The Leeds Teaching Hospitals NHS Trust is one of the many organisations that have signed up to Safety Express, a pilot programme of the Department of Health’s Quality, Innovation, Productivity and Prevention safe care coalition. Its aim is to reduce avoidable harm to patients in four areas: trips and falls, pressure ulcers, catheter-associated urinary tract infections and venous thromboembolism. Hourly rounding (hourly checks on patients) has been identified as a means of reducing harm to patients. This article describes the preparation needed to introduce hourly rounding in a high dependency unit.