Children's Hospitals Today - Winter 2022 - 26

FEATURE / FAMILY ENGAGEMENT
A
t the University of Iowa Stead
Family Children's Hospital in
Iowa City, service rounds were
leveraged in the pediatric bone marrow
transplant inpatient unit to provide
person-centered care to patients
experiencing multiple stressors.
Given the complexity of care and the
potential for long length of stay for
this population, these patients and
families are at risk for a high-stress
hospital experience.
For one patient and family, that
stress was evident during daily interactions
with staff. These negative and
at times confrontational interactions
created barriers for staff to provide
the highest quality care. The patient's
parents became verbally aggressive
and agitated with nursing interventions
and questioned the need for ceraddress
myriad concerns related to
the patient's experience. Based on a
foundation of patient- and familycentered
care, service rounds help
maximize patients' and families' overall
hospital experience using a multidisciplinary
team approach.
Implementing
service rounds
Prior to the implementation of service
rounds, it's crucial to identify
key stakeholders. There must be an
overall commitment from the hospital
and key members of the health
care team to provide service rounds.
What's more, multiple factors need to
be considered in the decision-making
process, including the recognition of
service rounds' overall perceived benefits
as well as the commitment to folIn
addition to sharing concerns,
families can identify any positive
interactions and strengths in the care.
tain requests, such as patient bathing
and vitals. This led to a strain on interactions
with the family, who would
perseverate on the previous night's
experiences. To address this, the care
team established a weekly meeting
with the parents and the patient to
listen to their concerns and reiterate
the care expectations on the unit.
The team found service rounds had
several purposes. They facilitated the
discussion of patients' and families'
expectations. This leads to a discussion
of what the health care professionals
on the unit expect while the
patient is hospitalized.
Also, service rounds allow staff to
low through with and the fulfillment
of action plans that may be created
because of the process.
In addition, staff members' time
and availability must be established
and protected to ensure consistency.
Implementing service rounds at
University of Iowa Stead Family
Children's Hospital
initially
took
the commitment of primary team
members, which included a member
of unit nurse management, a child
life specialist, a social worker and a
patient representative.
The team members discussed when
they would meet and the amount of
time they anticipated service rounds
would take per patient. While this
time commitment was hard to predict,
team members generally tried
to keep service rounds to one, 15-minute
visit per week per patient, with
the understanding that if a specific
issue needed further attention, the
representative would circle back to
continue the dialog. The team decided
they did not want anyone from the
medical team to be involved in service
rounds, as the team wanted patients
and families to feel they could share
their concerns or frustrations without
feeling their care would be negatively
affected.
The team also stressed that confidentiality
would be respected
within the constraints of resolving
issues as needed and any discussions
would not negatively affect patient
treatment or care. Finally, a plan for
communication of all outcomes was
identified. Patients and families were
assured that each member of the service
rounding team would be available
outside of meeting times should
needs or further questions arise.
How it works
During the initial visit, service round
team members explain to the patient
and family the intended goal of the
process, and this goal is reiterated at
each subsequent meeting. The team
also identifies any current needs or
concerns the patient or family may
have. Any identified needs or concerns
not addressed immediately are
addressed by the appropriate service
team member, who is then responsible
for follow through. This includes
sharing outcomes with the patient
and family at the next meeting. If the
patient and family do not voice any
concerns, no action is taken.
In addition to sharing concerns,
patients and families can identify any
26
CHILDREN'S HOSPITALS TODAY Winter 2022
Children's Hospitals Today - Winter 2022

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