Kathy Flanigan - QEII Jubilee Hospital - Communication in Clinical Handover: What is She Talking About?


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Kathy Flanigan delivered the presentation at the 2014 Operating Theatre Management Conference.

Focusing on strategies for implementing the National Safety and Quality Health Service Standards and the importance of communication to improve patient safety and clinical practice, the 2014 Operating Theatre Management Conference brought together operating room management and perioperative professionals to review current initiatives across the country.

For more information about the event, please visit: http://bit.ly/optheatremgmt14

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Kathy Flanigan - QEII Jubilee Hospital - Communication in Clinical Handover: What is She Talking About?

  1. 1. Clinical Communication: What is She talking about? Operating Theater Management Conference Sydney, 28th August 2014 Kathy Flanigan RN BN MN Adjunct Assos Professor (Griffith Uni) Nursing Director, QEII Jubilee Hospital
  2. 2. Over 70% of complaints involve communication
  3. 3. Overview Standard 6 – Clinical Handover Communication methods Clinical communication Practical Application
  4. 4. Standard 6 – Clinical Handover  (1)Clinical communications plays a vital role in several aspects of quality and safety in healthcare and developing clear, concise handovers will aid in improving the transfer of vital information
  5. 5. Standard 6  The Standard is a great starting point but we need to find workable practices to guarantee that we provide an efficient and safe handover to next clinician in the patient’s care journey  Communication methods (past and present) and ideas provided to assist clinicians in their clinical handover
  6. 6. Standard 6 Clinical Handover  (1) Clinical Handover: describes the systems and strategies for effective clinical communication whenever accountability and responsibility for a patient’s care is transferred.
  7. 7. Standard 6  (1) Three major domain areas relating to handover variables have been identified across both the health and non-health related documents.  These are:  System design factors  Organisational cultural factors  Individual factors
  8. 8. (1) System design factors  Handover: described within the context of policies and procedures, operating systems, work systems and routines, supervision and legislation.  System variables included support for information tools and systems such as computer based reports, written notes, checklists and tape-recording processes as well as a range of other methods of communication.
  9. 9. (1) Organisational cultural factors  Communication between and amongst health professional groups that impacts on patient care; and, interpersonal relationships influencing communication ability and willingness to share information.
  10. 10. (1) Individual factors  Individual staff variables relating to their knowledge, skills and attitudes that describe an individual’s ability to perform their role and transfer appropriate information to another person.  This can include the impact of fatigue, clinical decision-making and organisational skills in the process of knowledge transfer.
  11. 11. (1) Individual factors  Types of human errors that can be classified according to misperception, mistaken priorities, attention lapses, mistaken actions, or wilfulness, violations or sabotage.
  12. 12. Communication methods  Verbal – words, intonation, first language  Body language – eye contact, body positioning  Written – hand, typed, txt  Expectations – what are we waiting to hear?  ESP! – hasn’t quite got there yet.
  13. 13. Words  Lots of words – how many in the English language? (2) Oxford Dictionary indicates that there is no sensible answer, because it is difficult to decide actually what is a word. E.g Dog, a noun and a verb as in ‘to follow persistently’ – so is this one or two words? English language: What is an English word? There are many words in the English language that are not originally English. About 750,000 words
  14. 14. Words  Intonation has a lot to do with communication and how our words are taken. (3) Nordquist says that ‘in linguistics the use of a changing vocal pitch can convey grammatical information and personal attitude.’  I like you.  I, like you, etc.
  15. 15. Words  Is English your first language?  It is mine but ……………  The following slide is in English though, I can only understand and comprehend a few words.
  16. 16. As I stepped aboard the first comment was, Hi, whilst you’re down below stowing your gear can you pass up the sheets? Then I heard come on let’s get this main bent on, someone called ease the outhaul please, firm the vang up. Get the Heady up, into the prefeeder, good to go. Shortly after. Ok back off the donk, stick her into the wind and let’s get the main up. Great stuff, get the heady up, throw the sheets, more halyard, bit more, ok sheet on, bearing away. How long to the start, ok lets do a timed run, anyone got the pin? I got the boat. Easing away, cumon ease main. Lookin good going to run the line, bow, get a transit, we’re on the line. Ok, bearing away for a gybe, ‘thump bang crash’ coming up, there’s the boat get a transit (boats everywhere) Ok how long? Going to dig a hole. Someone call them up, they have no rights! Up, up, stay up,….. Up Gimme an ease, ….ease, great, …bit of power, damn get it on, %#@% ease,…… on , on ,on, we’re %#*#** racing here get us rolling. #**# we’re getting buried, lets tack out of here, get some clear air, set up,…. Lets go, helms down. Yup I see him, we’ll have to duck him, steady, ok, ease main, more more, Christ get it back on, power us up. Where’s the first mark? Cool Bear away set then, get the gear round, someone get the .5 big chute up here, hurry. NO not everyone, Christ keep some pork on the rail.
  17. 17. And so began my first and only yacht race!
  18. 18. Words  So English isn’t always the words you know.  For you consideration: How does a patient understand what we in the medical field are talking about?
  19. 19. Body language (4)  Facial expressions  Your eyes – window to your soul  Your mouth – smiling, frowning  Gestures – waving, pointing, thumbs up  Arms and legs – crossed arms or legs, tapping fingers  Posture – up straight, slumped over  Personal space – intimate, personal, social and public
  20. 20. Written  Hand written – who can read this?  Typed/computer – how many fonts??  Acronyms, abbreviations  Txt – OMG, LOL, LMAO, and the inevitable, auto correct!
  21. 21. Expectations and ESP  What are you expecting to hear?  Often we hear what we want to hear and not what has actually been said………
  22. 22. Clinical Communication Many methods Facility specific Discipline specific Clinically specific
  23. 23. Clinical Communication  Clinical Communication plays a vital role in several aspects of quality and safety in healthcare. (3)  Maybe these questions should be asked: What are we trying to achieve? How should this look for us? Who/what should be included? Where/When is this communication going to occur?
  24. 24. Nursing Clinical handover  (5) Nursing Clinical Handover can occur in a number of areas, most commonly, handover at the bedside.  Clinical handover at the bedside ensures a patient-centered approach to communication and added safety in the transfer of information.  Clinical handover is to occur at any point where care is transferred from one individual to another using English language and known abbreviations
  25. 25. Nursing Clinical handover  Change of shift  Transfer to another facility  Transfer to another unit  Transfer to Transit Lounge  Transfer to and from ICU; Endoscopy, theatre, PACU and ward specific transfer  Transfer to community  Escalation of concerns  Consult or referral  Emergency call – either Code Blue or Rapid Response Team call (or equivalent)– Nursing Handover critical to the team in this situation  Ward rounds  Multidisciplinary rapid rounds – elements of nursing handover  Theatre specific – change of team
  26. 26. Practical Application  SBAR  ISBAR  AIDET  Rapid Rounds  SSCL
  27. 27. ISBAR and SBAR  Introduction  Situation  Background  Assessment  Recommendation
  28. 28. AIDET (6) Studer: Key words at key times A. Acknowledge I. Introduce D. Duration E. Explanation T. Thank you
  29. 29. Rapid Rounds  Short duration – on time and kept to time  No hierarchy  One person leads  Multidisciplinary  Each patient discussed  Always with discharge (next step/outcome) in mind  Understanding of barriers and who is going to address them  Questions/actions for the team
  30. 30. Surgical Safety Checklist  (1) The World Health Organization Surgical Safety Checklist has been demonstrated to improve patient safety and is now widely used in Australia.  Agreed to in 2009 by all the state Health Ministers as the nationally agreed strategy for surgical safety in Australia.  This checklist should be used as patient / procedure matching protocol for surgery.  Also known as Standard 5
  31. 31. Surgical Safety Checklist  Ensure your audit process is robust and reliable  Maintain regular audit cycle  Keep discussing audit outcomes at a high level  Keep going because this is about patient safety
  32. 32. Popular publications  (1) OSSIE Guide to Clinical Handover Improvement  Clinical Handover and Patient Safety – Literature Review Report  Open Disclosure Standard
  33. 33. References  1. Australian Commission on Safety and Quality in Healthcare http://www.safetyandquality.gov.au/wpcontent/uploads/201 2/01/clinhovrlitrev.pdf viewed August 2014  2. Oxford dictionary. www.oxforddictionaryies.com viewed 1st August 2014  3. Nordqusit, R 2006. English Intonation: An introduction. Cambridge Press.  4. Cherry,K, Understanding Body language, 2014 http://psychology.about.com/od/nonverbalcommunication/s s/understanding-body-language_9.htm  5. QEII Clinical Handover procedure. August 2014  6. Studer https://www.studergroup.com accessed 1st August 2014
  34. 34. Thank You I wish you good communications!