Communication for Patient Safety in the Operating Rooms

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Communication for Patient Safety in the
Operating Rooms

• Keystone CUSP
• for the Operating Rooms
• Module 1
• September 2006

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Effective Communication
Across all types of reported events
miscommunication was identified as the root cause
of more than 60 of the cases.
Radiology Today, March 17, 2003
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Keystone

• History
• Michigan
• 70 hospitals
• In 15 months
• 1578 patient lives saved
• Over 81,000 hospital days saved
• Over 165 million saved in health care
• CUSP
• Beaumont Hospitals

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AORN Position Statement on Patient Safety

• AORN is committed to promoting patient safety by
  advancing the professions through scholarly
  inquiry to identify, verify, and expand the body
  of perioperative nursing knowledge. AORN
  supports the establishment of an accountable,
  trusting, safety culture that reflects individual
  and collective values, beliefs, behaviors, and
  skills with a desire and commitment to patient
  safety.

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Assertion

• Questioning Care That Places a Patient at Risk

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Assertiveness

• Ability to speak up, and state information, with
  persistence, until there is a clear resolution.
• An attitude and a way of positively relating to
  those around you skills set for effective
  communication.

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When Patient Safety is at Risk

• Question care which places patient safety at risk
• Get the others attention
• Use C U S
• State the problem
• Propose a solution
• Get a decision
• Appropriately politely
  persist until get a response
• Use chain of command, if needed

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Aggressiveness

• The state of uncomplimentary, obtrusive, crass,
  forwardness or brass self confidence
• Dr Jones, you will go back in the wound and check
  the sponge before I give you anything else!!

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We do not need aggressiveness

• We need assertiveness

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Assertive Communication

• Focus on the goal Safe, quality care
• Focus on problem, not other person
• Start from the heart What do you really want
  and are you acting that way?
• Avoid right versus wrong, or being judgmental
• Maintain respect and courtesy
• Be mindful of confidentiality
• Take care not to alarm patient/family

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Assertive Communication

• Pay attention to verbal and non verbal
  communication
• Tone of voice
• Use the word I
• Body language/facial expressions
• Take a deep breath, if nervous
• Act confident in that what you have to say is
  important (questioning care that may cause harm
  is never wrong)

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Assertion
Video
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Questions?
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Decision Making
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AORN Guidance Statement

• Creating a Patient Safety Culture

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Clinical Decision Making

• Ability to sift through and synthesize
  information, make decisions, appropriately
  implement and evaluate
• Components for optimal decision-making
• Experience
• Knowledge
• Ability to critically think
• Some intuition

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Barriers to Effective Decision- Making

• Complexity of patient
• Lack of knowledge
• Lack of experience
• Esteem issues
• Minimal, or no support
• Taking shortcuts
• Stressors
• Others?

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Stress and Decision-Making
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Tips

• Ask for help before you are overwhelmed
• Ask questions early
• Does it really need to be done?
• Can it be delegated to someone else?

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Team Communication

• Team Communication

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Clear communication, between all team
members, is imperative if patients are to receive
safe and effective care
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Why is it Difficult to Effectively
Communicate Patient Care?
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Crucial Concerns

• Most common crucial concerns in healthcare
• Broken rules
• Mistakes
• Lack of support
• Incompetence
• Poor teamwork
• Disrespect
• Micromanagement
• Source Silencekills.com

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What are the Ramifications of Poor Team
Communication ?

• For patients?
• For staff?
• For Beaumont?

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Communication

• Communication is made up of
• ? is verbal The words, or content
• ? is paraverbal How we say it cadence, tone,
  volume
• ? is nonverbal Body language, facial movement,
  gestures, etc.
• People get more upset over what they perceive
  your intention to be, not the words you are using

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Effective Communication

• Share what you know, or what you have learned
• Knowledge, skills and experiences of many far
  more powerful than of one
• Use words such as, we, lets and
  ours, to promote a sense of team
• Include patient/family

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Team Communication

• Know the team
• Use assertion
• Use the other persons name
• Make eye contact
• Clear and succinct wording
• Do not rush what you are saying to save time
• Communicate before a crisis, when possible

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Team Communication

• Leave room for questions and input
• Respectfully listen to others
• Avoid interrupting others
• Give indication you are listening
• Confirm what was said
• When delegating, confirm the other person clearly
  understands what you want done

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Team Communication

• Effectively resolve conflicts in patients best
  interest
• Create an environment where people feel safe and
  respected
• Collaboration
• Show appreciation of others
• Know the chain of command

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Keystone OR Communication

• Site and side
• Final verification
• Patient handoffs
• Pre-Op checklist

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Teams Communicate

• Team members also use the following to
  communicate for patient safety
• Assertion
• Briefing
• Debriefing
• Checklists
• Handoffs
• Repeat back verbal orders

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Call-outs

• Avoids misunderstanding or
  assumptions by having team members call-out when
  a task is completed
• Asking RN to turn down ESU setting
• Tourniquet time
• Clamp time
• Call-outs work in reverse IF you use team
  members name
• Ann, can you check his blood sugar, now?
• Tom, bring in the crash cart, now

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Nurses and Physicians

• Communication Styles

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Nurses and Physicians

• Doctors trained to expect give clinical
  bullets
• May tune out as waiting for relevant clinical
  information
• Need to elicit and listen more carefully to
  nurses unique perspective
• Nurses trained to expect and communicate the
  story of the patient
• Notice communication breakdown easier
• Need to convey essential information more
  concisely

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Communication

• Between Men and Women

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Gender-Neutral Communication

• Men need to
• Listen without feeling responsible
• Listen to objections and suggestions
• Explain their reasons

• Women need to
• State message clearly and concisely
• Eliminate unsure words
• Speak up
• Solve problems without personalizing them

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If we feel safe and respected, then will

• Speak up
• Learn better
• Help create better team

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Situational Awareness
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Situational Awareness

• An accurate perception of factors and situations
  affecting the patient and medical team. It uses
  the entire team to remain aware of the patients
  condition and to anticipate future problems or
  concerns.
• OR
• All team members know whats going on and what
  is likely to happen next
• OR
• Surgical Conscience and Patient Advocacy

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Knowledge is Key

• Knowledge must be shared to improve
  communication and improve patient outcomes
• Focus on
• Tasks and goals of team
• Individual tasks
• Names, roles and responsibilities
  of team members

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Red Flags of Diminishing SA

• Things dont feel right, but no one questions
  it
• Working in an unfamiliar environment or situation
  
• Working with new equipment
• Highly focused on a specific task
• Emergency situations
• Discrepancies in information

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Red Flags

• Human Factors
• Distractions and interruptions
• Verbal violence
• New team member, student

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Ineffective Communication and Teamwork
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The potential for human error increases when
Situational Awareness is lost

• So, how do we maintain Situational Awareness?

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SA Requirements

• Expertise
• Keep current
• Teamwork
• Use perspective of all team members to remain
  aware
• Include all members as you work together
• Know skills, experiences, roles of team
• Watch for signs of stress, fatigue, overwhelmed,
  etc. in team members and confront accordingly

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Maintaining Situational Awareness

• Effective communication may be most important
  factor in maintaining SA
• Ask yourself, What actions, information do I
  need to give others to do their job and optimize
  patient care?
• Include the whole

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Maintaining Situational Awareness

• Team members must continually assess and
  evaluate for actual or potential concerns
• Anticipate next steps and possible events
• Know policies and procedures
• Use assertion, briefings, call-outs, etc
• Cross check and verify
• Clarify expectations of team members
• Watch for performance changes in others

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Situational Awareness in the ORExamples

• All team members monitor noise in OR, including
  extraneous conversation, music
• Circulator offers assistance when CRNA appears to
  be dealing with a problem with the patient
• PA offers updates to CRNA on progress of
  procedure when there is limited view or when the
  procedure is unfamiliar
• ST notices med student looks unwell while
  observing surgery

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Questions?
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Evidence-Based Practice

• Conscientious, explicit and judicious use of the
  current best evidence in making decisions about
  the care of patients
• Scientific findings
• Clinician experience
• Patient preference

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EBP Examples

• Waterless surgical hand scrub
• Hand washing decreases transmission of infection
• Hair removal, using clippers, has lower rate of
  surgical site infection, than shaving
• Effects of normothermia on surgical site
  infections

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EBP Examples

• Artificial nails
• Double wrap
• Use of shoe covers

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• Indeed, if you look nationally, by far, the
  greatest opportunity to improve health in this
  country isnt from inventing some new wonder
  drug, its making sure that we deliver what we
  know works, safely and effectively.
• -Peter Pronovost, MD

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Who is the last patient that was not harmed
because of you?
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You can, and you do, make a difference, every
single day

• Never doubt the power that you have to create a
  safe environment for our patients

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Questions?