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Published in CenterView on April 29, 2013
Amanda McCullough, nurse on 5C, discusses McKinley Davis’ care with her mother, Mackenzie.
Amanda McCullough, nurse on 5C, discusses McKinley Davis’ care with her mother, Mackenzie.

New initiative brings nurses, patients, families in on treatment discussions

By Jennifer Hospodor

Michelle Palokas, inpatient clinical director at Batson Children’s Hospital, recalls going into a patient’s room as a staff nurse and being stumped when the patient’s family asked when the patient’s MRI was scheduled.

“I didn’t even know they were going to have an MRI,” she said. “That does not inspire confidence in us as a health-care team when they think we’re not even on the same page.”

When the lack of confidence began showing up in lower scores on patient satisfaction surveys, the Patient Satisfaction Committee proposed a new initiative, Patient and Family Centered Rounding, now being piloted on the surgical side of the hospital’s fifth floor.

Rounding practices traditionally involved attending physicians and residents discussing patient care outside the patient’s room and without nurse involvement. Now, when physicians and residents review the patient’s condition, any changes in the past 24 hours and plans for the day, the nurse, the patient and the patient’s family are present for the discussion.

“This type of rounding gives the family a sense that we are all involved in this together and that we are a cohesive group,” said Ashley Ramage, nurse manager on 5C. “We’re involving the nurses and family together so that we’re all saying and doing the same thing.”

Although getting nurses and doctors to collaborate has long been a challenge, Ramage and Palokas believe it is especially difficult on 5C because of the larger and more varied group of physicians and residents that work there.    

“There’s that rapport and those relationships,” said Ramage. “That’s kind of what lacks on the fifth floor just because the number of physicians that walk through is so big.”

She said there are approximately 48 pediatrics residents but more than 30 surgery residents.

“Their schedules make it complicated too,” said Palokas.

She noted that the physicians often come down to the floor in-between surgeries and that the nursing staff never know when that will be. The unpredictable schedules present a problem for doctors, too, who often feel guilty pulling a nurse away from another task to discuss a patient. 

Dr. Lawrence Haber, professor of orthopedics and chief of pediatric orthopedics, has long asked for nurses’ input while rounding, but said the newly formalized process makes it easier to include them.

“The nurses live here,” he said. “Having their input on what’s gone on prior to our rounds gives me important information to make the best decisions for my patients.”

And although communication between the nurses and doctors is a vital part of the initiative, it is ultimately aimed at patient satisfaction. 

Palokas said in addition to lower scores for questions about communication between the health-care team, the surveys also revealed dissatisfaction with the family’s input into the care of their child.

“We want them involved in their care,” Ramage said. “This is the most stressful time in a parent’s life. Any semblance of control or ownership or involvement that we can give them helps decrease their anxiety.”

To that end, the health-care team, patients and families set daily goals together. Ramage said having these goals helps families feel empowered and less anxious because they know what the plan is for the day.

“It helps them be an active participant in getting the child well, and then when the next day’s rounds happen, the parents can speak to those goals.”

Haber considers goal-setting the most important part of the new process because it gets everyone involved in working toward the same thing.

Palokas would like to see the program implemented on other floors, but said the priority is to get it right before moving to the next. 

“Right now, our main goal is to get the attending physician and the nurse to the bedside together,” Palokas said. “We’d love for social work to be there and respiratory therapy – anybody that’s involved in their care.”

In the coming weeks, the committee will revisit the initiative by surveying staff and patient families alike to see what is working and what challenges still exist.