NURSE-LED

INTERPROFESSIONAL
ROUNDS
Lab Group C:
Annie Giang, Angelica Caballero, Grace
Li, Dana Griffin, Holly Arana, Nicole
Blackburn, Becky Patty, Kaitlyn Hopkins,
Jesse Smith
 Annie Giang

Significance to Nursing, PICOT, & Evidence Based Practice

question
Significance to Nursing
● According to the World Health
Organization (WHO),
medication errors are the
leading cause of preventable
injury in health care systems (“WHO”,
2019)
in 2019. (“WHO”, 2019)
● “Impact of Nurse-Led ● Implementation of nurse-led
Interprofessional Rounding on interdisciplinary rounds
Patient Experience” study ○ Improves communication
showed communication
fragmentation between ● Nurses are the primary care
nurses, providers, and
provider at the bedside
patients, leading to unsafe
care, including medication
PICOT Question

In high acuity care (P),

how do nurse-led interdisciplinary rounds (I),
compared to physician-led interdisciplinary rounds (C),
affect medication errors (O)
during a patient’s hospital stay (T)?
What is the Best Practice for
interdisciplinary rounds to
improve patient safety and
reduce medication errors?
Angelica Caballero

Summary of Current
Practice
Summary of Current Practice
Interdisciplinary Rounds: The collaboration between healthcare professionals with
the goal of sharing information and positively impacting patient outcomes

Physician-Led Rounds: Rounding which may include interdisciplinary team members

but the attending physician shares information with the group with little
collaboration involved

Practices Identified in Research:

● Who is involved in interdisciplinary rounds?
● What is the focus of the rounds?
● Where do rounds take place?
● When do rounds take place?
● How long do rounds last?

(Burdick, Kara, Ebright, & Meek, 2017; Cao et al, 2017; Gausvik, Lautar, Miller, Pallerla, & Schlaudecker, 2015; Gormley et al, 2019;
Similar Practices
● Local
○ Banner UMC
○ St. Joseph’s
Hospital
● State
○ Arizona Nurses
Association
● National
○ The Joint
Commission
(Health Stream,
2018)

(Arizona Nurses Association, 2019; The Joint Commission,

2015)
 Grace Li
Synopsis of Current
Literature
Current Literature
Communication is key in patient care and patient
safety

● Nurse led interdisciplinary rounds

● The nurses insight on the patient is critical (Jimenez,
Swartz, & McCorkle 2018).
○ Decreased medication errors (Gormley et. al, 2019).
○ Continuity of care
○ Patient safety
○ Less details missed because the nurses were
able to discuss their findings with the
interprofessional team during rounding (Fisher,
Grosh, & Felty 2016).
○ Holistic discussion
 Holly Arana

Research Review: Strengths and

Limitations
 Research
ImpactArticles
of Nurse-Led Interprofessional Rounding on Patient Experience (Gormley et. al, 2019) Quantitative Level IV

Structured Nursing Communication on Interdisciplinary Acute Care Teams (Gausvik et al, Mixed Level IV
2015) Methods

Bedside Interprofessional Rounding: The view from the patient's side of the bed (Burdick et Qualitative Level IV
al., 2017)

Improving Quality Through Nursing Participation at Bedside Rounds (Jimenez, Swartz, & Mixed Level V
McCorckle, 2018) Methods

Patient safety after implementation of a co-produced family centered communication Quantitative Level IV
program (Khan et al., 2018)

Nurse-led rounds to improve quality measures related to HAPUs (Fisher, Grosh, & Felty, 2016) Quantitative Level IV

Patient-Centered structured Interdisciplinary Bedside Rounds in the Medical ICU (Cao et al., Quantitative Level IV
2018)

Effectiveness of nursing rounds in the Intensive Care Unit on workplace learning (Tobiano, Mixed Level IV
Murphy, Grealish, Hervey, Aitken, & Marshall, 2019) Methods

The Menefee Model for Patient-Focused Interdisciplinary Team Collaboration (Menefee, 2014) Mixed Level IV
Methods
Strengths
● Limiting Bias
○ Single researcher (Burdick et al., 2017)
○ Same data collectors (Cao et al., 2018)
● Providing Consistency and Structure during Rounding
04
○ Patient Centered Structured Interdisciplinary Bedside Rounds
(PCSIBR) checklist (Cao et al., 2018)
● Length of Study Holly Arana
○ Two year study (January 2016 - June 2018) (Gormley et al., 2019)
Here you could describe the topic of the section
● Working with Large Sample Size
○ >3000 patient size population (Khan et al., 2018)
○ Pilot with 3 hospital study (Menefee et al, 2014)
● Implementation of Education and Training
○ Nurse Rounding workshop (Khan et al., 2018)
● Measurement of Success
○ Rounding assessment analysis (Fisher, Grosh, & Felty, 2016)

(Covit,
2017)
Limitations
● Decreased Consistency
○ Inconsistency with Interprofessional Rounding (IR)
implementation (Burdick et al., 2017)
○ Variance in adherence with intervention, language, nurse
engagement (Kahn et al., 2018)
● Limited Sample Size
○ Single Unit
○ May not be generalizable
● Limited Time for Implementation of Study
○ Rounding time restrictions (Gormley et al., 2019) (Mueller, 2019)
● Interference with Regular Practice
○ Major change for staff/diverse communication styles
○ Nurses not ready for responsibility (Jimenez, Swartz, & McCorkle,
2018)
 Nicole Blackburn
Nursing Recommendations for Best Practice,
Application / Implementation of Intervention, &
Timeline
Nursing Recommendations:
Best Practice

re
Gain

o f ca
n u rs

uity
Ho n
io

e
l t

in
’s ins
is
tic ica

Cont
di un
sc m

ight
m
u ss co
io ed
n as
c re
In
nary
Less iscip li
miss interd
ed d ased tion
etail Incre u n ica
s comm
Nurse-led
nt
Rounds Ove
r
me all les
patie dic sh
ased at i o a
Incre a c tio n n e rmful
f rror
satis s

o n
si

Re ed
is

du ica
m
m

ce tio
d

of
a

s
Incr
re es

gth

po n e
d t
ce ra

te rro
eas
len
u

n t rs
d

safe

ia
Re

ed p

l
y
sed
sta

ty
rea

a
tien
Dec

(Burdick et al, 2017; Cao et al, 2017; Fisher et al, 2016; Gausvik et al, 2015; Gormley et al, 2019; Jimenez et al, 2018; Khan et al, 2018;
Menefee, 2014; Tobiano et al, 2019)
I-PASS Video
https://www.bmj.com/content/363/bmj.k4764

(Khan et al.,
2018)
Application /
Implementation
Structure: I-PASS
● Illness severity
● Patient summary
● Action list
● Situation awareness and contingency planning
● Synthesis by receiver
Emphasized Strategies
● Patient and family engagement ● Mid-shift interprofessional huddles
● Plain, non-medical terminology ● Sustainability campaign
● Bidirectional communication
● Interprofessional and nurse engagement
● Written summary (whiteboard or paper) (Khan et al.,
2018)
Timeline of Implementation
One One Up to two years
administrative administrative
meeting meeting
Weigh the risks Get nurse Implement
and benefits managers,
attending
physicians, other
leadership staff on
board

Analyze the Train the

budget and interdisciplinary
determine if this
team
- Simulation & role
plan is feasible
play
- Online video
modules (Khan et al.,
One Up to two years
2018)
administrative
Becky Patty
Cost Analysis
Cost Analysis
Interactive Workshops
● I-PASS training
○ Roles in rounds
○ Family engagement strategies
○ Health literacy
Trainer: $108.33 for training, $36.11 per shift
○ 3 hours of training for one hour
of instruction (“Estimating Costs”, 2015)
○ Average Arizona RN: $36.11/hour
(“Nurse Salary in Arizona”, 2019)
Reinforcement and Feedback
● Simulation and role play exercises
○ Nurses: independent computer
based video module
Module: $3,700-7,400
○ eLearning Developer: $37/hr
○ 100-200 hours to develop one
hour of eLearning (“Estimating Costs”,
2015)
(Khan et al, 2018)
(“Graphic Design Budget”,
Cost Analysis
Previous slide:
● Trainer: $108.33 + $36.11/shift
● Module: $3700-7400
Sustainability Campaign
● Promote the program
● Visual reminders for the team
Logo: $5,000 (“Graphic Design Pricing”,
2019)
Posters: $84 each 3’x4’
Prices”, 2019)
Family Brochure
● Orientation to I-PASS
● Team member roles and
responsibilities
Brochure: $15-$45 for unit worth of
patients
○ Average unit: 10-30 patients
○ 100 customized brochures for
$150 (“Brochure”, 2019)
(“Poster
○ $1.50 per patient

Total: $9,520.43-
$13,250.43
● One trainer, 10 shift meetings
● (Khan et al, 2018)
Nursing computer module
● Logo development and four
Kaitlyn Hopkins
Risks vs.
Benefits
Benefits for Institution, Nursing and
Patient
● Increased interdisciplinary communication (Gausvik et al.,
2015)

● Increased communication between patient, their family,

and the medical staff (Khan et al., 2018)
● Reduced high alert medication errors and potential
medication errors (Khan et al., 2018)

● Increased patient safety (Burdick et al, 2017)

● Decreased length of stay (Jimenez et al, 2018)

● Increased patient satisfaction (Menefee, 2014)

(“Medical team”,
2019)
Risks for Institution, Nursing and Patient

● Total medical errors remained

unchanged at times (Khan et. al, 2018)

● Interdisciplinary communication
breakdown (Burdick et. al, 2017)

● Not following or implementing a set

SBAR format (Menefee, 2014)

● Length of time rounding delays

(“Pills”,
patient care duties (Menefee, 2014) 2017)
Jesse Smith
Outcome
Evaluation
 SMART Outcome

Nursing-led interdisciplinary rounds will result in at least a

30 % reduction of the rate of medication errors hospital-
wide, measured using a combination of surveillance
techniques from physician & pharmacist self-reporting to
analysis of medication charts, in the period of a year
following the implementation of the intervention.

(Khan et al., 2018; )

(24+ Tape measure Clip Art,
2019)
Timeline of Evaluation

When initial Begin monthly Analyze data

training is assessment of gathered over the
complete, allow medication error evaluation period
one week for units occurrence on the over the course of
to become units. Be sure to
three weeks.
acclimated to the interview Doctors,
intervention. Pharm, and Nursing

Begin data Continue Data

collection at the collection for one
end of year minimum post
acclimation initial training
session. Reassess
period. Instruct
units for adherence
units to time each month
each Round.
Dana Griffin
Summary
Significance to Nursing Summary

● The Joint Commission (TJC) National Patient

Safety Goals 2019 (TJC, 2019)
○ “Use Medications Safely”
○ Improve Interdisciplinary Communication
○ Reduce preventable errors

(TJC, 2019)
PICOT

In high acuity care (P),

how do nurse-led interdisciplinary rounds (I),
compared to physician-led interdisciplinary rounds
(C), effect medication errors (O)
during a patient’s hospital stay (T)?
Reduces Medication Errors
● Potential overall errors (Gormley et. al, 2019; Menefee, 2014)
● Specifically reduces harmful errors 37.9% (Khan et. al, 2018)

(Medication
errors,
 Application Outcomes
Training
● Implement Structured Transfers of Information (IPASS) Est. $9,520.43-$13,250.43

Focus
● Nurse-Led
● Patient-Centered Care
● Non-Medical Terminology
● Bidirectional Communication
● Summarize

Outcomes
● Goal: 30% reduction in
medication errors
hospital-wide

(Khan et al, 2018) (AAFP,

2019)
 Risks
Benefits
● Potential for care
delays ● Reduces error
● Disorganization/ ● Patient safety &
chaos satisfaction
● Teamwork
● Efficiency
● Holistic Care
Vs.
Questions?
 References

Arizona Nurses Association. (2019). Public policy agenda. Retrieved from https://www.aznurse.org/page/PP01

AAFP. (2019). Retrieved from https://www.aafp.org/news/practice-professional-issues/20190904annalscollaboration.html

Brochure and Flyer Marketing. (2019). Retrieved from https://www.psprint.com/resources/brochure-flyer-marketing-budget/

Burdick, K., Kara, A., Ebright, P., & Meek, J. (2017). Bedside interprofessional Rounding. Journal of Patient Experience, 4(1), 22-27. doi:

10.1177/237437517692910

Cao, V., Tan, L. D., Horn, F., Bland, D., Giri, P., Maken, K., … Bryant Nguyen, H. (2018). Patient-Centered Structured Interdisciplinary

Bedside Rounds in the Medical ICU. Critical Care Medicine, 46(1), 85–92. https://doi.org/10.1097/CCM.0000000000002807

Covit, D. (2017). Why insisting on consistency is important for every business. Lingo Blog. https://blog.lingoapp.com/why-insisting-on-

consistency-is-important-for-every-business-d1c4d73a50ba

Estimating Costs and Time in Instructional Design. (2015). Retrieved from http://www.nwlink.com/~donclark/hrd/costs.html
Fisher, K., Grosh, A., & Felty, V. (2016). Using nurse-led rounds to improve quality measures related to HAPUs. Nursing, 46(11), 63-68.

doi: 10.1097/01.nurse.0000494657.67378.00

Gausvik, C., Lautar, A., Miller, L., Pallerla, H., & Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care

teams improves perceptions of safety, efficiency, understanding of care plan and teamwork as well as job satisfaction. Journal of

Multidisciplinary Healthcare, 33. doi:10.2147/jmdh.s72623

Gormley, D. K., Costanzo, A. J., Goetz, J., Israel, J., Hill-Clark, J., Pritchard, T., & Staubach, K. (2019). Impact of nurse-led

interprofessional rounding on patient experience. Nursing Clinics of North America, 54(1), 115-126.

https://doi.org/10.1016/j.cnur.2018.10.007

Graphic Design Pricing. (2019). Retrieved from https://www.straightnorth.com/services/graphic-design/pricing/

Health Stream. (2018). Where to focus on improving your nursing clinical development framework: Interactive infographic. [Image].

Retrieved from https://www.healthstream.com/resources/blog/blog/2018/06/13/where-to-focus-on-improving-your-nursing-clinical-

development-framework-interactive-infographic
How to Build a Graphic Design Budget. (2018). Retrieved from https://99designs.com/blog/business/graphic-design-budget/

Jimenez, R. A., Swartz, M., & McCorkle, R. (2018). Improving quality through nursing participation at bedside rounds in a pediatric acute

care unit: A pilot project. Journal of Pediatric Nursing, 43, 45-55. https://doi.org/10.1016/j.pedn.2018.08.010

Khan, A., Spector, N. D., Baird, J. D., Ashland, M., Starmer, A. J., Rosenbluth, G., . . . Landrigan, C. P. (2018). Patient safety after

implementation of a coproduced family centered communication programme: multicenter before and after intervention study. Bmj,

363, k4764. doi:10.1136/bmj.k4764

Medication errors [Image]. (2018). Safety Observer. Retrieved from http://safetyobserver.blogspot.com/2018/06/about-reporting-of-

medication-errors-in.html

Medical team [Image]. (2019). Retrieved from https://acphospitalist.org/archives/2019/04/are-bedside-rounds-evidence-based.htm

Menefee, K. S. (2014). The menefee model for patient-focused interdisciplinary team collaboration. JONA: The Journal of Nursing

Administration, 44(11), 598–605. doi: 10.1097/nna.0000000000000132

Muellar, D. (2019). The pennsylvania statute of limitations on debt: Three costly mistakes. Harborstone Law Group: Pennsylvania

Bankruptcy & Debt Resolution Attorneys. doi: http://bankruptcylawyerpa.com/blog/pennsylvania-statute-of-limitations-three-mistakes/

Nurse Salary in Arizona. (2019). Nurse Salary Guide. Retrieved from https://nursesalaryguide.net/nurse-salary-in-arizona/

Pills [Image]. (2017). Retrieved from https://www.goodrx.com/blog/why-do-some-medications-come-as-pills-and-others-as-injections/

Poster Prices. (2019). GW School of Medicine and Health Sciences. Retrieved from https://smhs.gwu.edu/communications/creative/poster-

printing/pricing

The Joint Commission. (2015). Engaging patients and families. Leading Health Care Transformation, 115–128. doi:10.1201/b18670-11

The Joint Commission. (2019). National Patient Safety Goals Effective January 2019 [PDF file]. Retrieved from

https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2019.pdf

24+ Tape measure Clip Art [Cartoon] (2019). Retrieved from http://clipartlook.com/img-157419.html

Tobiano, G., Murphy, N., Grealish, L., Hervey, L., Aitken, L. M., & Marshall, A. P. (2019). Effectiveness of nursing rounds in the intensive

care unit on workplace learning. Intensive and Critical Care Nursing, (53), 92-99. https://doi.org/10.1016/j.iccn.2019.03.003

World Health Organization. (2019). Patient safety. Retrieved from https://www.who.int/news-room/fact-sheets/detail/patient-safety

THANKS!
Does anyone have any questions?
youremail@freepik.com
+91 620 421 838
yourcompany.com

Facebook.com/Freepik CREDITS: This presentation template was

created by Slidesgo, including icons by
@Freepik_Vectors Flaticon, and infographics & images by
Freepik.
Please keep this slide for attribution.
company/freepik-company