Prog Prop Presentation

7/30/2019 Prog Prop Presentation

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Improving Patients Safety through Effective

Communication Skills of Health Care Providers

Prepared by:

Claudine Roxas, RN

Cathy Roxas, RN

Efren Juane, RN

Xavier Reyes, RNMichelle Geronimo, RN


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I. Introduction/ Background of the Problem

Ineffective communication is reported as asignificant contributing factor in medical

errors and inadvertent patient harm. In

addition to causing physical and emotionalharm to patients and their families,

adverse events are also financially costly.


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These errors have the potential to causesevere injury or unexpected patient death.

Medical errors, especially those caused by

a failure to communicate, are a pervasiveproblem in todays health care

organizations.


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When health care professionals are notcommunicating effectively, patient safety is

at risk for several reasons: lack of critical

information, misinterpretation ofinformation, unclear orders over the

telephone, and overlooked changes in

status.


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Over the years, there have been repeatedcries and admonitions for improving nurse-

physician communication and questioning

why it is so difficult to achieve. Someresearch has shown that the lack of

interpersonal and communication skills of

physicians and nurses is associated with

errors, inefficiencies in the delivery of care,

and frustration.


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The practice of nursing utilizes constantcommunication between the nurse and the

patient, the patients family, the nurses co-

workers, supervisors, and manyothers. Communication in nursingcan be

a complicated process, and the possibility

of sending or receiving incorrectmessages frequently exists.


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There are numerous intervention studiesindicating that the use of structured

communication tools or other strategies in

health care improves the structure andquality of information exchanged between

healthcare professionals, and/or reduces

patient harm.


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II. THEORETICAL FRAMEWORK

The theory that supports this programproposal is Humanizing Nursing

Communication Theory developed by

Bonnie Weaver Duldt-Battey (1996).

This theory addresses communication and

human relations in nursing.


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It emphasizes the interpersonalrelationships among nurses and others.

These relationships aim to prevent

ineffective communication and

inappropriate outcomes.

The theory aids the nurse in coping with

the negativity experienced in the practice

of nursing.


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Communication is crucial to understandingconcerns people have, especially whendealing with the communication betweenstaff nurses and physicians (Battey, 1996).

In relation to this theory, (Sutcliff et.al.2004) states that in health care

environments characterized by ahierarchical culture, physicians are at thetop of that hierarchy.


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When hierarchy differences exist, people

on the lower end of the hierarchy tend to

be uncomfortable speaking up about

problems or concerns.

Intimidating behavior by individuals at the

top of a hierarchy can hinder

communication and give the impressionthat the individual is unapproachable.


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The Theory of Humanizing NursingCommunication defines the following

concepts: nursing, human beings (the

client, and the nurse, colleagues andpeers), the nursing process, health, the

environment, critical life situations and

communication.


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Nursing

Nursing is the art and science of positive,humanizing intervention in changing healthstates of human beings interacting in theenvironment of critical life situations.

A set of three elements comprises theconcept of nursing, i.e., communicating,

caring, coaching. These are defined asfollows:


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Communicating

Communication, specifically, interpersonalcommunication, is a dynamic process

involving continual adaptation and

adjustments between two or more humanbeings engaged in face-to face

interactions during which each person is

continually aware of the other


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Caring

Caring involves valuing and touching. Thenurse values the client and is concerned

about the individuals well-being.


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Coaching

Coaching refers particularly to theteaching aspect of nursing. The nurse

plans and implements the

teaching/learning process and providessupport and encouragement to clients as

they strive to meet health goals.


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Human Being

The focus of nursing is the human being.Each profession defines the human being

according to those characteristics of

particular relevance to that discipline.


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Communication

Communication is a process characterizedby being existential in nature, involving an

exchange ofmeanings, concerning facts

and feelings, and involving dialogue.

Th t di i f


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There are two dimensions of

communication.

Humanizing communication involves anawareness of the unique characteristics of

being human

Dehumanizing communication ignores

these unique human characteristics.

II E id d b d h


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II. Evidenced based research

study

The study could support our proposal isthe study entitled Improving Patient

Safety through Provider Communication

Strategy Enhancement conducted byCatherine Dingley RN, PhD, FNP; Kay

Daugherty RN, PhD; Mary K. Derieg RN,

DNP; and Rebecca Persing, RN, DNP.


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The purpose of this study was to develop,

implement, and evaluate a comprehensive

provider/team communication strategy,

resulting in a toolkit generalizable to other

settings of care.The specific aims included implementation

of a structured communication tool; a

standardized escalation process; dailymultidisciplinary patient-centered rounds

using a daily goals sheet; and team huddles.


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communication issues with physicians asone of the two most highly contributing

factors, according to the National Council

of State Boards of Nursing reports.

The researchers found that

communication problems were relativelystraightforward and fell into four

categories:


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communications that were too late to beeffective

failure to communicate with all the relevant

individuals on the teamcontent that was not consistently complete

and accurate

communications whose purposes were notachieved


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Throughout the study, a number oflessons learned provided insight that

could be useful for other organizations

considering similar implementation ofteamwork and communication strategies.


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First, it is paramount to secure

administrative and clinical support on allmanagement levels, from the executive to

the unit level support.

It was important for management andleaders to demonstrate that teamwork and

communication were valued as important

factors contributing to patient safety andstaff satisfaction.


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Furthermore it was important that they providedthe means for staff to attend presentations,encouraged further unit level education, andfacilitated integration of the concepts into

practice.

The result of the study could help for caring ourclients because good interpersonal relationship

and open communication of the health careproviders is actually the leading cause ofpatients safety and quality of care.


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IV. Interpretation of Data

All data gathered were tallied and computedinto percentage for better outcome and toeasily interpret by the researchers. Thefollowing are the labels used for the

succeeding results.

n = number of respondents

% = percentageN = total number of respondents


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Communication with MD

10%

67%

23%

The Doctor is not clear in giving orders thrutelephone

average incidence ofmore than once a week

average incidence of atleast once a week

no encounter


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Communication with MD

47%53%

The Doctors handwriting is not clear to read

Average incidence ofmore than once a week

Average incidence of atleast once a week

no encounter


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0%

20%

80%

The Doctor does not accept any recommendations forpatients care

average incidence ofmore than once a week

average incidence of atleast once a week

no encounter


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48%

30%22%

0%

10%

20%

30%

40%

50%

60%

medication errors didn't relay laboratoryresults

forget to carry outorders

What errors did you usually encounter in carrying outdoctors order?


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0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

report to thehead nurse

write anincidence

report

seek help tothe colleagues

no action

43%

17%

34%

6%

How do you take over with these errors?


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0%

10%

20%

30%

40%

50%

60%

70%

act like nothinghappen

say sorry to theclient

monitor thecondition of the

patient

22% 11%

67%

How do you act to your clients when you commit errors?


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32%

32%

32%

4%

0% 5% 10% 15% 20% 25% 30% 35%

didn't verify doctor's order

doctor's order in unreadable

busy/ understaff

novice to work

What are the reasons of committing these errors?


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0%

10%

20%

30%

40%

50%

60%

stress poor interpersonalrelationship

wronginformationprocessing

lack of time

55%

30%

10% 5%

Frequent cause of miscommunication among healthcareworkers

D h it l i ti / i h t


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Does your hospital organize meetings/seminars on how to

improve communications among healthcare workers?

0%

5%

10%15%

20%

25%

30%

35%

40%

45%

50%

often not so often rarely never

13%

34%

50%

3%

Series 1


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93%

7%

Are you willing to attend a seminar regarding thesaid toolkit for effective communication?

yes

no


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V. Program Proposal

The growing body of literature on safety anderror prevention reveals that ineffective or

insufficient communication among team

members is a significant contributing factor to

adverse events.

A 1day seminar will be conducted to improve

patient care through effective communication ofhealth care professionals


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We adapted the toolkit of Dingley et al.which serves as a guide of the nurses and

MDs in providing care to the patients.

The toolkit is composing of situational

briefing guide (SBAR), team huddles and

multidisciplinary rounds using daily goalsheet.


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A standardized communication format, theSBAR, was utilized as a situational briefing

guide for staff and provider communication

regarding changes in patient status orneeds for no emergent events, related

issues, or for events on the unit, in the lab,

or within the health care team.


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SBAR also presents guidelines fororganizing relevant information when

preparing to contact another team

member, as well as the framework forpresenting the information, appropriate

assessments, and recommendations.


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Team huddles it was defined as a quickmeeting of a functional group to set the

day/shift in motion via commentary with

key personnel.

Huddles are Microsystems meetings with

a specific focus, based on the function of aparticular unit and team.


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Multidisciplinary rounds using daily goal sheet,Rounds were focused on open and collaborative

communication, decision-making, information

sharing, care planning, patient safety issues,

cost and quality of care issues, setting dailygoals of care, and communicating with patients

and/or family members as they were able.

VI T t P l ti


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VI. Target Population

The program entitled Improving Patients Safetythrough Effective Communication Skills of Health

Care Providers has a target population of 50

participants working at Nueva Ecija Doctors

Hospital.

The priorities of the said program are the

supervisors, head nurses before the staffnurses. The nurses working outside the

institution are welcome to participate.

VII SMART l / Obj ti


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VII. SMART goals/ Objectives

The seminar highlights the critical importance of,and common barriers to, effective

communication in healthcare organizations and

institutions, and points to some strategies and

tools available to promote effectivecommunication among healthcare professionals.


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SPECIFIC- The objectives of this seminarare to raise awareness and stimulate

discussion and action around what your

healthcare organization, division or unitcan do to improve communication and

teamwork.


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MEASURABLE- participants in thisseminar will learn:

To assess their professional communication

skills To assertively make recommendations to

physicians

To organize and present information to

communicate changes in patients status


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To review pertinent issues of the day and to

go over the days schedule

To identify effective communication strategies

To determine the cause of committing errors

and how to avoid it


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ATTAINABLE- we aim to provide information orskills in a form of a toolkit for the health care

providers to enhance communication strategy

for patients safety in this seminar.

REALISTIC- The seminar includes written

individual and group exercises, group

discussions, group activities and simulationsdesigned to create a highly-effective learning

experience.


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TIME BOUND- this program is a 1 day seminar

approximately 8hours for giving consideration to

the availability of the participants to attend the

provided seminar. We aim to conduct a seminarfor 1day only because of their work schedule.

VIII. Seminar Content and


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VIII. Seminar Content andschedule

Week 1Activity: dissemination of formulated assessment

tool to 30 staff nurses working at Nueva Ecija

Doctors Hospital.

Week 2

Activity: Analysis and Interpretation of the data

collected and formulation of the programproposal.


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Week 3Activity: Implementation of the program

proposal

Day1, September 10, 2012

Time: 8:00am to 8:30am

Registration


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Time: 8:30am to 10:00amTopic: understanding effective communication

among healthcare workers

Importance of Therapeutic Communication

Common Barriers to Effective Communication

and Collaboration

Effects of ineffective communication in patients

safety


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Time: 10:00am to 10:15amSnack/bathroom break

Time: 10:15am to 12:00nnTopic: introduction of toolkit, Situational Briefing

Guide (SBAR)

Definition of the acronym SBAR

Different aspects of situational briefing guide

Group activity/ evaluation


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Time: 12:00nn to 12:30pmLunch break

Time: 12:30pm to 2:45pm

Topic: introduction of toolkit, team huddles

Guidelines in doing huddles

Benefits of team huddles


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Time: 2:45pm to 3:00pmSnack/bathroom break

Time: 3:00pm to 4:00pmTopic: multidisciplinary rounds using daily goal

sheet

Tips to enhance decision making , setting daily

goals of the day and collaborative

communication


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Time: 4:00pm to 4:30pmActivity: giving certificate of attendance to the

participants

Week 4

Activity: Follow up assessment and evaluation of

the program proposal

IX Seminar Budget Plan


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IX. Seminar Budget Plan

a. Program Expenses

Speakers travel expense and food allowances ---------------------5000

Honorarium -------------------------------------------------------------------3000

Speakers gift ----------------------------------------------------------------1000

A/V rental ----------------------------------------------------------------------700

Certificates --------------------------------------------------------------------1500

Function hall rental (9hours) ----------------------------------------------3000


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b. Promotion

Paid advertising (tarpaulin 6x12) -------------------600

Brochure printing (100pcs) ---------------------------200

c. Registration

Printing -----------------------------------------------------20

Name tag -------------------------------------------------100Handouts -------------------------------------------------250


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d. Food and beverages

Am snack (yum burger, fries and regular coke) --------------3000

Lunch (flavor shots with regular coke) --------------------------3000

Pm snack (1 solo c2 and bread with cheese)-------------------700

__________________

TOTAL= P 22,070.00

Sources of Funds/ Resources to be Used in the


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Program

Registration fee 400/head -----------------------------20,000

Donation from NEDH Administrator -------------------2000

Donation from nursing office ----------------------------2000

___________________

TOTAL = P 24,000.00

X. Organizations/Agencies that can support the


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program

Agency of Healthcare Research and Quality, by continuallyconducts research regarding communications among

healthcare workers, and providing different tools on how to

develop excellent interactions in clinical settings.

Communication specialist, such as psychologist,psychiatrists, neuro-linguistic programmers, speaking

coaches, and healthcare workers who has specialization in

communication skills and reporting skills. They can provide

seminars and coaching sessions in improving rapport,

developing trust, understanding and connection among

healthcare professionals.


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Hospital administration of NEDH, by providing venuesand necessary equipments in conducting learning

programs regarding communications among healthcare

workers including dissemination of tools.

Nursing Division Office of NEDH, by proactively

participating in the implementation and continuously

enforcing of the program.

XI Significance and Applicability of the Program


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XI. Significance and Applicability of the Program

The study and its findings will benefit the following:

The Health Clients, for them to received effective,

efficient and quality health care services, thus shortening

their stay in the hospital.

The Nurses, for them to have effective communication

and good collaboration in handling different patient-

centered situations.

The Hospital Institution, for them to have an excellent

health care deliverance and utmost utilization of

manpower services.


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Communication is one of the important keys in renderingeffective health care services. Without it, healthcare

personnel can commit errors that are sometimes fatal to

the patients.

In the means of avoiding it, this program aims to improve

the communications between nurses, doctors, and other

personnel involved in patient care by providing learning

programs which can dramatically increase, hone and

enhance the nurses interpersonal communication skills.

XII Sustainability of the Program


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XII. Sustainability of the Program

Integrating sustainability into a health care improvement isa journey that proceeds incrementally, ideally developing

committed teams, creative solutions, solid strategies,

and measurable goals along the way.

No matter an organization's sustainability driverscost

reduction, regulatory compliance, environmental

stewardship, community pressures, social responsibility,

and so onplanning is essential to achieving

sustainability in a project as well as across theorganization.

Roadmap Approach


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Roadmap Approach

Building Teams. Building an effective team is critical to anysustainability effort. The Roadmap approach to strategic

team-building starts with leadership but includes

representatives from all levels within an organization.

Getting leadership support. Successful sustainability programs

require an institutional commitment, policies to drive change,and dedicated resources to make programs happen. Senior

leadership support and involvement, including good

communication as well as both symbolic and substantive

action, are key to a program's long-term success. The policies

and practices of top management will shape the behavior ofthe entire staff.
http://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/leadership.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtmlhttp://www.sustainabilityroadmap.org/strategies/greenteam.shtml


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Planning the Journey. The plethora of options andopportunities now promoted as ways to integrate sustainability

into a facility's operations can make it difficult to know where

to begin. The Planning a Journey section offers a guide to

getting a sustainable program under way: It begins with

foundational actions such as gathering baseline data againstwhich to measure progress; identifying drivers and barriers to

success; and developing sustainability goals, targets, and

action plans and moves on to broader, more strategic

activities like making the business case for a sustainability

initiative and managing an effort once it is up and running.
http://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtmlhttp://www.sustainabilityroadmap.org/strategies/start.shtml


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Financing. A number of funding options are available forfinancing sustainability initiatives, particularly large

capital projects. This section describes many of the

options and presents a template for evaluating the

business case for a project.

Getting It Done. Go to the Implementation section of the

Roadmap to view an extensive compilation of strategies

for effective communication for improvement of patients

care.

The Plan-Do-Check-Act (PDCA) Model: An Iterative

P I t C l
http://www.sustainabilityroadmap.org/strategies/financial.shtmlhttp://www.sustainabilityroadmap.org/implementation/index.shtmlhttp://www.sustainabilityroadmap.org/implementation/index.shtmlhttp://www.sustainabilityroadmap.org/implementation/index.shtmlhttp://www.sustainabilityroadmap.org/strategies/financial.shtml


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Process Improvement Cycle

Educateunderstand

issues/drivers

Defineobjectives

plan

Set targetgoals

Implementaction plan Do

Measure and

report ongoals Check

Build uponSuccess-Do it

again; Act

XIII. Parameters/ Tools for Evaluation


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a a e e s/ oo s o a ua o

Evaluation Form

TOPIC/ TITLE:___________________________________________

Date: __________________________________________________

Part I. Instructions: Please indicate your level of agreement with the

statements listed below. Put a check ( )


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Strongly

Agree

Agree Neutral Disagree Strongly

Disagree

1. The objectives of the

learning program were

clearly defined

2. Participation and

interaction wereencouraged

3. The topics covered

were relevant to me

4. The content was

organized and easy tofollow

5. The learning tools

distributed were helpful


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Strongly

Agree

Agree Neutral Disagree Strongly

Disagree

6. This learning

experience will be useful

in my nursing practice

7. The learning program

conductors were

knowledgeable in the

topics and well prepared


objectives are met

9. The time allotted for

the learning program

was sufficient


venue and facilities were

adequate and

comfortable


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Part II. Please indicate your answer in the blanks provided.

1. Overall how would you rate the learning program? 1-5, 5 as the highest and

1 as the lowest. _______________

2. What aspects of the learning program could be improved?

_______________________________________________

3. Do you think you can easily apply what you have learned at your work?

_______________________________________________

4. Would you recommend this learning program to other health care

professionals ( Doctors, Pharmacist, Midwives, Laboratory technician et.) ?

_______________________________________________

5. Other comments and suggestions:

_______________________________________________

THANK YOU FOR THE FEEDBACK!

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