Care Rounds Research Articles

Health Professions Students' Reflections About Principles of Interprofessional Collaboration after Shadowing Interprofessional Palliative Care Rounds.

Future healthcare professionals are educated on collaborative practice methods through interventions that may include shadowing. While shadowing allows students to learn from and about other health professions, it often fails to offer an opportunity for the student to work and collaborate with other health professionals. This study sought to investigate themes regarding interprofessional students' experiences during a palliative care shadowing activity and their understanding of collaborative patient-centered care, social determinants of health, and health disparities. Twenty-eight students representing 13 health professions from the Interprofessional Palliative Care program at Jefferson Center for Interprofessional Practice and Education at Thomas Jefferson University submitted reflection essays at the conclusion of their shadowing experience. Four hundred ninety-eight sentences from 28 essays were analyzed via qualitative directed content analysis. Coding categories were determined a priori using definitions of collaborative practice from the 2023 Interprofessional Education Collaborative (IPEC) competencies and definitions of social determinants of health from Healthy People 2030. Thirty-two percent of sentences described IPEC competencies, 18% described social determinants of health/ health disparities, 4% included student emotional reactions, and 2% included student descriptions of the development of their professional role. These results suggest that shadowing offers an opportunity to identify and learn interprofessional competencies in interprofessional palliative care curricula, as made evident through student reflection assignments.

Evaluation of the effectiveness of a segmented alternating shift pattern based on wearable vital signs monitoring devices during COVID-19: a cross-sectional study

AimTo explore the feasibility and effectiveness of an alternating shift pattern in two-hour segments in the state of emergency management of public health events.MethodsA cross-sectional research design was conducted in our study. The nursing staff working in the admission ward of suspected or confirmed patients with COVID-19 in December 2022 were selected as subjects by the whole-group sampling method. We adopted a shift pattern of alternating shifts every two-hour in the isolation wards. The vital signs parameters were captured by uniformly wearing the multi-signs sensing devices, and the questionnaires collected the symptoms.ResultsSixty-seven female participants, with a mean age of 33.09 ± 5.96 years, were included in this study. Measurements of body temperature (T), blood oxygen saturation (SpO2), respiratory rate (RR), and heart rate (HR) while wearing personal protective equipment (PPE) all remained within normal limits. None of the nurses reported sweating, dizziness, blurred vision, palpitations, or dyspnea. Statistical analysis showed significant differences between the critical care group and the non-critical care group in terms of age (P = 0.041), working duration (P = 0.036), and the total number of entries into isolation areas for nursing care (rounds) (P = 0.007). However, there were no statistically significant differences in vital signs based on age, work duration, or body mass index (BMI). The data indicated a notable increase in body temperature compared to other vital sign parameters with increasing work time while wearing PPE. Body temperature approached the upper limit when working close to 2 h long.ConclusionsThe alternating shift pattern in two-hour segments can effectively maintain the physical well-being of nurses wearing PPE without increasing the burden on nursing staff or the wastage of protective materials. This approach is recommended for addressing similar public health events in the future.

A pharmacist's guide to mitigating sleep dysfunction and promoting good sleep in the intensive care unit.

In an effort to expedite the publication of articles, AJHP is posting manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. To review causes, risk factors, and consequences of sleep disruption in critically ill patients; evaluate the role of nonpharmacological and pharmacological therapies for management of sleep in the intensive care unit (ICU); and discuss the role of pharmacists in implementation of sleep bundles. Critically ill patients often have disrupted sleep and circadian rhythm alterations that cause anxiety, stress, and traumatic memories. This can be caused by factors such as critical illness, environmental factors, mechanical ventilation, and medications. Methods to evaluate sleep, including polysomnography and questionnaires, have limitations that should be considered. Multicomponent sleep bundles with a focus on nonpharmacological therapy aiming to reduce nocturnal noise, light, and unnecessary patient care may improve sleep disorders in critically ill patients. While pharmacological agents are often used to facilitate sleep in critically ill patients, evidence supporting their use is often of low quality, which limits use to patients who have sleep disruption refractory to nonpharmacological therapy. Dedicated interprofessional teams are needed for implementation of sleep bundles in the ICU. Extensive pharmacotherapeutic training and participation in daily patient care rounds make pharmacists vital members of the team who can help with all components of the bundle. This narrative review discusses evidence for elements of the multicomponent sleep bundle and provides guidance on how pharmacists can help with implementation of nonpharmacological therapies and management of neuroactive medications to facilitate sleep. Sleep bundles are necessary for patients in the ICU, and dedicated interprofessional teams that include pharmacists are vital for their successful creation and implementation.

The Impact of COVID-19 on Healthcare-Associated Infections: A Survey of Acute Care Hospitals

Background: The COVID-19 pandemic has placed an enormous strain on the healthcare system, including infection prevention and control. The response to the COVID-19 pandemic required extraordinary resources, which were often diverted from routine infection prevention and control activities and may have contributed to increased rates of HAI in the acute care setting. However, the impact of the COVID-19 pandemic on infection prevention and control departments, including staffing and resources, and on routine infection prevention and control activities is not well-described. The objective of this study was to describe the impact of the COVID-19 pandemic on IPC departments and department response to the pandemic. Methods: Between August and December of 2023, we conducted an electronic survey of all acute care facilities participating in the National Healthcare Safety Network. Survey data were analyzed using descriptive statistics. Results: Over 594 infection control departments participated in the survey, representing 1,400 NHSN facilities (20% response rate based on number of eligible NHSN facilities). Half of the respondents reported that their hospital experienced increases in the following HAI rates during the first two years of the pandemic: central-line associated bloodstream infections (54%), catheter-associated urinary tract infections (46%) and ventilator associated pneumonia (45%). When asked to identify the top three contributors to increased HAI rates in their facility, respondents cited the following factors: staffing shortages (70%), patient acuity (69%), use of travel nurses (48%), increased device utilization (37%), and reduced bedside acuity (31%). Respondents reported that their department utilized the following actions to decrease these HAI rates: increased rounding and monitoring of IPC procedures (81%), reeducation of frontline staff on IPC policies and procedures (77%), environmental care rounds (69%), monitoring of isolation compliance (66%), HAI Task Force/Committee (57%), nurse-driven catheter removal protocols (53%), and insertion prevention protocols (53%). When asked if the department experienced applied pressure or attempts to influence HAI reporting due to the increase in HAI rates in the facility experienced in the wake of the pandemic, 19% of respondents reported increased pressure from management/C-suite and 7% reported increased pressure from providers. Conclusion: The COVID-19 pandemic had a substantial impact on IPC departments in acute care hospitals and had a profound effect on IPC staffing, resources and routine IPC activities. Future work needs to identify best practices and lessons learned from the pandemic to inform future pandemic preparedness.

QAPI 21 - Enhancing Infection Prevention: Effective Environment of Care Rounds in Dietary and Nutrition Settings in Acute Care Hospitals

QAPI 21 - Enhancing Infection Prevention: Effective Environment of Care Rounds in Dietary and Nutrition Settings in Acute Care Hospitals

Weaving the Outpatient Tapestry: A Model of Supportive Care Rounds Across Institutions and Teams

Weaving the Outpatient Tapestry: A Model of Supportive Care Rounds Across Institutions and Teams

755 Utilizing a Structured Critical Care Rounding Tool for Retrospective Morbidity and Mortality Review

755 Utilizing a Structured Critical Care Rounding Tool for Retrospective Morbidity and Mortality Review

Clinical outcomes of a joint ICU and palliative care multidisciplinary rounding model: A retrospective cohort study.

This retrospective cohort study assessed whether implementation of a joint inpatient palliative care (IPC) and ICU multidisciplinary rounding model affected clinical outcomes including ICU length of stay (LOS). Beginning in October of 2018, an IPC physician joined the pre-existing ICU multidisciplinary rounds. Data were collected for ICU patients admitted during a 6-month period before this intervention and a 6-month period after the intervention. Data were extracted from an integrated electronic medical records (EMR) data system and compared by Wilcoxon and chi-square test for continuous and categorical variables respectively. Negative binomial regression was used to analyze the primary outcome measure, ICU LOS. Patients in the intervention group spent fewer days in the ICU (3.7 vs. 3.9 days, p = 0.05; RR 0.82, 95% CI 0.70-0.97, p = 0.02) and in the hospital (7.5 vs. 7.8 days, p<0.01) compared to the pre-intervention group. The rate of CPR was lower in the intervention group, but the difference was not statistically significant [13(3.1%) vs. 23(5.3%), p = 0.10]. The groups did not differ significantly in rate of hospital mortality, number of days connected to mechanical ventilation via endotracheal tube, or bounceback to the ED or hospital. Multivariable analysis of the primary outcome demonstrated that patients with prior palliative care involvement had longer ICU LOS (RR 1.46, 95% CI 1.04-2.06, p = 0.03) when controlling for other variables. The presented joint IPC-ICU multidisciplinary rounding model was associated with a statistically significant reduction in ICU and hospital LOS, but the clinical significance of this reduction is unclear.

The Derivation of Epigastric Motion to Assess Neonatal Breathing and Sleep: An Exploratory Study.

New non-medical monitors are offered for respiration monitoring of neonates. Epigastric motion during sleep was investigated by means of a wearable tracker in parallel to clinical monitoring. 23 hospitalised neonates ready for discharge. A 3-axes-accelerometer and -gyroscope was placed in a standard epigastric position. Between two routine care rounds signals were recorded in parallel to monitoring of impedance pneumography (IP), ECG and pulse oximetry. Motion signals vs. time charts were evaluated using 10-min episodes and semiquantitatively assigned to breathing signal quality, regular breathing, periodic breathing and confounding artefacts. The results were compared with the impedance pneumographic data. 26 recordings (mean duration: 210 min/infant) were conducted without bradycardia or apnea alarm. The gestational age at birth ranged 28.9 to 41.1 and at recording from 35.6 to 42.3 postmenstrual weeks. Motion patterns of quiet sleep with regular breathing, periodic breathing and active sleep with confounding body movements were found. The longitudinal and transversal gyroscope axes resulted in best signal quality. Periodic breathing was found in up to 80% of episodes and decreased inversely with gestational age showing significantly more periodic breathing in preterm infants. Respiration signals of the gyroscope vs. IP showed a low bias and highly variating frequencies. Standardized motion trackers may detect typical neonatal breathing and body-motion-patterns, that could help to classify neonatal sleep. Respiratory rates can only be determined during quiet sleep.

Editor’s Choice Articles for May

May 2023–something different for a change: after each of the three Editor’s Choices articles, there is additional material that would normally fall within the educational content found in the section called PCCM Connections for Readers. This month I will use my main highlights as a guide to further read about extracorporeal membrane oxygenation (ECMO), delirium, and organization of PICU rounds. WHAT ABOUT THE NEED FOR ECMO IN CHILDREN WITH COVID-19 OR MULTISYSTEM INFLAMMATORY SYNDROME? Bembea MM, Loftis LL, Thiagarajan RR, et al; Overcoming COVID-19 Investigators: Extracorporeal Oxygenation Characteristics and Outcomes in Children and Adolescents With COVID-19 or Multisystem Inflammatory Syndrome Admitted to U.S. ICUs (1). Sixty-three hospitals in 32 US states collaborated in a registry (during March 2020 through December 2021) and now report their experience of using ECMO in children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related cardiorespiratory failure. The entire cohort included 2,733 patients, of whom 108 were supported with ECMO. In addition to important information about the time course of care, the authors also show data that add to PCCM’s focus on social determinants of health (2,3), with analyses according to race, ethnicity, healthcare insurance status, and social vulnerability index (1). All these themes are discussed in the accompanying editorial (4), and it is also worth rereading PCCM’s approach to SARS-CoV-2-related research (5): we are committed to innovation and new perspectives, and the 2020/2021 US registry satisfies these criteria. “PCCM Connections” for Readers: Please read the systematic review of support with ECMO during SARS-CoV-2-related cardiorespiratory failure (6). The authors have identified 44 studies (18 observational, four case series, and 22 case reports) involving 110 children receiving ECMO in the period up to March 2022. The review is a comprehensive summary of the literature up to PCCM’s latest edition (1), and the accompanying editorial provides a unique assessment of what these data mean in the wider context of the literature in adults (7). WHAT ABOUT FACTORS ASSOCIATED WITH DELIRIUM DURING CRITICAL ILLNESS: REMEDIABLE OR NOT? Ista E, Traube C, de Neef M, et al; Dutch Multidisciplinary Pediatric Delirium Guideline Group: Factors Associated With Delirium in Children: A Systematic Review and Meta-Analysis (8). Clinical research into delirium is a longstanding theme in PCCM. Now, international researchers in this field under the auspices of the Dutch Multidisciplinary Pediatric Delirium Guidelines Group report a systematic review of 1990 to 2022 literature. The authors describe information from 24 studies in which 54 factors were found associated with delirium. In the meta-analysis these findings are reduced to seven factors associated with greater odds of developing delirium during pediatric critical illness (8). In the accompanying editorial our writers propose that it is time to include delirium screening as part of our “vital sign” monitoring (9). “PCCM Connections” for Readers: On a similar theme to delirium prevention, please read the Brief Report describing a single-center, prospective, sleep hygiene quality improvement program in PICU patients eligible for early mobilization (10). There are also interesting details about how the program was organized, which is information that should be read together with the recent practice guideline on prevention and management of delirium (11). WHAT ABOUT ROUNDS AND SETTING AND IMPLEMENTING DAILY GOALS OF CARE? Jones AGR, Friedman S, Vu M, et al: Improving Daily Patient Goal-Setting and Team Communication: The Liber8 Glass Door Project (12). Improved communications between everyone, with a clearly defined plan, is the objective for all PICU patients, families, and the broader healthcare team. My last Editor’s Choice is work carried out in a single-center 12-bedded combined medical and surgical PICU. Here, the authors describe the development and implementation of a low-cost aid, literally writing on a glass door. There is an interesting accompanying editorial, which is both creative and challenging (13). “PCCM Connections” for Readers: We have already discussed an article about organization and goal setting during patient care rounds when considering optimizing sleep hygiene (10). Another article about rounding discussions in this issue examines the impact of unit census and patient acuity on effective discussion (14). Why not enhance your review of the literature on the topic of rounds by looking at similar work in recent issues of PCCM (15–17). Finally, another of this month’s highlights is the narrative essay entitled “Line in the Sand” (18).

Effects Of Implementing VA Surgical Transition Of Care Rounds

Lucy, Adam MD; Layton, Shannon DNP, MSW, RN, CNL; Grams, Jayleen MD, PhD, FACS Author Information

Implementation of the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme: an interdisciplinary, generalisable approach to inpatient neurodevelopmental care.

Children with CHD are at risk for neurodevelopmental delays, and length of hospitalisation is a predictor of poorer long-term outcomes. Multiple aspects of hospitalisation impact neurodevelopment, including sleep interruptions, limited holding, and reduced developmental stimulation. We aimed to address modifiable factors by creating and implementing an interdisciplinary inpatient neurodevelopmental care programme in our Heart Institute. In this quality improvement study, we developed an empirically supported approach to neurodevelopmental care across the continuum of hospitalisation for patients with CHD using three plan-do-study-act cycles. With input from multi-level stakeholders including parents/caregivers, we co-designed interventions that comprised the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme. These included medical/nursing orders for developmental care practices, developmental kits for patients, bedside developmental plans, caregiver education and support, developmental care rounds, and a specialised volunteer programme. We obtained data from the electronic health record for patients aged 0-2 years admitted for at least 7 days to track implementation. There were 619 admissions in 18 months. Utilisation of CINCO interventions increased over time, particularly for the medical/nursing orders and caregiver handouts. The volunteer programme launch was delayed but grew rapidly and within six months, provided over 500 hours of developmental interaction with patients. We created and implemented a low-cost programme that systematised and expanded upon existing neurodevelopmental care practices in the cardiac inpatient units. Feasibility was demonstrated through increasing implementation rates over time. Key takeaways include the importance of multi-level stakeholder buy-in and embedding processes in existing clinical workflows.

Does the Implementation of Multidisciplinary Developmental Care Rounds Increase the Utilization of Developmental Caregiving Interventions in the Neonatal Unit?

The aims of this project were to improve the utilization of developmental care practices in the neonatal unit and to increase opportunities for parental involvement in the planning and provision of caregiving. This implementation project was conducted in a 79-bed neonatal tertiary referral unit in Australia. A pre/postimplementation survey design was utilized. A preimplementation survey was conducted to collect data on staff's perceived perception of developmental care practices. Following analysis of the data, a process for multidisciplinary developmental care rounds was developed and then implemented across the neonatal unit. A postimplementation survey was then conducted to evaluate whether staff perceived any changes in developmental care practices. The project was conducted over 8 months. A total of 97 surveys (pre: n = 46/post: n = 51) were received. Differences were demonstrated in staff's perceived perception of developmental care practices between the pre- and postimplementation periods in 6 themes of developmental care practice. Identified areas of improvement included the use of the 5-step dialogue, encouragement of parents to contribute to care planning, availability of a well-defined care plan for parents to visualize and document caregiving activities, increased use of swaddled bathing, side-lying position for nappy changes, consideration of infants sleep state before caregiving, and increased use of skin-to-skin therapy for management of procedural pain. Despite the majority of staff members who participated in both surveys acknowledging the importance of family-centered developmental care practice on neonatal outcomes, their use in clinical care is not always considered or practiced. Although it is reassuring to see improvements in several areas of developmental care postimplementation of the developmental care rounds, continued awareness and reinforcement of developmental neuroprotective caregiving strategies through initiatives such as a multidisciplinary care rounds are warranted.

Developmental Care Rounds: An Initiative to Improve Nursing Confidence and Contributions at the Bedside.

Purpose: To describe the use of developmental care (DC) rounds as an initiative to ensure the implementation of bedside DC. To measure the confidence of NICU nurses with participation in DC rounds. Design: Evidence-based practice/quality improvement initiative aimed to answer the following questions: What are the implementation rates of bedside DC nursing interventions used or discussed during DC rounds? Do NICU nurses report agreement with education about DC rounds prior to DC rounds starting? Do nurses in the NICU feel confident participating in DC rounds Do nurses with more years of NICU nursing experience feel more confident than nurses with fewer years of nursing experience? Sample: 513 DC rounds and 101 nursing surveys. Main Outcome Variable: Nursing survey Likert score response and implementation rate of DC nursing interventions. Results: Implementation of bedside DC nursing interventions was strong in the NICU. Areas of opportunity include developmental bath, oral care with breast milk, use of scent clothes, kangaroo care, breastfeeding, use of head plan when appropriate, assignment of a primary baby buddy when appropriate, and use of schedule when needed. Nurses reported their confidence in participation in DC during the implementation of this project.

Patient and family engagement in patient care and research in Canadian intensive care units: a national survey.

While patient and family engagement may improve clinical care and research, current practices for engagement in Canadian intensive care units (ICUs) are unknown. We developed and administered a cross-sectional questionnaire to ICU leaders of current engagement practices, facilitators, and barriers to engagement, and whether engagement was a priority, using to an ordinal Likert scale from 1 to 10. The response rate was 53.4% (124/232). Respondents were from 11 provinces and territories, mainly from medical surgical ICUs (76%) and community hospitals (70%). Engagement in patient care included bedside care (84%) and bedside rounds (66%), presence during procedures/crises (65%), and survey completion (77%). Research engagement included ethics committees (36%), protocol review (31%), and knowledge translation (30%). Facilitators of engagement in patient care included family meetings (87%), open visitation policies (81%), and engagement as an institutional priority (74%). Support from departmental (43%) and hospital (33%) leadership was facilitator of research engagement. Time was the main barrier to engagement in any capacity. Engagement was a higher priority in patient care vs research (median [interquartile range], 8 [7-9] vs 3 [1-7]; P < 0.001) and in pediatric vs adult ICUs (10 [9-10] vs 8 [7-9]; P = 0.003). Research engagement was significantly higher in academic vs other ICUs (7 [5-8] vs 2 [1-4]; P < 0.001), and pediatric vs adult ICUs (7 [5-8] vs 3 [1-6]; P = 0.01). Organizational strategies and institutional support were key facilitators of engagement. Engagement in patient care was a higher priority than engagement in research.

Implementation and Modification of Developmental Care Rounds in the Cardiac Intensive Care Unit.

In 2019, an interprofessional team at Texas Children's Hospital designed and instituted developmental care rounds to better coordinate developmentally appropriate care within the cardiac intensive care unit. During the first 2 years, we conducted 230 developmental care rounds on 169 patients; for these rounds, family participation was greater than 85%. Since their inception, these rounds have undergone several modifications, including changes to the patient selection criteria and team role delegation. Importantly, the structure of these rounds has evolved to prominently integrate family members' perspectives and experiences. Lessons learned through developmental care rounds have formed a foundation for implementing other developmentally appropriate practices and initiatives throughout the hospital's Heart Center.

Clinical Pearls.

Most children born with a congenital heart defect (CHD) survive; however, those who require intervention during the neonatal period are more susceptible to neurodevelopmental disabilities. Developmental care improves outcomes in premature infants, but little evidence addresses the impact on infants with CHD.Elhoff and colleagues evaluated the use of developmental care rounds in their pediatric cardiac intensive care unit for a 2-year period. Their developmental care rounds comprise the following: Families are included in developmental care rounds and are asked at the start how they have been able to interact/bond with their infant. This guides the discussion on the plan of care.A weekly facilitator selects the patients to include in the rounds, on the basis of established criteria, and provides the family 24 hours’ notice.The team includes various disciplines such as physical, occupational, and/or speech therapists, child life, social work or chaplain, bedside nurse, and the therapy leader.Use of developmental care rounds in this unit showed sustained family involvement in more than 85% of rounds during the 2 years. The team used a virtual format during the pandemic but later moved to a hybrid format that still allows participation of team members and families who cannot be physically present.See Article, pp 494-498Patients with COVID-19–related acute hypoxemic respiratory failure and prolonged mechanical ventilation may require a tracheostomy. Research reports on COVID-19 transmission during a tracheostomy procedure have shown limited viral transmission, yet the reports have been primarily anecdotal.Standiford and colleagues investigated the rate of transmission of COVID-19 to health care workers (HCWs) during a tracheostomy protocol, as well as HCWs’ beliefs and attitudes on safety. They found Ninety-two percent of the HCWs described feeling extremely or moderately safe during the procedure.Five percent of the HCWs reported new symptoms or a positive COVID-19 test within 21 days after the tracheostomy procedure.Seven percent reported breaches of procedure protocol.The findings show that most HCWs were familiar with and adhered to institutional protocols. The authors recommend multidisciplinary engagement in development and implementation of tracheostomy procedure protocols as well as dedicated tracheostomy teams to streamline the procedure and limit the number of providers potentially exposed to COVID-19.See Article, pp 452-460Effective teamwork consists of interprofessional collaboration, cooperation, coordination, communication, and partnership. Intensive care units (ICUs) with low levels of these are often associated with worse patient outcomes and staff satisfaction. Provision of high-quality care depends on a healthy work environment (HWE), yet little is known about the perceptions of ICU teamwork from a “whole team” perspective.Pun and colleagues surveyed more than 3500 staff (nurses, nursing assistants, pharmacists, physicians, rehabilitation therapists, and respiratory therapists) on their perceptions of ICU teamwork and HWE. They found Overall scoring of interprofessional team collaboration was 3.92 (scale 1-5), with nursing assistants scoring the highest (4.18) and pharmacists the lowest (3.83).Scores on the HWE Assessment Tool (scale 1-5) were similar (3.45): highest for physician trainees (3.66), lowest for respiratory therapists (3.38).Among all the professions, nurses rated the appropriate staffing domain the lowest.The ratings for teamwork and HWE by the ICU team could be considered good but not great. The authors suggest that specific training on interprofessional communication and leadership occur in professional schools and in health care organizations.See Article, pp 443-451Many terms are used to describe major medical treatments—such as life support, life-sustaining treatment, withdrawing treatment—and the definitions have become more complicated as technology and care have evolved. The result is confusion for patients and families who must make a decision about the use of major medical treatments.Pecanac and colleagues explored the dialogue that patients and families used to describe their experience with decision-making about major medical treatments for themselves or someone else. They found Respondents’ descriptions indicated that they conceptualized major medical treatments as “keeping the patient alive” and forgoing major medical treatments as meaning that death would occur.Respondents understood that major medical treatments can have adverse consequences, such as pain or an undesirable neurological state.Understanding how patients and families make sense of major medical treatments can help clinicians during decision-making conversations.See Article, pp 461-468

Communication of Code Status Escalation for Nurses and Physicians in the Intensive Care Unit: A Case Study.

Interprofessional teams working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient's code status can help clinicians to understand the appropriate life support measures to deliver to patients in this setting. Members of the interprofessional team, such as physicians and nurses, can experience challenges related to communication when the code status is unclear. The purpose of this study was to explore how nurses and physicians in the ICU experience communication of code status escalations. A qualitative case study approach was used. Participants were physicians and nurses, working in the medical-surgical ICU of a large, urban academic hospital. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. Data were analyzed using qualitative content analysis. Thematic findings include: (1) engaging in an interprofessional discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the patient story. The study findings also provide contextual information about participants' experiences of code status communication during the first wave (February 2020 to May 2020) of the COVID-19 pandemic. The results of this study could inform standard communication frameworks or practices related to dissemination of code status decisions among members of the ICU team.

Seeing is Believing: Inclusion of Biomedical Scientist Educators as Observers on Clinical Rounds

Increasingly, medical school curricula seek to integrate the biomedical and clinical sciences. Inclusion of the basic sciences into the clinical curricula is less robust than including clinical content early in medical school. We describe inclusion of biomedical scientists on patient care rounds to increase the visibility of biomedical sciences, to nurture relationships between clinicians and biomedical scientists, and to identify additional opportunities for integration throughout medical school.

585 Focused Wound Care Handoff Improves Burn Center Physician-Nursing Communication and Wound Care Education

IntroductionBurn patients often require changing wound care routines dependent on wound characteristic and operative interventions. Unfortunately, order discrepancies on electronic medical systems, poor communication between providers, nursing, and wound care technicians leads to incorrect wound care treatment. By creating a daily dedicated wound care discussion involving integral components of the wound care team (provider, charge nurse, and wound care technicians), we hope to improve communication amongst team members and provide wound care education at all levels.MethodsThe study was carried out at a single-center burn unit. A pre-intervention, de-identified survey was distributed to the nursing staff to determine familiarity with wound care as well as assessment of communication regarding wound care in the burn unit. A planned intervention was then initiated for a period of four weeks. Daily, timed dedicated wound care rounds were carried out. The wound plan was then reflected on a personalized diagram for each patient, on electronic medical records and updated on resident/fellow notes. Nursing staff satisfaction and assessment of communication was completed again using a post-intervention, de-identified survey.ResultsInitial data from our planned four-week intervention showed that on average, we round on 7.9 patients on burn wound unit, 4 patients on intermediate care unit (IMC), and 2.9 patients on intensive care unit daily. During wound care handoff, we discussed 12.5 patients daily with an average time of 51 seconds per patient. When wound care routines are added to morning rounds, we spend 50 seconds per each burn wound unit patient, 120.5 seconds per each IMC patient and 735 seconds per each ICU patient. There was a total of 19 surveys collected prior to intervention. Four of the 19 surveys were filled by burn wound floor nurses and 15 were filled by ICU nurses. On average, nursing reported their wound care proficiency to be 4 out of 5 (5 being the highest score). Majority reported spending about 1-3 hours per shift on wound care (58%). Most nurses review wound care routine on nursing handoff (66%), resident/fellow notes (22%) and electronic medical record orders (11%). Mid-intervention satisfaction survey showed that most nurses felt that communication was improved, discrepancies between staff members were minimized, and that 100% of nurses wanted this intervention to be continued.ConclusionsAdverse wound care events can happen despite nursing self-reported high level of wound care proficiency. To ensure accurate plan of care, wound care routine needs to be communicated at multiple levels: during rounds, in daily progress notes, and on electronic medical record orders.