Implementing a daily multidisciplinary rounds standardized checklist in the medical ICU to improve nurse satisfaction and communication
Creators: name: Nicholas, Emma
Publisher: name: No Publisher Supplied
Year: 2022

description: Purpose of Project: The intensive care unit is responsible for the most critical patient population in the hospital. Collaboration and communication must be effective in order to optimize patient care. The Joint Commission, Society of Critical Care Medicine, and the American Association of Critical Care Nurses support that daily multidisciplinary, intensivist-led rounds are recommended in the critical care units (Seigel, et al., 2014). Prior to the COVID-19 pandemic, an adult medical intensive care unit (ICU) in a suburban North New Jersey midsized hospital was managed by a Pulmonary/Critical Care group of providers. There was a turnover of physicians during the pandemic and the ICU was then managed by a variety of physicians with different types of backgrounds including surgery and trauma. The change in physician coverage disrupted normal communication. Multiple orders needed to be reiterated, and created a lack of satisfaction with multidisciplinary rounds with nurses in the ICU. The purpose of this project was to determine if the implementation of a standardized checklist for multidisciplinary rounds in the medical intensive care unit for 30 days would increase nurse satisfaction and communication with the intensive care unit physicians.Methodology: This project is a quantitative Health Care Delivery Innovation project. The population of this study included day shift registered nurses (RN) that are employed on the critical care unit. All day shift RNs were recruited and asked to fill out the Collaboration and Satisfaction About Care Decisions (CSACD) survey prior to implementation of the standardized checklist which was created by the ICU team. The standardized checklist included multiple critical care items to be addressed in multidisciplinary rounds daily. After 30 days, the CSACD survey was sent out again to evaluate if there was improvement in communication and satisfaction with multidisciplinary rounding.Results: Implementation of the standardized multidisciplinary rounding tool in the medical ICU showed statistical significance with improvement in nurse satisfaction as well as communication in the ICU. Shared decision-making responsibility, coordinated decision making, open communication, and satisfaction with the process of decision-making improved and were also statistically significant. Implications for Practice: Implementation of the standardized multidisciplinary checklist has the implication of improving clinical practice by facilitating more effective communication and creating a cohesive plan for the day by serving as a tool to facilitate conversation about the patient case. With critical care elements identified, nurses and physicians were on the same page which created a clear plan of day for the patient. Best practices were discussed more frequently and consistently with facilitation from the tool, which generated a safety net for the patient with the open communication and collaboration. The multidisciplinary tool is also a resource for the newer critical care nurses to help facilitate communication as well as help them organize the plan of care. Also, while not the primary goal of this project, evidence does show that implementation of a standardized checklist decreases cost of the ICU stay (Lemkin et al., 2020).