“Opening our doors to better communication between patients/families and the WRHA Critical Care Team” Basil Evan, RN, BA, BN, TQM Critical Care Quality Improvement Officer May 17, 2016

Creating a Culture of Change

Where were we before 2014? Daily Rounds discussions were performed behind closed doors Families were asked to leave the ICU when Rounds began Families would have to wait until Rounds were complete

What are Daily Rounds in ICU? Interdisciplinary, patient-focused discussions between members of the Critical Care Team Collaborative efforts to establish Daily Goals and coordinate the patient’s plan of care

Family Satisfaction Survey 2011 Areas of Concern: Poor Communication Lack of respect for family involvement and/or presence Families feeling like they had limited access to their loved ones in ICU “We had to ask the nurses to tell us what was happening.” “I found that the doctors never really had a proper time to talk to us.” “When our Mom went to ICU, it was hours before we knew her condition or what was going on.”

Ask Yourself….. What would I want to know about the plan of care if I was visiting a loved one in ICU? What would I need to feel safe, comfortable, respected and welcome in ICU?

Research and Recommendations “To improve satisfaction with overall care in the ICU in the most efficient manner, efforts should be directed toward improving physician communication with families and improving the manner in which healthcare providers interact with patients and their families.” (Heyland, D., Rocker, G., Tranmer, J., & O’Callaghan, C., “Family satisfaction with care in the intensive care unit: Results of a multicenter study”, Critical Care Medicine, 2002; Vol.30, No.7, pp.1418) “Critical illness presents unaccustomed challenges to patients and their families. Connection and Communication have the potential to improve their experiences. All members of the interdisciplinary team are important in this endeavor.” (Munro, C. & Savel, R., “Communicating and connecting with patients and their families”, American Journal of Critical Care, 2013; Vol.22, No.1, pp.6)

Improving the Family Experience What do families need to know that will help improve their perception of ICU? How can we help families become more comfortable with the care we provide to their loved ones?

Improving Patient Safety/Outcomes What do families need to know about their role in improving patient safety? How can we help family members understand that they are our collaborative partners in ICU?

Change is a Process

First Steps Encourage team discussions aimed at improving the Patient/Family experience Explore research regarding family presence in ICU Begin a cultural transformation and open the doors to Daily Rounds

Lessons Learned Cultural change is a dynamic process which requires teamwork Buy-in requires support from Leadership Open doors create new questions A paradigm shift was happening…..

“If you change the way you look at things, the things you look at change.” Wayne Dyer

Site-specific processes….. Health Sciences Centre-IICU invites family members to attend Rounds during “Meet and Greet” upon Admission. Health Science Centre-SICU initially tested staff receptiveness through 2 separate surveys (51% up to 72% approval). They currently encourage family members who are present in ICU to join the interdisciplinary team at the Rounds table. Health Sciences Centre-MICU provides family members who are in ICU with a verbal invitation to attend Rounds. St. Boniface-ICMS surveyed the interest of families and developed a “What to Expect” during Rounds insert that is included with the Regional Information Pamphlet. They recently developed an ICU-specific video for their Waiting Area which provides families with an invitation to attend Rounds.

Site-specific processes….. Concordia-ICU provides family members who are in ICU with a verbal invitation to attend Rounds. Seven Oaks-ICU provides families with a verbal invitation to attend Rounds during the Admission process. Victoria-ICU developed an “ICU Daily Team Rounds” insert that is included with the Regional Informational Pamphlet. They currently look for family members who might be in the waiting area and invite them to attend Rounds. Grace-ICU incorporated the “Family Presence” initiative into their “Releasing Time to Care” project and established different methods (ie. poster, insert, verbal) to communicate their invitation to attend Rounds. They currently bring their Rounds Table discussions as close to the patient’s bedside as possible.

Best Practices Families are provided with verbal/written information about Daily Rounds Families are invited to attend Rounds, ask questions and learn more about the plan of care

Family Satisfaction Survey 2015 Areas of Value: Good communication Members of the health care team that are willing to go the extra mile Families feeling like they had access to their loved ones in ICU “We were made to feel welcome and any questions were addressed immediately.” “I was impressed with the visitor entry to the ICU. The desk was always very pleasant and made me feel welcome.” “The staff made us feel very welcome.”

Achievements Families are never asked to leave the ICU during Rounds Regional Guidelines for Patient and Family centered care have been established A Family Advisor has joined Critical Care’s Regional Outcomes Improvement Team (OIT)

Future Directions Share our best practices with different Units, Sites and Programs across the Region Strengthen our partnerships with patients/families Carpe Diem! And take the next step forward…