Nurses presenting patient on rounds

getoverit, BSN, RN, EMT-P · Apr 24, 2009

Hey.

yeah, we present our patients every morning during rounds. I think it's a good idea, definitely can strengthen the relationship between the doctors and nurses. Our Critical Care doctors also use it as a time for some informal education on disease processes, management, etc.

At first it was met with some reisistance, groaning, etc. but it's become a big success in my opinion.

Certain information is kind of scripted, but unless someone got admitted overnight and the docs are unfamiliar with them most of the info is any changes or anything new from the day before. Vent changes, I&Os, rates of infusion for vasopressors/sedation, any significant ectopy, etc.

The attendings usually then spell out what they feel the "plan of the day" should be. so it's a good time to have an open discussion and make sure everyone's on the same page. the residents usually follow the attendings around and don't say a whole lot. In fact, we always joke about throwing seeds on the floor to watch them gather around and squawk like a flock of geese!!

We also have sort of a modified Kardex that the physician can look at to get a real quick overview.

Hope this helps some and good luck with it. I think it's a good thing.

tri-rn · Apr 24, 2009

We do this with our MICU patients. We don't really have a script or even certain information we give...usually it's a synopsis of the patient's history and current situation, sort of like how many nurses give report.."So and so is a blank year old gentleman who came in through the ED with abdominal pain and black stools x 3days blah blah blah"....

Getting the negatives out of the way first...it's one more thing to do...they always seem to show up when you are busy (when aren't we busy though?LOL). Also, oftentimes you pick up a patient at 0730 with a complicated backround, rounds are at 1030, you haven't really had time to learn as much as you'd like, and nursing ends up looking ill-informed.

As to the residents' roles, usually the "presentation" leads to a question from someone and the whole thing turns into a discussion of something or another regarding the patient, and maybe a mini-lecture by the attending. Our rounds are multi-disciplinary with the attending, fellows, residents, med students, PT, RT, RD, Pharm, and the charge nurse all in attendance. So we're presenting to a rather large group.

On a positive note, some really good discussions come out of it. Creative solutions come from all different angles...someone will suggest that something is an issue and the PT or the RD will have a suggestion. (Nursing is expected to stay, listen, and have input after the initial presentation too ). It's kind of great when everyone puts thier heads together and solutions are reached - how to get a patient oob, how to most effectively time meds to work with nutrition and PT or a spontaneous breathing trial, etc etc. So I guess overall I like them even if they are sort of a disruption a lot of the time.

MistyDawnRN06, BSN, RN · Apr 24, 2009

Thanks for the great replies!

Would you mind telling me what facilities you work in?

I'm at Shands UF in Gainesville Florida and we're trying to launch the nurse presentation on rounds.

Thanks!

MD

wildflowerparn · Apr 24, 2009

We present the patient system by system with labs and cultures

the resident talks about the reason for hospitalization and course of stay including consults

Attending decides plan of care

cabin5 · Apr 27, 2009

We do this daily with the intensivist and it works well. We do use a form and other info==fasthug==food, analgesia, sedation. thrombolitics, head up, ucler prevention, glucose. We also look at their labs, antibiotics, meds, social and dischage plans. We include pharmacy, social services, case management, pastorial care, and dietary in these rounds--weekends get a little more lax--but we still do them. It really speeds up recovery and ICU time.

Cindy

United Regional in Wichita Falls, Texas