Communication breakdowns in healthcare are often the leading cause of serious mistakes reported to the Joint Commission’s Sentinel Event Root Cause Database. The Joint Commission defines ‘communication’ as that which is “oral, written, electronic, among staff, with/among physicians, with administration, with patient or family.” In nursing, if a message is not clear or perceived inaccurately, patient care can suffer.
So I ask, what methods have hospitals found most successful to communicate new information, policies or procedures to large numbers of staff? Staff in the hundreds or thousands -- specific to a department or hospital wide, often on several campuses, working day shift, night shift, per diem, and/or are travelers -- creates many obstacles for effective communication.
The Joint Commission’s 2012, National Patient Safety Goals, addresses improved staff communication. Staff must be informed at a pace that keeps up with the abundance of information. The most frequent form of communication between nurses occurs at shift change when patient reports are given. The outgoing nurse is exhausted, has multi-tasked all day, but need to give an accurate summary of her patient’s history and care. If not, treatments, medications, and more may be missed. Another example of poor patient reporting that I often see in the ER setting occurs when a patient arrives from a nursing home and appears confused. It is vital to know how cognitive impaired versus mildly confused versus demented a patient is at baseline so that the next nurse does not over-react. ‘Over-reacting’ often exposes a patient to more, unnecessary tests, radiation and needle sticks.
Of course communication does not just occur between nurses. The purpose of this blog is to go beyond nurse-to-nurse communication and tackle the gulf between administrators, physicians, nursing staff and patients. Policy changes, new documentation requirements, budget issues, changes in products supplied, a practice revision or staffing updates all originate from offices that do not frequently communicate with nurses. These types of changes often need to be filtered through to the nursing staff at a fast pace; they can require on-site training and frequent conversations that extend well past an hour staff meeting. However, these employer-specific changes and updates do not often cause poor patient outcomes or fatalities. For example, if a nurse hasn't been oriented to a new computer documentation system or new form, she/he can still take care of the patient. The documentation may suffer and the nurse may eventually need to go back in the chart, with the help of a peer, after the patient has been cared for, and make edits. Although the patient outcome should not be affected, employers seek compliance to changes and ultimately any breakdown in communication needs to be avoided.