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ICU Collaborative Outcomes Congress. Landmark Medical Center September 22, 2009. Landmark’s Team. Daily rounds included team lead, clinical pharmacist, and individual nursing staff. The nurses voiced the following concerns:

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Icu collaborative outcomes congress

ICU Collaborative Outcomes Congress

Landmark Medical Center

September 22, 2009



  • Daily rounds included team lead, clinical pharmacist, and individual nursing staff.

  • The nurses voiced the following concerns:

    • Nurses interrupting patient care to give data to each discipline separately. This could cause a decrease in nursing care time spent at bedside

    • There was an opportunity for patient care to be fragmented when each discipline focuses on their own goals for the patient


Disciplines will round together daily individual nursing staff.

Projected Results:

1.Daily goals will be identified by utilizing input from all disciplines

2. Improved patient outcomes resulting from this collaboration of care

3. Increased SAQ scores in the areas of job satisfaction and teamwork.


Potential barriers
Potential Barriers individual nursing staff.

1. Intensivists keep varying hours

2. Coordination of disciplines to meet at one time

3. Workloads of each discipline

4. Staff resistance to interruption in nursing care


Enhanced Team individual nursing staff.

Team Members

  • Nursing staff

  • Clinical Pharmacist

  • Team lead

  • Respiratory Therapist

  • Clinical Dietitian

  • Senior Leadership

  • Case Management

Original Team


Steps taken toward meeting the goal
Steps Taken Toward Meeting the Goal individual nursing staff.

  • Gain support from senior leadership

  • Vice president of nursing, director of Diagnostic Services, and Associate Vice-President of Critical Care supported the decision to create a more effective rounding forum

  • Rounding time set to accommodate all members

  • Nutritional services and case management became interested in participating and were added to the team

  • Rounding tool was formatted to enhance all discipline’s participation


Education individual nursing staff.

&

Collaboration

Our Results

Dietitian

Pharmacy

Respiratory

Therapy

Team

Lead

Case

Management

Nursing

Leaders

Nurses


Successes and failures
Successes and Failures individual nursing staff.

  • 1 year = no VAPS

    = Ice Cream Sundae Celebration

  • 1 year = no BSI

  • Nurses actively participate with team and are knowledgeable in discussions concerning their patients

  • Quality improvement issues that were identified and implemented due to multidisciplinary rounding:

    • Implementation of mouth care products designed to reduce VAPs

    • Implementation of products to address skin integrity concerns: support surfaces, boots, specialty skin care products

  • Since physicians are unable to round with the group due to their varying schedules, a tool was developed to maintain communication with physicians and any other team member who may be unable to attend daily rounds


Our future plans
Our Future Plans individual nursing staff.

  • Administer SAQ to evaluate the effect of multidiscipline rounding on the SAQ score

  • Quality improvement projects that arose and are being pursued due to multidiscipline rounding

    • Monitor glucose to achieve improved glycemic control

    • Closely monitor length of dwelling time for central venous catheters.

    • Change to multi-lumen PICC lines for select patients. PICC insertion at bedside improving patient safety

    • Rounding extended to step-down unit


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