Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Nursing shortage wikipedia , lookup
Adherence (medicine) wikipedia , lookup
Medical ethics wikipedia , lookup
Nurse–client relationship wikipedia , lookup
Rhetoric of health and medicine wikipedia , lookup
Licensed practical nurse wikipedia , lookup
Electronic prescribing wikipedia , lookup
Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Chapter 13 Health-Care Team Collaborative Patient-Safe Communication Strategies Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety High-Reliability Organizations Sustain an organizational culture of safety Commitment to safety that permeates all levels of an organization, from frontline personnel to executive management Build safety into operations Use specific communication strategies to maintain collaborative working relationships; coordinate and synchronize activities Have very low rates of harmful events Health care organizations are typically NOT high-reliability organizations Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Culture of Safety Commit to safety at all levels Acknowledge high-risk situations Encourage voicing concerns of threats to safety before harm occurs Encourage reporting errors and intercepted errors within an atmosphere of trust No fear of retribution for reporting errors Learn about errors to make safety improvements Focus on why and how errors happen Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety “Just Culture” The Systems Approach Systems approach Recognizes people are fallible and make mistakes Does not hold professionals accountable for system failures Does not tolerate gross misconduct of individuals Personal approach Traditionally used in health-care organizations Unrealistic expectation of perfection of professionals Blames, names, shames, and retrains individuals committing errors Belief that “bad” people make errors Errors and near misses often unreported Health-care organizations are slow in adopting a systems approach Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety High-reliability organization systems approach based on: Knowledge of communication principles and processes Knowledge of group process and teamwork principles Knowledge of strategies and tools to prevent harmful events Knowledge of an organizational culture of safety Knowledge of standardized processes to create shared mental models of patients’ situations Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient Safety Through Group Collaboration: Shared Mental Models Health-care providers must develop processes to form shared mental models of patient clinical situations Health-care providers make clinical decisions based on shared essential patient information Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient Safety Through Group Collaboration: Shared Mental Models Health-care providers must develop processes to form shared mental models of patient clinical situations Health-care providers make clinical decisions based on shared essential patient information Example: Concept Care Map to Form a Shared Mental Model Team members have a clear picture of the medical and nursing problems, with integration of pathology, medications, treatments, and laboratory and diagnostic testing Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety 6.Impaired Urinary Elimination I=2200 O=1800 Polyuria 3+sugar Not Sure Acetominophen? Widower? Concept Care Map 5.Impaired Physical Mobility Fall risk-4 OOB/chair Weakness Pressure Ulcer Risk-9 4. Impaired Tissue Perfusion, Peripheral Hx hypertension 138/92 98.4-77-18 VS qid, TPR Valsartan Newly Diagnosed Diabetes Signs & Symptoms of hypoglycemia, hyperglycemia, blood sugar, food intake, VS 1.Imbalanced Nutrition: Less than Body Requirements Polydipsia I=2200 O=1800 Weakness Humulin N Glucose (450) 120 Accu-check Glyco Hgb 12% Cholesterol 240 1800 ADA 3. Readiness for Enhanced Knowledge 2.Anxiety Expresses concern Over Performing Injections Diet Diagnosis Medications Diet Skin Care Foot Care Exercise Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Promoting Effective Health-Care Team Communication and Collaboration Standards for Team Communication Be respectful and professional Listen actively Try to understand the other person’s viewpoint Model an attitude of collaboration, and expect it Identify the bottom line; decide what is negotiable and nonnegotiable in patient care management; e.g., patient safety is not negotiable; when staff members take a break is negotiable Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Standards for Team Communication Acknowledge the other person’s thoughts and feelings Pay attention to your own ideas and what you have to offer the group Be cooperative Be direct Identify common, shared goals and concerns State your feelings using “I” statements Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Standards for Team Communication Do not take things personally Learn to say “I was wrong” and “You could be right” Do not feel pressure to agree instantly Think about all possible solutions before a meeting, and be willing to adapt if a more creative alternative is presented Recognize that negotiation and resolution of conflict take time and may require several interactions Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Group Process An understanding of the behavior of people in groups trying to solve problems and make decisions Principles apply to health-care team processes All members of the team must be trusted and respected Share information Help each other when needed Resolve conflicts Have high levels of communication competence Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Classic Group Process All team members must understand group process Forming Storming Norming Performing Adjourning Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Classic Group Process Forming: Relationship development—team orientation, identification of role expectations; beginning team interactions, explorations, and boundary setting Storming: Interpersonal interaction and reaction—dealing with tension, conflict, and confrontation Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Classic Group Process Norming: Effective cooperation and collaboration— personal opinions are expressed, resolution of conflict with formation of solidified goals and increased group cohesiveness Performing: Group maturity and stable relationships— team roles become more functional and flexible, structural issues are resolved leading to supportive task performance through group-directed collaboration and resource sharing Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Classic Group Process Adjourning: Termination and consolidation— team goals were met, closure occurs after evaluation, and review of outcomes Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Team Leader: Coordination of Health-Care Team Patient-Safe Communication Behaviors An effective team leader: Organizes the team—utilizes resources to maximize performance, balance workload, and delegate tasks and assignments as appropriate Articulates clear goals Makes decisions based on input of team members Empowers team members to speak up and openly challenge, when appropriate Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Team Leader: Coordination of Health-Care Team Patient-Safe Communication Behaviors An effective team leader: Promotes and facilitates good teamwork; e.g., briefs, huddles, debriefs Resolves conflict; e.g., uses the two-challenge rule, CUS, and DESC Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Team Briefs Coordination and Collaboration Briefs—Planning sessions Designate team roles and responsibilities Establish team goals Develop short- and long-term plans Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Team Huddle Coordination and Collaboration Huddle—Problem-solving sessions Touch-base meetings to gain awareness of new developments in a situation Discuss emerging events, express concerns Anticipate contingencies and anticipate outcomes Adjust plans and reallocate resources to meet changing needs of situation Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Team Debrief Coordination and Collaboration Debrief—Group process to improve team performance next time Informal feedback session with informal information exchange Designed to improve team outcomes Accurate reconstruction of key events Analysis of what worked and what did not Revise plans focused on what should be done differently next time Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Conflict Resolution Patient advocacy and assertion Advocate for the patient: When you believe patient safety is in jeopardy and you do not agree with the primary decision maker (physician) Use assertiveness in a firm and respectful manner to indicate a correction in care of the patient Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Conflict Resolution: Two-Challenge Rule When an initial patient-safety assertion is ignored: It is your responsibility to voice your concern at least 2 times to make sure it was heard The team member must acknowledge that it was heard If the outcome is not acceptable: Contact a supervisor Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety How to Make Assertive Statements Using the Two-Challenge Rule Make an opening-: “Dr. ____, Mr./Mrs. ___ is supposed to be discharged.” State the concern (#1 challenge): “I am concerned about the patient’s BP and pulse, which are substantially elevated (patient admitted for an MI) Physician says, “Don’t worry about that.” Restate the problem (#2 challenge)- “The patient is supposed to be discharged, but these appear to be significant alterations.” Offer a solution: “Would you assess the patient further?” Reach an agreement: Physician further assesses, or sends a resident, or says not to worry. If physician fails to address concerns, contact a supervisor. Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety ASSERTIVE STATEMENTS to Promote Conflict Resolution Using CUS C: “I am Concerned.” U: “I am Uncomfortable.” S: “This is a Safety issue.” Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Conflict Resolution Using DESC Sit down and discuss work-related conflicts; can be done with a supervisor present or between two professionals Strive for consensus and a win-win outcome: D—Describe the situation E—Express concerns about the situation S—Suggest alternatives and seek agreement C—Consequences of behaviors that are blocking attainment of team goals Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety High-Reliability Patient-Safe Communication Strategies Guidelines for effective handoff Medication reconciliation Guidelines for written documentation in health records Strategies to avoid errors due to look-alike/sound-alike medications Readback/hearback SBAR Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Effective Handoff During Transitions of Care Transfer information during shift-to-shift, unit-to-unit, hospital-to-long term care facility, etc. Ensure: All relevant information communicated Information clearly conveyed, plainly understood Communications are concise There is an opportunity to ask questions Information is clarified Information is confirmed, validated, and acknowledged by the nurse assuming responsibility for patient care Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Handoffs should include: Diagnosis Allergies Current condition Recent changes in condition Ongoing treatment Possible changes or complications that might occur Plan of action if complications occur Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety High-Reliability Handoffs Face to face with interactive questioning Topics initiated by person assuming responsibility as well as by the person being replaced Repeating back important information by the incoming person Information presented in the same order every time Limited interruptions Written summary of activities that occurred during the shift Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Medication Reconciliation at Handoff During Admission and Discharge Almost 50% of medications errors occur during admission and discharge Write complete list of medications taken at home Compare list with admission, transfer, and discharge orders, looking for discrepancies Keep list updated Communicate list to the next provider Keep list in a visible location in the patient’s records Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Guidelines for Written Documentation Write legibly—print drug names and dosages Do not use dangerous abbreviations Locate “Do not use lists” in each facility: Instead of U, u, IU, write units Instead of QD, write daily; instead of QOD, write every other day, etc. Always use a zero before a decimal point 0.5 mg Do not write a zero after a decimal point because trailing zeros lead to tenfold dosage errors 1 mg (not 1.0 mg) Use “tall man” lettering for look-alike, sound-alike drugs LamiCTAL and LamiSIL Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Readback/Hearback: Face-to-face and Telephone Ensure messages are clearly received and understood Sender states information concisely to the receiver Receiver first writes down, then reads back what was written Sender provides a hearback acknowledging that the readback was correct or makes a correction The readback/hearback continues until shared understanding between sender and receiver is created. Drug doses are expressed in single-digit format, e.g., “14 units of insulin” verified and read back as: “14-one, four-units of insulin” Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Guidelines for Telephone Communications: SBAR S- Situation B-Background A-Assessment R-Recommendations Michael Leonard, MD, Doug Bonacum, and Suzanne Graham Kaiser Permanente of Evergreen, Colorado Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Pre-SBAR: Before Calling the Physician or Nurse Practitioner Assess patient; take complete vital signs Review medical record for the appropriate physician to call Know the admitting diagnosis and admission date Read the most recent physician and nursing notes Have the medical record available and be ready to report: Code status, allergies, medications, IV fluids, lab and test results Focus on the problem; be concise Review with charge nurse/resource staff/preceptor prior to calling Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety S: Situation State your name and your department (say) I am calling about: (patient name, room number, code status) (say) The reason(s) I am calling is (are): (state specific problem) A change in patient’s condition Critical lab values A lack of response to current treatment/intervention Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety B: Background State the admission diagnosis, date, and brief summary of treatment to date State name of the primary physician when speaking to an on-call physician State the relevant medical history Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety A: Assessment State the most recent vital signs, oximetry, and pain level Give the physical assessment pertinent to the problem, stating changes from the prior assessment, mental status, and complaint given by the patient State how severe the problem seems to be. Examples: (say) I think the problem is ________(briefly describe the problem) or; (say) I am not sure what the problem is, but the patient’s condition is deteriorating. Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety R: Recommendation State what you think needs to be done. “Would you consider ______?” “I need you to _________.” “I would like to suggest_____.” “I would like you to______.” “Would you consider transferring the patient to higher level of care?” “I need you to come see the patient.” “I suggest ordering/discontinuing medications such as: IVF, antibiotic, transfusion, pharmacy protocol, etc.” “Would you consider ordering tests such as: CXR, ABGs, EKG, CT for PE, blood work, etc.?” Clarify how often to monitor the patient and under what circumstances to call again Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Communication Failures Leading safety hazard in health-care organizations Result in lack of collaboration, coordination, and synchronization of patient care It is critical that nurses develop high-level communication competence to avoid communication failures leading to harmful events Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety References References for this content can be found in the text. Chapter 12: Pp. 173-175 Chapter 13: Pp. 189-191