interdisciplinary rounds, hints for improving info I provide

[jamkpb]

My NM told me that she doesn't think I have a good understanding of my patients given the info I provide (or don't, from her perspective) during rounds. The other day she actually cut me off (b/c I started with why the pt was admitted)and said "We know why he is here" with a not so nice tone. AUGH..throw me a bone, I'm trying! Here is what I present:

Abn VS, any issues overnight, any issues w/meds(not taking,need,etc), if they want parameters for any abn BP/HR, PT/OT, fluids. (Usually I go over any abn. labs, but NM said I don't need to do that either, b/c the MD's can look up).

My patients are high acuity and I'm not sure what else to include. I try to figure if they may need tests or consults; that's an area I know I need to work on.

I know I go into rounds very frazzled most days because I am trying to get my tasks done (meds, minimal assessment for 4-5 pts while dealing w/families, sending people off the floor...)

So maybe some suggestions on how to organize my thoughts for rounds would be helpful as well. I feel like I need to bring it up a notch, but not sure how to do that.

[nerdtonurse?, BSN, RN]

Don't know how they do it at your place, but we only do IDT when things go wrong -- usually, REALLY wrong. When my pt's been a focus of an IDT, what I focus on is WHY this person is brought to the attention of the IDT team -- long length of stay? unexpected outcome (like a person who was supposed to be SDS ending up intubated in the ICU instead of going home), patient injury? etc. Think about it this way -- if you were dragged into one on another floor, not your patient...what would you want to know? If he's intubated because the pt had malignant hyperthermia when he was just supposed to have a same day surgery, focus on aspects of that -- pt still intubated, having problems weaning them off, possible pneumonia, that kind of thing, not what you'd give in report to the nurse coming on. At our place, they may have 15 - 20 people to see, so the shorter you can keep it for them, the better.

As an example, I'd say something like, "Ms. smith came in 3/12 for a lap chole, experienced malignant hyperthermia, and has been in the unit 3 days. We have not been able to wean the pt off the ventilator due to....." Let them ask questions beyond that. Or, "Mr. Smith was an inpatient with a bowel resection, fell out of bed on 3/13, and dehisced, and also broke his R hip. Pt had surgery on 3/13 to address the dehiscence and the R hip was replaced by Dr. Smith on 3/15." That tells you quickly why the guy's been put on the IDT list.

'Course, your boss sounds like a horse's rear, too. Ask to go on IDT rounds and see who's report they like, that will probably help you the best.