Opportunities for interprofessional input into nurse and physician hand-off communication

Standardized Work Rounds Enhance Teaming, Comprehensiveness, Shared Mental Model Development, and Achievement Rate of End-of-Shift Goals

OBJECTIVES

To determine the impact of standardized PICU work rounds on the frequency of ideal teaming behaviors, rounds comprehensiveness, shared mental model index development, and rate of completed end-of-shift goals.

DESIGN

A single-center, pre-post, prospective cohort study.

SETTING

A 259-bed, quaternary, pediatric referral center.

PATIENTS

Children 0-18 years old from November 2018 to January 2020.

INTERVENTIONS

Standardized, bedside, nurse-led PICU work rounds, emphasizing ideal teaming behaviors using a collaboratively developed rounding script and quality/safety checklist.

MEASUREMENTS AND MAIN RESULTS

Study data were collected by direct observation and immediate postrounds participant questionnaire data. Primary outcomes were frequency of observed ideal teaming behaviors, rounds comprehensiveness, efficiency (rounds content divided by duration), shared mental model index (congruence among rounds participants regarding key healthcare data and planning), rounds face validity, and achievement rate of rounds-established, end-of-shift goals. During study, 154 encounters were observed (50 preintervention, 52 after Plan-Do-Study-Act cycle 1, and 52 after Plan-Do-Study-Act cycle 2). We observed improvements in overall shared mental model index (24-87%), rounds comprehensiveness (72-98%), and ideal teaming behaviors (including closed-loop communication: 82-100%; responsibility delegation: 74-100%; interdependence behaviors: 26-98%, all p < 0.01) by the end of study. Nursing presentations accounted for 3.6 ± 1.5 minutes of rounds and rounds duration was unchanged postintervention (11 ± 5 min preintervention and 11 ± 4 min after Plan-Do-Study-Act cycle 2, p > 0.99). Face validity, assessed using questionnaire data from 953 participants, revealed positive attitudes regarding efficiency, clarity, and participant self-value. Greatest enhancements in self-value were noted among advanced practice providers and respiratory therapists. On exploratory modeling, we noted associations between ideal teaming behaviors, rounds comprehensiveness, and shared mental model index. Similarly, we noted a positive association between the shared mental model index and the rate of achieved rounds-established, end-of-shift goals (odds ratio, 8.9; 95% CI, 1.7-46; p < 0.01).

CONCLUSIONS

Standardization of PICU work rounds may encourage ideal teaming behaviors, enhance rounds comprehensiveness, strengthen the congruence of participant shared mental model, and affect the rate of achieved goals established during rounds without compromising workplace efficiency.

Defining the critical role of nurses in diagnostic error prevention: a conceptual framework and a call to action

Nurses have always been involved in the diagnostic process, but there remains a pervasive view across physicians, nurses, and allied health professionals that medical diagnosis is solely a physician responsibility. There is an urgent need to adjust this view and for nurses to take part in leading efforts addressing diagnostic errors. The purpose of this article is to define a framework for nursing engagement in the diagnostic process that can serve as a catalyst for nurses to engage in eliminating preventable harms from diagnostic error. We offer a conceptual model to formalize and expand nurses’ engagement in the diagnostic process through education, maximize effectiveness of interprofessional teamwork and communication through culture change, and leverage the nursing mission to empower patients to become active members of the diagnostic team. We describe the primary barriers, including culture, education, operations, and regulations, to nurses participating as full, equal members of the diagnostic team, and illustrate our approach to addressing these barriers. Nurses already play a major role in diagnosis and increasingly take ownership of this role, removing barriers will strengthen nurses’ ability to be equal, integral diagnostic team members. This model should serve as a foundation for increasing the role of the nurse in the diagnostic process, and calling nurses to take action in leading efforts to reduce diagnostic error.

Quality of anthropometric measurements in Spanish Intensive Care Units (The CAMIES Study)

INTRODUCTION

Real body weight and height are essential data to be obtained in all critically ill patients (CIP), due to their influence in the designing of therapies and monitoring. Visual estimation is a very inaccurate practice. No precise descriptions of anthropometric measurements among CIP are available in the clinical practice guides.

OBJECTIVE

To describe anthropometric quality in CIP, health professional perception of such quality, and its influencing factors.

DESIGN

Computer-assisted telephone or self-interviewing.

SETTING

Doctors and nurses of all Spanish Intensive Care Units (ICU) attending adults.

RELEVANT VARIABLES

Anthropometric practices were described in detail, along with the proclivity to obtain real measurements, and the influence of professional experience, the number of ICU beds, and the health professional group involved.

RESULTS

A total of 481 questionnaires were collected from 176 hospitals (36.8% from physicians). The availability of measuring tools is limited (weight 68.7% - height 76.7%), with no relation to the number of ICU beds (weight P=.343, height P=.61). Visual estimation was the most frequent way of obtaining measurements (weight 65.9% - height 64.8%), even when measuring tools were available. Willingness to take real measurements was very low, especially among physicians, and professional experience was associated to increased rejection (P<.001).

CONCLUSIONS

Visually estimated measurements exceed real measurements in the routine practice of Spanish ICUs. Measurement tools are not widely available in the ICU, and even when available, their use is not guaranteed. The surveyed population does not view anthropometric measures as being important for clinical practice. An effort should be made by scientific societies to promote reliable anthropometric practice in Spanish ICUs.