and hand hygiene.
Position
- Reposition the patient as per the pressure injury care plan and patient comfort.
- Inspect skin for redness or injury after repositioning.
- Check that pressure-relieving or pressure-redistribution equipment is in place and functioning.
Patient environment
- Place the call bell within easy reach.
- Check sensory aids are working and in reach.
- Check mobility aids and non-slip footwear are within easy reach.
- Verify linen is clean and adequate.
- Check the environment, including the ensuite, is safe and free from clutter, spills or trip hazards.
- Check oxygen and suction equipment is working at the bedside.
- If the patient is absent, check the bathroom or toilet in case they have collapsed or need help.
Discomfort
- Attend to and document the patient's pain score, where applicable.
- Assess discomfort or pain and provide interventions as required or charted.
- Administer medications if needed.
- Evaluate the effectiveness of pain management interventions.
Devices
- Check intravenous devices for placement, patency and duration.
- Check catheters and drains for drainage, placement and contents.
- Check IV fluids and medications are being administered as charted, and lines are labelled correctly.
- Observe oxygen delivery and suction systems are in place and working.
- Check for device-related pressure injuries, including removing bandages (where used) at least once every eight hours.
Documentation
- Check medication charts and document medications administered.
- Document fluid input and output on the fluid balance chart.
- Update relevant care plans.
- Document any variances in the health record.
- Attend to and document observations on the standard observation chart.
- Escalate care using ISBAR (Identify, Situation, Background, Assessment, Recommendation).