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Implementing Family Meetings Into a Respiratory Care Unit: A Care and Communication Quality Improvement Project
Vicki Loeslie1, Ma Sunnimpha Abcejo, Claudia Anderson
1Vicki Loeslie, DNP, APRN, CNP, is a Nurse Practitioner supervisor in the Medical Intensive Care Unit and Respiratory Care Unit, Division of Critical Care, Mayo Clinic, Rochester, Minnesota. Ma Sunnimpha Abcejo, MSN, RN, is the Nurse Manager of the Respiratory Care Unit, Department of Nursing, Mayo Clinic, Rochester, Minnesota. Claudia Anderson, APRN, CNP, is a Nurse Practitioner for the Palliative Care Service, Palliative Medicine, Mayo Clinic, Rochester, Minnesota. Emily Leibenguth, APRN, CNP, is a Nurse Practitioner in the Medical Intensive Care Unit and Respiratory Care Unit, Division of Critical Care, Mayo Clinic, Rochester, Minnesota. Cathy Mielke, APRN, CNS, is a Clinical Nurse Specialist of the Respiratory Care Unit, Department of Nursing, Mayo Clinic, Rochester, Minnesota. Jeffrey Rabatin, MD, is the Medical Director of the Respiratory Care Unit, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota.
Background:
Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care.
Objective:
The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit.
Methods:
Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record.
Results:
Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved.
Discussion:
This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.