Nurses play a key role in engaging and communicating with families. Empower them with clearly defined roles during family centered rounds.
From a patient safety standpoint, it's important to have families involved in their child's care. Communication—or a lack of it—between doctors and nurses, clinicians and families is the main root cause of sentinel events. While caregivers have intimate knowledge of a patient's historical background, they are often an untapped resource for medical teams.
At the 2018 Quality and Safety in Children's Health Conference, Christopher Landrigan, M.D., M.P.H., research and fellowship director of Inpatient Pediatrics at Boston Children's Hospital; Alisa Khan, M.D., M.P.H., staff physician at Boston Children's Hospital; and Jennifer Baird, Ph.D., M.P.H., M.S.W., R.N., director of nursing research at Children's Hospital of Los Angeles, outlined how the original IPASS concept is being adapted and used as a way to engage patients and families and improve the quality of care.
"As part of this concept, we start rounds by saying ‘hi' to families," Landrigan says. "They speak first and tell us their concerns. We use plain language, encourage health literacy and bi-directional communication, and make sure they are looped in on the care of their child for the rest of the day."
He says the team also introduced a rounds report for family members at the prompting of a family member advisor early in the process. Rounds were overwhelming for family members; so the team created a written form they could refer to or share with a spouse later.
Nurses also play a key role during family centered rounds, and the team created guiding principles for nurse engagement. "Nurses must be better engaged during family-centered rounds," Baird says.
"Historically, the nurse is not present for rounds, or has been an observer, but nurses are key members of the team during family centered rounds and are critical for development of the care plan. Nurses, physicians and family members need to come together for the care plan to be successful."
As part of the initiative, nurses have a defined role in family-centered rounds:
- Coach patients and families; orient and prepare them for family-centered rounds
- Advocate for patients and families; address their concerns
- Speak early to provide critical information, such as what happened during overnight events
- Speak often to share thoughts or concerns
- As questions to create a shared mental model
Overall, this communication intervention was associated with a 38 percent reduction of adverse events at Boston Children's and associated with improvements to aspects of the family experience and nurse engagement, which is helping keep kids safer.
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