Rounding in icu 2015
- 1. Purposeful Rounding in the ICU: Enhancing Communication WFCCN CONGRESS 2015 GORDON SPEED DUNEDIN, NEW ZEALAND
- 2. New Zealand
- 4. Land of the “Long White Cloud” on a good day
- 5. My Area
- 6. Rounds: A teaching conference or a meeting in which the clinical problems encountered in the practice of nursing, medicine, or other service are discussed. Mosby’s medical dictionary, 8th edition 2009, Elsevier
- 7. This talk is about: A discussion on various methods of communication to ensure best patient outcome. It will look at various types of Rounds including purposeful rounding and planned daily, or more frequent, interdisciplinary rounds.
- 8. Will look at: Purposeful rounding Daily interdisciplinary round
- 9. It is not going to look at: Nursing rounds* Nursing handover / hand-off Shift handover / hand-off *The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care: Pre-test post-test comparative study Leanne M. Aitken, Elizabeth Burmeister, Samantha Clayton, Christine Dalais, Glenn Gardner International Journal of Nursing Studies, 48 (2011) 918-925. Retrieved August 2015 http://www.journalofnursingstudies.com/article/S0020-7489(10)00359-7/pdf
- 10. Example from an American medical view: Bedside round only Rounds take too long (three hours+) Multiple interruptions (phone, visiting specialists, calls for immediate care, X-ray and other tests) Structure of nursing handover not useful (Long, system based and often not relevant) Structure varies with lead doctor Noisy unit How could this be done better?
- 11. What happens in Dunedin Hospital?
- 13. Small Unit 300 bed hospital 12 beds, but staffed for six Cardiac surgery, neurosurgery, paediatrics, trauma, etc. Retrieval service – nurse and doctor on helicopter, referrals from large area 40 Full time equivalent nurses, 37 have a post graduate qualification in Intensive Care. 30% have 20 years+ experience in ICU Most patients intubated so 1:1 nursing, separate High Dependency Unit
- 14. Daily routine: 0700 Nurse handover – 3 minutes brief all patients, then bedside 1:1 0800 Ward Round Sit down, Doctors, Nurses, Physiotherapist, Pharmacist. Sometimes Dietician, Biochemist, others 0900 Walk around round Doctors, Pharmacist, bedside Nurse 1700 Doctors walk around round/handover 1900 Nurse handover as above 2100 Doctors walk around round
- 15. 0800 ward round: Small Room No air conditioning or windows Handover structure not fully consistent Nurses handover on Wednesday Interruptions Limited ability to visually present data
- 17. So how can this be better? Critical Care Medicine, August 2013, vol 41, no. 8 pg 2015 - 2029
- 19. What do we do right? Multidisciplinary team Standardised time, location and team. Explicit roles for each team member Reduce non essential time wasting activities Focus discussions on daily goals Conference room and bedside used. Open collaborative discussion environment
- 20. What could we do better? Develop and implement structured tool (best practices checklist) Minimise unnecessary interruptions Better physical environment Improve visual presentation of patient information
- 21. Purposeful rounding? Purposeful or Intentional rounding is an evidence based methodology designed to improve the patient experience through the use of a structured hourly (or longer) rounding routine.
- 22. Even has a conference!
- 23. How does it work Patient visited every hour by nurse and checked for Positioning Personal needs Pain Placement As well as perform scheduled tasks Documentation
- 24. Variations Who visits How often Structured behaviours Documentation
- 25. Benefits (Ward based) Call bell usage (37% decrease) Falls (52% decrease) Pain reduced Pressure sore incidence (14% decrease) Patient satisfaction (12% increase) Nurse Satisfaction (20% reduction in distance walked!)
- 26. What about ICU? Little evidence One presentation to European conference about 12 hourly rounding in an ICU – reduced pressure ulcers In Dunedin we already do hourly observations and have 1:1 nursing; so role of intentional rounding is less clear
- 27. Intentional Rounding: What is the evidence? Policy+ Issue 35, April 2012, King’s College London National Nursing Research Unit. Retrieved August 2015 https://www.kcl.ac.uk/nursing/research/nnru/policy/By-Issue-Number/Policy--Issue- 35final.pdf
- 28. So what should the American example do? ?
- 29. What about Dunedin? Improving nurse handover during rounds in Dunedin ICU. Nurses vary but often find handover scary and stressful. Would a structure and checklist help?* *Quality and Safety at the point of care: how long should a ward round take? Herring, R. Desai, T, Caldwell, G. Clinical Medicine 2011, Vol11, No 1:20-2 Retrieved August 2015 http://www.clinmed.rcpjournal.org/content/11/1/20.long
- 30. And what do you do? ?
- 31. What questions do you have?
- 32. Kamsahmnida