This document discusses rounds in the intensive care unit (ICU) at Dunedin Hospital in New Zealand. It describes the current daily routine of rounds, which includes a morning sit-down ward round with doctors, nurses, and other staff. However, the room used is small with no air conditioning and there are often interruptions. The document suggests ways rounds could be improved, such as using a structured checklist, minimizing unnecessary interruptions, and improving the physical environment. It also proposes introducing a structured handover checklist for nurses to test whether it helps them feel less stressed and improves information sharing with the rest of the team.

1. Rounding in ICU
WFCCN CONGRESS 2014
GORDON SPEED
DUNEDIN, NEW ZEALAND

2. New Zealand

3. New Zealand
Dunedin

5. My Area

6. Rounds
A teaching conference or a meeting in which
the clinical problems encountered in the
practice of nursing, medicine, or other
service are discussed.
Mosby’s medical dictionary, 8th edition 2009, Elsevier

7. This talk is about:
Planned daily, or more frequent,
interdisciplinary meeting to discuss diagnosis,
progress and plans for a group of Intensive Care
Patients

8. It is not going to look at:
Nursing rounds*
Intentional rounding
Nursing handover / hand-off
Shift handover / hand-off
*The impact of Nursing Rounds on the practice environment and nurse satisfaction in intensive care:
Pre-test post-test comparative study
Leanne M. Aitken, Elizabeth Burmeister, Samantha Clayton, Christine Dalais, Glenn Gardner
International Journal of Nursing Studies, 48 (2011) 918-925.

9. Problem from a Doctor on e-mail list
Bedside round only
Rounds take to long (three hours+)
Multiple interuptions (phone, visiting specialists, calls for immediate care, X-ray
and other tests)
Structure of nursing handover not useful. (Long, system based and often not
relevant)
Structure varies with lead doctor
Noisy unit
How could this be done better?

10. What happens in Dunedin Hospital?

12. Small Unit
300 bed hospital
12 beds, but staff for six.
Cardiac surgery, neurosurgery, paediatrics, trauma, etc.
Retrieval service – nurse and doctor on helicopter, referrals from large
area.
40 Full time equivalent nurses, 37 have a post graduate qualification in
Intensive Care. Several have 30 years+ experience in ICU.
Five intensivists, 1-2 registrars based in ICU at all times.

13. Daily routine
0700 nurse handover – 3 minutes brief all patients, then bedside 1:1
0800 Ward Round Sit down, Doctors, Nurses, Physiotherapist,
Pharmacist. Sometimes Dietician, biochemist, others.
0900 walk around round Doctors, pharmacist, bedside nurse.
1700 Doctors walk around round/handover.
1900 nurse handover as above
2100 Doctors walk around round

14. 0800 ward round
Small Room

16. 0800 ward round
Small Room
No air conditioning

18. 0800 ward round
Small Room
No air conditioning
Handover structure not fully consistent

20. 0800 ward round
Small Room
No air conditioning
Handover structure not fully consistent
Nurses handover on Wednesday

22. 0800 ward round
Small Room
No air conditioning
Handover structure not fully consistent
Nurses handover on Wednesday
Interruptions

24. So how can this be better?
Critical Care Medicine, August 2013, vol 41, no. 8 page 2015
-2029

26. What do we do right?
Multidisciplinary team
Standardised time, location and team.
Explicit roles for each team member
Reduce non essential time wasting activities
Focus discussions on daily goals
Conference room and bedside used.
Open collaborative discussion environment

27. What could we do better?
Develop and implement structured tool (best practices
checklist)
Minimise unnecessary interruptions
Better physical environment
Produce visual presentation of patient information

28. So what should the Doctor on the
email list do?
?

29. And what should you be doing?
?

30. What else?
Improving nurse handover during rounds in Dunedin ICU.
Nurse vary but often find handover scary and stressful.
Would a structure and checklist help?
Pre and post survey, introduce structure and checklist, measure if
nurses feel better and if rest of team feel information is more
focused and relevant.
Present at World Congress in Seoul next year????

31. What questions do you have?

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