Interprofessional Rounding Presentations

Size: px

Start display at page:

Download "Interprofessional Rounding Presentations"

Imogene Gaines
5 years ago
Views:

Interprofessional Rounding Presentations Sue

Health Sciences Centre INTER-PROFESSIONAL STROKE

1 Interprofessional Rounding Presentations Sue Kelly & Diana Williamson, Grey Bruce Health Services Sandi Pincombe, St. Thomas Elgin General Hospital Sheila Hunt, London Health Sciences Centre INTER-PROFESSIONAL STROKE ROUNDS GREY BRUCE HEALTH SERVICES OWEN SOUND Acute Stroke Forum 2016 London, ON 1

2 WHO ARE WE AT GBHS Grey Bruce Health Services Owen Sound Grand Opening of Acute Stroke Unit (ASU) April/May bed ASU within our 6 bed cardiac stepdown unit - Telemetry monitoring 24/7 Thrombolytic Ischemic Strokes go to ICU for first 24-hours then transfer to ASU NON-Thrombolytic Ischemic Strokes directly to ASU Inter-professional Rounds is NEW to our ASU Acute Stroke Team Membership includes: NURSING, Unit Coordinator, PT, OT, RD, SLP, NP, SW, Stroke Educator, CCAC Meet at 2:30pm EVERY day 11/16/2016 Susan Kelly - NP District Stroke Centre Diana Williamson District Stroke Educator 3 WHY THE ADDITION OF STROKE ROUNDS Educational Venue for all members to learn about each other s roles A&P of strokes, neurology, assessments, test interpretation Communication tool For team members, patients and family members Utilize patient s whiteboard to indicate care needs Key disciplines in care provide patient/family with update post daily rounds Answer questions patient/family may have or bring questions back to the team Discharge Planning: Nurse leads rounds - case report and HPI for new admission presentation followed by brief daily updates Each team member adds their current day-to-day assessment and plan Electronic Rehabilitation Referral is started in rounds and completed by each team member Communication is made directly to Rehab Unit Coordinator 11/16/2016 Susan Kelly - NP District Stroke Centre Diana Williamson District Stroke Educator 4 2

OUTCOMES OF INTER-PROFESSIONAL ROUNDS Team building Improved respect for colleagues and roles Holistic Patient Centered Care Timely navigation through the stroke care continuum ER ICU/ASU Rehab

3 OUTCOMES OF INTER-PROFESSIONAL ROUNDS Team building Improved respect for colleagues and roles Holistic Patient Centered Care Timely navigation through the stroke care continuum ER ICU/ASU Rehab Rehabilitation starts immediately at the bedside Improved patient education of individualized care plan including diagnosis, Risk Factor identification and treatment and next steps Team awareness of QBP 11/16/2016 Susan Kelly - NP District Stroke Centre Diana Williamson District Stroke Educator 5 CHALLENGES FOR START UP Engagement of team members Daily attendance and on-time arrival Opportunity for Primary Care RN to attend rounds KEY to latest patient condition! Allowing each team member to work to scope Some overlap of roles occurs takes time to work through it as a TEAM Access to patient information Currently in paper/e-doc limbo! Limited access to online information during rounds 6 11/16/2016 Susan Kelly - NP District Stroke Centre Diana Williamson District Stroke Educator 3

LESSONS LEARNED Ensure Primary Care RN is part of the team Find a time that works for ALL members of the team NEED commitment from staff and support from administration Ensure Physician

across continuum Inclusion of Unit Coordinator for appropriate patient disposition within the stroke care continuum 11/16/2016 Susan Kelly - NP District Stroke Diana Williamson District Stroke

4 LESSONS LEARNED Ensure Primary Care RN is part of the team Find a time that works for ALL members of the team NEED commitment from staff and support from administration Ensure Physician (Neurologist/Internist) can attend at least once per week Clinical Lead necessary for continuity and flow NP role as Clinical Lead provides medical continuity and coordination of transfer of care across continuum Inclusion of Unit Coordinator for appropriate patient disposition within the stroke care continuum 11/16/2016 Susan Kelly - NP District Stroke Diana Williamson District Stroke Educator 7 NEXT STEPS Inter-professional rounds continually evolve over time be flexible Engage Neurologist to attend rounds at least weekly for care planning and educational support Make rounds a group learning environment Bring interesting literature findings forward Examine thrombolytic stroke data, provide feedback Survey Acute Stroke Team to assess current format, areas for improvement/change and development implementation plan 8 11/16/2016 Susan Kelly - NP District Stroke Centre Diana Williamson District Stroke Educator 4

5 Acute Stroke Forum Professional Rounding Background Integrated Stroke Unit(ISU) opened at STEGH in April 2016 (3 acute beds and 5 rehab beds with 2 flex beds). QBP states, The interprofessional stroke team should meet regularly to discuss assessment of new patients, review patient management and goals, and plan for discharge (9.4.2) (Health Quality Ontario, Dec. 2015) Professional Rounding The purpose is for all disciplines to be involved with discharge planning and meeting patient specific goals. Rounding takes place three days per week Monday, Wednesday and Friday next to the Huddle Board, which acts as a communication tool. 5

6 Professional Rounding The huddle board is used to keep OT, PT, SLP, Nursing, Coordinated Access, Social Work, Dietitian and physician informed of where the patient is with discharge planning and what the patient s goals are prior to discharge. Legend 6

Legend The coloured magnets indicate: Red - greater than 72 hours Yellow- 24-72 hours

7 Legend The coloured magnets indicate: Red - greater than 72 hours Yellow hours Green- less than 24 hours Black - a new referral which has not yet been assessed Huddle Board 7

Huddle Board Huddle Board Information collected on the Huddle Board includes: Acute Admit Date Alpha FIM Score and when due to be competed EDD (estimated date of discharge) Anticipated

8 Huddle Board Huddle Board Information collected on the Huddle Board includes: Acute Admit Date Alpha FIM Score and when due to be competed EDD (estimated date of discharge) Anticipated Discharge date Discharge Destination, referral to CSRT Family Meetings Notes: special diets, MoCA This encourages an acute awareness of the patients and target timelines to complete their goals. 8

9 Lessons Learned A need for sufficient huddle board columns to collect the information needed to understand the patient. The board needs to be constantly updated to be an effective communication tool Outcomes Professional rounding three times per week using our huddle board keeps the team informed and efficient with target lengths of stay. There is an acute awareness of timelines which enables the ISU team to meet the target length of stay depending on if the patient has had an ischemic or hemorrhagic stroke. 9

Neuroscience on 7 th floor Neurosurgery Non-Stroke Neurology

10 Interprofessional Stroke Rounds Acute Stroke Forum November 2016 Sheila Hunt University Hospital 407 Beds total Clinical Neuroscience on 7 th floor Neurosurgery Non-Stroke Neurology Stroke 64 beds total 3 Hyperacute Stroke 18 Acute Stroke 10

11 Before We did Interprofessional Rounds but: Poor attendance Hard to hear, crowded Unclear guidelines Took too long The Change Stroke Sustainability Committee Stroke Best Practice Working Group was formed to address rounds 11

12 Stroke Bullet Rounds Guidelines Stroke Bullet Rounds Guidelines Posted where rounds take place ed to all staff 12

13 Lessons Learned What worked? Working group What didn t work? Advice? Clear, written guidelines Sustainability group 13

14 Next Steps What do you still have to address? RN engagement?survey the barriers?possible solutions Ongoing maintenance with Stroke Sustainability Committee and working group Ongoing communication 14

INCLUSION CRITERIA. REMINDER: Please ensure all stroke and TIA patients admitted to hospital are designated as "Stroke Service" in Cerner.

INCLUSION CRITERIA. REMINDER: Please ensure all stroke and TIA patients admitted to hospital are designated as Stroke Service in Cerner. ACUTE STROKE CLINICAL PATHWAY The clinical pathway is based on evidence informed practice and is designed to promote timely treatment, enhance quality of care, optimize patient outcomes and support effective