Critical Path Network
Simple acronym helps staff focus on neuro patients’ needs
Team meetings are shortened, care is improved
The neurosurgical unit at United Health Service Hospital in Johnson City, NY, has cut 15 to 30 minutes off its daily interdisciplinary team meetings by using a simple acronym that keeps staff on track when it comes to issues that affect their patients.
"In an effort to efficiently and effectively manage patients’ care, we developed the acronym A PatienT MENDS, which we use to make sure the core components are discussed and met daily," says Pat Chamberlin, RN, CCM, CCUR, nurse case manager for the neurosurgical unit.
The neurological unit includes trauma, surgical, and stroke patients along with a six-bed neurological step-down unit.
Ensuring all key issues are addressed
The acronym’s letters stand for words that represent the major issues that affect all neurological patients. The acronym’s letters and their meanings are as follows:
Advance directives
Pain control
Treatments/tests
Mobility
Elimination
Nutrition
Discharge plan
Skin integrity and safety
The acronym is displayed on a poster in the conference room and is taught to new employees as part of the training process. It sets the agenda for daily team conferences and is part of the case conference documentation.
The idea for the acronym came up as the team brainstormed ways to expedite the often prolonged interdisciplinary team conferences.
"We knew that sometimes the team conferences became lengthy because people weren’t focused and we jumped from topic to topic. We wanted a way to make sure we covered all the issues that affect our patients, like pain, elimination, and nutrition. We started with a few items, and it grew," Chamberlin says.
Use of acronym frees up time for patient care
The interdisciplinary team includes the nurse manager, the case manager, the primary care nurse, and representatives from physical medicine, rehabilitation, and nutrition. The team meets every morning and discusses each patient on the unit. They invite physicians and other specialists as needed to discuss the care of specific patients. If physicians have an issue to discuss, they drop in on meetings.
"We cover a lot of issues with our patients, such as nutrition, elimination, mobility, and pain control. We were looking for a way to make sure that everybody focuses on these important components," she says.
Another goal was to provide structure for the interdisciplinary case conference, allowing staff to spend more time on direct patient care.
"We didn’t want our interdisciplinary case conference to be just another shift transfer report," Chamberlin explains. "We wanted to develop a structured procedure that allows us to focus on what each individual patient needs."
The interdisciplinary team sat down and tried to think of a catchy way to make sure all the crucial issues were covered, and that’s how they came up with the acronym.
"We wanted something simple so we could remember it. It ended up being A P(atien)T MENDS, which is exactly what we want our patients to do: to get better and go home," she says.
The team chose to create the acronym to make it memorable, rather than including the issues in order of importance.
"Of course discharge planning gets more emphasis than advance directives or skin integrity, but we wanted to come up with something simple and easy to remember," she says.
Important issues covered early in patient’s stay
The agenda for each case discussion starts with the first item and goes through the list in the order of the acronym’s letters.
The interdisciplinary case conference documentation includes a place for each of the items in the acronym. Ongoing issues are addressed every day. Those that already have been handled are not.
"Every day, we can see what we addressed the day before. If we document that the advance directives were done on Day 1, we don’t need to talk about it on Day 5," she says.
Using the acronym has ensured that issues such as elimination are covered early on in the stay, making it possible for the patient to move to a less intense level of care more quickly.
Elimination is an important factor in determining a neurological patient’s readiness for discharge, either to home or an acute rehabilitation facility, Chamberlin says.
"We make sure we are addressing their bowel movements and urinary output. If there is a Foley catheter, we look at whether it is time to remove it and make sure the patient is on a proper bowel regime," she says.
The documentation includes the name of the person responsible for making sure each of the items is handled. For instance, if a patient is three days post-operative and is still on IV medication, the documentation lists who is responsible for talking to the physician about putting the patient on oral medication in a timely manner to ensure that he or she can tolerate that particular medication.
At every session, the primary care nurse reviews the patient chart and goes down the list of issues to make sure every item is being addressed in a timely manner.
For instance, if a test has been ordered, the team makes sure it has been done and the results are available. They determine whether the treatment plan is being followed and whether there are issues, such as wound care, that need to be discussed with the physician.
The team started using the acronym at the end of the summer last year and has gotten very positive feedback from team members.
"We feel that using the acronym is ensuring excellent patient care and management," Chamberlin says.
The team uses the acronym as part of the orientation process for new graduates who work on the unit to orient them to the special needs of neurological patients.
"It helps the nurses, particularly those who are new to the unit, think through the process of caring for these patients. The cues help them as they focus on learning their job and organizing their day," she says.
The neurosurgical unit at United Health Service Hospital in Johnson City, NY, has cut 15 to 30 minutes off its daily interdisciplinary team meetings by using a simple acronym that keeps staff on track when it comes to issues that affect their patients.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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