COMMUNICATION

ESSENTIALS: Interdisciplinary Discharge

Planning

NURSING CORE COMPETENCIES:FOR INTERDISCIPLINARY DISCHARGE PLANNING

Communication

“The Nurse of the Future will interact effectively with patients,

families, and colleagues, fostering mutual respect and shared

decision making to enhance patient satisfaction and health

outcomes” (Masters, 2014, p.78).

Teamwork “The Nurse of the Future will function effectively within nursing

and interdisciplinary teams, fostering open communication,

mutual respect, shared decision making, team learning, and

development” (Masters, 2014, p.78)

WHAT IS COMMUNICATION?

A process that includes 5 factors:

SENDER – encodes a message to be transmitted;

MESSAGE – the ideas, symbols, signals being transmitted;

CHANNEL/MEDIUM – the means by which a message travels; and

RECEIVER – receives and decodes the message;

FEEDBACK – Receiver provides back to Sender to signal effective

reception of intended message (Oxford University Press, 2014;

Communication Models and Theories, n.d.).

COMMUNICATION:PROCESS CYCLE

Sender

Message

Chanel/MediumReceiver

Feedback

(Oxford University

Press,2014).

NURSE-PATIENT

COMMUNICATION: SUCCESSFUL INTERACTION

Scenario: During Admission Intake, Nurse Hope Soeiltry would like to

obtain a medication list from Patient Will U. Listinclose for a safe medication

reconciliation.

Sender (Nurse: Hope) – encodes her message with words by asking a question

Message (The Question) – what medications do you take at home? Can you tell

me and write them down on this paper to include the name, dose, and time you

take them?

Channel/Medium (Verbal/Written) – both verbal and written responses

Receiver (Patient Will) – decodes the message; begins to tell Nurse Hope his

medications from home while writing them down

Feedback (Patient: Will) - asks if he should write down his over-the-counter

medications while showing Nurse Hope his medication list in progress. Nurse

Hope nods in agreement while saying, “absolutely correct!”.

Outcome of Communication: SUCCESS!

EFFECTIVE COMMUNICATION:

BARRIERS TO SUCCESS

Noise or Interference – ambient noise, alarms, bells, televisions, radios;

Medium chosen poorly – incompatible language, incompatible medium i.e. hearing impaired (chose verbal transmission), visually impaired or illiterate (chose written transmission);

Message – unclear, inappropriate, incongruent, lacks context;

Receiver – emotionally/psychologically compromised (angry, anxious, sad, fearful, uncooperative/unreceptive); physically compromised (pain, fatigue, altered mental status);

Feedback – Receiver did not provide feedback to ensure successful communication occurred; Sender did not request for feedback (Communication Models and Theories, n.d.).

STRATEGIES TO OVERCOME

BARRIERS:

EFFECTIVE COMMUNICATION Sender – is clear, concise, and congruent during message

transmission process

Reduce or Eliminate – sources of interference with a calm, quiet, and timely delivery environment for the communication to take place

Select Appropriate Medium – relative to the age, ethnic/cultural, and language determined to be compatible with the receiver

Assess the Receiver – for readiness i.e. Alert, oriented, well rested, with a reasonable mood disposition

Request Feedback – ask the receiver is they understood the message delivered; exercise a repeat-back and verify process to ensure successful delivery

DISCHARGE PLANNING AND

EFFECTIVE COMMUNICATION: WHAT &

WHEN

Definition:

“Preparation for moving a patient from one level of care to

another within or outside the current health care agency”

(Bulechek, Butcher, Dochterman, & Wagner, 2013, p.150).

When:

“Planning for discharge begins during the initial contact with

the client by establishing the expected outcomes and

anticipating follow-up care that may be needed”

(Harkreader, 2007, p.206).

DISCHARGE PLANNING AND

EFFECTIVE COMMUNICATION: RATIONALES

Poor Planning and Discharge Communication is Costly:

“Poor communication can endanger patients’ lives and waste

fiscal and human resources” (Lattimer, 2011).

“Delays, omissions, and inaccuracy of discharge information are

common at hospital discharge and put patients at risk for adverse

outcomes” (Harlan, 2010).

“It’s often poor communication, coupled with an expectation that

patients or caregivers will remember and relate critical

information, which can lead to dangerous, even life-

threatening, situations” (Lattimer, 2011).

RN DISCHARGE ACTIVITIES:

OVERVIEWNURSING INTERVENTIONS CLASSIFICATION (NIC) SUMMARY Assist patient/family/significant others to prepare for discharge;

Collaborate with interdisciplinary team/patient/family/significant

others;

Coordinate with other providers for a timely discharge;

Identify patient / caregiver knowledge or skills required for

discharge;

Identify patient teaching required for post-discharge care;

Communicate patient discharge plans as appropriate;

Monitor readiness for discharge;

Formulate discharge maintenance plan;

Arrange post-discharge evaluation;

and Discharge to next level of care (Bulechek et al., 2013 p.150).

CASE MANAGEMENT: OVERVIEW

DISCHARGE ACTIVITIES

Screening and Intake – identify discharge disposition / placement and destination

Assess needs – financial resources, treatment plans coordinated with physician, patient and family for smooth discharge transitions

Service planning – initiate plan of care, identify barriers to outcomes achievement, post-discharge service need identification, setting mutual goals with family/patient

Link patient to what they need – resource utilization, appropriate length of stay planning, evaluation of expected outcomes progress

Implement Interdisciplinary Treatment Plan – monitor expected outcomes, begin arranging post-discharge arrangements, re-evaluate discharge destination if needed

Evaluate Patient Care Outcomes – based on plan of care progress towards achieving outcomes; round with the attending physician to obtain progress feedback (Cesta, 2013).

DISCHARGE COMMUNICATION:

INTERDISCIPLINARY STRATEGIES

Team Approach:

Discharge Planning Teams (Rose & Haugen, 2010).

Standardizing Communication:

“S-B-A-R” (Bengasco et al., 2013).

Evidence-Based Discharge Education:

“Teach-Back” (Kornburger et al., 2013).

DISCHARGE PLANNING TEAMS:

MULTIDISCIPLINARY INTERVENTION

STUDY Based on a study conducted in a Progressive Care Unit (PCU) in a

Midwestern Hospital

Problem – Current Discharge Process Concerns:

Incomplete / Inaccurate Discharge Summaries

Incomplete Prescriptions

Inconsistent Discharge Education

Communication Gaps regarding: Discharge dates, time, and disposition

Intervention – Formation of Discharge Planning Teams

Possible Outcomes – Effective Discharge Planning:

Decreases Re-admissions

Promotes Cost-effective Use of Inpatient Beds

Increased Patient / Staff Satisfaction (Rose & Haugen, 2010).

DISCHARGE PLANNING TEAMS:

IDENTIFYING KEY MEMBERS

Physician

Physician Assistant (P.A.)

Nurse Manager

Registered Nurse

Pharmacist

Social Worker

Discharge Planner

Secretary

Continuous Improvement Specialist (Rose & Haugen, 2010).

DISCHARGE PLANNING TEAMS:

ACTIVITIES PER DISCIPLINE Physician & P.A.

Education on pathology and surgical reports

Writes discharge prescriptions the night before discharge

Completion of discharge summaries

Registered Nurse

Education on post-discharge care requirements night before discharge and on the day

Coordinate follow up for outstanding discharge items to be completed

Pharmacist

fills prescriptions at Hospital Outpatient Pharmacy

Verifies insurance information as soon as possible (Rose & Haugen, 2010).

DISCHARGE PLANNING TEAMS:

JOINT ACTIVITIES – AUDIT & SURVEY

Pre-implementation of Discharge Planning Teams: Discharge Summaries – 60% completion rate

Prescriptions Written – 45% completed night before discharge

Nursing Staff Satisfaction – 37% contentment with discharge process

Patient Satisfaction – 93% perceived a smooth process

Post-implementation of Discharge Planning Teams: Discharge Summaries – 91% completion rate by 2007

Prescriptions Written – 88% completed night before discharge by 2007

Nursing Staff Satisfaction – 91% contentment with discharge process by 2007

Patient Satisfaction – 100% perceived a smooth process by 2007 (Rose &

Haugen, 2010).

DISCHARGE PLANNING TEAMS:

KEYS TO SUCCESSFUL

IMPLEMENTATIONCommunication Remains Open – Across all disciplines

must be open to facilitate acceptance of changes in processes

Multidisciplinary Involvement – input from various

disciplines facilitated the efficiency of workflow by identifying

barriers related to other departments/services

Continuous Improvement Process – teams must be

cognizant of the changes in health care environment: Payer

systems, regulatory agencies, and processes, ready to adapt to

changing conditions (Rose & Haugen, 2010).

STANDARDIZING COMMUNICATION:

RATIONALES FOR IMPLEMENTATION

Good Communication is characterized by:

Timeliness

Standardization of Content

Well coordinated between disciplines (Reilly, Marcotte, Berns, &

Shea, 2013).

Errors in Communication results in:

Adverse Events with Negative Patient Outcomes

Negative Emotional Impacts for Patients & Caregivers

Increased associated Costs

Increased Length of Hospital Stay

Loss of Patient Trust

Increased Risk for Litigation (Bagnasco et al., 2013; Reilly et al., 2013).

STANDARDIZED COMMUNICATION:

PROPOSED METHODS

S.B.A.R – Situation, Background, Assessment, &

Recommendations

Recommended as a Standardized Communication Tool

Has Written and Verbal components for Communication at Patient

Hand-off and Transfer (Bagnasco et at., 2013)

Proposed Benefits – S.B.A.R Implementation:

Mitigation of Risk associated with poor Communication during Patient

Hand-off and Transfer i.e. Memory Failures

Standardizes Communication Styles of various healthcare workers to

create uniformity

Optimizes communication timing via Standardized reporting

procedure (Bagnasco et al., 2013).

DISCHARGE EDUCATION:

EVIDENCE-BASED STRATEGIES

“Teach-Back” Process – “a comprehensive, interdisciplinary, evidence-

based strategy which can empower nursing staff to verify

understanding, correct inaccurate information, and reinforce medication

teaching and new home care skills with patients and families”

(Kornburger et al., 2013).

Proposed Benefits – “Teach-Back: Implementation

Provides opportunity to Verify Understanding, Correct Inaccurate

Information, and Reinforce Medication Education and Home Care Skills

Valuable, Easily Implemented and Understood, and Cost-effective Education

Strategy

Engages Patients and Families in learning activities

Patient and Family-centered Education Strategy (Kornburger et al., 2013).

DISCHARGE EDUCATION:

TEACH-BACK PROCESS

“Teach-Back” Goal – Effective Family / Patient Self-Management

Step 1: Teach a New Concept or Skill

Step 2: Clarify or Correct Misunderstandings

Step 3: Acknowledge any Questions Patient/Family may Have

Step 4: Continue the Process until Concept or Skill is Understood

Nurse Competencies – Understand Health Literacy Principles:

Encourage Patient/Family Questions

Use Plain Language

Limit Teaching to 3-5 Concepts

Document “Teach-Back” education in the identified form (Kornburger et al.,

2013).

SUMMARY & CONCLUSION

Communication

Is a vital function to ensure Patient Safety

Failures occur mostly during points of Transfer of Care

Failures carry a significant potential for Adverse Patient Events

Is best when Standardized Communication methods are utilized

Discharge Planning

Requires an Integrated, Multidisciplinary & Team Approach

Begins at Admission, is ongoing, and is constantly re-evaluative in nature

Is Patient and Family-centered; anticipating needs constantly

Requires effective communication between patients, family, and Healthcare

Team

Requires pre-emptive, evidence-based discharge Education from entire team

(Bagnasco et al., 2013; Kornburger et al., 2013; Reilly et al., 2013; Rose &

Haugen, 2010).

REFERENCESBagnasco, A., Tubino, B., Piccotti, E., Rosa, F., Aleo, G., Di Pietro, P., & Sasso, L. (2013).

Identifying and correcting communication failures among health professionals

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www.praccreditation.org/secure/documents/APRSG_Comm_Models.pdf

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doi:10.1111/j.1945-1474.2010.00105.x

REFERENCESKornburger, C., Gibson, C., Sadowski, S., Maletta, K., & Klingbeil, C. (2013). Using

“Teach-Back” to Promote a Safe Transition From Hospital to Home: An Evidence-Based Approach to Improving the Discharge Process. Journal Of Pediatric Nursing, 28(3), 282-291. doi:10.1016/j.pedn.2012.10.007

Lattimer, C. (2011). When It Comes to Transitions in Patient Care, Effective Communication Can Make All the Difference. Generations, 35(1), 69-72.

Masters, K. (2014). Role Development in Professional Nursing Practice. (3rd ed.). New York: Jones & Bartlett.

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Reilly, J. B., Marcotte, L. M., Berns, J. S., & Shea, J. A. (2013). Handoff Communication Between Hospital and Outpatient Dialysis Units at Patient Discharge: A Qualitative Study. Joint Commission Journal On Quality & Patient Safety, 39(2), 70-76.

Rose, K., & Haugen, M. (2010). Discharge planning: your last chance to make a good impression. MEDSURG Nursing, 19(1), 47.