The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

Respiratory Care Practitioners' Role In Multidisciplinary Patient Safety Rounds

Denise Franks, RRT, Michael Westley, MD, Penny Gilliatt, RN, CCRN, Julie Gorveatt, RN, CCRN, Judy Graham, RN, CCRN, Robert Hase, MS, RRT-NPS, Shirley Sherman, RN, CCRN, Laurel Tyler, RN, MN, CCRN,  Virginia Mason Medical Center, Seattle, Washington

Background: Virginia Mason Medical Center 's culture emphasizes a commitment to patient safety and Lean methodology. We implemented weekly multidisciplinary safety rounds in the Critical Care Units to monitor our clinical safety and reinforce our culture of patient safety.  Rounds are done at the CCU bedside allowing for critical issues to be addressed, education to take place, and the rationale for changes to be discussed.  Results of audits are posted weekly.

Methods: The multidisciplinary team consists of the CCU medical director, nurse manager, respiratory care practitioners, respiratory care manager, nursing education coordinator, staff nurses, patient and family. Three or four patients are selected ahead of time, focusing on those with the most complex care or with certain aspects of care that are of interest; patients requiring invasive and/or non-invasive ventilatory support are commonly chosen. The team meets at the bedside, interviews the patient, family and staff, and reviews documentation, equipment and patient care. All rounds review issues surrounding VAP prevention, critical alarms, hand hygiene, high risk medications, and plan of care.  In addition, our format encourages each participant to include one or more "ad hoc" focus of concern. Bedside rounds generally last 15 minutes per patient; following the bedside component, the team debriefs and each member is given opportunity to express both positive and negative observations.  Safety rounds are scheduled at least weekly at various times for all shifts.

Results: Safety rounds have identified multiple safety concerns through direct observation and discussion of patient care at the bedside. As a result we frequently have opportunity to provide immediate feed back and assist bedside staff to understand process changes and safety standards. In addition, the team assesses how well patient safety protocols are followed and allows a venue to discuss rapid process improvement strategies. Safety rounds data is available for the whole staff to review on a regular basis. This has provided an effective opportunity to reaffirm our culture of safety with staff, patients and family members.

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