Bringing the Heat: Nursing-led Rounds in the Burn Unit

Purpose:
Nurses at the bedside are acutely aware of their patient's conditions. This enables nursing to identify subtle changes, monitor trends, and alert the physicians to any concerns. Yet,residents, who tend to have less personal interaction with patients, spearhead multidisciplinary team rounds.

Relevance/Significance:
A literature review reveals that ineffective communication is a leading cause of error in patient care. Due to differences in communication styles, evidence-based practice guidelines suggest employing a standardized template that ensures critical information is effectively communicated to improve safety and result in better outcomes. It is crucial that nursing's voice is heard during the development of the plan of care by the multidisciplinary team.

Strategy and Implementation:
Nursing challenged the notion that rotating residents remain the primary source of patient information. To position nurses as leaders on the unit, legitimize nursing practice, and facilitate collaborative relationships between team members, a clinical practice change was implemented in which nurses lead rounds and present patients. A template incorporating the word "heat" was created and triggers the discussion of areas specific to burn patients. These sections: history, etiology, assessment, and treatment plan emphasize surgeries, wounds/dressings, pain management, nutrition,mobility, and discharge plan. The unit conducted a pre-survey followed by monthly surveys to evaluate the effectiveness of the practice change. The five item questionnaire asks about the frequency of various forms of communication. Answers range from "never" to "always" on a five-point scale. The entire multidisciplinary team completes the surveys either online or on paper.

Evaluation:
Data collected thus far from June 2014 to January 2015 show positive results. Productive communication with nursing increased by 18%. The frequency of missing information decreased by 41%. Ineffective communication with nurses decreased by 30%. Overall, feedback is positive, though some nurses report anxiety related to this new role as a dynamic part of the team.

Implications for Practice:
The practice change from resident to nursing-led rounds advances and legitimizes the profession of nursing. This forum permits all team members to better understand and appreciate the role and contributions of nursing, in addition to opening future opportunities for growth and culture change.