To improve care coordination and restart its antibiotic stewardship program, Texas County Memorial Hospital (TCMH) in Houston, Missouri, expanded patient rounding from the responsibility of the case management department to become a team effort that includes doctors, nurses, a pharmacist and social worker.
“Until February 2021, there was no team rounding at all,” said Shelby Ellison, RN, TCMH Case Management Department. “I was meeting with patients and found myself trying to locate ancillary staff to coordinate patient care.”
The team now collaborates in real time to provide care for patients from admission to discharge and beyond. The move also created the bonus effect of increasing communication between departments.
“There is no ego here,” said Jessica Gettys, TCMH Pharmacist. “Nurses feel free to make recommendations and doctors do not have an ego about it. Everyone is working in the best interest of the patient.”
Rounding not only improved care for patients but also led to identifying needs from departments. For example, Jessica said, meetings sometimes reveal a process that needs to be streamlined or allows them to make financial decisions to increase a department’s efficiency.
While the rounding team was not created because of COVID-19, the collaboration has certainly helped create a higher level of patient safety. For example, Jessica’s inclusion with the team helped treat a patient with the virus who had a pulmonary embolism and a gastrointestinal bleed.
“We couldn’t give him Lovenox because of the bleeding so Jessica suggested to treat him with nebulized Heparin,” Shelby said. “The doctor said this was a great idea because the nebulized Heparin had reduced risks to the patient.”
The involvement of a pharmacist during rounding has also brought back the hospital’s antibiotic stewardship program, which was paused because of the pandemic. A portion of each patient’s rounding includes a discussion about whether a person can come off the medicine.
“It’s a handshake stewardship,” Shelby said. “We get to have that real-time discussion with a physician about any patient who is receiving treatment.”
The stewardship continues after discharge with follow-up calls to prevent readmissions. Shelby said that in addition to checking with a patient to make sure they have a follow-up appointment scheduled, she asks whether they have their new prescriptions.
TCMH is a 66-bed general acute care hospital located in Houston, Missouri, a rural area in the south-central portion of the state. The non-profit hospital includes physicians and nurse practitioners who see patients of all ages. In addition to the main campus in Houston, they have several clinics located throughout Texas County and Wright County in Licking, Houston, Cabool and Mountain Grove.