What Can We Do Better? Current / Preferred State

In every profession there are changes that propel how tasks are done; nursing is no stranger to this. One of the biggest changes that have come into nursing’s daily events is how report hand-offs are being done. Gone are the days of taped report that each off going nurse must tape about each patient and the oncoming nurse must listen to. Nurses are now being encouraged to move their report to the bedside, in front of the patient (Trossman, 2007). It is very important to know how this can affect the patient and even the nurse’s schedule. With every change, there are positives and negatives that can finalize the decision to keep or forego

“Errors in communication give rise to substantial clinical morbidity and mortality (Riesenberg, Leitzsch, & Cunningham, 2010).” As a result, the Joint Commission has identified effective communication as one of its National Patient Safety Goals (Dunsford, 2009).

Investigating problems on both the doctors and patients side during the interaction at any medical appointment is key when interpreting statistics that relate to this matter. These aspects will be further explored later in this paper. The general consensus from many articles and studies indicate that miscommunication is a massive problem that impacts many individuals who die each year from miscommunication. Furthermore, each article shows a different perspective on where this error comes from and where, both doctor and patient, go wrong and what they can both do to improve the communication between them. Another aspect that must also be incorporated into this argument is that communication is not all verbal and that non-verbal communication can be just as effective or ineffective when it comes to dealing with other medical personnel or patients. The 7% rule coined by Albert Mehrabian in his book “Silent Messages” states that “93% of communication is non-verbal, with 55% being body language and 38% being tone of voice; leaving only 7% of communication being verbal.” (“Silent Messages” Albert Mehrabian), and that ineffective or bad non-verbal communication can be just as detrimental during an interaction as verbal communication. Unfortunately, for doctors, the precision of the execution in this small 7% of communication is crucial when explaining challenging

Communication, according to the Free Dictionary, is “the exchange of thoughts, messages, or information, as by speech, signals, writing or behaviors”. It is vital in the development and maintenance of personal and professional relationships. It is important to understand communication also includes non-verbal as well as verbal acts. According to Rane (2010), 93% of communication is nonverbal and body language is an effective nonverbal communication tool. There are two essential components in communication, which are a sender and receiver of a message. In the personal and professional health care communication paper, I will discuss the definition of healthcare

Effective communication during a patient handoff is critical in ensuring patient-care quality and safety and bedside shift reports have been found to increase patient involvement and satisfaction (Wakefield, Ragan, Brandt, and Tregnago, 2012). Bedside shift report is viewed as an opportunity to reduce errors and ensure improved communication between nurses (Gregory, Tan, Tilrico, Edwardson, and Gamm, 2014). Improved communication between nurses can be beneficial for all involved. In response to the Joint Commission’s National Patient Safety Goals, bedside report has been supported as improving patient safety, patient-centered care, and nurse communication as well as reducing medical errors (Gregory, et al., 2014). Ofori-Atta, Biniend, and Chalupka’s (2015) article examines statistics regarding hospital care and shows that according to the Inspector General Office, Health and Human Services

Verbal communication between the nurses during shift change or simply writing a progress report on the status of the patient does not cater to the needs of the patient, it is a mere communication method that is unreliable and nurse perception of the written report are often molded with bias and does not wholly represent the patient’s holistic health care needs. As dictated by Caruso (2007), “Change of shift signifies a time of carful communication in order to promote patient safety and best practices... [the risk exists of] relaying important information becomes muddled by irrelevant information instead...” (p.17). In essence, implementation of bedside nurse shift report/handover deems to provide the most opportune outcomes and focuses on patient-centered

It has been reported by various studies that most patient care errors occur during the handoff due to miscommunication between the caregivers and their reports regarding inaccurate information about the patient’s care, treatment and current condition.

On many occasions, I have seen situations in which effective communication involving the professional healthcare team played a vital role in the positive outcome of patient care. On the other hand, there have been miscommunication between the healthcare team resulting in situations that could have been tragic to the patient.

“We will find our baseline measurement using nurse surveys, audits and observation timings. We will track what steps are covered and how long each step takes and the number of occurrences of near misses due to inefficient handoffs relating to patient safety. We will also measure our patient baseline data from current patient satisfaction surveys” N. Guyse (personal communication, February 22, 2014). Currently we are inefficient and unsafe with handoff practices due to missing or incomplete information, multiple processes used between the nursing staff, and multiple report out processes being practiced on the floor. Multiple processes are causing confusion and incidental overtime. With multiple processes, information is being missed between nursing staff, which is a safety concern due to the increased errors. Our organization is working on the creation of one standardized process used between all employees to ensure that all handoffs are efficient and safe. “We have implemented a group report out for nursing staff in conjunction with the beside report outs” N. Guyse (personal communication, February 22, 2014).

An observational study published in January of 2015 found several barriers to effective communication in handoff reporting. Two prominent barriers were identified; disorganization and the inability to understand the information received. The study determined by incorporating a structured tool for communication, which included categories, aided in ensuring the information’s completeness, as well as improved the level of understanding of the report content (Foster-Hunt, Parush, Ellis, Thomas, & Rashotte, 2015). Halm (2013), identified three key elements incorporated into an effective handoff report. These components included face-to-face or 2-way communication, a structured template or form, and content which allowed the health care worker to hypothesize a diagnosis related to the patients’ clinical condition (Halm, 2013). The four most frequent elements discussed in a handoff report were history, events, patient status, and future care plan (McMullan, Parush, & Momtahan,

Communication breakdown is among the leading cause of medical errors such as gaps in health care, incomplete or missing information, and medication errors. Most importantly, communication supports the foundation of patient care. According to The Joint Commission (formerly Joint Commission for Accreditation of Healthcare Organizations [JCAHO]) improved communication among nurses during shift changes reduces injuries due to medical errors by 30 percent. So, hand-off reporting during shift change is a critical process that is crucial in protecting a patient’s safety. Throughout the hand-off report, it is vital to provide accurate, up-to- date and pertinent information to the oncoming nurse. An estimate of 80 percent of the most serious medical

New innovations are being created every year to help improve and protect patients from reckless and preventable errors. As healthcare providers, it is our duty to provide care ethically and to do no harm to our patients. On the contrary, “the culture of cover-up” still continues to exist today and although technology and informatics has progressively increased quality care, it has not completely eradicated errors. Integrity is the key component for every healthcare provider, along with other characteristics. Therefore, disclosing medical errors with our patients is imperative and our patients and their families deserve to know what occurred during their time of care. Technology is not able to prevent every mishap that causes patients harm (Gibson & Singh, 2003). On the other hand, communication and learning from the mistake can. As Gibson and Singh (2003) so eloquently stated, “…wise people learn form their mistakes, and those who don’t are bound to repeat

According to the first step of Lewin’s theory Unfreeze phase is about helping nurses to recognize the need for change and encourage them to think about what the current process of end of shift reporting, what the disadvantages are, and how it can be improved. According to Sand-Jecklin and Sherman (2014), significant percentage of a nurse’s communications occurs during end of shift handoffs, and the safety of the patient can be compromised at this time. Nurses recognized that patient handoffs as a factor regarding near miss incidents. According to the Joint Commission (2011), miscommunication is one of the factors that leading to sentinel patient events, therefore, it is a requirement of Joint Commission National Patient Safety Goals. Nursing handoff report is the time, when responsibility and accountability for the care of a patient would be transferred from one nurse to another. Ineffective handovers, such as when not all required information is provided, can be risky for patients and staffs. According to Novak and Fairchild (2012), the method for delivery of shift report varies among hospitals, units, and nurses. These handoffs occur at busy times with multiple distractions and time constraints. This makes shift-to-shift report a time with high potential for the occurrence of errors related to communication. Reports done away from bedside hinder the patient’s participation in their care, which results in a decrease in patient satisfaction scores.

Communication is the leading factor in heath care errors (book). (Treas & Wilkinson Book p463) defines communication as “a dynamic, reciprocal process of sending and receiving messages. The messages may be verbal, non-verbal,

Now that we have examined numbers in the aspect of the big picture, it is important to narrow it down to gain some perspective and to also experimental see if we can determine if the previous numbers could indeed be credible or not. I discovered an article dealing with deaths per year due to miscommunication based strictly from hospitals that are affiliated with Harvard University. In this study, 23,658 malpractice cases from 2009 to 2013 were examined and found that 7,000 cases involved communication failure between medical staff or doctor and patient. Within these cases it was determined that 1,744 deaths per year occurred due to communication related issues. This equates to approximately 30% of cases having communication failure that