Whiteboards across the system A Standardized Tool for Nurse-Patient Communication and Patient-Centric Care Mari Dee Sandra Cid RN, PCCN University of San Diego Master’s of Science in Nursing Maria Sudak RN, MSN, CCRN NEA-BC Palomar Pomerado Health Transformation

Background Patient/ Customer Quality of care and Satisfaction is undoubtedly on the minds of hospitals and healthcare systems. Patient satisfaction is tied to reimbursements. One of the things that patients value is good communication. The Joint Commission states that 65% of reported sentinel events were caused by communication errors. In 2007, one of the National Patient Safety Goals (NPSG) declared by The Joint Commission was to engage patients in their care.

PICO Question Does the use of a standardized or structured whiteboard versus a blank board result in increased nurse-patient communication and increased patient/family engagement with their care?

Goals of the Project Standardize “whiteboards” across the system Provide a tool for better communication between caregivers and patients. A mechanism for patient /family engagement in their care and education. Increase patient satisfaction scores / Improve HCAHPS survey scores. HCAHPS ( Hospital Consumer Assessment of Healthcare Providers and Systems) A standardized survey instrument designed to produce data about patients’ perspective of care. Publically reported data

SWOT ANALYSIS Opportunities: Strengths: Weakness: Threats: Improve nurse-patient communication Increase patient participation with their care Standardization of information written on the board Increase patient satisfaction rating Improve HCAHPS scores Threats: Nurses’ compliance Whiteboards not completed due to missing markers and erasers Strengths: Improve patient- centered care Improve teamwork Increase nurse/patient communication Increase patient education/engagement in their care “Shared” communication tool. Weakness: Controversy over nurses burdened with “one more task” to their responsibilities.

Challenges to implementing whiteboards: Standardization across the system…”special needs” Compliance Privacy Valid and accurate information Expectations Accountability Patient involvement Who’s “GOAL” is it?

Strategies and Solutions to Challenges? Recruit Input - Direct care providers - Ancillary team members - Customer Advisory Panel - Leadership - Professional Practice Committee Education and communication - in-services will be provided to staff - staff awareness through “huddles” - provide “Inpatient Communication Board” handouts to the team Participation and involvement

Current State….

Evidence Summary Standardized templates Structured format = more inclusive of relevant/accurate information Direct Care Provider accountability Whiteboards should be placed in clear view of patients Erasable markers should be readily available greatest barrier

Financial Projection Size of whiteboard: 24 x 36 18 x 36 for space challenges $ 110/whiteboard X 30 (# rooms/unit) = $ 3,300 approximate cost per Inpatient unit

Steps taken to standardize whiteboard format, utilization and expectations: Literature reviewed / unit rounds completed to evaluate current state Template created and searched Presentation to Service Excellence work group Templates combined Unit rounds at PMC & POM to recruit end user input/feedback Suggestions incorporated into template Template to marketing for quote Recruit funding Template sent out to Directors to share with UPC’s and recruit input/feedback Visit to Mother Baby and ED to assess special needs Template taken to Community Advisory Panel for input form the “Customer” Care Delivery 1/28/2011 Clinical Leadership Committee & Professional Practice Committee 2/2011 Pilot units…30 days…any last minute revisions 3/2011 Education and Deployment 6/2011

Name Nurse CNA MD Diet Vital Signs Pain Score Hearing/Visual limitations Interpreter needs Glasses Dentures Hearing Aid Intake/Output Patient Goal/Discharge Plans Case Manager Respiratory Rx Patient and Family Communication

Evaluation A post-intervention 5-questionnaire survey will be given to the patients upon discharge on the pilot units regarding usefulness of patient whiteboards. A post-intervention audit will be conducted to check for staff compliance and identification of removable barriers at 3 and 6 months Outcome= to increase nurse-patient communication/education and patient engagement in their care. Increased patient satisfaction scores (Press Ganey) that reflects nurses’ attention to patients’ special/personal needs nurses kept patients informed. Improve HCAHPS survey scores in 3 months post-intervention.

4 Evidence Based Standards & RBC

Questions? Thoughts? Ideas?