Whiteboards across the system
A Standardized Tool for Nurse-Patient Communication
and Patient-Centric Care
Mari Dee Sandra Cid RN, PCCNUniversity of San Diego
Master’s of Science in Nursing
Maria Sudak RN, MSN, CCRN NEA-BCPalomar Pomerado Health
Transformation
Background• Patient/ Customer Quality of care and Satisfaction is undoubtedly on the minds
of hospitals and healthcare systems.
• Patient satisfaction is tied to reimbursements.
• One of the things that patients value is good communication.
• The Joint Commission states that 65% of reported sentinel events were caused by communication errors.
• In 2007, one of the National Patient Safety Goals (NPSG) declared by The Joint Commission was to engage patients in their care.
PICO Question
Does the use of a standardized or structured whiteboard versus a blank board result in increased nurse-patient communication and increased patient/family engagement with their care?
Goals of the Project• Standardize “whiteboards” across the system
• Provide a tool for better communication between caregivers and patients.
• A mechanism for patient /family engagement in their care and education.
• Increase patient satisfaction scores / Improve HCAHPS survey scores.– HCAHPS ( Hospital Consumer Assessment of Healthcare Providers and Systems)
• A standardized survey instrument designed to produce data about patients’ perspective of care.
• Publically reported data
SWOT ANALYSIS Strengths:• Improve patient- centered care• Improve teamwork• Increase nurse/patient
communication• Increase patient
education/engagement in their care• “Shared” communication tool.
Weakness:• Controversy over nurses burdened
with “one more task” to their responsibilities.
Opportunities:• Improve nurse-patient
communication• Increase patient participation with
their care• Standardization of information
written on the board• Increase patient satisfaction rating• Improve HCAHPS scores
Threats:• Nurses’ compliance• Whiteboards not completed due to
missing markers and erasers
Challenges to implementing whiteboards:
• Standardization across the system…”special needs”• Compliance • Privacy• Valid and accurate information• Expectations• Accountability• Patient involvement• Who’s “GOAL” is it?
Strategies and Solutions to Challenges?
Recruit Input - Direct care providers - Ancillary team members - Customer Advisory Panel - Leadership - Professional Practice Committee
Education and communication - in-services will be provided to staff - staff awareness through “huddles” - provide “Inpatient Communication Board” handouts to the team
Participation and involvement
Current State….
DATE/DAY:
RN:
CNA:
SUPERVISOR:
PLAN OF CARE:
Figure 1 Category 1: Nurses wrote Date/Day/ Names; Category 2: Nurses added plan of care ; Category 3: No plan of care; Category 4: No entry on whiteboard
0
5
10
15
20
25
30
35
Category 1 Category 2 Category 3 Category 4
Day 1
Day 2
Day 3
Evidence Summary• Standardized templates
• Structured format = more inclusive of relevant/accurate information
• Direct Care Provider accountability
• Whiteboards should be placed in clear view of patients
• Erasable markers should be readily available – greatest barrier
Financial Projection
Size of whiteboard: 24 x 3618 x 36 for space challenges
$ 110/whiteboard X 30 (# rooms/unit) = $ 3,300 approximate cost per Inpatient unit
Steps taken to standardize whiteboard format,utilization and expectations:
Literature reviewed / unit rounds completed to evaluate current stateTemplate created and searchedPresentation to Service Excellence work groupTemplates combinedUnit rounds at PMC & POM to recruit end user input/feedbackSuggestions incorporated into templateTemplate to marketing for quoteRecruit fundingTemplate sent out to Directors to share with UPC’s and recruit input/feedbackVisit to Mother Baby and ED to assess special needsTemplate taken to Community Advisory Panel for input form the “Customer”Care Delivery 1/28/2011Clinical Leadership Committee & Professional Practice Committee 2/2011Pilot units…30 days…any last minute revisions 3/2011Education and Deployment 6/2011
Room Number:
Patient Name:
Please Call Me:
Patient’s Priority Today:
Health Care Team:
RN:
CNA:
Charge Nurse:
Doctor:
Diet:
Activity:
Safety Alerts/Special Needs:
Phone #:
Today’s Date/Day:
Anticipated Discharge Date/Time:
Plans and Goals for the Day: (Tests/Treatments)
Pain Management Goal:
My Pain Goal:
Family/Patient Comments/Notes:
NameNurseCNAMDDietVital SignsPain ScoreHearing/Visual limitationsInterpreter needsGlassesDenturesHearing AidIntake/OutputPatient Goal/Discharge PlansCase ManagerRespiratory RxPatient and Family Communication
Palomar Pomerado Health System: Specializing in you
Palomar(Pomerado) Hospital (Unit Location ) (Room Number)
Your name preference:
Your priority/goal for today:
Health Care Team & Contact #
Charge RN:Doctor:
Diet:Activities:Safety Alerts/ Special Needs:
Your room phone #Today's Day/Date:Anticipated Discharge Date:
Tests/Treatments for Today:
Your pain management goal:
Pain Scale
Patient /Family Comments & Notes
7am____7pm____
8am____8pm____
9am____9pm____
10am___10pm___
11am___11pm___
12pm___12am___
1pm____1am____
2pm____2am____
3pm____3am____
4pm____4am____
5pm____5am____
6pm____6pm____
HourlyRounding
Next pain medication due:
(Magnet Logo)
Inpatient Communication Board
Purpose, Guidelines, and Entry Examples
Purpose: The inpatient communication board is used as a tool to increase nurse-patient communication and patient-family education.
Guidelines:
Always keep the information on the whiteboards about the patient.
Update the board at the start of the shift and throughout the day.
Write legibly and big enough so the patient can read it from the bed.
Only use erasable markers and keep them with the whiteboards.
Do not use abbreviations or medical jargons.
Entry Examples
Patient’s Priority
My pain level maintains at a 3
Get out of bed and ambulate
Wean from oxygen
Will get at least 5 hours of sleep
Diet
NPO
Clear liquid
Cardiac Persantine diet
Regular diet
Activity
Up in the chair for all meals
Get out of bed only with assistance
Ambulate in the hallway with PT
Safety Alerts/Special Needs
Fall risk
Ambulate with walker
Legally blind
Two person assist
Anticipated Discharge Date/Time
Today before noon
Tomorrow after negative stress test result
Pending – Ask my doctor
Plans and Goals for the Day (Tests/Procedures)
Stress test in AM
Chest x-ray
Pacemaker placement
Morning blood draw
Patient-Family Comments:
Contact person phone #
Questions for the doctor
“ Wishing you well”
Evaluation
• A post-intervention 5-questionnaire survey will be given to the patients upon discharge on the pilot units regarding usefulness of patient whiteboards.
• A post-intervention audit will be conducted to check for staff compliance and identification of removable barriers at 3 and 6 months
• Outcome= to increase nurse-patient communication/education and patient engagement in their care.– Increased patient satisfaction scores (Press Ganey) that reflects
• nurses’ attention to patients’ special/personal needs• nurses kept patients informed.
• Improve HCAHPS survey scores in 3 months post-intervention.
Whiteboard Survey
Please answer the questions in this survey about the usefulness of the whiteboard in the patient’s room.
1. Did you notice the whiteboard in your room?
YES NO
2. Did the whiteboard help keep you informed about your care?
3. Did the staff explain to you what’s written in the whiteboard?
4. Did the staff update the whiteboard at the start of the shift and throughout the day?
5. Is the writing on the whiteboard legible and big enough for you to read?
4 Evidence Based
Standards &
RBC
Questions?
Thoughts?
Ideas?