Clinical Communication: What is She talking about?

Operating Theater Management Conference

Sydney, 28th August 2014

Kathy Flanigan RN BN MN Adjunct Assos Professor (Griffith Uni)

Nursing Director, QEII Jubilee Hospital

Over 70% of complaints involve communication

Overview

Standard 6 – Clinical Handover

Communication methods

Clinical communication

Practical Application

Standard 6 – Clinical Handover

(1)Clinical communications plays a vital role in several aspects of quality and safety in healthcare and developing clear, concise handovers will aid in improving the transfer of vital information

Standard 6

The Standard is a great starting point but we need to find workable practices to guarantee that we provide an efficient and safe handover to next clinician in the patient’s care journey

Communication methods (past and present) and ideas provided to assist clinicians in their clinical handover

Standard 6 Clinical Handover

(1) Clinical Handover: describes the systems and strategies for effective clinical communication whenever accountability and responsibility for a patient’s care is transferred.

Standard 6

(1) Three major domain areas relating to handover variables have been identified across both the health and non-health related documents.

These are:

System design factors

Organisational cultural factors

Individual factors

(1) System design factors Handover: described within the context of

policies and procedures, operating systems, work systems and routines, supervision and legislation.

System variables included support for information tools and systems such as computer based reports, written notes, checklists and tape-recording processes as well as a range of other methods of communication.

(1) Organisational cultural factors

Communication between and amongst health professional groups that impacts on patient care; and, interpersonal relationships influencing communication ability and willingness to share information.

(1) Individual factors

Individual staff variables relating to their knowledge, skills and attitudes that describe an individual’s ability to perform their role and transfer appropriate information to another person.

This can include the impact of fatigue, clinical decision-making and organisational skills in the process of knowledge transfer.

(1) Individual factors

Types of human errors that can be classified according to misperception, mistaken priorities, attention lapses, mistaken actions, or wilfulness, violations or sabotage.

Communication methods

Verbal – words, intonation, first language

Body language – eye contact, body positioning

Written – hand, typed, txt

Expectations – what are we waiting to hear?

ESP! – hasn’t quite got there yet.

Words

Lots of words – how many in the English language?

(2) Oxford Dictionary indicates that there is no sensible answer, because it is difficult to decide actually what is a word.

E.g Dog, a noun and a verb as in ‘to follow persistently’ – so is this one or two words?

English language:

What is an English word? There are many words in the English language that are not originally English.

About 750,000 words

Words

Intonation has a lot to do with communication and how our words are taken. (3) Nordquist says that ‘in linguistics the use of a changing vocal pitch can convey grammatical information and personal attitude.’

I like you.

I, like you, etc.

Words

Is English your first language?

It is mine but ……………

The following slide is in English though, I can only understand and comprehend a few words.

As I stepped aboard the first comment was, Hi, whilst you’re down below stowing your gear can you pass up the sheets?

Then I heard come on let’s get this main bent on, someone called ease the outhaul please, firm the vang up.

Get the Heady up, into the prefeeder, good to go. Shortly after.

Ok back off the donk, stick her into the wind and let’s get the main up.

Great stuff, get the heady up, throw the sheets, more halyard, bit more, ok sheet on, bearing away.

How long to the start, ok lets do a timed run, anyone got the pin? I got the boat. Easing away, cumon ease main. Lookin good going to run the line, bow, get a transit, we’re on the line. Ok, bearing away for a gybe, ‘thump bang crash’ coming up, there’s the boat get a transit (boats everywhere)

Ok how long? Going to dig a hole. Someone call them up, they have no rights!

Up, up, stay up,….. Up Gimme an ease, ….ease, great, …bit of power, damn get it on, %#@% ease,…… on , on ,on, we’re %#*#** racing here get us rolling. #**# we’re getting buried, lets tack out of here, get some clear air, set up,…. Lets go, helms down.

Yup I see him, we’ll have to duck him, steady, ok, ease main, more more, Christ get it back on, power us up. Where’s the first mark? Cool

Bear away set then, get the gear round, someone get the .5 big chute up here, hurry. NO not everyone, Christ keep some pork on the rail.

And so began my first and only yacht race!

Words

So English isn’t always the words you know.

For you consideration: How does a patient understand what we in the medical field are talking about?

Body language (4)

Facial expressions

Your eyes – window to your soul

Your mouth – smiling, frowning

Gestures – waving, pointing, thumbs up

Arms and legs – crossed arms or legs, tapping fingers

Posture – up straight, slumped over

Personal space – intimate, personal, social and public

Written

Hand written – who can read this?

Typed/computer – how many fonts??

Acronyms, abbreviations

Txt – OMG, LOL, LMAO, and the inevitable, auto correct!

Expectations and ESP

What are you expecting to hear?

Often we hear what we want to hear and not what has actually been said………

Clinical Communication

Many methods

Facility specific

Discipline specific

Clinically specific

Clinical Communication

Clinical Communication plays a vital role in several aspects of quality and safety in healthcare. (3)

Maybe these questions should be asked:

What are we trying to achieve?

How should this look for us?

Who/what should be included?

Where/When is this communication going to occur?

Nursing Clinical handover

(5) Nursing Clinical Handover can occur in a number of areas, most commonly, handover at the bedside.

Clinical handover at the bedside ensures a patient-centered approach to communication and added safety in the transfer of information.

Clinical handover is to occur at any point where care is transferred from one individual to another using English language and known abbreviations

Nursing Clinical handover

Change of shift

Transfer to another facility

Transfer to another unit

Transfer to Transit Lounge

Transfer to and from ICU; Endoscopy, theatre, PACU and ward specific transfer

Transfer to community

Escalation of concerns

Consult or referral

Emergency call – either Code Blue or Rapid Response Team call (or equivalent)– Nursing Handover critical to the team in this situation

Ward rounds

Multidisciplinary rapid rounds – elements of nursing handover

Theatre specific – change of team

Practical Application

SBAR

ISBAR

AIDET

Rapid Rounds

SSCL

ISBAR and SBAR

Introduction

Situation

Background

Assessment

Recommendation

AIDET (6)

Studer: Key words at key times

A. Acknowledge

I. Introduce

D. Duration

E. Explanation

T. Thank you

Rapid Rounds

Short duration – on time and kept to time

No hierarchy

One person leads

Multidisciplinary

Each patient discussed

Always with discharge (next step/outcome) in mind

Understanding of barriers and who is going to address them

Questions/actions for the team

Surgical Safety Checklist

(1) The World Health Organization Surgical Safety Checklist has been demonstrated to improve patient safety and is now widely used in Australia.

Agreed to in 2009 by all the state Health Ministers as the nationally agreed strategy for surgical safety in Australia.

This checklist should be used as patient / procedure matching protocol for surgery.

Also known as Standard 5

Surgical Safety Checklist

Ensure your audit process is robust and reliable

Maintain regular audit cycle

Keep discussing audit outcomes at a high level

Keep going because this is about patient safety

Popular publications

(1) OSSIE Guide to Clinical Handover Improvement

Clinical Handover and Patient Safety – Literature Review Report

Open Disclosure Standard

References

1. Australian Commission on Safety and Quality in Healthcare http://www.safetyandquality.gov.au/wpcontent/uploads/2012/01/clinhovrlitrev.pdf viewed August 2014

2. Oxford dictionary. www.oxforddictionaryies.com viewed 1st August 2014

3. Nordqusit, R 2006. English Intonation: An introduction. Cambridge Press.

4. Cherry,K, Understanding Body language, 2014 http://psychology.about.com/od/nonverbalcommunication/ss/understanding-body-language_9.htm

5. QEII Clinical Handover procedure. August 2014

6. Studer https://www.studergroup.com accessed 1st August 2014

Thank You

I wish you good communications!