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Prospective application of the interdisciplinary bedside rounding checklist ‘TEMP’ is associated with reduced infections and length of hospital stay

Authors :
Nila S Radhakrishnan
Frederick S Southwick
Kiran Lukose
Richard Cartwright
Andressa Sleiman
Nicholas Matey
Duke Lim
Tiffany LeGault
Sapheria Pollard
Nicole Gravina
Source :
BMJ Open Quality, Vol 11, Iss 4 (2022)
Publication Year :
2022
Publisher :
BMJ Publishing Group, 2022.

Abstract

Protocols that enhance communication between nurses, physicians and patients have had a variable impact on the quality and safety of patient care. We combined standardised nursing and physician interdisciplinary bedside rounds with a mnemonic checklist to assure all key nursing care components were modified daily. The mnemonic TEMP allowed the rapid review of 11 elements. T stands for tubes assuring proper management of intravenous lines and foleys; E stands for eating, exercise, excretion and sleep encouraging a review of orders for diet, exercise, laxatives to assure regular bowel movements, and inquiry about sleep; M stands for monitoring reminding the team to review the need for telemetry and the frequency of vital sign monitoring as well as the need for daily blood tests; and P stands for pain and plans reminding the team to discuss pain medications and to review the management plan for the day with the patient and family. Faithful implementation eliminated central line-associated bloodstream infections and catheter-associated urinary tract infections and resulted in a statistically significant reduction in average hospital length of stay of 13.3 hours, one unit achieving a 23-hour reduction. Trends towards reduced 30-day readmissions (20% down to 10%–11%) were observed. One unit improved the percentage of patients who reported nurses and doctors always worked together as a team from a 56% baseline to 75%. However, the combining of both units failed to demonstrate statistically significant improvement. Psychologists well versed in implementing behavioural change were recruiting to improve adherence to our protocols. Following training physicians and nurses achieved adherence levels of over 70%. A high correlation (r2=0.69) between adherence and reductions in length of stay was observed emphasising the importance of rigorous training and monitoring of performance to bring about meaningful and reliable improvements in the efficiency and quality of patient care.

Subjects

Subjects :
Medicine (General)
R5-920

Details

Language :
English
ISSN :
23996641
Volume :
11
Issue :
4
Database :
Directory of Open Access Journals
Journal :
BMJ Open Quality
Publication Type :
Academic Journal
Accession number :
edsdoj.65d5fbb65a13445b8e8f14d3ea73291d
Document Type :
article
Full Text :
https://doi.org/10.1136/bmjoq-2022-002045