Communication Among Healthcare Providers

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Communication Among Healthcare Providers
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Purpose

• To review the importance of excellent
  communication among health care providers in
  promoting career satisfaction and patient safety

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Objectives

• 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

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Nurse-Physician Communications

• Frequent occurrence
• Communication across a hierarchy can be
  intimidating
• Gender or cultural issues may complicate further
• Often named as cause of nurse job dissatisfaction
• Critical for patient safety

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Communication and Safe Care

• 60 of medication errors are caused by mistakes
  in interpersonal communication1
• Poor coordination of care is the most common
  cause of adverse events triggering root cause
  analyses1

1Joint Commission Data
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Steps to Excellent Healthcare Communication
4 Assert concerns if needed
3 Actively listen to response
2 Concisely describe the problem
1 Clarify the problem gather data
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Communication with Other Healthcare Workers

• 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

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

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Case Presentation

• What additional information do you need to gather
  prior to contacting the physician?

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Case Presentation

• 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

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Case Presentation

• Vital signs and pulse oximetry
• T 37.5, P 108, R 24, O2 sat 82 (RA)
• Name, dose and timing of pain medication
  previously given
• Morphine sulfate 2 mg IV two hours ago
• Any additional observations that you feel would
  be helpful
• Patients respirations seem somewhat labored

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Communication withOther Healthcare Workers

• 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

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Role Play

• 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.
• Have that person give you feedback on
• What was effective about your communication?
• What could have been clearer?

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Communication withOther Healthcare Workers

• Step 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

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Case Presentation

• 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?

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Case Presentation

• 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?
• Since her respirations are somewhat labored,
  should patient be placed on O2?

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Case Presentation

• 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.

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Case Presentation

• The patients O2 sat is now 88 on 50 face mask,
  and her respiratory rate is 30/minute.
• You feel she needs almost 11 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.

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Communication withOther Healthcare Workers

• Step 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

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Role Play

• 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

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Assertive Communication in Patient Care

• Is not
• Yelling or bullying
• Accusatory
• Being disrespectful of authority
• Is
• Focused on patient
• Noting your perceptions
• Persistently raising concerns, intended to move
  toward desired action

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Case Presentation

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

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When Assertiveness Doesnt Work

• Restate your concerns in another way
• Engage another healthcare worker (i.e.
  Respiratory Therapy)
• Engage your supervisor
• Engage another physician on the team

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Effective Communication

• Essential for real teamwork
• Essential for long term career satisfaction
• Essential for patient safety and quality care