Assessing Implementation Adherence of a Rounding Process in Cardiac Intensive Care

Abstract

Problem: In a 15-bed cardiac medical intensive care unit, there has been decreased nurse presence and participation in multidisciplinary rounds. Purpose: The purpose of this quality improvement project was to implement a practice change that improves communication and provides a consistent rounding process while increasing nurse presence and participation in the cardiac intensive care unit during daily multidisciplinary rounds. Methods: Over 15 weeks during the Fall of 2023, the introduction of and utilization of the tool adapted from the Agency for Healthcare Research and Quality (AHRQ) daily goals checklist and served as a daily cue during rounds. The structure change was creating the evidence-based tool. At the start of rounds, nurses discussed overnight events and remained with the team to discuss the care plan for each system. Data was entered into an encrypted data collection system using a QR code embedded in the rounds sheet by the charge nurse. Weekly text reminders were sent to attending physicians to remind them of process changes. Daily huddle announcements were given to the nursing staff to remind them of the process change. Results: Results showed nurse attendance rates ranged from 10% to 100%, with an overall increased median rate of 70 % attendance during rounds. Complete utilization of the tool on all occupied beds ranged from 14% to 93.9%, with a median rate of 53.9%. Conclusions: Results indicate that nurse attendance during rounds has improved during implementation. Adherence to completing the rounding tool was challenged due to the changing rounding location and the location of the rounding tool on the unit. Adherence to process change was also challenged by varying high acuity days and mock surveys for accrediting bodies.