SMART Rounding: development of a nurse-driven rounding checklist as a sustainable intervention for improved care communication

Background/Project Intent: Use of checklists in the healthcare setting is increasingly common and is important to the development of high reliability and standard avenues for communication. At our tertiary care freestanding pediatric hospital, there was no widely used rounding checklist that discussed items important to quality care and patient safety outside of the intensive care unit. The development and implementation of medical checklists for the standard patient floor are inadequately described. We will develop and implement a rounding checklist with at least 80% daily checklist use sustained over 6 months. Team members will report improved multidisciplinary discussion of patient safety and clinical plans.Methods: Key stakeholders in the rounding process (subspecialty and general pediatrics physicians, resident physician, bedside nurses, and nursing leadership) modified an existing PICU rounding checklist for use on the floor. We titled it SMART, as it included discussion of items related to : Situational Awareness, Medications, Access, Routine, and Transition. (Figure 1). To foster open multidisciplinary communication and project sustainability, bedside nurses owned the task to prompt daily review of checklist items with the team during rounds. We developed badge buddies as an aid and an audit tool to assess checklist compliance. Iterative Plan-Do-Study-Act (PDSA) cycles assessed checklist compliance. The first PDSA cycle implemented unit-wide education and distributed badge buddies to eligible providers. Our second PDSA cycle created a simpler audit tool to encourage compliance during the ongoing COVID-19 pandemic. A 6-month post implementation survey of nurses, residents, and staff measured acceptability of the checklist.Results: Daily audits showed between 75%-88% checklist use (Figure 2). 29% of eligible providers (physicians, nurse practitioners, PAs, and nurses) completed the survey (n=51) (Table 1). 77% of respondents perceived communication improvement with SMART card usage with 4% disagreement. 66% reported discussion of vital patient care details that would otherwise have been missed. Only 2% found the checklist led to delays in patient care. A majority responded that checklist completion took 30-60 seconds.Conclusions: This project emphasizes the importance of multidisciplinary teams in development and implementation of a daily rounding checklist for a pediatric floor. We demonstrate the feasibility and acceptability of inserting a rounding checklist into the workflow of a multidisciplinary pediatric care team. These early results led to acceptance of SMART tool use across all medical-surgical units to improve care communication. Further study is needed to determine long-term effects on this initiative on discharge timeliness and patient safety outcomes.