Increasing Parental Participation During Rounds in a Pediatric Cardiac Intensive Care Unit

Abstract

Background Inviting parents of sick children to participate during the rounding process may reduce parents’ anxiety and improve communication between the parents and the health care team. Objectives To increase the percentage of available parents invited to participate in morning rounds in a pediatric cardiothoracic intensive care unit (CTICU). Methods Invitations to parents to participate in morning CTICU rounds were randomly audited from June 2012 to April 2014 (mean, 15 audits per month). From June 2012 to February 2013 (before intervention), 73% of parents available during morning rounds received an invitation to participate. From April 2013 to May 2013, the following interventions (family participation bundle) were implemented: (1) staff education, (2)“Invitation to Rounds” handout added to the parent welcome packet with verbal explanation, (3) bedside tool provided for parents to communicate desire to participate in rounds with the team, (4) reminder to invite parents added to nursing rounding sheet. Following interventions, family feedback was obtained by 1-on-1 (physician-parent) open-ended conversation. Results From April 2013 to April 2014, 94% of parents available during morning rounds received an invitation to participate. Reasons for not participating: chose not to participate (63%), sleeping—staff reluctant to wake (25%), not English speaking (7%), breastfeeding (5%). Conclusion Implementation of a family participation bundle was successful in increasing invitations to parents to participate during morning rounds in the CTICU. Engagement of staff and addressing specific staff concerns was instrumental in the project’s success.

Families’ Experiences With Pediatric Family-Centered Rounds: A Systematic Review

“…The majority of parents who experienced FCR in a cardiac PICU felt their participation in rounds increased their understanding. 25 In sum, parents who experience FCR report increased participation, resulting in greater understanding about their child's condition and treatment plan, which is consistent across studies with and without a comparator.…”

“…For example, parents have benefited from being given a brochure along with a verbal explanation of FCR. 25 Hospitals may also include a magnet outside of rooms used to indicate family and patient preference for participating in rounds, which has been successfully implemented in other hospital interventions. 43 It is also important to better understand the role and preferences of pediatric patients.…”

Communication in Pediatric Critical Care Units: A Review of the Literature

“…30,31 Of the 26 remaining studies, 16 were deemed high quality 1,2,6,7,8,[10][11][12]14,18,[22][23][24][25][26][27][28] and 10 were considered good quality. 9,13,[15][16][17][19][20][21]26,29 Eight studies reported significant results related to increased communication, satisfaction, and compliance. 6,7,11,20,[22][23][24]28 In the examination of level of evidence, 16 articles were deemed to be level III, which includes nonexperimental studies, qualitative studies, and meta-synthesis.…”

“…9,13,[15][16][17][19][20][21]26,29 Eight studies reported significant results related to increased communication, satisfaction, and compliance. 6,7,11,20,[22][23][24]28 In the examination of level of evidence, 16 articles were deemed to be level III, which includes nonexperimental studies, qualitative studies, and meta-synthesis. 7,9,10,12,[14][15][16][17][18][19][22][23][24][25]29,30 One study, a systematic review, was deemed to be level IV, which includes expert consensus in systematic reviews and clinical practice guidelines.…”

“…Continued projects and descriptive reviews. 1,2,6,8,11,13,20,21,27,28,31 Of the included studies, 4 focused on provider communication, 8 focused on parent/caregiver communication, 6 focused on patient communication, and 10 focused on communication tools.…”