Multidisciplinary Rounds in the ICU: How to Be Prepared

Multidisciplinary Rounds in the ICU are an important part of patient care. They provide an opportunity for all members of the health care team to come together and discuss each patient’s case. This can help ensure that everyone is on the same page and that no important details are missed.

We will discuss what Multidisciplinary Rounds are, and how you can be prepared for them.

Table of Contents

What are Multidisciplinary Rounds in the ICU?

Multidisciplinary Rounds in the ICU are an opportunity for the entire health care team to come together and discuss each patient’s case. This includes the attending physician, surgeon, residents, nurses, social workers, registered dietitians, physical therapists, and other members of the team. The goal of these rounds is to ensure that everyone is on the same page and that no important details are missed.

During Multidisciplinary Rounds, each team member will have the opportunity to share their thoughts and concerns about the patient’s care. The attending physician will then make decisions about the plan of care.

How can you be prepared for Multidisciplinary Rounds in the ICU?

If you are a member of the health care team, there are a few things you can do to prepare for Multidisciplinary Rounds in the ICU.

First, review the patient’s chart before rounds. This will help you be familiar with the case and be able to contribute to the discussion.

Second, come prepared with questions or concerns you may have about the patient’s care. This will help the team identify any areas where more information is needed.

It is important to note that many if not all, multidisciplinary rounds are physician-led rounds whereas many of the rounds on the lower acuity floors such as PCU, Medical Surgical, and Telemetry are nurse-driven rounds. We will be discussing ICU rounds with the understanding that the physician is leading the rounds.

As a new nurse in the ICU, it can be scary to know which questions you need to ask during rounds. It is helpful to use the mnemonic A, B, C, D to make sure you are addressing all the important topics.

A

  • Aspiration – Is the patient at risk for aspiration?
  • Airway – What is the patient’s respiratory status? Is the patient’s airway secure? Are they tolerating the ventilator? Do we need to start weaning based on the patient’s readiness? Have we tried a sedation vacation? What needs to happen to get the patient extubated?
  • Antibiotics – Are the antibiotics still necessary and how long have they been on them?
  • Activity – Is the patient tolerating the activity guidelines? Are there any new restrictions or could the restrictions be lifted? For example, bed rest to chair transfer.

B

  • Balance – Is the patient a fall risk? Does the patient need to be evaluated by PT?
  • Bowel – Is there a regimen ordered? Is the patient at risk for C. Diff (older than 65, recent hospitalization or nursing home stay, weakened immune system, and/or previous C.Diff Infection)

C

  • Central Lines, Arterial Lines, and Foley Catheter – Why is the line in? Are any of these lines still necessary? What needs to happen to get the line removed from the patient?
  • Communication – Is there any communication that needs to take place between the nursing team, family, or consulting providers? It’s good to read the consultation notes.
  • Code Status – Has the code status been addressed with the patient, family, or healthcare surrogate?
  • Case Management Needs – Does case management need anything to get the patient discharged such as paperwork for the nursing home, equipment, and home healthcare?
  • Cardiac – Are there any changes to the hemodynamic stability of the patient? Are there any new cardiac rhythms noted? Are these issues keeping them in the ICU?

D

  • Diet – What kind of nutrition is the patient receiving while in the ICU (normal saline is not a form of nutrition)? How is the patient tolerating the diet? Do we need to make adjustments to the intake?
  • DVT – Do we have any kind of DVT prophylaxis on board such as Lovenox, SCDs? This is highly important in the ICU as the patients are not ambulating.
  • Devices – Are there any drains, devices, or restraints present? Do we need to get any updated orders on these devices or restraints? Are they still necessary and why?
  • Disposition – Has discharge planning been started? What needs to happen for the patient to be downgraded to a lower acuity or discharged from the hospital? Is the patient on palliative care?
  • Drugs – Has the medical reconciliation been completed? Are there Pain Control orders and guidelines? Have the pain control medications been working? Do we have an electrolyte protocol in place?
goal meaning

Goal for the Day

At the end of your rounds, it is always best to ask what the goals are for the patient that day. This will help you keep the patient and family up-to-date as well as the consulting providers. There should always be some kind of goal we are working towards with every patient.

Additional Topics that may be covered

Readmission: A readmission is defined as a patient who is discharged from the hospital and then admitted to the hospital within a certain time frame, usually 30 days. There are many reasons why a patient may be readmitted to the hospital, but some of the most common reasons are complications from the original illness, not following discharge orders, and/or injury, dehydration, sepsis, and pneumonia.

  • What can be done to prevent readmission?
  • What was and is the patient’s readmission score? High, Medium, or Low? What factors make this score that status?

Bedside Medication upon discharge: A lot of healthcare facilities are providing pharmacy prescription pick-up services at the bedside before the patient is discharged. The patient or family member is able to ask the pharmacist any questions they may have about the medications.

This is a great way to ensure that the patient or family member understands what medications the patient is being discharged on, how to take them, and why they are taking them.

What happens after the meeting is over?

After the meeting is over, each team member will go back to their own respective units/roles and carry out the orders that were discussed during rounds.

If you are able to execute the multidisciplinary rounds efficiently, you may not need to reach out to the intensivist or provider for additional orders. However, you always have the opportunity to reach out for patient updates or missed orders by paging the provider.

Paging the provider should be done in a timely manner as the patient’s condition may have changed since rounds.

It is important to document in the patient’s chart what was discussed during rounds as well as any new orders that were given. This will help keep everyone on the same page and ensure that the patient receives the best care possible.

Tips for attending Multidisciplinary Rounds in the ICU

  1. Arrive to rounds on time
  2. Be prepared with updates on your patient
  3. Be respectful of others’ time
  4. Have a clear understanding of your role on the team
  5. Communicate effectively
  6. Make sure to follow up after rounds
FAQ

FAQs about Multidisciplinary Rounds in the ICU

What is the difference between an MDT and a MDR?

  • An MDT (multidisciplinary team) is a group of healthcare professionals from different disciplines who work together to provide comprehensive care to a patient. An MDR (multidisciplinary round) is a meeting that is held among the MDT to discuss the care of a patient.

What is the purpose of an MDT?

  • The purpose of an MDT is to provide comprehensive care to a patient by utilizing the expertise of different disciplines.

What is the purpose of an MDR?

  • The purpose of an MDR is to discuss the care of a patient and develop a plan of care.

Who is typically part of an MDT?

  • The members of an MDT vary depending on the needs of the patient but typically include a physician, nurse, pharmacist, respiratory therapist, physical therapist, registered dietitian, and social worker.

Who typically attends an MDR?

  • The members of an MDR vary depending on the needs of the patient but typically include a physician, nurse, pharmacist, respiratory therapist, physical therapist, registered dietitian, and social worker.