The Need for Multidisciplinary Rounds at CMC

The Need for Multidisciplinary Rounds at CMC

Wanda Baker

American Sentinel University

The Need for Multidisciplinary Rounds at CMC

The Intended Change

After speaking with my Nurse Manger, we both agree we would like to see improvement in the area of multidisciplinary rounds.  Multidisciplinary rounds refer to mechanisms through which healthcare providers in varied specialties meet so as to communicate and coordinate healthcare provision to the patients, as well as make joint decisions not to mention manage responsibilities. They allow several fundamental members of the healthcare team that is taking care of patients to come together and provide their expertise in taking care of the patients. It is noteworthy that, on numerous occasions, physicians prescribe a certain type of care for patients without incorporating other professionals’ input. While it is not required that they undertake multidisciplinary rounds, even highly efficient physicians would benefit from the input of other providers especially as far as enhancing the provision of healthcare services is concerned. The intended incorporation of multidisciplinary rounds would bring together all care providers every day to discuss each patient’s condition, as well as the occurrences of the past 24 hours while planning for the day ahead.  Hospitalists, nurses, case managers, social workers, respiratory, physical and occupational therapist and pharmacist, would engage in face-to-face communication and participate in decision making.  It is noteworthy that it is not a perfect world and not all of the disciplines can be available each day at a specific time.   At the minimum rounds should include the physician, bedside nurse, charge nurse, case manager and nursing manger if available and be completed in 30 minutes or less(Knowles, 2006).

Rationale for the incorporation of multidisciplinary rounds

Multidisciplinary rounds improve patient care and outcomes (Muething, Kotagal, Schoeltker, Gonzales, & Dewitt, 2007).  There is empirical evidence that multidisciplinary rounds are needed on our unit.  Right now there is not a multidisciplinary program in place.  The Hospitalist or Physician writes notes and tries to talk to the case manager and nurses on the fly by.  Often, a nurse is in the room providing care for  another patient then gets called to the nursing station because the Physician needs to speak to her about Mrs. J’s condition.  At certain times, the nurse may not be available to come right away, and the Physician tires of waiting and must go ahead and see Mrs. J.  When he has to do this it does not allow for him to receive an accurate update on Mrs. J’s condition, therefore, does not allow him to increase efficiency in prescribing care for Mrs. J. which may result in a longer hospital stay.  Multidisciplinary rounds would allow the entire process to happen at one time (Malcolm, 2011).

On the same note, multidisciplinary rounds are known to facilitate the implementation of invaluable clinical practices including evidence-based treatments for sepsis and acute lung injury, as well as prevention of complications arising in the ICU. Research shows that the participation of pharmacists in rounds results in a reduction in adverse drug events, which reduces the mortality rates among Intensive Care Unit patients (Boyle & Kochinda, 2004). In addition, multidisciplinary rounds come as one of the ways of enhancing communication between healthcare providers. It is noteworthy that the provision of efficient patient care is dependent on close communication between healthcare professionals such as nurses, physicians, physical therapists, as well as discharge planners (Boyle & Kochinda, 2004). In most cases, the numerous services that have to be offered and their consequent workload slows down communication as seen in Mr. J’s case. Scholars have also noted that the incorporation of multidisciplinary rounds enhances the satisfaction of the nurses and physicians, as well as patients. There is an overall improvement in the quality of care thanks to the enhanced collaboration and communication among the participants. This is especially considering that every team member is provided with an opportunity to offer his or her expertise, as well as bring up evidence-based practice or any new research, all of which will be channeled to the enhancement of healthcare services provided to the patient.

Audience to be convinced about the incorporation of Multidisciplinary Rounds

The success of this project is fundamentally built on consistency. Needless to say, consistency in carrying out multidisciplinary rounds would necessitate that the concerned parties be properly consulted and informed beforehand. This is especially considering that there is an element of difficulty in synchronizing or harmonizing the schedules of the different healthcare participants. It is worth noting that multidisciplinary rounds have, in the past, implemented in our unit without much success thanks to the fact that the parties concerned had not been appropriately consulted or even convinced about its importance.

In this case, it is extremely imperative that the medical director and the nursing director are convinced to allow for the incorporation of the multidisciplinary rounds. The basis of the conviction would be the alignment of the institution’s vision and mission with the expected outcomes of multidisciplinary rounds. The institution has outlined its mission as the provision of patient-centered healthcare, something that would require effective teamwork and communication, as well as a culture of safety among clinical nurse specialists, educators, physicians, nurses, dieticians, respiratory therapists, as well as other administrative and allied health leaders. While convincing the medical director and nursing director would be an immense step towards the implementation of the multidisciplinary rounds, it is imperative that all other mentioned parties are convinced about the importance of this exercise so that they can devote time to participate in the rounds. Convincing and consulting them will allow them to own the process and actively participate in it through personal initiative. The unit medical director ensures that every aspect pertaining to the patient as a whole is addressed. The primary nurse plans, coordinates, assesses and presents the case of the patients to the multidisciplinary team during the rounds. Intensivists would also need to be convinced as they provide clarity, as well as in-depth knowledge pertaining to the pathophysiology surrounding the medical diagnosis of the patient.

How the institution will benefit

The healthcare institution will undoubtedly be one of the biggest beneficiaries of the incorporation of multidisciplinary rounds. Enhanced communication and collaboration between the different healthcare professionals is bound to cooperation and efficiency in the provision of healthcare services. Needless to say, this would have a positive effect on the patients as research has shown that it reduces the amount of time that they spend in hospitals and enhance their experience. On the same note, the cooperation leads to increased satisfaction and motivation of the different healthcare professionals, something that leads to increased efficiency in the provision of healthcare services.

Main leaders of the initiative

It takes time for new ideas to be gradually introduced in an effort to implement the varied stages of change, as well as eliminate familiar practices (Grohar-Murray & Langan, 2011).  One of the things that my manager thinks would be effective in improving the efficiency of multidisciplinary rounds would be to have a rounding leader.   This could be the Charge Nurse of either shift and would be a good resource, since she receives a report on every patient.  This could also be decided in a group meeting with a vote from each member.  The person who is chosen must accept and commitment to the rounding leader role.  By having a leader, the Physician does not have to have a set time to make rounds on his patients.  He could receive most of the pertinent information from the rounding leader.  Another idea would be to try and find time allocated to round that all disciplines could meet to discuss the patient’s progress on a daily basis.  To try and implement multidisciplinary rounds into place, there must be rounding participants that are willing to make a daily commitment to be present during the rounds(Malcolm, 2011).

From a theoretical perspective linking staff member’s perceptions for the plan through social interaction can be conceptualized in many ways by bargaining between different professions as they come together to carry out their duties (Mconey & Schacht, 2000).  The structure of the health care team can be negotiated through a series of compromises between the team mem.............