families participating in am rounds

[spacey]

We are looking to involve families in our a.m. rounds. Our unit mostly has an open layout with bed spaces being in close proximity to one another. We are looking for ways families can participate in rounds while maintaining their privacy. The group that rounds is multidisciplinary and includes up to 20 people at times... so simply speaking very quietly isn't an option. We desperately need some feedback from others who have made this change! Do a large number of parents actually come and participate in this? How do you handle the privacy issue? What do you wish you had known when you were just starting this process? Thanks in advance for any input!!! We are really looking to benefit from other units' experiences!!

[NicuGal, MSN, RN]

We have been doing this for several years now. It depends on the parent...some don't come because they just don't, some don't come because of other kids at home or work. Also, we can't tell them a specific time they will round on their kiddo since it depends on census, unit activity etc. We just tell them rounds start at 8a and go until noon.

We only allow parents in the unit during rounds for privacy. We have 6 kids in a pod and of the other parents over hear things then it is an incidental overhearing. If it is a really complex kid they will ask the parents to come to team meeting that is set up in the afternoon, usually as warranted by the attending.

[brithoover]

We do this mon-Fri on my unit peds heme/onc and I absolutely love it. Parents get answers to questions I may not be able to answer. And I get answers from all interdisciplinary members instead of chasing them down. We don't have pods instead we have rooms down 3 different hallways. Team members go room to room and meet outside the rooms. Nurses ask parents during morning assessments if they wanna be apart of rounds.

As far as privacy goes most of our parents are pretty open with the other parents because they are typically there for so long. We try to encourage everyone to stay out of the hallways during rounds.

[babyNP., APRN]

We have 24/7 access for parents and private rooms, although the docs round at the door, not inside the room. Parents are welcome to participate in rounds; usually the team talks about all the numbers and medical jargon and then at the end ask the nurse to summarize and ask the parents if they have questions. Some of our docs aren't the best in the world at breaking things down for parents, so I try to serve as a bridge ("NPO means that he won't be able to eat before the surgery") when I can. After rounds I try to sit with the parents and ask if they understood what was going on. I also tell them to write down all their questions prior to rounds because often they forget to ask them; it's a little intimidating with 6+ people staring at you (attending, 2 residents, fellow, nutritionist, social work, pharmacist, etc).

On our old unit with open bays, I seem to remember that we tried to private in the presence of other parents, but most of the time there weren't a lot of sets of parents right next to each other.

[MistyM]

Our unit does this at present and if parents are visiting when rounds are on they are welcome to stay. It's quite simple the way we avoid other parents over hearing, just simply asking all other parents except the baby we are talking about to please take a seat in the waiting area and we will come and get them once its their babies turn

[NicuGal, MSN, RN]

We aren't allowed to ask parents to leave unless there is a code going on, and even then they can stay if the insist. Family centered care and TJC say parents have a right to be with their child no matter what. The ONLY exception is if the are doing an operative procedure or IR PICC in the room as it has to stay closed to maintain sterility. And of course you always have the parent who is nosy nosy nosy lol

[MistyM]

Hmm we r in the UK and I'm very new there so I'm not sure on all the guidelines yet, but it appears the parents r very accommodating and usually leave anyway when a round is on or handover is taking place

[jnick31]

We have 12 babies per pod and just close all the doors and invite the parents out to the center when it's their babies turn. Works well for us but we don't have 20 people, for us it's about 10-12.

[spacey]

Thank you to all who have shared so far!! It seems like most units have more privacy "built in".... I'd love to hear from someone who has a more old school totally open room design about how they manage.

From your comments I think one thing we might need to adjust is the sheer number of people who are participating. We usually have a member of management (at least 1) the nursing coordinator (charge nurse) outcomes coordinator (does immunizations / mst's etc) all of our Neos and NNPs, the medical director, pharmacy, 2-3 residents and frequently a medical student, a SW and frequently a SW intern or student, the RT and then there's usually 3-4 nurses (and usually a student or new-hire) in a level 3 room with 8-9 babies (and if you add in just one parent for just half the babies it brings the total up to over 30 people (not counting the babies!.. haha!)

The idea of sending families out until it's their turn is awkward for us as our waiting room is shared with L&D / NBN and is outside the unit (and would require them to scrub in again when it's their turn). We could have them stand in the hallway near the HUC desk, but that hardly seems considerate of their comfort and needs.

I'm open to suggestions! I really want us to think this through from the parents' perspective before we try to implement it... and I see the change on the horizon!!!

[NicuGal, MSN, RN]

All those people round every morning????? OMG. We do discharge rounds one day a week with all those people! Morning rounds are a pharmacist, the team taking care of the baby, the nurse and family if there. I would think that many people would be totally overwhelming for the parents!

[acenab4jc]

I work in an open area - 3 hexagonal things with 5 beds (one off each side), one isolation room, and 2 open bay with about 7 beds each (maybe about 3 feet between beds, especially with all equipment). We have always allowed parents to be at the bedside for rounds, but I don't really remember many parents participating (I work nights, haven't been on days for a while). Also, I don't remember there being that many people - usually: RN, charge nurse, maybe a student, attending, fellow, a few residents, pharmacist, SW, RT, and nutritionist. Like NicuGal, we also have discharge rounds weekly with DC planning, PT, OT, ST, etc plus others involved. There are usually 2 different teams (3 if we are really busy), and each team has a different patient list, so they try not to round near each other at the same time.

We just started "including" parents in shift report (I know this is only 2 people versus rounds). Most parents who participate don't really listen during report and just ask questions when they have them during the shift, and, even though we are close proximity, I don't really see the majority of parents listening in (if they are, try to redirect - tell them that they wouldn't want other people knowing sensitive info about them or their baby, please be respectful) - we also do not have good parental involvement to begin with. I think that the unit is talking about calling parents daily, few times a week, not sure? in order to update them because many parents don't visit or call for days at a time. I do encourage parents, especially if they have a lot of questions, to ask for a family meeting - where it's a sit down with any support they want and docs/professionals from every team involved in the baby's care - more personalized and less rushed than rounds.

[shermrn]

Th NICU I work in had headphones at each bedside that we plugged into the computer so parents could listen to music while the other patients were being discussed. It was a bit of a pain and overcrowded the nursery during rounds. Now we do rounds in a seperate report room, parents are always welcomed and encouraged to come.