1. Family Presence in Multidisciplinary Rounds

2. Family Presence in Multidisciplinary Rounds
The process of rounds in hospitals is changing. Today we have an opportunity to learn from the experience of others and consider ways we might bring about change and improvement on our unit(s) to better serve Veterans and families and create a better learning environment for students and trainees.
Family Presence in Multidisciplinary Rounds

3. Doctor—Birmingham VAMC
This physician shares with us his perspective on why it is so important for everyone to hear the same information…
Click on black box on slide to activate.
MDR slide 3 VC AS6.wmv 
(Instructors, this is the transcript of the video: In my opinion one of the difficulties in communicating is telling everyone the same information. What I tell the wife, I may leave out part when I’m talking to the son and so they’re confused and then that makes me confused the next time we talk or whatever so I think somehow finding a way to do that on maybe not every day but on a consistent basis when people are in the hospital that’s what I’d like to do.)
Family Presence in Multidisciplinary Rounds

4. The process of rounds is changing…
Intentional restructuring of daily hospital medical rounds to enhance collaboration with patients and families and to facilitate better coordination among the all members of the care team.
Moving from the hallway to the bedside and engaging the patient and family in planning and decision-making.
Involving physicians, trainees, nurses, and staff from a variety of disciplines in the rounding process.
Including the bedside nurse and the charge nurse to share perspectives and ensure that they are informed about the plan of care and thus can be a source of ongoing information and support for the patient and family.
Review the key points on the slide.
The manner in which rounds are conducted is changing. Increasingly physicians, nurses and other members of the interdisciplinary team are including patients and families in the process of rounds.
Family Presence in Multidisciplinary Rounds

5. The Traditional Model of Rounds
Timing primarily based on physician schedule.
Information primarily transmitted from physician to patient.
Goals for hospitalization are not always explicit.
Other members of the care team are not necessarily present.
Teaching of students takes place separately.
Review the key points on the slide describing the traditional model of rounds.
This was the way care was planned and the way physicians learned clinical practice and communication skills. We are learning that there are better ways. . .
Family Presence in Multidisciplinary Rounds

6. Patient- and Family-Centered Rounds
Patients and families are viewed as partners in care and decision-making, not visitors.
Patients and families have a range of choices in how they can participate in rounds.
Efforts are made to schedule rounds to fit family availability.
Cincinnati Children’s Hospital Medical Center
2006 Recipient of the AHA McKesson Quest for Quality Prize
2008 Recipient of Picker Award for Excellence in the Advancement of Patient- Centered Care
Cincinnati Children’s Hospital Medical Center, a hospital nationally recognized for its efforts in safety and quality improvement, has been a national leader for changing the rounding process, serving as a resource for pediatric, neonatal, geriatric, and other adult hospital units. The concepts of patient- and family-centered care have informed the way rounds have been changed at this hospital.
Changes and improvements have been made within a context of respect and support for patients and their families‘ choices and priorities.
Family Presence in Multidisciplinary Rounds

7. Patient- and Family-Centered Rounds
Information is provided at admission to prepare patients and families for the rounds process and offer choices for participation.
Care team has had training in working together. Roles are clearly defined. Support resources are available.
Key members of the team participate; others may observe.
Orders are entered in the room; residents call the orders out loud.
Teaching occurs at the bedside.
While this article describes the process and results from a pediatric setting, we are discovering that these approaches and findings are very relevant and useful to adult health care settings.
Discuss the key points on the slide about the preparation of patients and families and other members of the care team for working together and highlights of the rounding process.
The Cincinnati Children’s Hospital Model: Muething, S. E., Kotagal, U. R., Schoettker, P. J., Gonzalez del Rey, J., & DeWitt, T. G. (2007). Family-centered bedside rounds: A new approach to patient care and teaching. Pediatrics, 119(4),
Family Presence in Multidisciplinary Rounds

8. Patient- and Family-Centered Rounds
Rounds take 20 % longer.
But overall daily time per patient is reduced.
Patients/families benefit from active preparation.
85% participation; satisfaction increased.
Staff feel more knowledgeable about the care plan.
Errors in orders decreased from 7-9% to 1%.
Education improved.
Faculty, students, residents all report increased satisfaction.
Review the findings/benefits shown on the slide.
A primary concern of both physicians and nurses is that patient- and family-centered rounds will take too long.
Ask the group how this collaborative approach to rounds at the bedside may actually save times.
The Cincinnati Children’s Hospital Model: Muething, S. E., Kotagal, U. R., Schoettker, P. J., Gonzalez del Rey, J., & DeWitt, T. G. (2007). Family-centered bedside rounds: A new approach to patient care and teaching. Pediatrics, 119(4),
Family Presence in Multidisciplinary Rounds

9. Family-Centered Rounds A Fundamental Shift in Practice…
Most orders and discharge paperwork are written and clarified on rounds which has helped with efficiency for the limited work hours for residents.
With nurses, families, and physicians all communicating at the same time during rounds, “there is exponentially less confusion about the plan of care.”
Discharge planning begins at admission and each member of the team contributes to carrying out and tracking well-defined goals.
“A care plan, truly comes together and becomes maximally effective when family, nurse, and physician can listen to each other’s points of view.”
“Nurse and physician both must actively participate and take ownership of the process.”
The core of physician reluctance is sharing uncertainty in front of the family.
The author of this article was a “disbeliever” and “skeptic” during the early part of his residency. He thought that family-centered rounds would not be an efficient process. With his training and experiences as a resident and learning from the modeling and mentoring from attending faculty, he became convinced of the many positive benefits of this approach to rounds. He also developed an appreciation for the role of nurses in multidisciplinary rounds.
Review slide.
Simmons, J. The Hospitalist, March 2006.
Family Presence in Multidisciplinary Rounds

10. Family Presence In Rounds
Ask the patient to define their family or other support persons and how they will be involved in care and decision-making as part of the admitting process to the unit.
Include the family/support person, according to patient preference, as another member of the health care team.
Ask the patient to identify any family members who should not be included in discussions during rounds or nurse change of shift.
Model open communication and clear and supportive language with patients, families, and health professionals from all disciplines.
Contrary to some beliefs, family presence in rounds is not contraindicated in an environment regulated by HIPAA.
In fact, family presence is not only possible, but has been associated with improved outcomes, fewer readmissions, and far greater patient and family satisfaction with care. But it does require a thoughtful and planned approach.
Review key points on the slide about how you can involve families according to patient preference and meet HIPAA requirements.
We will see shortly a demonstration on video.
There is additional material on rounds in the supplemental section of your Toolkit, as well as a resource related to HIPAA.
TOOLKIT REFERENCE:
RESPONDING TO HIPAA
Family Presence in Multidisciplinary Rounds

11. Collaborative Rounds in Cardiology
This excerpt on Collaborative Rounds in Cardiology, presents a non-hierarchical process for including adult patients, families, and staff and physicians from a variety of disciplines in the rounds process. In addition to portraying collaborative care planning, a model for identifying problems and solutions is shared.
Click on black box on slide to activate
MDR slide 11 VC Spirits.wmv
Family Presence in Multidisciplinary Rounds

12. Critical Care Tower Vanderbilt University Medical Center
Developed with Patient and Family Advisors
In critical care at Vanderbilt University Medical Center, patient and family advisors collaborated in the development of the Critical Care Patient & Family Guide. Families are not labeled as visitors. They are welcomed and encouraged to be present and to participate actively in the care and support for their loved one. You might read the welcome statement on the brochure’s center panel. Note also that the times for rounds are included in the brochure. This provides useful information to families and builds in some accountability for physicians.
Critical Care Tower Vanderbilt University Medical Center
Family Presence in Multidisciplinary Rounds

13. There is a trauma survivors network affiliated with the Trauma ICU at Vanderbilt University Medical Center. Note how families are encouraging and supported in participating in care and decision-making…even guidance for participating in rounds.
Review key section of displayed brochure, highlighting language that encourages and supports patient and family participation.
Family Presence in Multidisciplinary Rounds

14. Involvement in Rounds
The Georgia Health Sciences University and Medical College of Georgia, with support from the Picker Institute have developed a practical implementation guide that presents evidence-based references that support the case for implementing patient- and family-centered rounds. Essential criteria necessary to support a transition to rounds are presented, and basic steps to implement patient- and family-centered rounds are described.
Family Presence in Multidisciplinary Rounds

15. Patient- and Family-Centered Rounds
Strategies:
Provide patient/families informational and educational materials about rounds.
Develop practices for the process of rounds that respects privacy and confidentiality and balances with access to information and support.
Commit time for staff education and provide continuing support.
Develop logistics/implementation plan.
Organize team to promote efficiency.
Utilize support tools to develop and track goals.
Address confidentiality directly.
Clarify education process with learners and teachers.
Briefly review strategies for implementing patient- and family-centered rounds successfully on slide. Further details can be found in the guidance documents, Applying Patient- and Family-Centered Concepts to Rounds.
TOOLKIT REFERENCES:
APPLYING PATIENT- AND FAMILY-CENTERED CONCEPTS TO MULTIDISCIPLINARY ROUNDS PARTICIPANT HANDOUT
PATIENT- AND FAMILY-CENTERED ROUNDING: GUIDANCE FOR STAFF PARTICIPANT HANDOUT
Family Presence in Multidisciplinary Rounds

16. How can nurses and nurse managers assist a unit in adopting a patient- and family-centered approach to rounds?
Your Toolkit includes a a listing of approaches for nurses to consider in assisting in the development of patient- and family-centered rounds on a specific unit—How Can Nurses and Nurse Managers Assist a Unit in Adopting a Patient- and Family-Centered Approach to Rounds? Initial Approaches to Consider.
TOOLKIT REFERENCE: HOW CAN NURSES AND NURSE MANAGERS ASSIST A UNIT IN ADOPTING A PATIENT- AND FAMILY-CENTERED APPROACH TO ROUNDS?
Family Presence in Multidisciplinary Rounds

17. Applying Patient- and Family-Centered Concepts to Multidisciplinary Rounds Discussing the Benefits: A Group Exercise
There is guidance in your Toolkit for facilitating a group discussion about multidisciplinary rounds and the benefits. See page 3–131. It is a great team builder exercise when embarking on a journey to implement multidisciplinary rounds with patients and families part of the process. You can also refer to the handout, Applying Patient- and Family-Centered Concepts to Bedside Rounds. It includes practical guidance and suggestions on a variety of topics including key implementation steps and specific language tips.
TOOLKIT REFERENCE: APPLYING PATIENT- AND FAMILY-CENTERED CONCEPTS TO MULTIDISCIPLINARY ROUNDS PARTICIPANT HANDOUT
Family Presence in Multidisciplinary Rounds

18. Family Presence in Multidisciplinary Rounds