Post on 10-Aug-2020
transcript
2016/11/14
1
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
2016/11/14
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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
3
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
Susan Kelly - NP District Stroke Centre
Diana Williamson – District Stroke Educator 11/16/2016
2016/11/14
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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
Susan Kelly - NP District Stroke Centre
Diana Williamson – District Stroke Educator
5
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
11/16/2016
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Susan Kelly - NP District Stroke Centre
Diana Williamson – District Stroke Educator
2016/11/14
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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
Diana Williamson – District Stroke Educator
7
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
Diana Williamson – District Stroke Educator
8
2016/11/14
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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)
Professional Rounding
• 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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Professional Rounding
• 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
2016/11/14
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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