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Experience shows need for walking rounds Editor's note: The following story was contributed anonymously and reprinted with permission from the booklet, “The Many Faces of Nursing.”   Early in my career, I was introduced to walking patient rounds at change of shift.   I found patients could be introduced to the oncoming nurse, patients could be quickly assessed and their care needs prioritized. Intravenous pumps could be assessed, patient controlled analgesic pumps checked and many tidbits of information essential to patient care could be exchanged.   The following clinical situation reinforced my practice.     I received the call late Monday night.   “We need you to come to work tomorrow. Come in whenever you can in the afternoon.” Hurricane Floyd was spinning towards Charleston. I was on Team A, the first response team. Driving down Interstate 26, I was acutely aware that there was no other traffic going into Charleston.   In the westbound lane, traffic was inching along bumper to bumper. Ambivalent could be an accurate description of how I was feeling. I wanted to do what was right but I wasn’t ecstatic about being in the path of a hurricane and away from my family who was leaving the area.   Arriving on 8 East at 2 p.m., I received a report on the patients from rooms 816, 817, 819, and 820.   On most occasions I would conduct a walking round of patients with the registered nurse I was relieving. However, the RN was in a hurry to get home to her family. Instead, I started my assessments in room 816 and worked my way to 820.   About a half-hour later, in room 820, I found Mr. N. From the kardex and report, I learned he was 59 years old, had a history of COPD and polio. He arrived on the unit the day before and was a general medicine patient.   The reason for his admission was altered mental status and pneumonia. He was being monitored by telemetry and was restrained as he had repeatedly attempted to pull his IV out.   I noted that he had no visitors and was not moving. His lips appeared bluish in color.   As I began my examination of Mr. N, I observed that he appeared to be sleeping and his respiration was shallow with a rate of 40. I immediately raised the head of the bed. Mr. N was receiving two litres of oxygen through nasal canula prongs. I inspected the thorax, percussed, and then listened to the chest. Percussing the right side I noticed hyperresonance (increased sound) and I heard no lung sounds.   Only the left side of his chest was rising. Ausculating the heart I noted the heart rate was 140, just as the telemetry unit paged me to say the same thing. I asked the PCT to get a set of vital signs while I phoned the resident on call.   His blood pressure was 90/60, respirations 40, heart rate 144, oxygen saturation 89, and he was groaning and gesturing towards his right side. The resident asked for arterial gases to be done. I asked the resident if we could get a stat portable chest X-ray. He agreed and stated that he would assess the patient. I paged the respiratory therapist and turned up the oxygen to four litres on the patient.   I asked the PCT to retrieve a chest tube tray, pleurovac, Vaseline, tape, and a bottle of sterile water. The respiratory therapist drew an arterial blood gas just as the resident arrived. He assessed the patient and immediately asked for a chest tube and called for the senior pulmonary resident on call.   We prepared Mr. N and called his family to let them know of his deteriorating condition. I retrieved and administered morphine sulfate. The two residents then decompressed the lung and inserted a thoracostomy tube.   Immediately, Mr. N’s color improved. The oxygen saturation monitor read 95. Mr. N’s heart rate went to 92 with blood pressure 120/70. He began to talk rapidly as everyone breathed a sigh of relief. He appeared to be on the road to recovery and I monitored his recovery for the next two days.   This situation reinforced my belief in walking rounds. I feel that if my colleague and I had conducted walking rounds, then the situation could have been found earlier and not advanced to critical status.   I now conduct walking rounds on all my patients at shift change. In fact, there are three of us now that insist upon it.     The walking rounds on patients led to a change in other facets of care on the nursing unit.   Discussing discharge planning one day, a colleague and myself were dismayed about the length of time the meetings ate up. I mentioned it would be faster if we could go to the bedside. We decided to trial walking discharge rounds.       Before the change in practice, discharge planning was long and laborious. Everyone would gather in the conference room and wait for the bedside nurses to find time away from the patients to attend the session, but they couldn’t always get away.   Now the discharge team goes from room to room to discuss each patient’s discharge needs. We close the patient’s door and surrounding doors to maintain patient confidentiality and reopen them to greet the patients. The time required for discharge rounds was reduced in half and the floor nurses are able to participate without leaving the nursing unit and patient care.   All parties have expressed satisfaction with the new change of practice. Ultimately, the patients receive better care because the entire health care team is better informed.   Friday, July 22, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to petersnd@musc.edu or catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Community Press at 849-1778.