| |
Communication, Communication, Communication! Everywhere we turn these days effective communication is at the top of the list. Whether you are a Fortune 500 CEO, the coach of a sports team, or a healthcare worker, communication is paramount to our roles and responsibilities on a daily basis.
It is not a surprise then, to find communication in the Top 11 Compliance Challenges in Hospitals from January 2006 through July 2006, according to The Joint Commission Perspectives, February 2007. Communication, or the lack of, is alsothe most frequent cause of sentinel events, according to The Joint Commission.
National Patient Safety Goals (NPSGs) are derivatives of sentinel events and NPSG 2, "Improve the effectiveness of communication among caregivers" represents 59% of noncompliance among organizations surveyed in the first six months of 2006. Communication has set the bar as challenging healthcare organizations nationally.
NPSG 2 has four requirements that are scored as either a category A, which means the presence or absence of the requirement, or a category C, which means it is frequency-based and requires totaling the number of occurrences identified as compliant vs. noncompliant.
Requirement 2A requires a verification process for verbal or telephone orders or telephonic reporting of critical test results by having a "read-back" of the complete order or test. Does your staff read-back the order after writing the order on the physician order form or do they repeat back what they heard as the order? There is a difference and compliance can be assessed based upon direct observation of the staff taking the physician's order on the telephone.
Standardize a list of abbreviations not to be used throughout the organization, Requirement 2B, has been a challenge for the past several years. It seems "old habits are hard to break". This year, The Joint Commission added the term "dose designations" which includes units of measurement e.g., "unit" or "International unit" in addition to "daily" or "every 6 hours". Hospitals continue to struggle with this requirement. Education and compliance monitoring are paramount in tackling this challenging requirement.
Timeliness of critical tests and critical test results reporting, Requirement 2C, remains elusive as well. Hospitals experience a two fold challenge; identifying critical tests and the result reporting process. How would you answer this question: Are you developing a process for a test result that is critical or the result of a critical test? The answer is: Both. Organizations must establish "critical tests" and "critical results." The organization must then implement an effective means to communicate these results to the appropriate clinicians. The initial communication must also be supported by a fail-safe back up communication plan if the responsible clinician cannot be reached. Measuring and monitoring systems must be in place to ensure compliance along with the communication of such results. It is important to also keep in mind the process does not apply solely to Laboratory tests but to Radiology tests, Cardiology tests and arterial blood gases as other examples.
Requirement 2E requires the implementation of a standardized approach to "hand-off" communication. This communication goal was added in 2006. This hand-off system must include an opportunity to ask and respond to questions. In determining the system for hand-off communication it is important to identify the situations in which this communication is required. The process does not need to be documented, but needs to be standardized and interactive.
Communication is not just the problem, it is the solution. Do not get caught up in applying "quick fixes." Look at systems and processes, identify the barriers for compliance and analyze them to implement change that can be sustained by the staff. Methods that can be used to implement sustained improvements include:
- Physician and clinical staff participation in performance improvement teams
- Leadership champions to support the initiatives and be the ambassadors of change
- Staff access to leaders to assess and remove obstacles and barriers to communication
- Development of clear goals, expectations, written policies, staff tools and newsletters as vehicles for communication
- Communication of the change organization wide being sure not to forget the outpatient and ancillary staff
- Concurrent compliance monitoring to assess the effectiveness of the improvement
Communication is a complicated process whether it is in the delivery of healthcare or coaching the sports team. By empowering staff, organizations can tackle this top compliance challenge as identified by The Joint Commission. Achieving a culture of safety based upon consistent systems in the delivery of healthcare will yield these improvements and decrease communication errors.
References
The Joint Commission Perspectives, The Official Newsletter of The Joint Commission, February 2007. Volume 27, Number 2.
Comprehensive Accreditation Manual for Hospitals, The official handbook of The Joint Commission, 2007.
For more information, please contact Cynthia Kowalski, RN, BSN, MPA at 609-514-1400 or via email at ckowalski@beslerconsulting.com or Laureen Rimmer, RHIA, CPHQ, BS at 609-514-1400 or via email at lrimmer@beslerconsulting.com.
Go to the current issue of BESLER eNEWS
|
|
