Nursing

Poor communication cited in patient deaths

Nurse Leader Weekly, November 13, 2003

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Poor communication cited in patient deaths

Patient safety officers are taking a closer look at how physicians and nurses communicate after deficiencies were cited in three highly publicized deaths at Boston's Children's Hospital.


The Harvard University-affiliated teaching hospital was thrust into the spotlight in September after investigators from the Massachusetts Department of Public Health (DPH) harshly criticized its handling of three cases during the past year.


Hospitals nationwide now face similar communication challenges, particularly academic medical centers, where young residents are encouraged to take responsibility and think independently. This sometimes makes residents reluctant to ask for help and physicians annoyed about giving it.


The patient safety committee at Connecticut Children's Medical Center in Hartford has been trying to effect a cultural shift around communication for years, says Lori Notowitz, RN, MJ, CPHRM, risk manager and corporate compliance officer.


"Regardless of the institution, communication is always part of the series of events that causes an adverse event," she says. "It's almost never due to one person's error."


The hospital has made it clear to nurses, residents, and all physicians that everyone has an obligation to ask any question they need to about a patient's care.


The hospital discourages physicians and nurses from responding with irritation to another provider's questions.


Notowitz offers the following tips to help staff improve communication:


  • Consider a more stringent communication policy. The policy should clearly dictate how consulting physicians and primary care physicians should communicate and work together.


  • Make sure administrators and physician leaders openly support your efforts to create a safer atmosphere. Nothing will change if senior leadership doesn't hold staff accountable for their actions.


  • Reward staff for good behavior. Connecticut Children's Medical Center presents "spot awards," such as gift certificates or temporary VIP parking privileges, to employees and staff who exemplify model behavior, Notowitz says.


  • Make sure staff members feel supported. Reward your staff for refusing to do something they feel might be dangerous even if they may be wrong.


  • Take swift action on your staff's patient safety suggestions. Send a clear message that you not only want feedback from employees and staff, but that you'll act on it if it's appropriate.


    • "You must show them that their input is taken seriously," says Notowitz. "Otherwise, they'll think, 'Why should I stick my neck out? Nothing will change.' You want them to know that you'll listen to them and respond."


    Adapted from: Briefings on Patient Safety, www.hcmarketplace.com



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