Effective Floor and ICU Rounding
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1 Effective Floor and ICU Rounding Scott C. Gardner, MMSc, PA-C Physician Assistant, Intermountain Medical Center, Intermountain Healthcare; Salt Lake City, Utah Objectives: Identify the elements of effective rounding Summarize the ideal data that is documented in a daily progress note Discuss barriers to effective rounding and strategies to overcome them
2 Effective Floor and ICU Rounding. Scott Gardner, M.M.Sc, PA-C Intermountain Medical Center Trauma Services
3 I have no disclosures
4 Rounding Topics Why When Where Who How
5 When Generally, the earlier the better: gives you more opportunity to accomplish goals earlier in the day before the inevitable interruptions. Round more than once if you have time. Follow up on diagnostics and therapy changes.
6 Why Identify, review, and summarize patient data Identify patient/family problems Define goals and discuss progress Identify interventions Revise goals and plans Making and clarifying responsibilities Improve communication with all parties Address patient and family concerns and answer questions
7 Where Stationary: Sitting in a rounds in a room with a projector Good: no moving required, can view images easier. Bad: takes nurse away from bedside, family not involved, can t examine patient while rounding. Bedside: walking rounds Good: family involved, nurse at bedside, examine patient while rounding, you can see tubes/lines/drains. Bad: mobility, large group takes up room and may be disruptive
8 Who Multidisciplinary team: Bedside nurse Attending physician Family PA/NP (APCs) Clinical pharmacist Respiratory therapist Nutrition support Social work/case management Therapies: PT/OT/speech pathology Student(s)
9 Advantages to Multidisciplinary Rounds Literature suggests: Improves outcomes Reduces errors Streamlines services Promotes effective use of resources Decreases length of stay Happier staff, patients and families Summarized from: Multidisciplinary Ward Rounds: A Resource NSW Health website
10 MDR cont. Real-time fact finding and decision making Consistency! Resolution of concerns and problems Unified approach with the family everybody hears the same thing. Review and implementation of protocols and guidelines Teaching opportunities Barriers: time constraints, availability, noise, interruptions (cell phones)
11 How Pre-rounds vs. discovery rounds Prioritize: procedures, discharge One person is the leader Problem list make it specific, up-to-date, and include dates and procedures. Someone to write orders Everyone should feel welcome and encouraged to participate. Follow a general outline - checklist
12 Checklist Medicine often compared to commercial aviation. A checklist helps you to be consistent in fact finding and planning. As in commercial aviation, checklists contribute to safety.
13 Example Ventilator settings and weaning progress Sedation holidays HOB 30 degrees Nutrition Review of indwelling catheters and need for each Stress ulcer prophylaxis DVT prophylaxis Activity
14 Example cont. Activity Pain control Simplification of medication list Antibiotics: Is it the right antibiotic for the right indication? How many days? Can it be narrowed? Review of culture data daily Follow your protocols and guidelines
15 Resources for ICU Checklist Measurable outcomes of quality improvement using a daily quality rounds checklist: one-year analysis in a trauma intensive care unit with sustained ventilatorassociated pneumonia reduction. Dubose J, Teixeira PG, Inaba K, Lam L, Talving P, Putty B, Plurad D, Green DJ, Demetriades D, Belzberg H. J Trauma Oct;69(4): Enhancing patient safety in the trauma/surgical intensive care unit. Stahl K, Palileo A, Schulman CI, Wilson K, Augenstein J, Kiffin C, McKenney M. J Trauma Sep;67(3):430-3; discussion Measurable outcomes of quality improvement in the trauma intensive care unit: the impact of a daily quality rounding checklist. DuBose JJ, Inaba K, Shiflett A, Trankiem C, Teixeira PG, Salim A, Rhee P, Demetriades D, Belzberg H. J Trauma Jan;64(1):22-7; discussion 27-9.
16 Thank You!
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