Previously, we conducted daily interdisciplinary chart rounds including the pharmacist, charge nurse, nurse practitioner and physician. Since stable NHCU patients were not routinely seen by a physician or nurse practitioner every month, nursing suggested expanding the routine chart round to interdisciplinary walking rounds. Currently, one-fourth of the patients are seen each week. The list is posted 24 hours in advance for staff preparation. The pharmacist generates medication action profiles and highlights drugs for psychotropic review.
Nursing obtains routine vital signs prior to walking rounds.
We use a rolling cart with chart rack and examination supplies. Medication profile review is conducted between nursing, pharmacy and the physician. Review includes polypharmacy, psychotropic drug use and the appropriateness of the general medication regimen. The physician reviews the chart since the previous note, discusses care with patient and staff, and takes appropriate action. This system allows the physician and nurse practitioner to alternate monthly visits as appropriate.