Date of Graduation
Project/Capstone - Global access
Master of Science in Nursing (MSN)
School of Nursing and Health Professions
The nature of this project is to improve communication, within the interdisciplinary team, the patients and families by establishing nurse-driven daily multidisciplinary rounds (MDR). The intensive care environment is quite frightening and disorienting for the patients and families due to the technology used, the constant care involved and the delirium that often ensues. The large number of professionals involved in care due to the complexity of the health issues the critically ill patients face also intensifies the amount of information the patients and families need to process.
Coordination of care can be complex and difficult. The social issues observed in the population served by the microsystem have increased significantly since the hospital has joined the county system and since the covid-19 pandemic began. This complexity of care has repercussions on the nurses’ workload. Enhanced communication with other professionals such as social workers and case managers will help the team to address those issues in a timely fashion and more effectively since rounds save time since all professionals get the same information simultaneously and then all have a consistent message with the patient (Hospital Case Management, 2016). Therefore, a nurse-led interdisciplinary daily rounding is needed to improve communication, patient's safety and increase patients, families and staffs’ satisfaction.
The goal of this project is to implement structured nurse-led multidisciplinary daily rounds. The project will be implemented using a fifteen minutes teaching session with a power point presentation. The visual support of the power point presentation will be available for consultation at a later time by all employees. The structured rounds will be based on evidence-based practice guidelines. Guidance will be provided to the team about which care issues should be discussed and how efficiently to prepare for the rounds. A critical care multidisciplinary rounds tool will be used to guide the rounds and point out pertinent aspect of care to be discussed. Dutton et al. (2003) have concluded that using a rounding script to guide nurses during multidisciplinary rounds contributed to the successful implementation. In order to improve satisfaction and safety, in-person coaching about how to integrate patients and families in the rounds will be part of this overall project. For the first couple weeks, support and feedback will be provided by the Clinical Nurse Leader (CNL) during daily rounding.
Nurses and patient's satisfaction surveys (see Appendix K) (see Appendix L) will be distributed pre and post-intervention in order to measure the effect of the MDRs. Alert and oriented patients are asked to fill out a pre-intervention satisfaction surveys from patients showed that communication with the healthcare team was consistently ranked at the lowest of the satisfaction score. Using a likert scale from 0 to 4, communication with nurses and physicians was ranked an average of 3.78 (94%) for the pre-intervention survey. A month after implementation, the patient’s satisfaction surveys showed an average of 3.88 (97%), the highest score recorded. 2 months later the average score was 3.75 (94%) and the final score after 3 months of implementation was 3.81 (95%). This represents only a minimal variation of one percent. Given the results, the improvement is not significant and the results are nonconclusive. The pre-implementation Healthy Work Environment (HWE) Survey taken by staff nurses assessed communication using three sections: skilled communication, true collaboration and effective decision making (see Appendix L). The pre-intervention average score was 3.9/5 (78%) and the post-intervention score improved to 4.3/5 (86%). This represents an improvement of 8%. This outcome was not reached either since the goal was to increase nurses’ satisfaction by 10%. The results are also nonconclusive.
The daily nurse-led multidisciplinary rounds project was very useful and beneficial for the microsystem. MDRs have proven to improve communication between professionals even though the surveys’ results were not conclusive. Feedback from nurses showed that cohesion improved in the multidisciplinary team regarding the plan of care. Rounds improve teamwork and consistency for the patient and family regarding care goals and instructions. Rounds have been in place for 3 months so the maintenance phase of the project can now start. In the future, the practice could be expended to the new progressive care unit that is projected to open in the next few months.
Champagne, Sandra, "Implementation of Nurse-Led Multidisciplinary Rounds in a Critical Care Unit" (2020). Master's Projects and Capstones. 1115.