ROADMAP...Setting the Course for Patient and Family Involvement in Their Plan of Care

Purpose:
An ineffective and outdated approach to handoff communication at shift change spurned adoption of bedside nurse shift report. Simultaneously, an electronic daily care plan - coined ROADMAP (Review Of All My Daily Medical Actions and Plans) - to be incorporated with the bedside report, was devised.

Significance:
In 2006, the presenting organization conducted a “future search” to define what the ideal patient experience should look like in 2016. Of the ensuing projects, several related to the theme “patients and families feel they are not informed.” Bedside shift report and ROADMAP address this theme.

Strategy and Implementation:
Implementation of bedside shift report included: unique strategies to address staff concerns and engage commitment; replacement of the traditional Kardex with an SBAR Report Card; an electronic staff education module; and a patient education document describing the process and discussing their and family's role. This process was hardwired into unit culture while work on the ROADMAP began. A ‘GEMBA' walk was performed to formulate ROADMAP content desired by patients and families. The goal was to automatically populate data from the electronic medical record. The ROADMAP is printed in the AM, discussed with the patient and family during bedside nurse shift report, and revised as necessary. Information includes: care team names, daily goals, discharge plan, medications, and tests completed and planned. The process has been standardized as a component of bedside report throughout the organization.

Evaluation:
Evaluation metrics include: specific Press Ganey patient satisfaction questions; observations for standard work; and, staff satisfaction. Quantitative outcomes have demonstrated improvements. Patient and family qualitative comments are very positive, specifically citing knowledge of care plan.

Implications for Practice:
This offering will review process, pragmatic strategies, and lessons learned when changing the communication culture in an acute care setting to improve patient safety. Take home learnings will focus on how to engage patients and families as active and knowledgeable participants in their care.