Improving communication using a daily goals sheet.

www.ccnonline.org Improving communication using a daily goals sheet I am writing in regards to the article by Peggy Siegele (“Enhancing Outcomes in a Surgical Intensive Care Unit by Implementing Daily Goals Tools,” December 2009:58-69) on improving outcomes in a surgical intensive care unit (SICU) after initiating a daily goals tool. I must say the timing of this article was perfect. The Shared Governance Council for our SICU began work on a daily goals sheet a few months ago. Our aim was to improve communication among the physicians, nurses, patients, and families. Our sheet was basic and included the resident completing the form on rounds and writing down the plan for the day, including diet, change of central catheter, and transfer to the step-down unit. As this daily goals sheet was discussed among the council, physicians, and management, we found that, as described in the article by Siegele, this tool could be used to improve communication and teamwork but also to improve Institute for Healthcare Improvement and Surgical Care Improvement Project (SCIP) bundle adherence. Another strength of the daily goals sheet is to help educate the staff and resident physicians about the concept of “bundles,” which facilitate best practices based on the literature. Use of this tool also coordinates and streamlines patient care, which improves patient outcomes. The daily assessment of the 12 major aspects of care also progress the patient toward recovery and transfer out of the SICU. We discovered that the final outcome, or improvement, was not mentioned in the article and involves development of the staff through role modeling. Our unit has a relatively young staff with newly acquired critical care skills. Consequently, they are uncomfortable participating in physician rounds and communicating with the physicians. Educating the nurses about the common patient-centered goals, the bundles, and SCIP elements as the standard of care empowers the nurses. It allows them to go through the daily goals list, to see which aspects of care need to be addressed for that day, to make a “wish list” for the team, and to discuss their desired plan of care with the physicians. During daily rounds with the team, the clinical nurse educator (CNE) observes staff for further educational needs, in-servicing, and processes that may need further improvement. Letters to the Editor