Nurse Led Rounds - IQIC

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Nurse Led Rounds11th Global Forum of Humanitarian Assistance in Cardiology andCardiac SurgeryInternational Quality Improvement Collaborative(IQIC) Learning SessionsGeneva June 24-27 2015Frank Molloy RN, MSC ANP (UK)Clinical Nurse Specialist, Educator & Co-FounderThe William Novick Global Cardiac AllianceNurse Led Rounds by Frank Molloy RN, MSc ANP is licensed under aCreative Commons Attribution-NonCommercial 4.0 InternationalLicense.2

Disclosures Personal and professional observations fromover 15 years of international assistance work Covers two large NGO’s (current - NCA and former ICHF) No work is proprietary3

Core Messages4

Core messages Rounds - define Other communication agendas Nurse led rounds - how to Experience from sites Visiting teams Pro and con nurse led rounds5

RoundsFrank Molloy RN, MSC ANP (UK)Clinical Nurse Specialist, Educator & Co-FounderThe William Novick Global Cardiac Alliance6

Rounds“Bedside visits by a physician—or other healthprofessional—to evaluate treatment, assesscurrent course and document the patient’sprogress or und7

Rounds“In a teaching conference which theclinical problems encountered in thepractice of medicine, dentistry, nursing, orother service are d8

Rounds9

Rounds Rounds - treatment planning, as a bedsideevent Information - sequence Discussion and decision Almost always includes teaching Discussion and decision - plan9

Rounds Rounds - treatment planning, as a bedsideevent Information - sequence Discussion and decision Almost always includes teaching Discussion and decision - planclinical “communication agenda”9

Communication AgendasFrank Molloy RN, MSC ANP (UK)Clinical Nurse Specialist, Educator & Co-FounderThe William Novick Global Cardiac Alliance10

Communicaton Agenda Defined Speaker(s) Specific information Defined time Listeners and Participants Relevant to the information presented11

Communicaton Agendas12

Communicaton Agendas Examples Airline Safety briefing Preoperative time out12

Communicaton Agendas Examples Airline Safety briefing Preoperative time out12

Communicaton Agendas Examples Airline Safety briefing Preoperative time out12

Communicaton Agendas Examples Airline Safety briefing Preoperative time out Reading the rights12

Communicaton Agendas Examples Airline Safety briefing Preoperative time out Reading the rights12

Communicaton Agendas Examples Airline Safety briefing Preoperative time out Reading the rights12

Communicaton Agendas Examples Airline Safety briefing Preoperative time out Reading the rights Information relevant to listener and withinthe scope of responsibility of the speaker12

Golden Rules - Communication Agenda13

Golden Rules - Communication Agenda Everybody listen13

Golden Rules - Communication Agenda Everybody listen No background conversations13

Golden Rules - Communication Agenda Everybody listen No background conversations No taking calls or looking at phones13

Golden Rules - Communication Agenda Everybody listen No background conversations No taking calls or looking at phones Don’t interrupt13

Golden Rules - Communication Agenda Everybody listen No background conversations No taking calls or looking at phones Don’t interrupt Speaker - be concise - and correct13

Golden Rules - Communication Agenda Everybody listen No background conversations No taking calls or looking at phones Don’t interrupt Speaker - be concise - and correct Listeners - be patient and attentive13

Communicaton Agendas Examples Airline Safety briefing Preoperative time out Reading the rights Information should be relevant to listener and the resposibiitoes of the listener14

Communicaton Agendas Examples Airline Safety briefing Preoperative time out Reading the rights Information should be relevant to listener and the resposibiitoes of the listener14

Communicaton Agendas15

Rounds - Structure16

Rounds - Structure Someone is speaking16

Rounds - Structure Someone is speaking Team is listening16

Rounds - Structure Someone is speaking Team is listening Sequence of information16

Rounds - Structure Someone is speaking Team is listening Sequence of information Added information other team members16

Rounds - Structure Someone is speaking Team is listening Sequence of information Added information other team members Insights, conclusions,16

Rounds - Structure Someone is speaking Team is listening Sequence of information Added information other team members Insights, conclusions, Questions and Plan16

Rounds - Structure Someone is speaking Team is listening Sequence of information Added information other team members Insights, conclusions, Questions and Plan move on .16

Making it work17

Making it work Presenting structure17

Making it work Presenting structure Primary presenter - who ?17

Making it work Presenting structure Primary presenter - who ? Additional information17

Making it work Presenting structure Primary presenter - who ? Additional information Listening structure17

Making it work Presenting structure Primary presenter - who ? Additional information Listening structure Know the sequence17

Making it work Presenting structure Primary presenter - who ? Additional information Listening structure Know the sequence Dont interrupt17

Making it work Presenting structure Primary presenter - who ? Additional information Listening structure Know the sequence Dont interrupt Part of the routine17

Rounds, Handover, OR signout18

Rounds, Handover, OR signout Common features Schedule of who should speak and when Every one else should be listening - or notpresent The information IS IMPORTANT Transferable team based skills18

Nurse led roundsFrank Molloy RN, MSC ANP (UK)Clinical Nurse Specialist, Educator & Co-FounderThe William Novick Global Cardiac Alliance19

Nurse led rounds?20

Nurse led rounds? Nurse introduced rounds - nurse is the firstspeaker on a communication agenda20

Nurse led rounds? Nurse introduced rounds - nurse is the firstspeaker on a communication agenda Common issues with other clinicalCommunication Agendas . e.g.20

Nurse led rounds? Nurse introduced rounds - nurse is the firstspeaker on a communication agenda Common issues with other clinicalCommunication Agendas . e.g.- OR-ICU (anaesthesiologist or surgeonfirst),20

Nurse led rounds? Nurse introduced rounds - nurse is the firstspeaker on a communication agenda Common issues with other clinicalCommunication Agendas . e.g.- OR-ICU (anaesthesiologist or surgeonfirst),- end of shift (end of shift person starts),20

Nurse led rounds? Nurse introduced rounds - nurse is the firstspeaker on a communication agenda Common issues with other clinicalCommunication Agendas . e.g.- OR-ICU (anaesthesiologist or surgeonfirst),- end of shift (end of shift person starts),“Handovers” (Sign-outs, Sign-offs, Hand-offs)20

Clinical Communication Agendas21

Clinical Communication Agendas Quality of information spoken is important Quality of listening is equally important21

Handovers and Rounds - Differences22

Handovers and Rounds - Differences Handover objective is pure information transfer22

Handovers and Rounds - Differences Handover objective is pure information transfer- Go home and don’t get called with a question22

Handovers and Rounds - Differences Handover objective is pure information transfer- Go home and don’t get called with a question May be less listeners (less pressure)22

Handovers and Rounds - Differences Handover objective is pure information transfer- Go home and don’t get called with a question May be less listeners (less pressure) Single responsible individual22

Handover or Rounds - Similarities23

Handover or Rounds - Similarities Rounds - Basic information sequence is same23

Handover or Rounds - Similarities Rounds - Basic information sequence is same Rounds usually closely follows a shift change- Nurse handovers can be a rehearsal for nurseled rounds23

Handover or Rounds - Similarities Rounds - Basic information sequence is same Rounds usually closely follows a shift change- Nurse handovers can be a rehearsal for nurseled rounds Same information structure can be used in both23

Information Structure - nurses24

Information Structure - nurses With a good Information Structurepresenting the information - Can be done by nurses at all levels24

Information Structure25

Information Structure Who is the patient Demographics and diagnosis What operation - and when What were the perioperative issues and earlypost course, recent events What is status and progress in last 12 hours - andnow25

Junior Nurses - Information presentation26

Junior Nurses - Information presentation Fact based presentation May miss some rich detail e.g. breath sounds, heart sounds, complexity ofoperative details Will stick to the script Information may be incomplete - but it is rarely “wrong” Listener needs to work DO NOT INTERRUPT26

Junior Nurses27

Junior Nurses Generally will not create linkages betweensystems Story will not have a bias based on an opinion27

More experienced Nurses28

More experienced Nurses Fact based presentation28

More experienced Nurses Fact based presentation Add skills based observations28

More experienced Nurses Fact based presentation Add skills based observations Strays from the script - appropriately links cardiac andrespiratory and renal issues in a narrative28

More experienced Nurses Fact based presentation Add skills based observations Strays from the script - appropriately links cardiac andrespiratory and renal issues in a narrative May be repetitive, and longer28

More experienced Nurses Fact based presentation Add skills based observations Strays from the script - appropriately links cardiac andrespiratory and renal issues in a narrative May be repetitive, and longer Forms an opinion,28

Expert / Advanced29

Expert / Advanced Rich observational information throughout Strays from the script - appropriately links cardiacand respiratory and renal issues in a narrative Summarises based on context29

Depth of Presentation30

Depth of PresentationBasic - Short and Factual30

Depth of PresentationBasic - Short and Factual30

Depth of PresentationBasic - Short and FactualInteremediate - combines some opinions,linkeages and suggests diagnosisfrom issues30

Depth of PresentationBasic - Short and FactualInteremediate - combines some opinions,linkeages and suggests diagnosisfrom issues30

Depth of PresentationBasic - Short and FactualInteremediate - combines some opinions,linkeages and suggests diagnosisfrom issuesAdvanced - Integrated thinking,informed recommendations,can outline majority of the plan30

Examples - sitesFrank Molloy RN, MSC ANP (UK)Clinical Nurse Specialist, Educator & Co-FounderThe William Novick Global Cardiac Alliance31

Sites AFIC - Rawalpindi STAR hospitals Hyderabad Beijing Childrens Hospital Skopje Paediatrc Surgical Clinic Kharkiv Centre for Urgent and General Surgery Tobruk Medical Centre Guayaquil - Hosp Fco y Casa Bustamante32

AFIC - Rawalpindi33

AFIC - Rawalpindi Collaboration June 2005-Dec 2009 (19 trips)33

AFIC - Rawalpindi Collaboration June 2005-Dec 2009 (19 trips) Nurse Led Rounds - introduced at beginning of ourcollaboration - nurse educator resident in country infirst phase33

AFIC - Rawalpindi Collaboration June 2005-Dec 2009 (19 trips) Nurse Led Rounds - introduced at beginning of ourcollaboration - nurse educator resident in country infirst phase Simultaneous creation of new paediatric team withinCICU33

AFIC - Rawalpindi Collaboration June 2005-Dec 2009 (19 trips) Nurse Led Rounds - introduced at beginning of ourcollaboration - nurse educator resident in country infirst phase Simultaneous creation of new paediatric team withinCICU Nurse (8-12) v Doctor (1)ratio favourable to nurseled rounds structure33

AFIC - Rawalpindi Collaboration June 2005-Dec 2009 (19 trips) Nurse Led Rounds - introduced at beginning of ourcollaboration - nurse educator resident in country infirst phase Simultaneous creation of new paediatric team withinCICU Nurse (8-12) v Doctor (1)ratio favourable to nurse Minimal written structure- mentored and taughtled rounds structuresequence33

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AFIC - Rawalpindi35