In Safe Hands – Structured Interdisciplinary Bedside
Rounds – Sample Implementation Templates
Communication Protocol Worksheet
Start Time and Duration
The team will need to agree on a round start time and day (if not rounding 5-7 days per week). The
start time should always be the same. You might choose to assign different times to different days,
but the time should always remain set (For example you might choose to round at 1000am on
Monday, Tuesday and Wednesday and then round at 9am on Thursday and Friday). The duration
should be no longer than 1 hour.
Start Time(s):
Duration:
Team Composition
The composition of your unit teams may differ from those represented in the SIBR diagram on page
4. The team needs to decide the different roles that will be represented during SIBR.
Team Participants
Senior Doctor
Nurse
Patient and family
Pharmacist
Allied Health
Allied Health
Allied Health
Communication protocol
•
•
The SIBR communication protocol should be customised to match your unit’s specific needs
and care goals.
The communication protocol uses an ISBAR format and follows a set structure to maintain a
consistent flow. There are elements within the set structure which are customisable to suit
the needs of individual units.
Update current status & patient safety checklist
•
•
•
•
At least 1 item under update current status is required but you should consider up to 6*
items
At least 1 item under patient safety checklist is required up to a maximum of 5 – 7* items
*The more items to cover the longer these sections will take
Items in this section are mirrored in the nursing prompt sheet
The chosen items should directly correlate with existing unit based care protocols
1
In Safe Hands – Structured Interdisciplinary Bedside
Rounds – Sample Implementation Templates
Item 1:
Item 2:
Item 3:
3. Update current status
Item 4:
Item 5:
Item 1:
Item 2:
Item 3:
4. Patient safety checklist items
Item 4:
Item 5:
Summarise plan for care
A summary using all interdisciplinary input must be verbalised before the round is complete. The
summary will include a plan for the day and an estimated day of discharge.
2
In Safe Hands – Structured Interdisciplinary Bedside
Rounds – Sample Implementation Templates
SIBR Communication protocol
I
S
B
1. Introduction
1. Lead team into room
2. Introduce team members
2. Review of issues, test results
1. Summarise active problems
2. Provide update of investigation results
3. Waiting for what?
4. Invite input from patient and family
≤15
seconds
≤45
seconds
3. Update current Status
1
2
3
4
≤45
seconds
5
A
4. Patient safety checklist
1
2
3
4
5
6
7
5. Allied Health input
1. Introduction
2. Update current plan
R
6. Summarise plan for care
1. Summarise plan for the day and assign responsibility
2. Propose plan for discharge
3. Estimated Day of Discharge (EDD)
≤30
seconds
≤60
seconds
≤30
seconds
3
In Safe Hands – Structured Interdisciplinary
Bedside
Rounds – Sample Implementation
Sample Medical
Unit
Templates
Structured Interdisciplinary Bedside Rounds (SIBR)
I
Ensure Hi Level SIBR
Performance
Coach team members as
needed
Step into JMO or Registrar
role as needed
JMO
Consultant
B
Confirm Plan for Discharge
Discharge needs & next site
of care
Anticipated day of
discharge
Enters Orders in Real Time
Management decisions
Quality safety decisions
S
≤15
seconds
2. Review of issues, test results
1. Summarise active problems
2. Provide update investigation results
3. Waiting for what?
)
f
&f
l
≤45
seconds
3. Update current status
1. Overnight events & patient’s goal for the day
2. Vital signs & call modifications
3. Fluid & food intake
4. Urine & bowel output
)
Bedside
Nurse
Family & Patient
Intern 1
A
SIBR Round
Coordinator
Pharmacist
Registrar
≤45
seconds
4. Patient Safety Checklist (address each item)
1. Resus status
2. IDC & IVC
3. Medication reconciliation
4. VTE Prophylaxis
5. Falls risk
≤30
seconds
≤60
seconds
5. Allied Health input (where required)
1. Introduction
2. Update current plan
Allied Health
Manage SIBR Rounds
Ensure next bedside nurse
ready for SIBR
Orient new/casual staff
1. Introduction
1. Lead team into room, greet patient & family
2. Say name of bedside nurse, roles of team
members
R
6. Summarise plan for care
1. Summarise plan for the day and assign
responsibility
2. Propose plan for discharge
3. Estimated Date of Discharge
4. Invite input from patient & family
≤30
seconds
4
Planning Template
In Safe Hands – Structured Interdisciplinary
Bedside Rounds – Sample Implementation
TemplatesBedside Rounds (SIBR)
Structured Interdisciplinary
Ensure Hi Level SIBR
Performance
Coach team members as
needed
Step into JMO or Registrar
role as needed
I
Consultant
JMO
xxxxxxxx
S
B
Confirm Plan for Discharge
Discharge needs & next site
of care
Anticipated day of
discharge
1. Introduction
1. Lead team into room, greet patient & family
2. Say name of bedside nurse, roles of team
members
≤15
second
2. Review of issues, test results
1. Summarise active problems
2. Provide update investigation results
3. Waiting for what?
4. Invite inputs from patient & family
≤45
seconds
3. Update current status
1.
2.
≤45
seconds
3.
4.
Enters Orders in Real Time
Management decisions
Quality safety decisions
Bedside
Nurse
Family & Patient
Medical
A
Allied Health
Manage SIBR Rounds
Ensure next bedside nurse
ready for SIBR
Orient new/casual staff
SIBR Round
Coordinator
Pharmacist
Registrar
R
4. Patient Safety Checklist (address each item)
1.
2.
3.
4.
5.
≤30
seconds
5. Allied Health input (where required)
1. Introduction
2. Update current plan
≤60
seconds
6. Summarise plan for care
1. Summarise plan for the day and assign
responsibility
2. Propose plan for discharge
3. Estimated Date of Discharge
4. Invite inputs from patient & family
≤30
seconds
5
In Safe Hands – Structured Interdisciplinary Bedside
Rounds – Sample Implementation Templates
Developing the nurse prompt sheet
•
•
•
•
•
The nurse prompt sheet assists with gathering the required information prior to the round
to ensure that all the relevant information for each patient is available during the round and
provides a guide for the nurse to follow when presenting the information during the round.
This ensures that the information provided follows a sequence that is easily followed by
team members participating in the round.
The nurse prompt sheet should match the communication protocol and have the same items
for update and patient safety items for review.
The nurse will gather this information through multiple sources including shift to shift
handover, interaction and assessment with the patient and the patient’s medical records.
A prompt sheet may be a single sheet per patient or may accommodate all the patients an
individual nurse is responsible for during that shift.
The template below provides a starting point for identifying key items and will assist with
outlining the nursing items to be discussed, the order of items to be discussed and any other
information that may be of use.
Update events overnight
Patient
Patient
Identify any nursing concerns
Identify patients goal for the
day
Update current Status
a)
b)
c)
d)
e)
Patient Safety checklist items
a)
b)
c)
d)
e)
6
In Safe Hands – Structured Interdisciplinary Bedside
Rounds – Sample Implementation Templates
Developing the round documentation sheet
•
Consider the important elements of the round that you wish to capture in the patient
medical records. Consider including on the documentation sheet:
o
o
o
o
o
o
Team members / team member roles present for the round
Summary of current status
Clinical concerns raised for consideration
Patient safety checklist items
Plan for care / plan for the day
Plan for discharge and estimated discharge date
•
Keep the documentation format in sync with the communication protocol. Completion of
documentation in a 3 – 5 minute encounter is difficult if the information and the
documentation template do not flow in the same order.
•
Consider how this information will be filed in the medical record, in keeping with local
hospital medical record requirements. Things to consider:
o
o
Can the required prompts be printed onto existing progress notes
Is a submission to the local forms committee required
Date
Team members present
Update of current issues
Patient Name
Patient/family
Medical (RMO) (Consultant)(specify)
Bedside Nurse
Allied Health (specify)
Other
Patient’s Goal
Patient Safety Checklist items
Agreed Plan
EDD
Person completing the form
Sign
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In Safe Hands – Structured Interdisciplinary Bedside
Rounds – Sample Implementation Templates
Developing the Team Ground Rules
SIBR Team Ground Rules (Sample)
1. We SIBR on all patients Mon-Fri and begin & finish on time
2. All SIBR team members take positions around the bed*
*two exceptions: we SIBR without the patient if the patient …
a. Is off the unit or otherwise indisposed
b. Opts out of bedside SBIR, in which case SIBR occurs outside the room in a
manner that preserves confidentiality
3. SIBR may start for each patient only when the doctor & nurse are both
present
4. SIBR may end for each patient only after the plan-for-the-day is
verbalised
5. We enter all new orders & plans in real-time during SIBR
1.
SIBR Team Ground Rules (planning template)
2.
3.
4.
5.
8