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Poor self-care is a safety issue
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Create a dream team
A children's hospital shows how interdisciplinary care pays off.
It's all about the team
Learn how the TeamSTEPPS strategy took shape.
Patient care gets revamped
A cancer center reboots bedside reporting and improves care.
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Create an interprofessional care dream team
Adopt collaborative care practices for better outcomes
Debra Anscombe Wood, RN
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Debra Anscombe Wood, RN, is a freelance writer.
Collaboratively working in an interdisciplinary practice holds the potential for improving outcomes and healthcare processes. Some hospitals have brought professionals from different disciplines together for the benefit of patients, and others are embarking on the journey.
“We’re all part of the puzzle, and no one piece is more important than the other,” said Jill Wegener, MSN, RN, CCRN, CNO at Blythedale Children’s Hospital, Valhalla, N.Y. Blythedale Children’s began its path toward greater interdisciplinary practice several years ago. In 2011, the hospital began interdisciplinary training in therapeutic crisis intervention. It has continued the training for new hires, with annual recertification for all staff. The following year, a new chief nursing officer and chief medical officer began a serious push to enhance interprofessional practice at the hospital. They convened an interdisciplinary work group to improve communication. Interprofessional practice now has become a part of the organization’s culture, Wegener said. Blythedale Children’s, with an average 40-day length of stay, conducts weekly interdisciplinary care plan meetings, attended by every discipline who touches the child to discuss goals and achievements and to map out a comprehensive plan. The patient has a multidiscipline care plan.

This approach enables nurses to follow through with the PT plan for positioning or splinting or the child-life specialists to work with the phlebotomist during blood draw rounds. PTs, OTs and nurses coordinate with teachers and enter the on-site classroom, working with the child without disrupting his learning.
“The opportunities we saw for working collaboratively, keeping the patient as the focus, has taken off,” Wegener said. “We’ve started to explore how we can come together to meet all of the [patient’s] well-rounded needs.” Scheduling presents the greatest challenge to the meetings. Each unit holds the meeting on a different day based on what’s best for that unit. If issues develop, members of each discipline meet for a short huddle to come up with a consensus plan to deal with the situation. Although some people think a unilateral decision is faster, Wegener believes a team approach leads to better outcomes for the patient. “Everyone weighs in, it’s not one discipline making a decision,” Wegener said. “The team decides how to move forward.” Wegener recalled a recent near-drowning case in which the music therapist worked with the OT and PT and created songs to help with rhythmic motion during the therapy sessions. Within eight weeks, the child went home, walking with minimal assistance and speaking again. “If the therapists worked in a silo, nursing had worked in a silo and respiratory had worked in a silo, it would have taken much longer,” Wegener said. Wegener attributes much of the success to Blythedale Children’s being a smaller facility, with fewer layers; support from senior administration and frontline staff; and bringing on leaders with the same vision. She also keeps a pulse on the team dynamics and individual perceptions. “To see significant gains day to day, it’s amazing what this team can do,” Wegener said.
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To see significant gains day to day, it’s amazing what this team can do.”
— Jill Wegener, RN
Patient focus
Getting started
While Blythedale Children’s has made great strides bringing together members of the various health disciplines, Boca Raton (Fla.) Regional Hospital is just embarking on an interdisciplinary practice project, in collaboration with Florida Atlantic University’s Christine E. Lynn College of Nursing and Charles E. Schmidt College of Medicine, both in Boca Raton. “We’re trying to build interprofessional collaborative competencies and practices,” said Terry Eggenberger, PhD, RN, NEA-BC, CNE, CNL, assistant professor at the FAU College of Nursing. The project, Aligning Education and Practice to Support Interprofessional Collaboration, with funding from The Josiah Macy Jr. Foundation in New York, aims to align academic and healthcare delivery to support interprofessional collaboration. Three units at BRRH will participate in the pilot, which focuses on the discharge process. Melissa Durbin, MSN, RN, NEA, CNO/vice president at BRRH, explained that with so many specialists participating in patients’ care, coordination at discharge sometimes is lacking. “At the root of it all is safe patient care,” Durbin said. The project began with a survey to assess the three units’ culture in terms of team building, communication and perceptions of the other disciplines’ roles. While the survey data are still being analyzed by an outside entity, Shelly Gonzales, MSN, RN, CCRN, executive director of nursing at BRRH, said it has identified barriers, which the project will seek to break down. All members of the healthcare team will learn TeamSTEPPS, an evidence-based communication curriculum, which Eggenberger will teach. The hospital is considering staff job shadowing other professionals. The units also will implement interprofessional rounds and select faculty and practice champions. “We hope with interprofessional rounding we will start the discharge process earlier,” Durbin said. After nine months, Eggenberger and the hospital will reassess the culture and patient satisfaction using the same tools. Although BRRH started with the discharge process, it plans to expand to other aspects of care. “I think we can make a difference in practice,” Eggenberger said.