The Collaborative Rounding in Long Term Care Project
Essential Background Information
The Collaborative Rounding in Long Term Care Studystudy will build on previous research evaluating the outcomes of collaborative rounding with a specific focus on a residential care setting. This collaborative rounding initiative aims to develop a new approach to resident care including regular rounds at the bedside involving multiple members of a resident’s care team at a defined interval with advance notice for residents and their families. The study will use validated survey tools to collect the essential data to evaluate the research questions.
Introduction
Nursing homes, also known in Canada as long-term care facilities represent a critical component of our health care system, especially as our population ages. These homes serve residents who do not need to be in hospital but who do require a level of care not generally available through community supports. The CIHI report on Canadian nursing homes revealed that while some homes do better than others, no single home or jurisdiction performed well on all indicators surveyed leaving significant room for improvement in quality of care.
Despite the demonstrated need to improve the quality of care provided in nursing homes, little practical guidance exists for nursing home staff to effect change. Quality improvement characterized by structured, organization-wide approaches to understanding and improving underlying work processes may be a promising means for enhancing nursing home quality because it allows staff, regardless of discipline or role, to collaboratively identify problem areas and to develop strategies for improvement. Interdisciplinary rounds have been defined as planning and evaluating individual care with health professionals from a variety of health disciplines. Key activities may be integrated into interdisciplinary rounds including summarizing health data, identifying resident or family problems, identifying interventions, discussing progress and reviewing treatment goals. Through a collaborative rounding process, the resident and their family are intimately involved in any discussions regarding their condition, prognosis and plans about their care. Healthcare team members from different disciplines, as well as residents themselves, are encouraged to question each other and explore alternative avenues to achieve the best outcome possible for residents.
The successful implementation of collaborative interdisciplinary rounding has achieved improvements in quality of care, communication between team members, and communication between residents and their families in acute care settings. Improvements include increased patient safety, improved person-centered care, as well as improved teamwork and staff satisfaction.
Collaborative rounds can also serve as a platform for quality improvement efforts. In the spirit of “nothing about me, without me”, residents and families should be equal participants and therefore participate in the discussion, decision-making and implementation of the plan of care. Interdisciplinary rounds are a promising method to not only to meet our system’s needs for communication, but also to ensure that residents of long term care and their families have similar person-centred experiences in all areas of the healthcare system, including long term care.
Study Design
This is a pilot study. The pilot involves 6 of 10 publicly-funded long term care residences in the province of Prince Edward Island.
The residences are included in this study are those which use a nurse practitioner/medical director model for medical care delivery.
The primary goal of this initiative is to measure the impact on teamwork, resident satisfaction with care, and family satisfaction with resident care.
Secondary goals include determining the impact on resident outcomes including adverse events, falls, emergency department visits and hospitalization rates.
The main research question in this study is to determine the impact of collaborative rounding in long term care through an assessment of patient-reported
experience measures (PREMS) and patient-reported outcome measures (PROMS). The measures are based on a person-centred care approach and have well-established validity and reliability.
What New Knowledge is Anticipated
Open communication, positive relationships and the exchange of diverse ideas between team members involved in resident care are associated with encouraging outcomes. With a focus on early recognition, assessment and management of residents’ conditions, as well as developing positive relationships with care providers and resident families, hospitalization may be avoided in some instances and resident care improved.
Why are we conducting this study?
Long term care homes face many challenges. Currently, most individuals who reside in long term care are assessed by their medical provider on
an as needed basis rather than scheduled routine visits. This ad hoc assessment is rarely collaborative and often inconsistent, creating confusion for residents
and their families. Infrequent and sporadic documentation also contributes to confusion among the care team and inconsistent messaging to residents and their families.
Long term care also continues to struggle with human resource challenges including poor recruitment and retention of healthcare workers. As a result of these factors,
those living and working in long term care face significant challenges for safe and effective communication which contributes to adverse events experienced by residents.
Collaborative rounding in acute care settings have been shown to improve communication with patients and patient families as well as communication among health care team members.
Other positive outcomes observed include improved patient safety, and provision of person-centred care, as well as improved teamwork and staff satisfaction.
Collaborative rounds can also serve as a platform for quality improvement efforts. Using a similar model, the research team seek to determine if similar outcomes will result with collaborative
rounding in long term care.
What will I be asked to do?
Collaborative bedside rounding will occur at monthly intervals for each resident living at Beach Grove or Prince Edward Homes. Residents who reside in the control group homes will receive standard care. Residents will be assessed on a scheduled monthly interval at the bedside. All members of a resident’s care team are invited to participate. Team members will include family members, resident care workers, licensed practical nurses, registered nurses and the resident’s nurse practitioner. Allied health and pharmacy will have opportunity for involvement at a pre-round huddle. Residents and their families will be given advance notice of rounding times. Current restrictions posed by COVID-19 include visiting restrictions at long term care homes. When visiting is permitted, families and partners in care will be invited to participate. Documentation will be standardized and will include a progress note that will exist electronically in the electronic record visible to outside care providers and a printed copy on the resident’s paper chart. Residents, families and team members will be invited to complete surveys at 0, 6 and 12 month intervals. Participation is voluntary. Patient-experienced outcomes will be tracked using the Provincial Safety Management System (PSMS) which is the tool used to monitor adverse events. The team of healthcare professionals will continue entering adverse events using PSMS; this study will not alter the current reporting process and will not result in increased reporting requirements.
What data are you collecting?
Residents, family members and staff members will be surveyed at 0, 6 and 12 months. Residents will be surveyed using the “Resident Experience” questionnaire with the assistance of a trained research assistant. Family members of current residents are surveyed annually using the “Family Experience questionnaire, one additional data collection point at 6 months will be collected and analyzed. Healthcare team members involved in direct resident care will be surveyed using the “TeamSTEPPS 2.0 Teamwork Perception Questionnaire”
Who is conducting this study?
Dr. Janet Rogerson is the Medical Director of Long Term Care and will be the primary co-investigator responsible for the project and knowledge translation to healthcare providers
and policy makers. Dr. Rogerson will be responsible for overall study implementation, coordination, and will lead the application of this research in the LTC Facility.
Dr. William Montelpare is a Professor and Research Chair who will be a co-investigator with Dr. Rogerson. He will be responsible for research design, management of data, and data processing on this project.
He will assist Dr. Rogerson with knowledge translation to healthcare providers and policy makers.
Ellen Christie is a Nurse Practitioner in long term care who will be a research associate on this project. Ellen will be involved in data collection and analysis.
What is the process for confidentiality?
Potential participants will be introduced to the study through a 20 minute presentation in which the purpose and expectations of the project will be described.
Letters of information will be provided to all residents, families and team members.
Consent is implied via voluntary completion of survey instruments.
Surveys for residents will be conducted in person by a trained research assistant.
The research assistant will clearly explain that all concerns will be kept confidential, and that questionnaire results will be used for research purposes only.
Residents will be provided with contact information of facility administrator If they wish to share concerns with a health care team member.
The investigators analyzing data will have anonymous surveys.
Surveys from family and team members are completed anonymously and on a strictly voluntary basis. Consent is implied upon voluntary survey completion.
