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One of the most common barriers to implementing patient- and-family centered rounds seems to be that physicians are not able to observe other physicians practicing patient- and family-centered rounds. Observing through the video vignettes may give ideas on how to implement them.
The vignettes do not work well on their own as a “how to” video. We recommend that a group of people watch the videos together and discuss them. Watching in a group stimulates valuable discussions among providers about the perceived benefits and obstacles of partnering with patient and families. No performance depicted in the videos is perfect. Rather, the vignettes are intended to stimulate group discussion of what went well and what could have been done better. While somewhat dramatized, the videos capture many common mistakes made by teams new to the process.
Any organization may use the videos in training as long as Cincinnati Children’s is cited as the source.
First, remember that this requires a culture change and will take time. You will never be “ready,” so start practicing and you will learn as you go. Begin with physicians and nurses who are ready to try patient- and family-centered rounds. Gain experience and success; then let your initial supporters become your local champions.
Initially, we began practicing patient- and family-centered rounds and then implemented a formal policy. The policy will not change culture. Culture change will lead to policy change.
Patient- and family centered rounds have developed over a number of years. At Cincinnati Children’s, we generally follow the steps outlined below.
The patient and family decide on how rounds should be conducted. At admission, staff members explain rounds and outline options for patient and family involvement. After addressing confidentiality issues, the family’s preference is marked on a card and taped outside the patient’s door. Some of the options:
A decision is made on who needs to be involved in rounds and if any information needs to be discussed before entering the room. This is the optimal time to discuss sensitive patient or family issues (e.g., suspected nonaccidental trauma or confidential test results) and to discuss how this information will be shared with the patient and family. The team members also decide individual roles and responsibilities. Ideally, rounds should occur with the parents present. The team also puts on any necessary personal protective equipment.
A team member enters the room and confirms that the family is ready for rounds.
Physicians, nurses other key team members and the patient and family contribute information during the rounding process.
Throughout this process, the attending physician observes the interns’ understanding of the patient’s condition and the family’s and staff’s comfort levels.
Review the feedback about patient- and family-centered rounds that we've received from physicians, nurses and families whose children were seen at Cincinnati Children’s.
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