Rounding on patients with physicians, nurses, and other members of the health care team is a great way for respiratory therapists to show their value to patient care.
It’s also a great way for individual therapists to stand out from the crowd and further their own career potential.
Making the most of these opportunities, however, isn’t as easy as it sounds. You have to know when to speak, what to say, and perhaps most importantly, how to integrate yourself into the team process without alienating any of the other team members along the way.
We turned to members of the AARC’s Adult Acute Care, Long-Term Care, and Neonatal-Pediatrics Specialty Sections to find out what they think RTs should and should not be doing on interdisciplinary team rounds.
Most therapists agree that being prepared to speak knowledgeably about the patient is the number one goal for therapists participating in interdisciplinary team rounds. “Do a chart review prior to rounds and know your patient,” says Lorraine Bertuola, RRT. ”Be prepared to defend your input.”
Kenny Miller, MEd, RRT-ACCS, RRT-NPS, advises RTs to come armed with potential interventions to achieve the desired outcomes, and Andy Brown, RRT-NPS, notes the importance of knowing all the essential laboratory values and having a good working knowledge of the previous plan of care and the past 24 hour clinical status of the patient.
Douglas Kirk, BS, RRT-ACCS, believes notifying the physician of the results of any daily spontaneous breathing trials (SBT) is vital for patients on mechanical ventilation. “The SBT results help guide the discussion of extubation … fewer vent days can make a difference in a patient’s status.” For some patients, that means going outside of protocols, and identifying those needs during team rounds can optimize care for the patient.
Sandy Saffa, RRT, who works in the long-term care setting, suggests addressing patient and family goals as well, along with a possible timeline for placement in another setting, particularly in cases where permanent or long-term ventilator care might be necessary.
Keep it short and collegial
Team rounds are designed to give everyone a chance to talk, and that means no one can talk for too long. “Make your discussion short and to the point,” advises Vickie Sollars, CRT.
“Avoid distractions and talking when other team members are talking,” says Kelly Switzler, RRT-NPS, CPFT. “Pay attention and listen to all team members when they are speaking.”
“Be concise, honest, and admit if you are unsure of answers or do not know them,” says Marie Agustin, RRT. No one always knows every answer to every question and your colleagues will look more favorably upon you if you don’t try to defend an indefensible position.
Speaking out of turn or interrupting or arguing excessively with other team members should be avoided at all costs as well. Having an “us vs. them” attitude will do no one any good, says Charles Bishop, BS, RRT-NPS, AE-C.
But don’t undervalue your own input either. “Don’t be afraid to speak up,” says Andy Brown. “Sometimes the RT is the absolute expert in what is being suggested for the plan of care.”
And of course, it goes without saying that RTs should always be on time for rounds. “Tardiness shows lack of professionalism, which in turn damages the reputation of the individual and the department,” says Douglas Kirk.
It’s a good idea to avoid long discussions that go off topic too. “Nonproductive discussions can distract from appropriate patient care and patient goals,” he continues. “Only bring up information that’s appropriate to the patient’s situation.”
Luckily, at some hospitals, rounds are strictly structured to eliminate many of these issues. Says Deanna Cook, BS, RRT, “I worked at UNC Hospitals in the PICU and they had a very specific order to rounds. First a brief history of the patient, then overnight events from the overnight resident, then the rounding resident would follow with a more detailed ROS. When they came to respiratory, we were expected to give current vent settings, secretion quality/quantity if significant … then BBS in asthmatics and RSV type patients, where appropriate.”