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.