Improving the Effectiveness of Intentional Rounding: A Quality Improvement Project

Ineffective intentional rounding (IR) may lead to missed care opportunities and an increased risk of adverse events. Quality improvement (QI) strategies may enhance nurses' compliance with rounding protocols and improve patient safety.

To evaluate the impact of a multifaceted QI program on the rate of effective IR and the incidence of nursing-related adverse events.

This pre-post study was conducted at a tertiary hospital. The department of nursing-level interventions included the following: revising the scope of required hourly patient rounds to direct nurses' attention toward elderly patients and those at high risk of falls; mandating that nurses could only document round completion by scanning either patient wristbands or bedside QR codes containing patient information; and providing standardized, organization-wide training. Ward-level interventions included disease-specific training, high-risk time reminders, establishing standardized effective round assessment forms, monthly reviews by liaison nurses, and regular random checks by the QI team. Effective round rates and adverse events (including unplanned extubation, intravenous injection safety events, and falls) were compared before and after implementation.

The timely rounding rate for first-level nursing increased significantly from 77.46% in 2023 to 91.89% in Q4 2024 (χ ² = 3561.443, p < 0.001). The proportion of unplanned extubations attributed to ineffective rounding decreased from 20.69% (6/29 events) to 0% (0/12 events), and similar attributions for intravenous safety incidents decreased from 61.54% (8/13) to 30.77% (4/13); however, these reductions were not statistically significant (p = 0.106 and p = 0.119, respectively). Process audit data indicated that gains in some areas were not fully sustained across all quarters.

The multifaceted QI program improved nurses' compliance with IR processes and was associated with improvements in selected nursing safety indicators. Sustaining these gains requires continuous monitoring, targeted feedback, and adaptive reinforcement strategies.