1. Team Communication & Patient Safety Partnerships in Implementing Patient Safety Grant

2. Why Communication? The majority of adverse patient events involve communication failures Denver Health Patient Safety Net 2005 occurrence data - 21% of contributing factors attributed to team factors 84% of team factors involve provider communication problems

3. The Need for Teamwork Healthcare is an extremely complex environment There are: –Surprises –Uncertainty –Incomplete Information –Interruptions –Multitasking

4. Psychological Safety Does it feel safe to raise your hand & ask a question 100% of the time? Effective Leadership Commitment from Denver Health leadership When someone asks for help, come with a smile on your face 100% of the time “Lets frame a plan for Mr.___. Call me if he goes out of the box” or “When do you want me to call you?”

5. Psychological Safety… Recognition that human error is inevitable Complex systems Inherent Human Limitations – stress, limited memory capacity, fatigue, & multitasking ● Safety is often ASSUMED, not ASSURED ● Culture of the expert of the individual Solution: Teamwork & Communication!

6. Psychological Safety… Level the playing field Do you know all the names of the personnel you work with? “Hi, I’m ___. I’m sorry I missed your name.” “I don’t have any pride invested here. I just want to get it right, so if you think I am doing anything wrong, please let me know.”

7. Psychological Safety… Environment of Respect “A fundamental, non-negotiable respect for every employee, everyday, by everyone” The work is recognized and acknowledged

8. Effective Communication Requires Structure Communication (SBAR) Critical Language (key words) Assertion Debriefing

9. Different Communication Styles National Culture Gender Roles (Physician, Nurse, Manager) –Nurses: narrative & descriptive –Physicians: problem solvers “just give me the facts”

10. Structured Communication: SBAR If the phone goes dead in 10 seconds – will the person on the other end know what is needed? S ituation – State what you are calling about (5-10 second punch line) B ackground – State what you are calling about (including objective date i.e. vitals, labs) A ssessment – State what you think the problem is (diagnosis not necessary – include severity) R ecommendation – State what you think needs to be done for the patient (get a time frame)

11. Structured Communication S –Mr. M has sudden onset of radiating chest pain & shortness of breath B – He has a history of MI’s, & his vitals are 186/76, 180, 24 & he is on 5L of O2 per nasal cannula sats 84% A – I think Mr. M might be having an MI R – I need you to come evaluate the patient, how soon will you be here?

12. Assertion Speak up and state your information with appropriate persistence until there is a clear resolution What is it? Organized in thought and communication Valued by the entire team Looking for clarification & common understanding What is it not? Aggressive or hostile Ridiculing Confrontational Ambiguous *

13. Critical Language Key phrases understood by all to mean “stop and listen to me – we have a potential problem” United Airlines “CUUS” program: I’m C oncerned I’m U ncomfortable This is U nsafe I’m S cared “I just need a little clarity” Stop & make sure you are all in the same movie! No surprises!

14. Debriefing An opportunity for the individual, team & organizational learning What did we do well? What did we learn? What would we do differently next time? Be specific, timely and to the point

15. The Difficult Conversation When anticipating a difficult conversation focus on: What needs to happen for us to do the right thing for our patient? Focus on the common goal - high quality, safe care Depersonalize the conversation - focus on the patient Avoid judgment - don’t place blame It’s not about you & me, it’s about the quality & safety of our patient care!

16. Practice Scenarios – Med/Surg R.D. is a 68 year old man with pleuritic chest pain. He has a history of lymphoma & received chemotherapy and radiation. He also has a history of coronary artery disease & has a 40 pack year smoking history. He was admitted this time for readjustment of his chemotherapy and treatment of his pleural effusion.

17. Practice Scenarios – Med/Surg L.K. is a 48 year old woman admitted with abdominal pain and nausea and vomiting. She was recently diagnosed with HIV/AIDS and is noncompliant with her medication regimen. The nursing assistant finds L.K. seizing in bed. You are called and as you enter the room, you see that the patient is still having tonic clonic seizures. VS 122/70, 88, RR 18, even and unlabored. You call the physician.

18. Practice Scenarios - MICU Mr. Jones, a 48 year old neurosurgery patient, is being treated for a post-op fungal infection. His Amphotercin B infusion was started 1 hour ago. Prior to beginning the med, his vital signs were as follows: HR 80, RR 24, T 36.8, BP 136/84. You recheck him & he is now has a HR 148, T 37.4, rigors & SpO2 of 97% without supplemental oxygen. After stopping the infusion, you page the MD and tell her:

19. Practice Scenarios - MICU Your patient Mrs. Smith, is an 80 yr old diabetic. She is hospitalized for an infection in her right foot. At 0300 you drew and sent blood to the lab for a Chem 7. At 0600 you check the computer and it says the request was cancelled. The ordering physician is with you and states he did not cancel the order. You call the lab & state the following: