Use of a daily goals checklist for morning ICU rounds: a mixed-methods study
John Eugenio Centofanti1, Erick H Duan, Neala C Hoad
11Department of Anesthesia, McMaster University, Hamilton, ON, Canada. 2Department of Medicine, McMaster University, Hamilton, ON, Canada. 3Department of Critical Care, St Joseph's Healthcare, Hamilton, ON, Canada. 4Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
Objective:
To understand the perspectives and attitudes of ICU clinicians about use of a daily goals checklist on rounds.
Design:
Our three data collection methods were as follows: (1) Field observations: two investigators conducted field observations to understand how and by whom the daily goals checklist was used for 80 ICU patient rounds over 6 days. (2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. (3) Interviews: With 56 clinicians, we conducted semistructured individual and focus-group interviews, analyzing transcripts using a qualitative descriptive approach and content analysis. Triangulation was achieved by a multidisciplinary investigative team using two research methods and three data sources.
Setting:
Fifteen bed closed ICU in a tertiary care, university-affiliated hospital.
Patients:
Medical-surgical ICU patients.
Interventions:
None.
Measurements And Main Results:
Field observations: The daily goals checklist was completed for 93% of observed rounds, largely by residents (86%). The champion of the verbal review was commonly a resident (83%) or medical student (9%). Document analysis: Domains with high completion rates included ventilation, sedation, central venous access, nutrition, and various prophylactic interventions. Interviews: The daily goals checklist enhanced communication, patient care, and education. Nurses, physicians, and pharmacists endorsed its enhancement of interdisciplinary communication. It facilitated a structured, thorough, and individualized approach to patient care. The daily goals checklist helped to identify new patient care issues and sparked management discussions, especially for sedation, weaning, and medications. Residents were prominent users, finding served as a multipurpose teaching tool.
Conclusions:
The daily goals checklist was perceived to improve the management of critically ill patients by creating a systematic, comprehensive approach to patient care and by setting individualized daily goals. Reportedly improving interprofessional communication and practice, the daily goals checklist also enhanced patient safety and daily progress, encouraging momentum in recovery from critical illness. Daily goals checklist review prompted teaching opportunities for multidisciplinary learners on morning rounds.
More Related Videos
06:04Objective Nociceptive Assessment in Ventilated ICU Patients: A Feasibility Study Using Pupillometry and the Nociceptive Flexion Reflex
Published on: July 4, 2018
08:25Polar Histogram Visualization of Acute Stress Disorder Scale Scores for Comprehensive Clinical Assessment
Published on: December 6, 2024
Related Concept Videos
01:21Methods of Documentation III: PIE
01:26Methods of Documentation IV: Focus Charting
It typically involves three columns for recording information:
01:17Flow Sheet
Here's a closer look at the examples of flowsheets commonly used by nurses:
Graphic Sheet Documentation:
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:15Nursing Evaluation
01:11Guidelines for Writing Outcome
Patient outcomes reflect the patient's response to the goal rather than what the nurse aims to achieve. Terminology should be observable and measurable to avoid the reader's interpretation. The desired outcome should be realistic and achievable in the designated care timeframe. Expected outcomes should align with adjunctive therapies. The outcome should enhance care...