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Team Communication
Coordinating Care
Discharge Planning Family Meeting Universal Protocol
A communication barrier is anything that blocks, degrades or interferes with clear exchange of ideas. Cultural barriers: Shyness; excessive deference to authority; keeping quiet to avoid embarrassment. Rank, age, position barriers: Gaps between superiors and subordinates, between doctors and non-doctors
In the procedure room, doctors and nurses who may not know each other must quickly form teams that will perform high risk operations. Here are some techniques for rapidly initiating two-way communication and building rapport among crew members.
Introduce yourself
Easier to communicate with one you already know.
Clearly tell team members to provide information, express their concerns and speak up when necessary. Say If you see anything that appears to be unsafe or otherwise causes your concern, please bring it to my attention immediately.
Ask Whats our patients status? to invite response Break the ice and begin cycle of communication Avoid hard questions. The aim is to invite participation, not test knowledge.
Insist on feedback.
MD to nurse: If I dont acknowledge your
question or comment, assume I didnt hear it and ask again. Nurse to MD: If I do not repeat your orders, assume I did not understand it and ask for a read back.
SEE IT!
SAY IT! FIX IT!
Stop what you are doing and help your entire team reclaim collective situational awareness.
State the current situation, including Your name and unit Patients name, physician and room
number Brief statement of your concerns Patients immediate problems that you want addressed Reason for the call or referral
Provide a brief and pertinent history of the patient or situation, which may include:
Admission diagnosis
and date of admission Pertinent medical history Brief summary of treatment to date Results of clinical assessments
imaging results Status of IV fluid Gait / fall precautions Diet Living situation / discharge plan Vaccines, allergies
patients problem or concern In other words, what do you think the problem is?
Give a suggested response based on the situation, background and assessment. In other words, what do you think needs to be done? The recommendation should include
Anything that needs to be attended immediately. Details on what the patients physician has been
told. Anything that has been left undone. Information on anything that could not be finished during your shift / time with the patient.
Use critical language to ensure that your recommendations are taken seriously Critical words convey urgency
Now
Must
Need
Immediately
Critical
Priority
Important
Quickly
Requires
At once
Instantly
Acute
Fast
Urgent
Essential
The Patient Passport is used to safely and efficiently endorse critical patient information during handoffs which includes patients condition, procedures, and other special endorsements.
Transfers from one hospital unit to another are guided by admission and discharge criteria specific to the sending and receiving units. MD to MD, and nurse to nurse endorsements occur at the time of transfer. The SBAR format is used in endorsing transferred patients.
Preoperative verification
Consent has been obtained? Site has been correctly marked (if applicable) Patient has known drug allergies?
Significant blood loss prepared for? Correct implants or special devices, if needed, are available
All diagnostic results are available MD briefed team on key procedure steps, potential problems and actions
care plan
recovery plan
It is a venue for patients and their family members to participate in the planning of health care goals.
A safe environment where questions can be raised by the family and appropriate strategies agreed upon Explain what the service can and cannot offer
Prioritize issues Referrals to other health professionals
Facilitating Meetings
Disclosure
Diffusing Tension
Coaching
Goal Setting
It needs preparation
Inform attendees (family
carers, financiers, health care professionals) Set a time and place Establish the agenda beforehand
Documentation
Who were present
Our responsibility towards our patients does not end upon their discharge
We have the duty to ensure that their care is seamlessly continued at home and in other places. Because our patients need to get out of their sick roles. Our patients need to re-imagine themselves as whole, self-sufficient and satisfied people again. They need wellness goals to aim for, mental images to sustain their recovery efforts.
Efficiently and safely separate the patient from the hospital setting
Challenge your patient to paraphrase and demonstrate mastery of your educational messages.
Avoid getting sick again Take their medications and when Modify their diet if needed Resume normal activities and when Call for medical help if needed and whom Go for a follow-up visit and when
Their condition, treatments and outlook Diet and nutrition Rehabilitation techniques Pain relief
Two Goals: Safe and efficient discharge, and continuing care in the community The Attending Physician leads the health care team in discharge planning. Information, understanding and therapeutic alliance are essential components of discharge planning
Discharge planning begins upon admission and continues throughout confinement. Discharge planning for chronic care patients anticipates many health care needs and helps patients gain access to community health care resources.
Team Communication
Coordinating Care
Universal Protocol Family Meeting Discharge Planning
Your patient has an unclear history of allergies and needs a stat CT scan with contrast. How will you deal with this problem? (More than one answer)
A. You will clearly write the indication and precautions
on the chart B. You will ask your RIC to just accompany your patient to CT scan. C. You will use SBAR to communicate your concerns to the patient and NIC. D. You will use SBAR in conferring with the radiologist on the choice of imaging procedure and precautions
Your patient has an unclear history of allergies and needs a stat CT scan with contrast. How will you deal with this problem? (More than one answer)
A. You will clearly write the indication and precautions
on the chart B. You will ask your RIC to just accompany your patient to CT scan. C. You will use SBAR to communicate your concerns to the patient and NIC. D. You will use SBAR in conferring with the radiologist on the choice of imaging procedure and precautions
Your patient has an unclear history of allergies and needs a stat CT scan with contrast. How will you deal with this problem? (More than one answer)
A. You will clearly write the indication and precautions
on the chart B. You will ask your RIC to just accompany your patient to CT scan. C. You will use SBAR to communicate your concerns to the patient and NIC. D. You will use SBAR in conferring with the radiologist on the choice of imaging procedure and precautions
Your patient has an unclear history of allergies and needs a stat CT scan with contrast. How will you deal with this problem? (More than one answer)
A. You will clearly write the indication and precautions
on the chart B. You will ask your RIC to just accompany your patient to CT scan. C. You will use SBAR to communicate your concerns to the patient and NIC. D. You will use SBAR in conferring with the radiologist on the choice of imaging procedure and precautions
You admit a 78/F for dizziness and heart failure. She has cataracts and insomnia. How will you help prevent accidental falls?
A. You will review the falls risk assessment of the nurse
on the Patient Assessment Form and the falls prevention protocol for her. B. You will go over the falls prevention protocol with the Nurse in Charge. C. You will go over the falls prevention protocol with the patient. D. You will communicate your concerns with the Nurse in Charge and the patient using SBAR.
You admit a 78/F for dizziness and heart failure. She has cataracts and insomnia. How will you help prevent accidental falls?
A. You will review the falls risk assessment of the nurse
on the Patient Assessment Form and the falls prevention protocol for her. B. You will go over the falls prevention protocol with the Nurse in Charge. C. You will go over the falls prevention protocol with the patient. D. You will communicate your concerns with the Nurse in Charge and the patient using SBAR.
You order ceftazidime IV on the patients chart and give the chart back to the nurse. What do you do next?
A. You tell the nurse to note the antibiotic order
before leaving the station. B. You ask the nurse to read back the order to you and then you confirm it. C. You tell the nurse to just contact the RIC if she has any questions. D. You ask the nurse if she can read your order.
The following statements are true regarding the sign in briefing procedure:
A. B. C. D. E.
Surgeon must brief the team about the key points of the surgery, potential problems and risks The sign in procedure must be done before anesthesia induction Anesthesiologist must brief the team about airway route and any difficulties A and C only All of the above
While wound is being closed, surgeon review the key intra-operative events and post-operative care plan while the wound is being closed Before drapes are removed, anesthesiologist review key intra-operative events and post-anesthesia recovery plan While sutures are being placed, nurses confirm sponge and instrument counts A and C only All of the above You will clearly write the indication and precautions on the chart
admission C. Informing the patient of the expected LOS D. All of the above
patient B. Ensuring the patients understanding C. Establishing rapport and trust with patient and family D. Reaffirming therapeutic alliance with the patient