Rounding with Purpose:Improving Communication, Safety and Collaboration with Nurse Driven, Multidisciplinary Family Rounds

Topic Significance & Study Purpose/Background/Rationale

With an emphasis on patient safety, hospitals are utilizing practice models that incorporate highly reliable (HRO) practices to decrease the potential for human error (Seago, 2008). Additionally, ineffective communication and communication failures are the most commonly cited causes for sentinel events and approximately 50 % of adverse events in the United States (JCAHO, 2008). In response to these patient safety concerns, communication during bedside patient rounds was examined on an in-patient Midwestern pediatric bone marrow transplant (BMT) unit. Improving the communication and collaboration within the multi-disciplined patient care team was addressed with the development and implementation of an HRO modeled report sheet, process and nurse lead bedside rounds.

Methods, Intervention, & Analysis

 The primary intervention used HRO principles to increase effective collaborative communication by incorporating bedside nursing presence, nursing participation and advocacy, patient / family presence, patient/ family participation in bedside rounds, and the implementation of a standardized report sheet.

Findings & Interpretation

BMT nurses were looking for a way to address patient care concerns and increase collaboration during the bedside rounding process. Pre-intervention data was gathered to assess the frequency of bedside nurse presence and participation during patient rounds at 37.5%. A standardized report sheet was developed by BMT nurses and physicians to address patient status, family concerns, and significant findings related to patient prevention standards, JCAHO and CMS compliance. Education was completed by all members of the multi-disciplined team. Post- intervention data collection via daily charge nurse audits is ongoing at 68 % measuring nursing presence, participation and use of standardized report sheet.

Discussion & Implications

BMT multi- disciplined teams are using this intervention to address ongoing collaborative communication needs in the complex care of pediatric BMT patients. Utilizing this tool assists in effective communication, forming a culture of safety and reliability using a standard HRO modeled report process, and addresses JCAHO and CMS compliance.