Communication Among Healthcare Providers

Communication Among Communication Among Healthcare ProvidersHealthcare Providers

PurposePurpose

• To review the importance of To review the importance of excellent communication excellent communication among health care providers among health care providers in promoting career in promoting career satisfaction and patient safetysatisfaction and patient safety

ObjectivesObjectives• At the completion of this exercise, you At the completion of this exercise, you

should:should:– Understand the contribution of good Understand the contribution of good

communication to safe patient care communication to safe patient care – Be able to concisely summarize a concern Be able to concisely summarize a concern

about a patientabout a patient– Actively listen to information communicated Actively listen to information communicated

by the physician or other healthcare by the physician or other healthcare providersproviders

– Assertively yet professionally communicate Assertively yet professionally communicate concerns you have about a patient that are concerns you have about a patient that are not being adequately addressednot being adequately addressed

Nurse-Physician Nurse-Physician CommunicationsCommunications

• Frequent occurrenceFrequent occurrence• Communication across a Communication across a

hierarchy can be hierarchy can be intimidatingintimidating

• Gender or cultural Gender or cultural issues may complicate issues may complicate furtherfurther

• Often named as cause of Often named as cause of nurse job dissatisfactionnurse job dissatisfaction

• Critical for patient Critical for patient safetysafety

Communication and Safe Communication and Safe CareCare

• 60 % of medication errors 60 % of medication errors are caused by mistakes in are caused by mistakes in interpersonal interpersonal communicationcommunication11

• Poor coordination of care is Poor coordination of care is the most common cause of the most common cause of adverse events triggering adverse events triggering root cause analysesroot cause analyses11

1Joint Commission Data

Steps to Excellent Steps to Excellent Healthcare CommunicationHealthcare Communication

1 Clarify the problem & gather data

2 Concisely describe the problem

3 Actively listen to response

4 Assert concerns if needed

Communication with Communication with Other Healthcare WorkersOther Healthcare Workers

• Step 1 - Gather and clarify all of the Step 1 - Gather and clarify all of the information you need to provide to information you need to provide to the physician:the physician:– Nature of the problemNature of the problem– Supporting information or dataSupporting information or data– Clarify in your mind what you Clarify in your mind what you

would like for the patient to dowould like for the patient to do

Case PresentationCase Presentation

• You are assigned to care for a 68 year You are assigned to care for a 68 year old lady for the evening shift. She is two old lady for the evening shift. She is two days post-op following hip fracture days post-op following hip fracture surgery. No problems were noted at surgery. No problems were noted at nursing sign-out other than c/o pain, for nursing sign-out other than c/o pain, for which she was receiving pain which she was receiving pain medication. medication.

• When you perform your initial When you perform your initial assessment on this patient, you find her assessment on this patient, you find her to be confused.to be confused.


• What additional information do What additional information do you need to gather prior to you need to gather prior to contacting the physician?contacting the physician?


• Additional information you might Additional information you might gather:gather:– Vital signs and pulse oximetryVital signs and pulse oximetry– Name, dose and timing of pain Name, dose and timing of pain

medication previously givenmedication previously given– Any additional observations that you Any additional observations that you

feel would be helpfulfeel would be helpful


• Vital signs and pulse oximetryVital signs and pulse oximetry– T 37.5, P 108, R 24, O2 sat 82% (RA)T 37.5, P 108, R 24, O2 sat 82% (RA)

• Name, dose and timing of pain Name, dose and timing of pain medication previously givenmedication previously given– Morphine sulfate 2 mg IV two hours Morphine sulfate 2 mg IV two hours

agoago

• Any additional observations that Any additional observations that you feel would be helpfulyou feel would be helpful– Patient’s respirations seem somewhat Patient’s respirations seem somewhat

laboredlabored

Communication withCommunication withOther Healthcare WorkersOther Healthcare Workers

• Step 2 – State concisely to the Step 2 – State concisely to the physician the problems that the physician the problems that the patient is experiencing.patient is experiencing.– Nature of the problemNature of the problem– Supporting information or dataSupporting information or data– Question or issue on which you Question or issue on which you

need his/her inputneed his/her input

Role PlayRole Play• When you call the resident physician on When you call the resident physician on

duty, how would you state your duty, how would you state your concerns and question?concerns and question?

• Give a brief summary (no more than 60 Give a brief summary (no more than 60 sec) to the person sitting next to you.sec) to the person sitting next to you.

• Have that person give you feedback on:Have that person give you feedback on:– What was effective about your What was effective about your

communication?communication?– What could have been clearer?What could have been clearer?


• Step 3 – Actively listen to Step 3 – Actively listen to information communicated by the information communicated by the physician/healthcare worker physician/healthcare worker – Listen to the plan of careListen to the plan of care– Clarify areas which are unclear by Clarify areas which are unclear by

asking appropriate questionsasking appropriate questions

Case PresentationCase Presentation• The resident physician asks that The resident physician asks that

you obtain the following tests:you obtain the following tests:– CXRCXR– ABGABG– EKGEKG– Routine blood work (HPD, BMP)Routine blood work (HPD, BMP)

• Is there any additional information Is there any additional information you need to know at this time? you need to know at this time?

Case PresentationCase Presentation• The resident physician asks that The resident physician asks that

you obtain the following tests:you obtain the following tests:– CXRCXR– ABGABG– EKGEKG– Routine blood work (HPD, BMP)Routine blood work (HPD, BMP)

• Is there any additional information Is there any additional information you need to know at this time? you need to know at this time? – Since her respirations are somewhat Since her respirations are somewhat

labored, should patient be placed on labored, should patient be placed on O2?O2?

Case PresentationCase Presentation• The CXR suggests pneumonia, and The CXR suggests pneumonia, and

the resident orders an IV the resident orders an IV antibiotic.antibiotic.

• Two hours later, as you start the Two hours later, as you start the antibiotic, you note that the patient antibiotic, you note that the patient is more short of breath. You is more short of breath. You request that the resident re-request that the resident re-evaluate the patient.evaluate the patient.

Case PresentationCase Presentation• The patient’s O2 sat is now 88% on The patient’s O2 sat is now 88% on

50% face mask, and her respiratory 50% face mask, and her respiratory rate is 30/minute.rate is 30/minute.

• You feel she needs almost 1:1 You feel she needs almost 1:1 nursing, and are worried about how nursing, and are worried about how you will care for your other three you will care for your other three patients.patients.

• You ask if the resident if the patient You ask if the resident if the patient should be moved to the ICU, but he should be moved to the ICU, but he states he wants to first see how she states he wants to first see how she responds to the antibiotic.responds to the antibiotic.


• Step 4 – Know how to tactfully use Step 4 – Know how to tactfully use assertive communication when assertive communication when necessarynecessary– State your concernState your concern– State information that supports your State information that supports your

concernsconcerns– Suggest a course of actionSuggest a course of action– Recap why you feel this action is best Recap why you feel this action is best

optionoption

Role PlayRole Play

• Practice assertive communication to Practice assertive communication to the person sitting next to you:the person sitting next to you:– State your concernState your concern– State information that supports State information that supports

your concernsyour concerns– Suggest a course of actionSuggest a course of action– Recap why you feel this action is Recap why you feel this action is

best optionbest option

Assertive Communication Assertive Communication in Patient Carein Patient Care

• Is not:Is not:– Yelling or bullyingYelling or bullying– AccusatoryAccusatory– Being disrespectful of authorityBeing disrespectful of authority

• Is:Is:– Focused on patient Focused on patient – Noting your perceptionsNoting your perceptions– Persistently raising concerns, intended Persistently raising concerns, intended

to move toward desired action to move toward desired action

Case PresentationCase Presentation• If your effort at assertive If your effort at assertive

communication does not have the communication does not have the desired effect, what other options desired effect, what other options are available to you?are available to you?

When Assertiveness Doesn’t When Assertiveness Doesn’t WorkWork

• Restate your concerns in another Restate your concerns in another wayway

• Engage another healthcare worker Engage another healthcare worker (i.e. Respiratory Therapy)(i.e. Respiratory Therapy)

• Engage your supervisorEngage your supervisor• Engage another physician on the Engage another physician on the

teamteam

Effective CommunicationEffective Communication

• Essential for real teamworkEssential for real teamwork• Essential for long term career Essential for long term career

satisfactionsatisfaction• Essential for patient safety and Essential for patient safety and

quality carequality care

Documents

Communication Among Healthcare Providers