Nurs 204 U3L10: Hands Off Communication for a Safe Environement

Safety Definitions

- IOM/NAS: "prevention of harm to the patient"

- WHO: "patient safety is the prevention of errors and adverse effects to patients associated with health care"

- AACN/QSEN/ANA: "the minimization of risk for harm to patients and to providers through both system effectiveness and individual performance"

To ensure comprehensive and safer handoffs...

Use a consistent blueprint, or handoff sheet or tool to prevent errors of omission and optimize nursing care

General Safety Communication Guidelines for Organizations

error databases and improved communication

Characteristics of Safe, Effective Communication:

•Correct/accurate

•Clear/understandable

•Concise

•Concrete/specific yet complete

•Confidential

•Contemporary/timely

Effective Communication

a two-way exchange of information between patients & healthcare providers ensuring that the expectations and responsibilities are clearly understood.

➢An active process.

➢Provides feedback, which enables understanding by both senders and receivers.

➢timely, accurate, & usable.

Difficulties with Communication

1.System failures: channels of communication that are absent

2.Transmission failures: channels exist but message isn't sent or not clearly sent

3.Reception failures: channels exist, message is sent, but recipient misinterprets the message

Scope of Practice

Rules, regulations, & boundaries within which a person may practice in a field of healthcare

Standards of Practice

Used to communicate to the public the nursing care they can expect from professional nurses.

•Requires clear, comprehensive communication.

ANA

publishes the "Scope & Standards of Practice"

AHRQ & AHA

compiles evidence for best practice protocols - TeamSTEPPS

AACN

guidelines for nursing curricula - recommends student nurses be taught standard "handoff" protocols

American Association of Critical Care Nurses

nurses need to be proficient in communication skills as well as clinical skills

ICN

codes of ethics

SBON

each state regulates professional standards of practice

WHO

modernize professional regulations for the workforce

QSEN

•6 prelicensure competencies to promote high quality, safe care. Each competency specifies knowledge, skills, attitudes.

Barriers to Safe, Effective Communication in Healthcare System

-lack of unique patient identification numbers

-fragmentation of systems

-handoff/transfer to care

-underreporting of errors in a punitive culture

Individuals and Factors that Result in Errors:

•Fatigue

•No breaks

Innovations that Foster Safety

communication clarity

collaboration

communication

Best Practice: Communicating Clearly for Quality Care:

1. Increase use of evidence-based "best practice" versus "usual practice"

2. AHRQ funding research to identify most effective methods of promoting clear communication such as:

*Practice guidelines

*Protocols

*Situation checklists

3. EHRs improve the safety of patient care & empower providers

*Aid in decision support

Best Practice: Standardization of Communication

Standardized Communication:

•An effective tool to avoid incomplete or misleading messages.

•Needs to be clear, unambiguous, timely, accurate, complete, open, & understood by the recipient

•Patient Safety Outcomes

•Use of standardized tools prevents harm

•Regulatory agencies mandating use

Standardized Communication for Safer Care

Decreased Interruptions

Improve the Medication process

Applications

Safe Care Climate

•Quality & safety education competencies - developed for all nurses by national leaders - emphasize safety.

Attitude

•Safety is the top priority.

•Prime goal: improve communication about a patient's condition among all people providing care.

When nurses are comfortable using clinical guidelines and EBP procedures, and accessing information they will see:

They are providing higher quality of care

•Improving their decision-making skills

•Avoiding errors

•Resulting in safer care for their patients

Skills Acquisition:

a gradual transition from rigid adherence to rules, to an intuitive mode of reasoning that relies heavily on deep tacit understanding

Standardized Communication Checklists

specific, structured list of actions to be performed in a specific clinical setting whose contents are based on evidence

SBAR

Situation

Background

Assessment

Recommendation

Situation in SBAR?

-Identify yourself. State name & title and where you work.

-Clearly & briefly define the situation (should be 1 statement, mention level of concern)

Background in SBAR?

-what is relevant to the problem?

-summary of background

-relevant information only

-may include: patient's diagnosis, prescribing physician, date, dosage strength, dosage form, & labs

Assessment in SBAR?

What do I think the problem is?; state conclusion and what you think is wrong with the patient.

Recommendation in SBAR?

Suggested actions for patient care.