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One of the most effective innovations at Arnot Ogden Medical Center in Elmira, NY, has been the institution of "daily care rounds" for every patient in the hospital, says Tina Davis, RN, MS, CNS, senior director of continuum of care.
"This is a multidisciplinary forum where we identify an interdisciplinary plan of care for the patient." There are representatives from case management, social work, nursing, respiratory therapy, pharmacy, physical therapy, occupational therapy and the dietary department, she notes. "We’re all sitting at the table, discussing the patient, and this includes every patient in every nursing unit."
For eight units, the process happens every day; for the long-term care unit, it occurs once a week, Davis says. "We spend 20 to 30 minutes for each unit, depending on the unit."
The goal, she explains, is to move the patient through the system in such a way that all disciplines know what’s going on and exactly what they are to do for each patient. "Nursing knows what physical therapy is doing, and dietary [staff] know what they’re supposed to do. It’s wonderful because a lot of the assessment piece happens here and it is concurrent. We know now what has to happen with the patient, not tomorrow after reading the chart."
Although daily care rounds have been in place for three years, in the past year the process has been taken to a new level, Davis notes. In conjunction with the implementation of new computer systems at Arnot Ogden, she sat down with an analyst from Atlanta-based Per Se Technologies and developed a documentation tool for the process.
"Every day, for each patient, we document that this is happening," she says. "We used to just write things down on a sheet of paper and archive those pieces of paper separately from the medical record, but now the information is in the patient’s chart. Anybody who wants to see what’s going on with the patient from daily rounds can see this. It’s a very integral piece of communication that benefits the patients."
The case manager who is present does the documentation and is responsible for entering it into the computerized medical record, she notes. "From the daily rounds format, case management can move forward into doing a more in-depth assessment if needed."
That might include, for example, determining if the patient should go to a nursing home, Davis says. "Once we identify that the patient could benefit from nursing home placement and the patient agrees, the social work department facilitates this process, because of all the emotional issues involved. It may be difficult for the patient’s family to get used to the idea of moving [the family member] into a nursing home."
This part of the process is where social work "really excels," she points out. "They identify all the emotional baggage, all the support the family and patient need, and then bring that information to daily rounds, when we decide the patient is going to be placed."