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WE CARE 4 KIDS: Use of a Rounding Tool in the Pediatric Intensive Care Unit
Rani Ganesan1, Priya Rajakumar1, Louis Fogg1
1Department of Pediatrics, Rush University Medical Center, Chicago, Ill.; Department of Internal Medicine, Rush University Medical Center, Chicago, Ill.; Department of Community, Services, and Mental Health Nursing, Rush University College of Nursing, Chicago, Ill.; and Department of Pediatrics, University of Chicago Medicine and Comer Children's Hospital, Chicago, Ill.
Insights
A new daily rounding tool in a pediatric intensive care unit (PICU) significantly improved clinical element discussions and bedside nursing presence. The tool demonstrated sustained effectiveness over five years, enhancing care plan clarity for nurses.
Area of Science:
- Pediatric critical care medicine
- Healthcare quality improvement
- Nursing practice
Background:
- Effective communication and structured discussions are crucial in pediatric intensive care units (PICUs).
- Previous methods for tracking clinical elements during rounds may have lacked consistency or comprehensive engagement.
- Multidisciplinary team involvement is key to developing effective clinical tools.
Purpose of the Study:
- To implement and evaluate a novel, semi-structured daily rounding tool in a multidisciplinary medical-surgical PICU.
- To enhance the discussion performance of identified clinical elements during patient care rounds.
- To assess the long-term sustainability and impact of the rounding tool on nursing practice and patient care communication.
Main Methods:
- A pre-post interventional study design was employed in a PICU setting.
- A nurse-driven, comprehensive rounding checklist was developed based on covert observer data of clinical elements.
- Metrics were assessed pre- and post-intervention, with sustainability evaluated at the 5-year mark.
Main Results:
- Significant improvement (70%) in checklist elements was observed six months post-implementation.
- The rounding tool demonstrated sustained discussion frequency (74% of checklists collected at 5 years) and effectiveness (80% of measures sustained).
- Bedside nursing presence improved significantly at year 5, with high nursing satisfaction regarding tool utility and care plan understanding.
Conclusions:
- A multidisciplinary-developed, semi-structured rounding tool was successfully implemented and sustained in a PICU for five years.
- The rounding tool led to sustained improvements in clinical element discussions and enhanced bedside nursing presence.
- The initiative positively impacted nursing confidence in understanding patient care plans and improved documentation of daily goals.
Objective:
To implement a daily rounding tool in a pediatric intensive care unit (PICU) to improve the discussion performance of identified clinical elements. We hypothesized that a semi-structured rounding tool created by a multidisciplinary team would be successfully implemented and sustained in the PICU.
Patients And Methods:
A pre-post interventional study was conducted in a multidisciplinary medical-surgical PICU. Baseline data collection of undisclosed clinical elements was performed by covert observers, which resulted in the development of a comprehensive, nurse-driven rounding checklist. Frequencies of pre- and postintervention metrics were assessed after implementation, and sustainability was assessed at 5 years.
Results:
Six months after implementation, 70% (7/10) of checklist elements demonstrated significant improvement. Five years after implementation, 172 of a possible 222 (74%) checklists were collected. Eighty percentage (8/10) of the measures sustained discussion frequency after 5 years of use. Nursing presence significantly improved at year 5 compared with the preimplementation period. Nursing satisfaction surveys distributed at year 5 showed that the rounding tool was useful and nurses were confident in understanding care plans at the end of rounds. Ninety-eight percentage of checklists revealed discrete transcription of qualitative daily goals.
Conclusions:
A semi-structured rounding tool created by a multidisciplinary team was successfully implemented, and performance was sustained at 5 years. This initiative led to improved bedside nursing presence during patient care rounds.
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