2 Checklists to Improve Patient Safety Why a Checklist? J Trauma. Nurses are responsible for ï¬lling out the yellow section, I have an average of 20 patients per day, about 2-3 new admissions to displace discharges on daily basis. -Seeing oral vancomycin as an order doesn’t necessarily mean anything, but knowing that the cdiff test was negative and the CT did not find colitis makes it immediately clear the vancomycin can be discontinued safely. The report also serves as a “bare minimum” for me to review if other priorities cut into the time I have to pre-round on patients. rounding process and have implemented multidisciplinary rounds on non-critical care units. I hope they are helpful to you! Interestingly, some other professions in hospital DO NOT EVEN KNOW what pharmacists do to make patients’ journey smoother and commenting negatively on this. 'Daily rounding' checklist improves ICU compliance. -There is a CRRT machine in a room where there wasn’t one yesterday. This note template is not meant as a permanent part of the record and is not viewable to non-pharmacy staff, rather it is meant for me (or my resident/student) to track the patient’s problems and our recommendations. Once . I go more in-depth on this topic and share my rounding templates in the ICU Rounds Masterclass within my Critical Care Pharmacy Academy. Resident/Med Student/NP . Drips – EJS, ALD â 7/1/15 * ICU Attendings and fellows have a formal order in which they expect to hear the ICU presentation. During morning and evening rounds the care team reviews the goals for the patient using the checklist. Please try again. I use a paper report to facilitate my pre-rounding review of patients. There are 3 reasons why a patient might be in an ICU. When I observe the patient and see they can take oral meds I already have a list of the most important meds to get ordered for the patient. VAP – Infectious – I go more in-depth on this topic and share my rounding templates in the ICU Rounds Masterclass within my Critical Care Pharmacy Academy. Takes a multidisciplinary effort. At no additional cost to you, as an Amazon Associate, I will receive a small commission from qualifying purchases. Objective To evaluate the benefits of using a checklist form in a 'closed' ICU to increase the utilization of prophylactic and safety interventions. The medical ICU is based out of the 9-North in the CCD. SUP – Takes a multidisciplinary effort. I am curious to find out, are there any services to which you provide to increase interactions between patient/patient family, so to improve visibility of pharmacist? Many of my pharmacists are heros behind the scene. This electronic patient tracking board identifies those patients who are planned to transfer to a lower level of care and therefore are not as sick. Neurologic –, -help track and solve problems -provide basic information to “refresh my memory” about a patient when asked a question in the middle of the day Compliance with checklist use during ICU rounds improved at both academic hospitals during the intervention phase. Faculty, fellows, pharmacists, and nurses were trained in its use. If you like this post, check out my book – A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies. May 18, 2018 at 6:27 PM. In the next episode, I’ll share how I participate in ICU rounds, including how I present my recommendations. It is a 6 page document that is a treasure trove of patient data. Additionally, I prioritize who I see first based on the unit’s bed board. PURPOSE: Use of daily checklists during rounds in the intensive care unit (ICU) has previously been shown to improve compliance with evidence based practices, enhance physician-nurse communication, promote consistency of patient care, and improve outcomes. Whenever I am in the room though I make sure I introduce myself as a pharmacist to the patient/family. Checklist ICU âElegibility ICUs â¢Inclusion criteria: ICUs that primarily admit adult patients, conduct (or want to conduct) multidisciplinary daily rounds with at least a physician and a nurse on all working days. Initial compliance rates were 67% at both institutions and subsequently improved to 90 and 81%, respectively, after accountability measures were employed. You sir are amazing, I’m a pharmacy student interested on residency and i’m passionate about critical care and emergency medicine, your lectures just motivate me more, Your email address will not be published. A vital system has failed and we need to support it (respiratory failure, on vasopressors, etc…). 3. I take a quick walk around the unit in the morning, looking for clues for sick patients that should get my attention first: -The code cart has been placed in front of their room, preparing for the inevitable. Using a "daily rounding quality checklist," which takes just a few minutes to complete, the Los Angeles County/University of Southern California Hospital increased compliance with "care bundles" to prevent ventilator-associated pneumonia (VAP) and other intensive care unit complications. <– Previous Post Next Post –>, As a nurse who works in a medical ICU and a cardiothoracic ICU, I often wonder why the pharmacist is present during rounds. Kind of limits their role unfortunately…. Preparation for ICU rounds on a critical care pharmacy rotation, A Pharmacist’s Guide to Inpatient Medical Emergencies: How to respond to code blue, rapid response calls, and other medical emergencies. When I review the patient’s home medication list, I look for medications that, if held, could cause a withdrawal syndrome. Daily Intensive Care Unit Rounds: A Multidisciplinary Perspective [ Appl Med Inform 33(3) September/2013 65 regarding the tasks required, and identifying obstacles to completion of tasks, and their potential solutions. Improve team performance and care of ICU patients through implementation of team-driven and patient-centered Daily Goal Sheets in the Surgical ICU, Cardiac ICU, and Neurosciences ICU at UNC. Hi Joe, 5. Review current medications, Read the history & physical, consult and progress notes to determine who is the patient and why are they here. The Society of Critical Care Medicine (SCCM) is the largest non-profit medical organization dedicated to promoting excellence and consistency in the practice of critical care. The MICU rounding tool can help you implement the ABCDEF Bundle. Reason for Admission – Inadequate sedation or other problems can easily be identified by a brief observation of the patient. We usually have 10-15 patients but my problem is usually the fact that in the mornings i don’t have enough time to pre-round and write my report before the team gets there. Problems that might not be recognized by looking at the meds first often jump out at me if I have already reviewed the rest of the patient’s record. I am curious to know how many patients you oversee? In most cases I can complete my review of a new patient in 20-30 minutes, and an existing patient in 10-15 minutes. The intervention, consisting of presentation of attending-level checklist compliance, was then shared once monthly at the division clinical conference and electronically via email. PMH – When I have a pharmacy resident or student, we are able to spread some of the pre-rounding tasks between us. â¢Exclusion criteria: ICUs that admit exclusively cardiac patients, step down units, and ICUs that already systematically used checklists during daily rounds. So glad you are finding the podcast helpful! I m new to yr writings n find immensely useful. Using a "daily rounding quality checklist," which takes just a few minutes to complete, the Los Angeles County/University of Southern California Hospital increased compliance with "care bundles" to prevent ventilator-associated pneumonia (VAP) and other intensive care unit complications. Combining home meds on the problem list with doing my pre-rounds in view of the patient makes things more efficient. An infection control audit checklist is used by healthcare administrators in hospitals, clinics, and nursing homes to assess the infection control protocols in place. 2. I want to make sure I identify the reason as early as possible in my review. If I am seeing the patient before the physician has that day, this is a perfect opportunity to place a sticky note in their workflow suggesting for them to resume the patient’s venlafaxine. Leadership Rounding in the Intensive Care Unit to Improve Satisfaction Leadership rounding is a new, innovative, and simple interview that can be implemented in any care facility. -There is more than 1 nurse in a patient’s room. You mentioned at the beginning that you are constantly revising your method. Interdisciplinary Rounding Toolkit: 5 Interdisciplinary Documentation Template The second component of reinforcing our rounding format was the creation of document templates that mirror the ISDA framework. Reply. Checklist forms have been successfully used during multidisciplinary rounds in an 'open' ICU to increase the use of prophylactic and risk reduction interventions. I wonder if their uni lecturers and professors teach what is called interdisciplinary cooperative work in patient care or multidisciplinary team work. If I make a recommendation to adjust a medication dose for renal insufficiency, add VTE/SUP/VAP prophylaxis, or something similar I do not put that in the permanent medical record. Your email address will not be published. I don’t have a patient workup written up in a form I can share. DuBose JJ, Inaba K, Shiflett A, et al. Something has happened that makes it likely a vital system will fail, and we need to recognize and support it when that happens (tPA for stroke within the last 24 hours, overdose of unknown substances, high risk surgical procedure). Measurable outcomes of quality improvement in the trauma intensive care unit: the impact of a daily quality rounding checklist. Maybe the radiologist doesn’t see an infiltrate on the chest x-ray, or the cdiff test came back negative, or the urine legionella screen is negative. The attending physician was given responsibility for completion of the 18-item DRC for all ICU patients from admission to ICU discharge, and three months of baseline data were collected. Have you seen my productivity tips in episode 114? First and foremost, the focus on rounds must be on thepatient. Leadership rounding can be used to improve upon the patient centered care currently implemented. Moffitt ICU Rounding Template. I also prioritize who I am going to see first based on how sick they appear. How do you prepare for ICU rounds? xpath and xquery functions and operators 3 1. old news home van s aircraft rv builder forums and news. Now that I have a complete pharmacy problem list and my recommendations are planned, it is time to attend ICU rounds. This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. Continued use of this site indicates your agreement with the terms and privacy policy. Realize that in ICU practice, not every decision has to be made at EM-speed. Sigh…we are in 2018, i cannot believe this as a pharmacist. I feel like I may be getting too much into the weeds of some things that aren’t as important, but still missing out on other things from the PMH (especially when some patients have been here for 4 weeks and they just got added to my team). Primary Objective: To understand the perspectives and attitudes of ICU clinicians about use of a âDaily Goals Checklistâ (DGC) on morning rounds. I am having problems organizing all the information I obtain before rounds. 4. Review the bedside flow sheet Despite my hospital being mostly electronic, the critical care flowsheet is still on paper at my hospital. This is a modified version of the basic Scutsheet double sided sheet to be folded in half. I’m a pharmacy student and just got done with my critical care elective. 1. Some links on this site are affiliate links. Hardly ever says anything, doesn’t really know the patient because they have almost no contact with them, and isn’t trained to evaluate them. Episode 570: Euglycemic Diabetic Ketoacidosis After Stopping Canagliflozin, Episode 569: Evidence for gastrointestinal cation exchangers other than sodium polystyrene sulfate in acute hyperkalemia, A Pharmacist's Guide to Inpatient Medical Emergencies. As far as the clinical team [Drs, nurses, respiratory therapists, PTs, dietitians etc] are concerned, we do get good recognition for our work. (2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. I’d love to hear! Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. Icu Rounding Checklist Template electives courses. Here are some examples: -Propofol alone as sedation might be OK for some patients, but if I know they are s/p exploratory laparotomy with lysis of adhesions, the absence of fentanyl becomes clear. Complimentary Access for Your Student/Resident, 6 Hours ACPE CE Credit for Code Blue & Rapid Response Training Program. In this episode, I’ll discuss how I build my pharmacy problem list, use a paper report to supplement the electronic system, list my current 5 step pre-rounding process, and explain how I prioritize which patient to see first. I look for oxygen requirements, ventilator settings, vital signs, pressor and sedative requirements, depth of sedation, and urine output on the flow sheet. After all, you need to remember that when at the hospital. Print as duplex (on both sides) with page flip on SHORT edge. Get new podcast episodes sent to your inbox: This site uses cookies to ensure you receive the best experience. I am a bit overwhelmed to get everything done in an 8 hr shift. I’ll think about the dose, frequency, indication, and renal adjustment too, I just don’t need to write all that information down. The report includes basic demographic information for the patient, creatinine clearance estimate, allergies, creatinine/potassium/magnesium/wbc/hb/plt and any current orders for antibiotics, stress ulcer prevention, steroids, anticoagulants, or chlorhexidine. Daily rounding checklist. I talk in more detail about these reasons in episode 11 but in brief the 3 reasons are: 1. Rounds were audited in a blinded fashion over a 3-month period to obtain baseline data on rounding topic discussion. In our setting, charge nurses complete the documentation and are enabled to do so during or shortly after rounds. Read the history & physical, consult and progress notes to determine who is the patient and why are they here 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. Hi Ally! Thanks again for a great podcast! Rounds start at 7 AM I’m also an ICU clinical pharmacist and you & I seem to have very similar methods for working up our patients. Three interventions were then trialed (plan, do, study, act cycles) over a 12-month period. The Society of Critical Care Medicine (SCCM) is the largest non-profit medical organization dedicated to promoting excellence and consistency in the practice of critical care. 2. Review home medications © Society of Critical Care Medicine. Trying to find ways to work “smarter!” . 2008 Jan;64(1):22-9. ⦠Nonsense. I have found your articles very helpful to help me organize myself in this new place. The paper report serves as a “2nd computer screen” and allows me to see more information at once. Reading the history & physical and consult and progress notes. Cardiac – physician assistant vs nurse practitioner vs medical. During all phases of the study, attending physicians were allowed to either manually complete the checklist themselves or delegate its completion to a member of their ICU rounding team, and they were encouraged to complete the checklist during daily ICU bedside rounds. Figure 1. While multiple elements of rounding will have to be tailored to aspecific ICU, having the patient at the centre of all that happens on rounds musttranscend differences in ICU structure and culture. NIHSS, Stroke alert timeline, ICH score and prognosis, Hunt & Hess, tPA exclusion criteria and the most pertinent past. One paper contains all what you need during stroke alert! Success! To improve patient safety and quality outcomes, health care professionals are using multiple methods to reduce patient harm and eliminate medical errors. I.e., some decisions youâve time to think thru, consult the literature/a colleague, etc. I look at documentation as having 2 purposes: 1. Hi Joe, Do you have a template that you use for each patient rounded on? Rigorous adherence to this order (especially the order of vitals, labs and vent settings) will greatly improve rounding efficiency and afford more time for teaching. 2. Recommendations – medical history questions to ask in the acute setting! Then I write “on venlafaxine at home” under the neurologic section of my note. So sometimes i need to look up my patients at home before getting in (not ideal!). Do you have any recommendations? Equally important, clearcommunication between team members is a requirement that positively impacts thequality and safety of patient care. Our ICU and CCU have recently combined and now have a total of 26 patients. They also find that the pharmacist has little understanding of the technology we use. Multiple parameters are included along the left side. Most of my interaction with the patient/family is with medication reconciliation or pain management consults. Please adapt this form to your own environment. Crit Care Med. -provide a starting point to begin my review of the patient the next day. I am a last year pharmacy student and currently I am in a NICU roation. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. oals checklist was used for 80 ICU patient rounds over 6 days. How long does this take and who should I see first? Measurable outcomes of quality improvement in the trauma intensive care unit: the impact of a daily quality rounding checklist. You may be wondering, how long does this process take? I am a SICU/NICU pharmacist and I work out my patients the way you do as well. I am constantly tweaking and improving my method for pre-rounding on ICU patients. Improving an ICU Daily Goals Checklist: Integrated and End-of-Grant Knowledge Translation. Kp lau says. Listen to episode 19 for more on how I use sticky notes before ICU rounds. Templates for Calls and Morning Rounds. All rights reserved. To record activities for internal tracking purposes. Required fields are marked *. As an EM-CCM Fellow, slowness is unlikely to be a weakness â so even if it feels odd at first, take your time during routine rounds, while still being the hyper-efficient code-runner that EM docs pride themselves in being. I only document items that meet the first criteria in the medical record. Inspect trash segregation and proper disposal of different materials. As a medical student, one of my favorite ICU attendings advocated the step of running the âuntamable beastâ that is the medication administration record and med list â making sure that ordered meds were given, that every med that is ordered has a corresponding problem, that everything you think is ordered actually is, etc. Hi Ashley, I’ll write basic information on my pre-rounding sheet, like the name and day of therapy for the antibiotics that the patient is on. Thanks Jim, great idea! By observing the patient I can see how sick they look, whether they are intubated or have SCDs on. Most our attending rely heavily on our (pharmacist) recommendation and so I am looking for ways to make this process more efficient. DuBose JJ, Inaba K, Shiflett A, et al. Who is the patient and why are they here? One of the best things to look at the flow sheet for, is to determine “how sick is this patient?”. Alimentary – I have limited time to finish pre-rounding, and the purpose of the note is to facilitate problem solving so I do not copy-paste lab values or medication orders into my note. With members in more than 100 countries, SCCM is the only organization that represents all professional components of the critical care team. To communicate to other members of the healthcare team Respiratory – One method being implemented more and more is the checklist. LearnICU is a comprehensive library housing thousands of online educational materials, many available only to SCCM members. Launer J. Whatâs wrong with ward rounds? I also cover several dozen general medical beds, although I do not pre-round/round on those beds. One Liner. My focus during pre-rounding is to identify problems so that I can evaluate the best solutions for those problems. I liked that you pointed out that you should know that the templates are made to help keepings in track. PADIS Guidelines Teaching Slides: Sedation, PADIS Guidelines Teaching Slides: Delirium, PADIS Guidelines Teaching Slides: Immobility, Addressing Burnout: A Success Story from Mayo Clinic, SCCM Pod-VCCR7 The Basics of Veno-Arterial and Veno-Venous ECMO and the Indications of ECMO Therapy, Post-ICU Syndrome: Truth About Consequences, Right Care Right Now... and Later, The Difficult Task of Treating Multidrug-Resistant Acinetobacter baumannii. In this episode, I’ll discuss how to prepare for ICU rounds on a critical care pharmacy rotation. Here is my current routine for evaluating new ICU patients in preparation for patient care rounds. A Systematic Review of Evidence-Informed Practices for Patient Care Rounds in the ICU*. There was an error submitting your subscription. You can always look at the intensivist’s note or talk to the nurse for an idea of what the main problems are. Looking at the medications last helps me develop a more complete pharmacy problem list. Subscribe to the #1 ranked critical care and hospital pharmacy podcast. 3) Interviews: With 56 clinicians, we conducted semistructured individual and focus-group interviews, analyzing transcripts using a qualitative descriptive approach and content analysis. Joe, so happy i came across your podcast. Critical Care and Hospital Pharmacy Resources for Hospital Pharmacists, PGY-1 Pharmacy Residents, PharmD students, and Preceptors, September 28, 2015 by Pharmacy Joe 21 Comments. Whenever possible I like to be in front of the patient’s room when I evaluate them before rounds. Users of this website are cautioned to use their own professional judgment and consult any other necessary or appropriate sources prior to making clinical judgments. Do you have a specifc template that you use to write down all your pre-round information or do you just do it all electronically in the computer? J Trauma 2008 Jan;64(1):22-9. ⦠If the NG tube is being used for tube feeding, I know it can be used for meds too. Now check your email to confirm your subscription. Metabolic – The authors list 22 suggestions specific to surge capacity and mass critical care under the following topics: stockpiling of equipment, supplies, and pharmaceuticals; staff preparation and organization; patient flow and distribution; deployable critical care services; and using transportation assets to support surge response. Title: ICU - Daily Goals Checklist and Plan of Care Author: lwaugh Subject: ICU Daily Goals Checklist Created Date: 2/14/2014 3:02:21 PM Gain confidence in your ability to save lives and improve patient outcomes: Free downloadable PDFs to help you in your practice. At each step of my evaluation of the patient, I am filling out my note template in the pharmacy computer system with my “pharmacy problem list”. 2013 Aug;41(8):2015-29. I pay particular attention to the history of present illness and the assessment/plan. ... MICU Scutsheet- Tailored for the ICU environment, with emphasis on daily labs, ABGs, Vent settings. -remember my recommendations for rounds Interesting – I would appreciate it if you directed them to this site! 'Daily rounding' checklist improves ICU compliance. take accountability and clearly communicate the pharmaceutical care plan) in the medical record? Most of my pharmacy students are surprised that I look at medications last in my pre-rounding review of ICU patients. Thank you for this amazing lecture…could you help me please ..I need ICU pharmacist form. Interestingly, some other professions in hospital DO NOT EVEN KNOW what pharmacists do to make patientsâ journey smoother and commenting ⦠What Are Multidisciplinary Rounds? Check current hygiene practices, use of PPE, and the cleanliness of equipment and facilities such as patient rooms, kitchens, nursesâ stations, etc. I use the TITRS format as I describe in this post: pharmacyjoe.com/episode19. I m new to yr writings n find immensely useful. and completing my pharmacy problem list and recommendations for rounds. Objectives . 2) Document analysis: The 72 completed daily goals checklists from observed rounds were analyzed using mixed methods. Episode 571: How low can the dose of ketamine for analgesia in the ED go? 3. Review labs, cultures and imaging reports . a checklist is completed it is signed by the attending, given to the patientâs nurse to be kept at the bedside and the team moves on to the next patient. -Determining the cause of a patient’s agitation can be very time consuming, but if I know they were on paroxetine at home and haven’t had it for 2 days it is easier to narrow down the possible causes. J Centofanti, E Duan, N Hoad, M Swinton, D Perri, L Waugh, M Soth, DJ Cook . Checklists to Improve Patient Safety Why a Checklist? the compliance store â the only complete web based. VTE – core elements of hospital antibiotic stewardship programs. I have up to 19 patients in my ICU. If this is missing out, i suggest hospitals should start investing in this for benefits of patients. Two specific tools were created 1) a standard Plan of the Day (POTD) template (see Strategy section) which includes a checklist for review of Quality and Safety indicators and 2) a formal rounding schedule which provided families with the specific time when the care team would be arriving at the room to discuss and plan their child's PICU care. Stroke Alert Template. The medical intensive care unit (MICU) checklist was introduced in March 2009. I see the patients who are anticipated to stay in the unit before moving on to those who are identified for transfer out. Hi Dan, I am glad you have found things helpful! It does seem like a smart thing to be aware of when need to work at a hospital. As a critical care pharmacist, how do you document the recommendations you make on rounds (i.e. By March 31, 2015, 80 percent of all neonatal intensive care unit (NICU) bedside rounding will include a summary in parent-friendly language of all tests, labs, and procedures completed over the previous 24 hours. Postgrad Med J 2013;89:733-734 Leape LL, Cullen DJ , Clapp MD et al. I was wondering if you have made any changes that would warrant a new episode or revisit to this episode? As I review the current medications, I am looking at the choice of medication regimen, dose, considering the patient’s renal function, interactions, clinical condition, etc. My preceptor has given me a sheet to write down information but it is not user friendly and it dosent really allow me to write down medication information. To stay “out of the weeds” focus on the problems that relate to why the patient is in the ICU. The Society offers a variety of activities that ensures excellence in patient care, education, research and advocacy. I will add it to my list of new episodes! Would you be able to share an example of one of your patient work-ups?