1. Communication Among Healthcare Providers

2. Purpose To review the importance of excellent communication among health care providers in promoting career satisfaction and patient safetyTo review the importance of excellent communication among health care providers in promoting career satisfaction and patient safety

3. Objectives At the completion of this exercise, you should: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

4. Nurse-Physician Communications Frequent occurrenceFrequent occurrence Communication across a hierarchy can be intimidatingCommunication across a hierarchy can be intimidating Gender or cultural issues may complicate furtherGender or cultural issues may complicate further Often named as cause of nurse job dissatisfactionOften named as cause of nurse job dissatisfaction Critical for patient safetyCritical for patient safety

5. Communication and Safe Care 60 % of medication errors are caused by mistakes in interpersonal communication 160 % of medication errors are caused by mistakes in interpersonal communication 1 Poor coordination of care is the most common cause of adverse events triggering root cause analyses 1Poor coordination of care is the most common cause of adverse events triggering root cause analyses 1 1 Joint Commission Data

6. Steps to Excellent Healthcare Communication 1 Clarify the problem & gather data 2 Concisely describe the problem 3 Actively listen to response 4 Assert concerns if needed

7. Communication with Other Healthcare Workers Step 1 - Gather and clarify all of the information you need to provide to the physician: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

8. 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.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.When you perform your initial assessment on this patient, you find her to be confused.

9. Case Presentation What additional information do you need to gather prior to contacting the physician?What additional information do you need to gather prior to contacting the physician?

10. Case Presentation Additional information you might gather: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

11. Case Presentation Vital signs and pulse oximetryVital signs and pulse oximetry –T 37.5, P 108, R 24, O2 sat 82% (RA) Name, dose and timing of pain medication previously givenName, dose and timing of pain medication previously given –Morphine sulfate 2 mg IV two hours ago Any additional observations that you feel would be helpfulAny additional observations that you feel would be helpful –Patient’s respirations seem somewhat labored

12. Communication with Other Healthcare Workers Step 2 – State concisely to the physician the problems that the patient is experiencing.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

13. Role Play When you call the resident physician on duty, how would you state your concerns and question?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.Give a brief summary (no more than 60 sec) to the person sitting next to you. Have that person give you feedback on:Have that person give you feedback on: –What was effective about your communication? –What could have been clearer?

14. Communication with Other Healthcare Workers Step 3 – Actively listen to information communicated by the physician/healthcare workerStep 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

15. Case Presentation The resident physician asks that you obtain the following tests: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?Is there any additional information you need to know at this time?

16. Case Presentation The resident physician asks that you obtain the following tests: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?Is there any additional information you need to know at this time? –Since her respirations are somewhat labored, should patient be placed on O2?

17. Case Presentation The CXR suggests pneumonia, and the resident orders an IV antibiotic.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.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.

18. Case Presentation The patient’s O2 sat is now 88% on 50% face mask, and her respiratory rate is 30/minute.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 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.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.

19. Communication with Other Healthcare Workers Step 4 – Know how to tactfully use assertive communication when necessaryStep 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

20. Role Play Practice assertive communication to the person sitting next to you: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

21. Assertive Communication in Patient Care Is not:Is not: –Yelling or bullying –Accusatory –Being disrespectful of authority Is:Is: –Focused on patient –Noting your perceptions –Persistently raising concerns, intended to move toward desired action

22. Case Presentation If your effort at assertive communication does not have the desired effect, what other options are available to you?If your effort at assertive communication does not have the desired effect, what other options are available to you?

23. When Assertiveness Doesn’t Work Restate your concerns in another wayRestate your concerns in another way Engage another healthcare worker (i.e. Respiratory Therapy)Engage another healthcare worker (i.e. Respiratory Therapy) Engage your supervisorEngage your supervisor Engage another physician on the teamEngage another physician on the team

24. Effective Communication Essential for real teamworkEssential for real teamwork Essential for long term career satisfactionEssential for long term career satisfaction Essential for patient safety and quality careEssential for patient safety and quality care