Nursing

Simple tools to forge clear communication

Nurse Leader Weekly, November 7, 2003

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Simple tools to forge clear communication

Use daily rounds checklists and more to prevent errors
One of the most vexing challenges caregivers face is effective communication. So it's not surprising that communication is the leading root cause of sentinel events, according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)'s sentinel event statistics posted at www.jcaho.org

Take a pause to ask 'why'
The most common pitfall in root cause analysis is identifying communication as a root cause and then stopping the process there, says Della Lin, MD. Instead, go further by asking why communication is a root cause.

Part of the problem is that the most experienced practitioners tend to resort to what patient safety experts call "pattern recognition," which means they assume they know the diagnosis based on a particular set of symptoms. This way of thinking can lead to errors.

TIP: When discussing a plan of care based on pattern recognition, share the rationale so the other team members can help prevent errors.

Follow an outline to target communication
Consider using a tool derived from the military: the SBAR model, which stands for "Situation, Background, Assessment, and Response." The SBAR model helps caregivers craft communication by gathering all the important pieces of information, especially during busy times.

TIP: Create a checklist using the SBAR model to trigger staff to ask each other pertinent questions about patient backgrounds, assessments, and recommendations for care.

Try a daily goals checklist
To improve communication during rounds among practitioners in the ICU-including attending physicians and fellows, anesthesia and surgery residents, nurse practitioners, nurses, and a pharmacist-develop a daily goals form.

A goals form prompts staff to verify the tasks for completion, the care plan, and communication plan, which encompasses talking to the patient/patient's family or other caregivers. All providers, physicians, nurses, respiratory therapists, and pharmacists review the goals for the day and initial the form.

Encourage team 'huddles'
Follow football players' example and form a huddle as a way of taking a "time-out" when needed, Lin said. The huddle concept is akin to the JCAHO's patient safety goal #2, which requires a timeout before surgery to verify the correct patient, procedure, and surgical site.

Avoid dependence on tape recorders
Shift changes entail the exchange of vital information, but miscommunication often occurs during this time. Although many facilities rely on taped overviews of the patient with key points that every caregiver coming on the shift should know, don't rely on this as the only means of communication. Hold a face-to-face discussion to pass on details beyond the big events that were recorded, such as clearly stating, "The patient will go to surgery at 9 a.m."

Adapted from: Briefings on JCAHO,www.hcmarketplace.com



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