Interdisciplinary Rounds in TLC

1
Interdisciplinary Rounds in TLC

• Utilizing Nurses to help in Decision Making

2
Introduction of Presenters

• Leza Warnke RN
• TLC Unit Council Chair
• Lisa Davis RN
• TLC Unit Council Co-Chair

3
WELCOME to TLC

• Where a team approach is necessary and patient
  care is 1

4
NDNQI

• National Database of Nursing Quality Indicators
• Yearly Goal setting
• Goal picked based on satisfaction scores
• 2010 Goal Improve RN satisfaction in
  participation in Decision Making
• Would like to see score higher based on data
  supporting RN satisfaction directly correlating
  with interdisciplinary communication and patient
  outcomes.

5
As a unit, we focus on a Healthy Work Environment
in addition to achieving excellent clinical
outcomes. Communication skills are just as
important as clinical skills.
6
Purpose

• To familiarize new Medical Residents and Interns
  to the purpose of TLC Interdisciplinary Rounds
  and ways to utilize Nurses in their decision
  making.

7
Goal

• Physicians and nurses will communicate,
  coordinate and collaborate using shared decision
  making to provide the patient and their families
  the best care possible.

8
Interdisciplinary Rounds in TLC

• Two teams, each consists of the following
• Attending Physician, Fellow, Residents, Intern,
  Medical Student
• Nurse with or without a Nurse Resident
• Pharmacist
• Respiratory Therapist
• Dietician
• Patient and Family

9
Day Rounds

• Usually Attending Physician driven
• Take place after 0800 CXR rounds at approximately
  0830 until finished
• In depth look at each TLC patient
• Involves input from each person of the
  Interdisciplinary Team

10
Evening Rounds

• Sign Out
• Admitting team gets sign out from post-call team
  of each TLC followed patient at approximately
  1600 or earlier
• Quick rounds outside each TLC patient room.
  Physicians have already gone over each patient
  with each other independently.

11
Night Rounds

• On-call team rounds on each patient at
  approximately 2100
• Not as in depth as Day Rounds
• Purpose is to go over plan for the night with
  each TLC followed patient
• Excellent way to prevent AM labs and CXR from
  being forgotten
• Nurse is available to go over plan to prevent
  unnecessary pages

12
Nurse importance during Interdisciplinary
Rounds in decision making

• Important to get Nurses perspective of plan of
  care
• At the bedside more continually
• Can provide some insight that a snapshot view
  may not be able to see

• Family Issues
• Sedation
• Spontaneous Breathing Trials
• IV access
• Pain
• Wounds
• Transfer Status
• End of Life

13
When your TLC rotation ends.

• Communication strategies
• Collaborate with TLC team in developing the plan
  of care, especially during the night when
  resources are limited
• Check in with Nurse if there is anything that
  needs to be clarified.
• If you receive a page to clarify, it probably
  wasnt clear
• If possible, join Interdisciplinary Rounds with
  TLC to get the plan of care clarified.

14
Benefits for you

• Less pages
• More well rounded view of the patient
• Mutual respect
• Use these skills as your career progresses

15
Take home points

• We all have the same goal Optimal Patient Care
• We learn from each other.
• We need each other to care for the patient.
• Miscommunication kills patients.
• Silence Kills
• If you have a question, ask. Nurses are excellent
  resources.

16
THANK YOU!
17
References

• Vazirani, S., Hays, R., Shapiro, M., Cowan, M.
  (2005) Effect of a Multidisciplinary Intervention
  on Communication and Collaboration among
  Physicians and Nurses. American Journal of
  Critical Care, 14, 71-77.
• Yeager, S. (2005) Interdisciplinary
  Collaboration The Heart and Soul of Health Care.
  Critical Care Nursing Clinics of North America,
  17, 143-148
• Stein-Parbury, J., Liaschenko, J. (2007)
  Understanding Collaboration between Nurses and
  Physicians as Knowledge at work. American Journal
  of Critical Care,16, 470-477
• Fewster-Thuente, L., Velsor-Friedrich, B. (2008)
  Interdisciplinary Collaboration for Healthcare
  Professionals Nursing Administration Quarterly,
  32, 40-48