interprofessional rounding...

2016/11/14

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Interprofessional Rounding

Presentations

Sue Kelly & Diana Williamson, Grey Bruce Health Services

Sandi Pincombe, St. Thomas Elgin General Hospital

Sheila Hunt, London Health Sciences Centre

INTER-PROFESSIONAL

STROKE ROUNDS

GREY BRUCE HEALTH SERVICES –

OWEN SOUND

Acute Stroke Forum 2016

London, ON

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WHO ARE WE AT GBHS

Grey Bruce Health Services – Owen Sound Grand Opening of Acute Stroke Unit (ASU) April/May 2015

4 bed ASU within our 6 bed cardiac stepdown unit - Telemetry monitoring 24/7

Thrombolytic Ischemic Strokes go to ICU for first 24-hours then transfer to ASU

NON-Thrombolytic Ischemic Strokes directly to ASU

Inter-professional Rounds is NEW to our ASU

Acute Stroke Team Membership includes: NURSING, Unit Coordinator, PT,

OT, RD, SLP, NP, SW, Stroke Educator, CCAC

Meet at 2:30pm EVERY day

11/16/2016

Susan Kelly - NP District Stroke Centre

Diana Williamson – District Stroke Educator

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WHY THE ADDITION OF STROKE ROUNDS

Educational Venue for all members to learn about each other’s roles

A&P of strokes, neurology, assessments, test interpretation

Communication tool For team members, patients and family members

Utilize patient’s whiteboard to indicate care needs

Key disciplines in care provide patient/family with update post daily rounds

Answer questions patient/family may have – or bring questions back to the team

Discharge Planning: Nurse leads rounds - case report and HPI for new admission

presentation followed by brief daily updates

Each team member adds their current day-to-day assessment and plan

Electronic Rehabilitation Referral is started in rounds and completed by each team member

Communication is made directly to Rehab Unit Coordinator 4


Diana Williamson – District Stroke Educator 11/16/2016

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OUTCOMES OF INTER-PROFESSIONAL

ROUNDS

Team building

Improved respect for colleagues and roles

Holistic Patient Centered Care

Timely navigation through the stroke care

continuum ER ICU/ASU Rehab

Rehabilitation starts immediately at the

bedside

Improved patient education of individualized

care plan including diagnosis, Risk Factor

identification and treatment and next steps

Team awareness of QBP 11/16/2016



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CHALLENGES

FOR START UP

Engagement of team members

Daily attendance and on-time arrival

Opportunity for Primary Care RN to attend

rounds – KEY to latest patient condition!

Allowing each team member to work to scope

Some overlap of roles occurs – takes time to work

through it as a TEAM

Access to patient information

Currently in paper/E-doc limbo!

Limited access to online information during rounds

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LESSONS LEARNED

Ensure Primary Care RN is part of the team

Find a time that works for ALL members of the

team – NEED commitment from staff and

support from administration

Ensure Physician (Neurologist/Internist) can

attend at least once per week

Clinical Lead necessary for continuity and flow

NP role as Clinical Lead provides medical continuity

and coordination of transfer of care across continuum

Inclusion of Unit Coordinator for appropriate

patient disposition within the stroke care

continuum

11/16/2016

Susan Kelly - NP District Stroke


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NEXT STEPS

Inter-professional rounds

continually evolve over time

be flexible

Engage Neurologist to attend rounds at least

weekly for care planning and educational support

Make rounds a group learning environment

Bring interesting literature findings forward

Examine thrombolytic stroke data, provide feedback

Survey Acute Stroke Team to assess current

format, areas for improvement/change and

development implementation plan

11/16/2016 Susan Kelly - NP District Stroke Centre


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Acute Stroke Forum

Professional Rounding

Background

• Integrated Stroke Unit(ISU) opened at STEGH in April 2016 (3 acute beds and 5 rehab beds with 2 flex beds).

• QBP states, “The interprofessional stroke team should meet regularly to discuss assessment of new patients, review patient management and goals, and plan for discharge (9.4.2)” (Health Quality Ontario, Dec. 2015)


• The purpose is for all disciplines to be involved with discharge planning and meeting patient specific goals.

• Rounding takes place three days per week Monday, Wednesday and Friday next to the Huddle Board, which acts as a communication tool.

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• The huddle board is used to keep OT, PT, SLP, Nursing, Coordinated Access, Social Work, Dietitian and physician informed of where the patient is with discharge planning and what the patient’s goals are prior to discharge.

Legend

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Legend

• The coloured magnets indicate:

• Red - greater than 72 hours

• Yellow- 24-72 hours

• Green- less than 24 hours

• Black - a new referral which has not yet been assessed

Huddle Board

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Huddle Board

Huddle Board • Information collected on the Huddle Board includes:

– Acute Admit Date

– Alpha FIM Score and when due to be competed

– EDD (estimated date of discharge)

– Anticipated Discharge date

– Discharge Destination, referral to CSRT

– Family Meetings

Notes: special diets, MoCA

This encourages an acute awareness of the patients and target timelines to complete their goals.

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Lessons Learned

• A need for sufficient huddle board columns to collect the information needed to understand the patient.

• The board needs to be constantly updated to be an effective communication tool

Outcomes

• Professional rounding three times per week using our huddle board keeps the team informed and efficient with target lengths of stay.

• There is an acute awareness of timelines which enables the ISU team to meet the target length of stay depending on if the patient has had an ischemic or hemorrhagic stroke.

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Interprofessional Stroke Rounds Acute Stroke Forum

November 2016

Sheila Hunt

University Hospital • 407 Beds total Clinical Neuroscience on 7th floor • Neurosurgery • Non-Stroke Neurology • Stroke

64 beds total • 3 Hyperacute Stroke • 18 Acute Stroke

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Before

We did Interprofessional Rounds but:

– Poor attendance

– Hard to hear, crowded

– Unclear guidelines

– Took too long

The Change

• Stroke Sustainability Committee

• Stroke Best Practice Working Group was

formed to address rounds

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Stroke Bullet Rounds Guidelines

Stroke Bullet Rounds Guidelines

• Posted where rounds

take place

• Emailed to all staff

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Lessons Learned

• What worked?

– Working group

• What didn’t work?

• Advice?

– Clear, written guidelines

– Sustainability group

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Next Steps

• What do you still have to address?

– RN engagement

– ?Survey the barriers ?possible solutions

• Ongoing maintenance with Stroke

Sustainability Committee and working

group

• Ongoing communication

interprofessional rounding...

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