The subject of patient safety has been a critical issue in our facilities, with the safety of patients being threatened every day that passes. The joint commission highlights effective staff communication as one of the ways the goal of patient safety could be realized. Essentially, effective communication among caregivers is a pillar of patient safety culture. Besides, the joint commission accentuates that the timely reporting of significant test results and diagnostic findings is critical to ensuring that caregivers are up to date with the care of their patients, alleviating the risk of errors due to a paucity of current information (The Joint Commission, 2022). However, I have noted detrimental communication gaps in my current clinical setting that are risking the safety of the patients we care for. This paper will discuss the current practice in my setting regarding provider-to-provider communication and explore the root causes of this issue.
Setting
The problem of threatened patient safety related to ineffective communication among caregivers is not limited to one particular setting but spans all healthcare departments. However, I have observed the problem skyrocket significantly in my male medical unit department. There is a marked break in the chain of communication among caregivers that impairs the efforts to foster interdisciplinary collaboration and continuity of care, posing a challenge to realizing positive outcomes of care.
The skill mix of the staff in my department is quite varied to address every aspect of patient care. The attending physician heads the care team and is responsible for diagnosing the patients and making recommendations regarding their medical care. Registered nurses administer medication to the patients, monitor the progress and effectiveness of care, and detect deviations from normal. Physical therapists attend to patients experiencing challenges with walking and changing positions to avert the development of contractures and pressure ulcers. Besides, nutritionists evaluate the nutritional needs of the patients and recommend any appropriate modifications to their diets. Pharmacists supervise the use of medications in the unit and advise on the safe and effective use of prescribed medication. Also, we have laboratory and radiological technicians who facilitate the diagnostic procedures by carrying out tests and imaging procedures, respectively.
The patients in the male medical unit comprise male adults who suffer from a range of acute and chronic illnesses that do not require surgery but medical interventions and nursing care. Some patients are admitted due to the exacerbation of chronic conditions such as chronic obstructive pulmonary disease and diabetes mellitus. Others are admitted due to acute conditions such as acute kidney injury. In some cases, we take care of patients who require oxygen therapy for respiratory support.
Identification of Policy Issue
The 2023 national patient safety goal (NPSG) I am interested in centers on improved communication. The focus of this NPSG issue is to improve the effectiveness of communication among caregivers. It aims to enhance care delivery by promoting consistent patient care through properly handing over information regarding actions taken in patient care. Besides, the joint commission emphasizes the need to communicate key test and diagnostic results in a timely manner to ensure that caregivers are updated as they carry on their busy schedules and change shifts (The Joint Commission, 2022).
Challenges in effective communication are a major problem as they threaten the continuity of care and the safety of patients (Tiwary et al., 2019). For instance, in one instance, a patient who was designated for transfer to the critical care unit was kept to wait until the next day because the trainee who was on shift did not perform a comprehensive handover of the patient care, and therefore, there was a break in the continuity of care. Moreover, in another case, there was a significant delay in initiating treatment for a malaria patient because the laboratory technologist did not promptly communicate the malaria antibody detection test results.
Statement of Current Policy
The current practice regarding communication among caregivers in my facility is centered around verbal and written communication. The majority of the communication, including handoffs, takes place verbally. Essentially, written communication is limited to records of critical patient information, cardex, and medical notes during bedside rounds. This nature of communication limits the amount of information that can be exchanged among caregivers and leaves room for miscommunication since most of the details are not recorded. Also, different caregivers in the unit utilize different styles of communicating findings since there is no provision of an established communication standard. This may be confusing to some caregivers who may need help comprehending the full details of patient care when presented in different styles.
I appreciate that this issue is currently being addressed at my facility. The institution is rolling out electronic medical records and structuring standardized communication tools to facilitate effective communication. Electronic medical records will ensure the provision of accurate and up-to-date patient information at all times (Uslu & Stausberg, 2021). Also, they will ensure that all care team members can access vital information regarding patient care in a timely manner. Moreover, laboratory and radiological technicians will be able to promptly communicate the findings of diagnostic tests by simply inputting the results into the hospital database. Furthermore, my facility is adopting SBAR (Situation, Background, Assessment, and Recommendation), which serves as a standardized communication tool during handoff (Shahid & Thomas, 2018). Pieces of training are ongoing to ensure that all care team members are equipped with the knowledge and skills to utilize SBAR. This will avert confusion in handoffs since every caregiver will use a tool that all are acquainted with.
This issue is not new, as the members of the care team have identified it as one that impedes continuity of care and negatively impacts patient safety. Thus, our facility is in the process of addressing the issue by implementing electronic medical records and a standardized communication tool.
Scope of the Problem
A paucity of and the presence of ineffective policies within the hospital are the root cause of ineffective communication among caregivers. Various factors linked to the weaknesses in the policies hinder clear, concise, and effective communication among caregivers and, therefore, impede the continuity of care and patient safety. There are ineffective policies that dictate a hierarchical communication structure in the hospital. This creates challenges with the timely communication of findings as the results have to follow a predetermined procedure in communicating the findings of diagnostic tests. Also, there is a lack of policies to guide the nature of communication styles to be applied in communication among caregivers. The different pieces of training that the care team members undergo in their different institutions of learning bring up the varied styles of communication that may create breaks in the communication channels. Additionally, there is a marked paucity of guidelines dictating the use of standardized communication tools within the facility. Standardized and structured communication tools are critical to accurate and effective communication in any facility (Shahid & Thomas, 2018). Moreover, existing policies guiding staffing in the facility are inadequately implemented, creating a staffing crisis. Resultantly, an increased workload is created in the units propagating busy schedules that limit the time available for proper communication (Dall’Ora et al., 2020).
Conclusion
The joint commission endorses effective communication among caregivers to preserve patient safety in all aspects of care. However, this is not the case in my unit, as communication inconsistencies among the care team members continually threaten patient safety. This is an issue since it compromises the timely transfer of information and the accuracy of the information transmitted, negatively influencing the nature of care offered. The primary cause of this issue is ineffective policies and a lack of guidelines to streamline communication channels. To address this issue, my facility has rolled out policies to streamline the communication channels through the use of electronic medical records and a standardized tool for communication during handoffs, SBAR.
References
Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: a theoretical review. Human resources for health, 18, 1-17.
Shahid, S., & Thomas, S. (2018). The situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–a narrative review. Safety in Health, 4(1), 1–9.
The Joint Commission. (2022). Hospital: 2023 national patient safety goals. Www.jointcommission.org; The Joint Commission. https://www.jointcommission.org/standards/national-patient-safety-goals/hospital-national-patient-safety-goals/
Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019). Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Wellcome open research, 4, 7. https://doi.org/10.12688/wellcomeopenres.15042.1
Uslu, A., & Stausberg, J. (2021). Value of the Electronic Medical Record for Hospital Care: Update From the Literature. Journal of medical Internet research, 23(12), e26323. https://doi.org/10.2196/26323
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