Download Communication Among Healthcare Providers

Communication Among
Healthcare Providers
Purpose
• To review the importance of excellent
communication among health care
providers in promoting career
satisfaction and patient safety
Objectives
• At the completion of this exercise, you should:
– Understand the contribution of good
communication to safe patient care
– Be able to concisely summarize a concern about a
patient
– Actively listen to information communicated by the
physician or other healthcare providers
– Assertively yet professionally communicate concerns
you have about a patient that are not being
adequately addressed
Nurse-Physician Communications
• Frequent occurrence
• Communication across a
hierarchy can be
intimidating
• Gender or cultural issues
may complicate further
• Often named as cause of
nurse job dissatisfaction
• Critical for patient safety
Communication and Safe Care
• 60 % of medication errors are
caused by mistakes in
interpersonal communication1
• Poor coordination of care is the
most common cause of adverse
events triggering root cause
analyses1
1Joint
Commission Data
Steps to Excellent
Healthcare Communication
4 Assert concerns if needed
3 Actively listen to response
2 Concisely describe the problem
1 Clarify the problem & gather data
Communication with
Other Healthcare Workers
• Step 1 - Gather and clarify all of the
information you need to provide to the
physician:
– Nature of the problem
– Supporting information or data
– Clarify in your mind what you would like for
the patient to do
Case Presentation
• You are assigned to care for a 68 year old lady
for the evening shift. She is two days post-op
following hip fracture surgery. No problems
were noted at nursing sign-out other than c/o
pain, for which she was receiving pain
medication.
• When you perform your initial assessment on
this patient, you find her to be confused.
Case Presentation
• What additional information do you need to
gather prior to contacting the physician?
Case Presentation
• Additional information you might gather:
– Vital signs and pulse oximetry
– Name, dose and timing of pain medication
previously given
– Any additional observations that you feel would
be helpful
Case Presentation
• Vital signs and pulse oximetry
– T 37.5, P 108, R 24, O2 sat 82% (RA)
• Name, dose and timing of pain medication
previously given
– Morphine sulfate 2 mg IV two hours ago
• Any additional observations that you feel
would be helpful
– Patient’s respirations seem somewhat labored
Communication with
Other Healthcare Workers
• Step 2 – State concisely to the physician the
problems that the patient is experiencing.
– Nature of the problem
– Supporting information or data
– Question or issue on which you need his/her
input
Role Play
• When you call the resident physician on duty,
how would you state your concerns and
question?
• Give a brief summary (no more than 60 sec) to
the person sitting next to you.
• Have that person give you feedback on:
– What was effective about your communication?
– What could have been clearer?
Communication with
Other Healthcare Workers
• Step 3 – Actively listen to information
communicated by the physician/healthcare
worker
– Listen to the plan of care
– Clarify areas which are unclear by asking
appropriate questions
Case Presentation
• The resident physician asks that you obtain
the following tests:
–
–
–
–
CXR
ABG
EKG
Routine blood work (HPD, BMP)
• Is there any additional information you need
to know at this time?
Case Presentation
• The resident physician asks that you obtain
the following tests:
–
–
–
–
CXR
ABG
EKG
Routine blood work (HPD, BMP)
• Is there any additional information you need
to know at this time?
– Since her respirations are somewhat labored,
should patient be placed on O2?
Case Presentation
• The CXR suggests pneumonia, and the
resident orders an IV antibiotic.
• Two hours later, as you start the antibiotic, you
note that the patient is more short of breath.
You request that the resident re-evaluate the
patient.
Case Presentation
• The patient’s O2 sat is now 88% on 50%
face mask, and her respiratory rate is
30/minute.
• You feel she needs almost 1:1 nursing, and
are worried about how you will care for
your other three patients.
• You ask if the resident if the patient
should be moved to the ICU, but he states
he wants to first see how she responds to
the antibiotic.
Communication with
Other Healthcare Workers
• Step 4 – Know how to tactfully use assertive
communication when necessary
– State your concern
– State information that supports your concerns
– Suggest a course of action
– Recap why you feel this action is best option
Role Play
• Practice assertive communication to the person
sitting next to you:
– State your concern
– State information that supports your concerns
– Suggest a course of action
– Recap why you feel this action is best option
Assertive Communication
in Patient Care
• Is not:
– Yelling or bullying
– Accusatory
– Being disrespectful of authority
• Is:
– Focused on patient
– Noting your perceptions
– Persistently raising concerns, intended to move
toward desired action
Case Presentation
• If your effort at assertive communication does
not have the desired effect, what other options
are available to you?
When Assertiveness Doesn’t Work
• Restate your concerns in another way
• Engage another healthcare worker (i.e.
Respiratory Therapy)
• Engage your supervisor
• Engage another physician on the team
Effective Communication
• Essential for real teamwork
• Essential for long term career satisfaction
• Essential for patient safety and quality care