This document discusses effective communication strategies for interdisciplinary discharge planning. It emphasizes that discharge planning should begin at admission and involve a team approach. Barriers to effective communication can lead to poor outcomes, so standardized methods like SBAR and teach-back techniques are recommended. One study found that forming discharge planning teams improved processes like completing discharge summaries and prescriptions, which increased patient and staff satisfaction and reduced readmissions. Overall, the document stresses that discharge planning requires open communication across disciplines to ensure safe transitions of care.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
Abstract:
It is difficult to find in Spanish a word that can translate the meaning of Counselling and encompassing all those elements and nuances that you are your own. The translations more frequently used are "assisted advice" and/or "aid relationship" and/or advice, it also includes all the skills that are necessary to establish that interpersonal relationship.
Although the communication skills, and in particular communication of bad news and the relationship with users are currently not part of the university education within the degree in Medicine, Nursing, Physiotherapy or Psychology if it has been of concern on the part of practitioners in these areas present sufficient levels of training in this core competency. In fact, we presented/displayed a communication where the little information received in the own hospital on the part of parents with children with Syndrome of Down is reflected in particular on this genetic alteration before making decisions referred to the birth from the boy. Thus, just as the curative art is learned can be learned the abilities of communication referred the unexpected news, which will help to diminish the psychological cost for the professional and the own patient.
Wessex AHSN is pleased to announce the publication of a short report on the evaluation of how people feel when they experience new models of care. The report has been produced in partnership with R-Outcomes and the Centre for Implementation Science (University of Southampton) and responds to local evaluation guidance, published by NHS England in June 2017, that calls for a strengthened focus on capturing and evaluating patient and residents’ experience of transformed services.
A prominent nursing center in the mid-size East South Central city in the South has come under the fire due to a major challenge of shortage in the nursing staff. An increase in the health care expenses led to a temporary reduction in the staff’s earning that led them to decrease in the number of nurses. Decreasing the nursing staff is the only logical way to combat the increased health costs, however, it partly kills the working enthusiasm of the staff.
But, the decreased staff is birthing more problems, as there is an array of patients that come to this center for care and cure and the decreased number of nurses cannot put up with all of them.
An Introduction to the National Institute for Medical Assistant AdvancementCHC Connecticut
View the slides from NIMAA's Webinar about a groundbreaking new way to train key primary care team members featuring national leaders, including:
Thomas Bodenheimer, MD, MPH, UCSF School of Medicine, California
Edward Wagner, MD, MPH, MacColl Center, Washington
Mark Masselli, CEO, Community Health Center, Inc; Chairman, NIMAA
The retarded development of nursing and nursing profession seems to be mainly due to the fact that no serious thought has been given to this discipline.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
Patient’s experience, improve the quality health3zsaddique
Putting patients first requires more than world-class clinical care – it requires care that addresses every aspect of a patient’s encounter with Hospital, including the patient’s physical comfort, as well as their educational, emotional, and spiritual needs. A team of professionals should serves as an advisory resource for critical initiatives across the Hospital health system. In addition, it should provide resources and data analytics; identify, support, and publish sustainable best practices; and collaborate with a variety of departments to ensure the consistent delivery of patient-centered care.
To innovate is to put new ideas into practice or existing ideas into practice in new ways. Every nurse is an agent of change and an innovator. Every day, nurses work together to solve difficult challenges in the workplace and for their patients.
Taking Efficiency to Scale: Spread of a Delegate Model in an FQHCJSI
A large rural federally qualified health center (FQHC) in Maine seeks to increase access to and quality of care through decreasing variability in efficiency and panel sizes among its primary care teams across 5 of 17 sites through spread of a "delegate model." Secondary objectives are to enhance provider and team job satisfaction, increase team function, and decrease provider and staff burnout.
Improving Discharge Care for Children with Special Health Care Needs through...LucilePackardFoundation
Being discharged from the hospital is a vulnerable time for families and caregivers of children with special health care needs (CSHCN). Appropriate resources and support are essential for care at home and can prevent complications or readmission. The California-based Nurse-led Discharge Learning (CANDLE) Collaborative brings together interdisciplinary clinicians to improve discharge care delivery for CSHCN. Learn about two new discharge practices: closed-loop medication reconciliation and tailored medication teaching, and multidisciplinary discharge rounds with early discharge notification. Speakers share how these innovative practices can be integrated into existing clinical workflows.
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Wessex AHSN is pleased to announce the publication of a short report on the evaluation of how people feel when they experience new models of care. The report has been produced in partnership with R-Outcomes and the Centre for Implementation Science (University of Southampton) and responds to local evaluation guidance, published by NHS England in June 2017, that calls for a strengthened focus on capturing and evaluating patient and residents’ experience of transformed services.
A prominent nursing center in the mid-size East South Central city in the South has come under the fire due to a major challenge of shortage in the nursing staff. An increase in the health care expenses led to a temporary reduction in the staff’s earning that led them to decrease in the number of nurses. Decreasing the nursing staff is the only logical way to combat the increased health costs, however, it partly kills the working enthusiasm of the staff.
But, the decreased staff is birthing more problems, as there is an array of patients that come to this center for care and cure and the decreased number of nurses cannot put up with all of them.
An Introduction to the National Institute for Medical Assistant AdvancementCHC Connecticut
View the slides from NIMAA's Webinar about a groundbreaking new way to train key primary care team members featuring national leaders, including:
Thomas Bodenheimer, MD, MPH, UCSF School of Medicine, California
Edward Wagner, MD, MPH, MacColl Center, Washington
Mark Masselli, CEO, Community Health Center, Inc; Chairman, NIMAA
The retarded development of nursing and nursing profession seems to be mainly due to the fact that no serious thought has been given to this discipline.
Measuring “Culture of Safety” Tawam’s Experience
Discovery:
Tawam Hospital’s Executive leadership realized the need to establish a “Culture of Safety” within the organization and implemented the Johns Hopkins Medicine “Comprehensive Unit based Safety Program” (CUSP). CUSP was introduced as a pilot project in the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NNU) and Paediatric Oncology Unit (Peds Onc).
Prior to implementation the leadership decided to measure staff perception of safety using evidence based tool.
Solution:
Tawam partnered with Pascal Metrics to implement the Safety Attitude Questionnaire survey. The SAQ was administered to all Tawam Hospital staff in three phases (2008, 2010 and 2011). In 2010 the pilot CUSP units were also resurveyed to determine the status of safety culture since its introduction in 2008.
An email from the CEO was sent to the participants encouraging them to participate in the SAQ survey.
Physicians, nurses, ward-clerks; respiratory therapist, physiotherapist, dieticians etc were included in the survey.
Those who spent at least 50% of their time in the identified units were only included to participate in the survey.
Survey was administered during departmental meetings to increase response rate.
Conducted separate sessions of physicians.
Staff dropped the completed surveys in an envelope.
82% of staff in the patient care areas of the whole hospital participated in the overall 3 phases of SAQ Survey.
The three CUSP pilot units were re-surveyed in 2010.
Anonymity, privacy and confidentiality were maintained from the beginning till the end.
Outcome:
The survey results were graded against percentage positive responses. Responses that were less than 60% mark were graded in the danger zone and anything above the 80% mark were graded in the goal zone. Teamwork climate and Safety climate scale scores are considered to be primary dependent variables, because they are important in preventing patient harm.
The overall hospital score on all the domain scores were in the danger zone, less than 60%. 20 clinical locations in 2010 and 7 clinical locations in 2011 had less than 60% scores in the primary dependent variables.
The SAQ results were disseminated department wise in the presence of a hospital Senior Executive. Every department did an action plan using the SAQ de-briefer tool. The hospital administrators to bring about the change played a facilitators role and helped the departments to come up with their actionable plans.
The hospital leadership in their pursuit to continuing the culture of safety journey, identified six more units for CUSP implementation based on the Phase 2 SAQ scores of 2010. Accordingly the Medical 1, Medical 2, Surgical 1, Surgical 2, Day Case and OBGYN Units were identified for the CUSP roll out. Senior Executive leaders were assigned to each of these new CUSP units to ensure leadership commi
Patient’s experience, improve the quality health3zsaddique
Putting patients first requires more than world-class clinical care – it requires care that addresses every aspect of a patient’s encounter with Hospital, including the patient’s physical comfort, as well as their educational, emotional, and spiritual needs. A team of professionals should serves as an advisory resource for critical initiatives across the Hospital health system. In addition, it should provide resources and data analytics; identify, support, and publish sustainable best practices; and collaborate with a variety of departments to ensure the consistent delivery of patient-centered care.
To innovate is to put new ideas into practice or existing ideas into practice in new ways. Every nurse is an agent of change and an innovator. Every day, nurses work together to solve difficult challenges in the workplace and for their patients.
Taking Efficiency to Scale: Spread of a Delegate Model in an FQHCJSI
A large rural federally qualified health center (FQHC) in Maine seeks to increase access to and quality of care through decreasing variability in efficiency and panel sizes among its primary care teams across 5 of 17 sites through spread of a "delegate model." Secondary objectives are to enhance provider and team job satisfaction, increase team function, and decrease provider and staff burnout.
Improving Discharge Care for Children with Special Health Care Needs through...LucilePackardFoundation
Being discharged from the hospital is a vulnerable time for families and caregivers of children with special health care needs (CSHCN). Appropriate resources and support are essential for care at home and can prevent complications or readmission. The California-based Nurse-led Discharge Learning (CANDLE) Collaborative brings together interdisciplinary clinicians to improve discharge care delivery for CSHCN. Learn about two new discharge practices: closed-loop medication reconciliation and tailored medication teaching, and multidisciplinary discharge rounds with early discharge notification. Speakers share how these innovative practices can be integrated into existing clinical workflows.
OVERVIEW -- Care by Design - Putting Care back into healthcare the University of Utah experience in building PCMH level care over the decade of 2001 to . 2011
Comment 1Development of an evidence-based practice project musJeniceStuckeyoo
Comment 1
Development of an evidence-based practice project must include the direct and indirect impact that will be encountered through implementation. Staff retention of newly hired nurses specific to the night shift is the focus of my project and its impact on the nurses, facility and community that is served. According to published reports, a supportive work environment, especially between managers and employees, creates a strong deterrent to nurses leaving an organization by improving perception of organizational support, employee engagement, team cohesion, and connection to the mission of the health-care setting (Kurnat-Thoma, Ganger, Peterson, & Channell, 2017).
Financial aspect
– staffing cost/turnover cost
Hospital staffing turnover is projected to 5% to 5.8% of total hospital annual operating budget and is largely driven by the loss and necessary replacement of qualified nurses according to Waldman, J., Kelly, F., Arora, S., Smith, H. (2010).
Proposal direct impact
– hospital revenue/staffing costs,
Proposal indirect impact
– patient outcomes, positive healing environment perception by staff/patients
Quality Aspect
– High turnover in any industry can be a concern, especially those that are customer-centric. Industries that deal with people’s health are in an even more precarious position. Institutions with high attrition must consider how a “revolving door” of care providers affects the quality of care an institution is able to provide, and the satisfaction of patients with their overall experience according to Arena (2018).
Proposal direct impact
–
Separation Costs – Continued benefits, temporary labor, overtime to existing employees
• Recruitment Costs – Job description, posting on job boards, screening candidates, interviewing candidates, assessing candidates
• Onboarding Costs – Orientation and training of new hire
Proposal indirect impact
–
Loss of productivity
• Lack of staff while positions are being filled
• Increased pressure on existing staff to cover and pick up the extra work often leading to burnout
• Patients receiving less attention
• Pressure on current staff to train and then gel with the new employees
• Lack and lag of knowledge with new employees concerning institutional practices, workplace norms, team behaviors, and patient knowledge, familiarity, and care experience
Clinical aspect
– unit cohesiveness/patient care
Many nurses leave their positions because of negative experiences with heavy or unrealistic workloads and due to feeling unheard and undervalued. Clinical nurses' sense of disempowerment can be related to lack of leadership interventions. Clinical nurses may feel that managers are insensitive to their staffing needs, don't support employee well-being, and don't invest enough in staff education or clinical advancement according to Linnen and Rowley (February 2014).
Proposal direct impact
– nurses will see themselves as stewards for their unit. “Nurses are leaders by virtue ...
Discussion 1 GeorgeIntroduction Teamwork is a significant aVinaOconner450
Discussion 1 George
Introduction
Teamwork is a significant aspect of health care delivery. With the increasing complexity and specialization of clinical care, healthcare workers have
to learn more complicated methods and procedures to achieve the desired patient outcomes. Teamwork is associated with reduced medical errors and
improve patient safety. Additionally, teamwork reduces staff burnout since a healthcare professional team is responsible for patient welfare (Zajac et al.,
2021). Various strategies are key to ensuring effective teamwork for better patient outcomes.
Strategies for effective teamwork during patient care
Effective communication across staff members of a clinical team increases teamwork efficacy, leading to improved patient outcomes. Working
towards a common goal, effective communication expands the traditional roles of each member to make decisions as a team (Zajac et al., 2021). One
particular strategy that worked for my clinical team is goal setting at the beginning of the scheduled activities so that each member has a clear purpose
for their roles for the day. Several studies also agree that goal setting provides the direction for implementing procedures and coordinated care.
Organizing regular meetings and using digital communication platforms such as emails and WhatsApp groups to convey information relating to patient
care to team members and debate suggestion is key to improving performance and, ultimately, patient outcomes.
Another effective team strategy is collaboration. By definition, health care involves multiple disciplines- nurses, doctors, and health care specialists
in different fields, working together, communicating often, and sharing resources (Zajac et al., 2021). A clinical team is made up of professionals of
different health specialities and responsibilities. Cumulatively, these differences contribute to the overall patient well-being and safety. The different
teams contribute to patient outcomes by understanding the patient presenting illness, asking them probing questions regarding their situation, making
an initial evaluation, discussing, and providing a recommendation based on their findings.
Strategies for ineffective teamwork during patient care
It is common for challenges to arise during teamwork. According to Hendrick et al. (2017), some of the most common challenges that impede a
team’s efforts to improve patient care include a lack of commitment of team members, different individual team members’ goals, and conflict
about how the team members individually relate to the patient. The input of individual members is vital to realizing the overall team’s goal. Therefore,
each member must demonstrate full commitment to the course of the team. Also, if the goals of the individual members do not align with the team’s
goal, then they might be less committed to achieving the team’s goal (Rawlinson et al., 2021). The healthcare team should help the patient understand
that their care is multidisci ...
Acute hospitals end of life care best practiceNHSRobBenson
Delivering reliable best practice in an acute hospital setting for patients whose recovery is uncertain. Including details of the AMBER care bundle. Presentation from Anita Hayes and colleagues from England's National End of Life Care Programme as part of the Department of Health's QIPP end of life care workstream seminar series at Healthcare Innovation Expo 2011
The Impact of Chronic Illness refers to the wide-ranging effects and consequences that chronic illnesses have on individuals, their families, and society as a whole. Chronic illnesses are long-term health conditions that often require ongoing medical care and management.
The impact of chronic illness can be multifaceted and encompass various aspects of a person's life. Physically, chronic illnesses can result in persistent symptoms, pain, fatigue, and limitations in daily activities. These health challenges may require individuals to make adjustments to their lifestyle, such as adopting medication regimens, dietary changes, or incorporating regular medical appointments and treatments.
Emotionally, chronic illnesses can lead to psychological distress, including feelings of sadness, anxiety, frustration, or even depression. Coping with the uncertainties and limitations imposed by the illness can significantly impact a person's mental well-being.
Socially, chronic illnesses can disrupt social relationships, as individuals may face difficulties participating in social activities, maintaining employment, or fulfilling family roles. The need for accommodations and support can create challenges in personal relationships and may require adjustments in work environments.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
2. NURSING CORE COMPETENCIES:
FOR INTERDISCIPLINARY DISCHARGE PLANNING
Communication
“The Nurse of the Future will interact effectively with patients, families,
and colleagues, fostering mutual respect and shared decision making to
enhance patient satisfaction and health outcomes” (Masters, 2014, p.78).
Teamwork
“The Nurse of the Future will function effectively within nursing and
interdisciplinary teams, fostering open communication, mutual respect,
shared decision making, team learning, and development” (Masters, 2014,
p.78)
3. WHAT IS COMMUNICATION?
A process that includes 5 factors:
SENDER – encodes a message to be transmitted;
MESSAGE – the ideas, symbols, signals being transmitted;
CHANNEL/MEDIUM – the means by which a message travels;
RECEIVER – receives and decodes the message; and
FEEDBACK – Receiver provides feedback to Sender to signal effective
reception of intended message (Oxford University Press, 2014;
Communication Models and Theories, n.d.).
5. NURSE-PATIENT COMMUNICATION:
SUCCESSFUL INTERACTION
Scenario: During Admission Intake, Nurse Hope Soeiltry would like to obtain a
medication list from PatientWill U. Listinclose for a safe medication reconciliation.
Sender (Nurse: Hope) – encodes her message with words by asking a question
Message (The Question) – what medications do you take at home? Can you tell me and
write them down on this paper to include the name, dose, and time you take them?
Channel/Medium (Verbal/Written) – both verbal and written responses
Receiver (Patient Will) – decodes the message; begins to tell Nurse Hope his medications
from home while writing them down
Feedback (Patient:Will) - asks if he should write down his over-the-counter medications
while showing Nurse Hope his medication list in progress. Nurse Hope nods in
agreement while saying,“absolutely correct!”.
Outcome of Communication: SUCCESS!
6. EFFECTIVE COMMUNICATION:
BARRIERS TO SUCCESS
Noise or Interference – ambient noise, alarms, bells, televisions, radios;
Medium chosen poorly – incompatible language, incompatible medium
i.e. hearing impaired (chose verbal transmission), visually impaired or
illiterate (chose written transmission);
Message – unclear, inappropriate, incongruent, lacks context;
Receiver – emotionally/psychologically compromised (angry, anxious,
sad, fearful, uncooperative/unreceptive); physically compromised (pain,
fatigue, altered mental status);
Feedback – Receiver did not provide feedback to ensure successful
communication occurred; Sender did not request for feedback
(Communication Models and Theories, n.d.).
7. STRATEGIES TO OVERCOME BARRIERS:
EFFECTIVE COMMUNICATION
Sender – is clear, concise, and congruent during message transmission
process;
Reduce or Eliminate – sources of interference with a calm, quiet, and
timely delivery environment for the communication to take place;
Select Appropriate Medium – relative to the age, ethnic/cultural, and
language determined to be compatible with the receiver;
Assess the Receiver – for readiness i.e.Alert, oriented, well rested, with
a reasonable mood disposition; and
Request Feedback – ask the receiver is they understood the message
delivered; exercise a repeat-back and verify process to ensure successful
delivery.
8. DISCHARGE PLANNING AND EFFECTIVE
COMMUNICATION: WHAT & WHEN
Definition:
“Preparation for moving a patient from one level of care to
another within or outside the current health care agency”
(Bulechek, Butcher, Dochterman, &Wagner, 2013, p.150).
When:
“Planning for discharge begins during the initial contact with the
client by establishing the expected outcomes and anticipating
follow-up care that may be needed” (Harkreader, 2007, p.206).
9. DISCHARGE PLANNING AND EFFECTIVE
COMMUNICATION: RATIONALES
Poor Planning and Discharge Communication is Costly:
“Poor communication can endanger patients’ lives and waste fiscal and
human resources” (Lattimer, 2011).
“Delays, omissions, and inaccuracy of discharge information are common
at hospital discharge and put patients at risk for adverse outcomes”
(Harlan, 2010).
“It’s often poor communication, coupled with an expectation that patients
or caregivers will remember and relate critical information, which can lead
to dangerous, even life-threatening, situations” (Lattimer, 2011).
10. RN DISCHARGE ACTIVITIES: OVERVIEW
NURSING INTERVENTIONS CLASSIFICATION (NIC) SUMMARY
Assist patient/family/significant others to prepare for discharge;
Collaborate with interdisciplinary team/patient/family/significant others;
Coordinate with other providers for a timely discharge;
Identify patient / caregiver knowledge or skills required for discharge;
Identify patient teaching required for post-discharge care;
Communicate patient discharge plans as appropriate;
Monitor readiness for discharge;
Formulate discharge maintenance plan;
Arrange post-discharge evaluation; and
Discharge to next level of care (Bulechek et al., 2013 p.150).
11. CASE MANAGEMENT: OVERVIEW
DISCHARGE ACTIVITIES
Screening and Intake – identify discharge disposition / placement and destination;
Assess needs – financial resources, treatment plans coordinated with physician,
patient and family for smooth discharge transitions;
Service planning – initiate plan of care, identify barriers to outcomes achievement,
post-discharge service need identification, setting mutual goals with family/patient;
Link patient to what they need – resource utilization, appropriate length of stay
planning, evaluation of expected outcomes progress;
Implement InterdisciplinaryTreatment Plan – monitor expected outcomes, begin
arranging post-discharge arrangements, re-evaluate discharge destination if needed;
and
Evaluate Patient Care Outcomes – based on plan of care progress towards achieving
outcomes; round with the attending physician to obtain progress feedback (Cesta,
2013).
12. DISCHARGE COMMUNICATION:
INTERDISCIPLINARY STRATEGIES
Team Approach:
Discharge Planning Teams (Rose & Haugen, 2010).
Standardizing Communication:
“S-B-A-R” (Bengasco et al., 2013).
Evidence-Based Discharge Education:
“Teach-Back” (Kornburger et al., 2013).
13. DISCHARGE PLANNING TEAMS:
MULTIDISCIPLINARY INTERVENTION STUDY
Based on a study conducted in a Progressive Care Unit (PCU) in a
Midwestern Hospital (Rose & Haugen, 2010):
Problem – Current Discharge Process Concerns
Incomplete / Inaccurate Discharge Summaries
Incomplete Prescriptions
Inconsistent Discharge Education
Communication Gaps regarding: Discharge dates, time, and disposition
Intervention – Formation of Discharge Planning Teams
Possible Outcomes – Effective Discharge Planning
Decreases Re-admissions
Promotes Cost-effective Use of Inpatient Beds
Increased Patient / Staff Satisfaction
15. DISCHARGE PLANNING TEAMS:
ACTIVITIES PER DISCIPLINE
Physician & P.A.:
Education on pathology and surgical reports,
Writes discharge prescriptions the night before discharge, and
Completion of discharge summaries;
Registered Nurse:
Education on post-discharge care requirements night before discharge
and on the day, and
Coordinate follow up for outstanding discharge items to be completed;
Pharmacist:
Fills prescriptions at Hospital Outpatient Pharmacy; and
Verifies insurance information as soon as possible to fill script promptly
(Rose & Haugen, 2010).
16. DISCHARGE PLANNING TEAMS:
JOINT ACTIVITIES –SURVEY, AUDIT & RESULTS
Pre-implementation of Discharge Planning Teams:
Discharge Summaries – 60% completion rate,
Prescriptions Written – 45% completed night before discharge,
Nursing Staff Satisfaction – 37% contentment with discharge process, and
Patient Satisfaction – 93% perceived a smooth process;
Post-implementation of Discharge Planning Teams:
Discharge Summaries – 91% completion rate by 2007,
Prescriptions Written – 88% completed night before discharge by 2007,
Nursing Staff Satisfaction – 91% contentment with discharge process by 2007, and
Patient Satisfaction – 100% perceived a smooth process by 2007 (Rose & Haugen,
2010).
17. DISCHARGE PLANNING TEAMS:
KEYS TO SUCCESSFUL IMPLEMENTATION
Communication Remains Open – Across all disciplines must be
open to facilitate acceptance of changes in processes;
Multidisciplinary Involvement – input from various disciplines
facilitated the efficiency of workflow by identifying barriers related to
other departments/services; and
Continuous Improvement Process – teams must be cognizant of
the changes in health care environment: Payer systems, regulatory
agencies, and processes, ready to adapt to changing conditions (Rose &
Haugen, 2010).
18. STANDARDIZING COMMUNICATION:
RATIONALES FOR IMPLEMENTATION
Good Communication is characterized by:
Timeliness,
Standardization of Content, and
Well coordinated between disciplines (Reilly, Marcotte, Berns, & Shea, 2013).
Errors in Communication results in:
Adverse Events with Negative Patient Outcomes,
Negative Emotional Impacts for Patients & Caregivers,
Increased associated Costs,
Increased Length of Hospital Stay,
Loss of PatientTrust, and
Increased Risk for Litigation (Bagnasco et al., 2013; Reilly et al., 2013).
19. STANDARDIZED COMMUNICATION:
PROPOSED METHODS
S.B.A.R – Situation, Background,Assessment, &
Recommendations:
Recommended as a Standardized Communication Tool, and
Has Written andVerbal components for Communication at Patient Hand-
off andTransfer (Bagnasco et at., 2013).
Proposed Benefits – S.B.A.R Implementation:
Mitigation of Risk associated with poor Communication during Patient
Hand-off and Transfer i.e. Memory Failures,
Standardizes Communication Styles of various healthcare workers to
create uniformity, and
Optimizes communication timing via Standardized reporting procedure
(Bagnasco et al., 2013).
20. DISCHARGE EDUCATION:
EVIDENCE-BASED STRATEGIES
“Teach-Back” Process – “a comprehensive, interdisciplinary, evidence-based
strategy which can empower nursing staff to verify understanding, correct
inaccurate information, and reinforce medication teaching and new home care
skills with patients and families” (Kornburger et al., 2013).
Proposed Benefits – “Teach-Back”: Implementation
Provides opportunity toVerify Understanding, Correct Inaccurate Information, and
Reinforce Medication Education and Home Care Skills;
Valuable, Easily Implemented and Understood, and Cost-effective Education Strategy;
Engages Patients and Families in learning activities;
Patient and Family-centered Education Strategy (Kornburger et al., 2013).
21. DISCHARGE EDUCATION:
TEACH-BACK PROCESS
“Teach-Back” Goal – Effective Family / Patient Self-Management:
Step 1: Teach a New Concept or Skill,
Step 2: Clarify or Correct Misunderstandings,
Step 3: Acknowledge any Questions Patient/Family may Have, and
Step 4: Continue the Process until Concept or Skill is Understood (Kornburger et al.,
2013).
Nurse Competencies – Understand Health Literacy Principles:
Encourage Patient/Family Questions,
Use Plain Language,
LimitTeaching to 3-5 Concepts, and
Document “Teach-Back” education in the approved form (Kornburger et al., 2013).
22. SUMMARY & CONCLUSION
Communication Highlights:
Is a vital function to ensure Patient Safety;
Failures occur mostly during points ofTransfer of Care;
Failures carry a significant potential for Adverse Patient Events;
Standardized Communication methods optimize outcomes;
Discharge Planning Highlights:
Requires an Integrated, Multidisciplinary & Team Approach;
Begins at Admission, is ongoing, and is constantly re-evaluative in nature;
Is Patient and Family-centered; anticipating needs constantly;
Requires effective communication between patients, family, and Healthcare Team; and
Requires pre-emptive, evidence-based discharge Education from entire team
(Bagnasco et al., 2013; Kornburger et al., 2013; Reilly et al., 2013; Rose & Haugen,
2010).
23. REFERENCES
Bagnasco,A.,Tubino, B., Piccotti, E., Rosa, F.,Aleo, G., Di Pietro, P., & Sasso, L. (2013). Identifying
and correcting communication failures among health professionals working in the
Emergency Department. International Emergency Nursing, 21(3), 168-172. doi:10.1016/
j.ienj.2012.07.005
Bulechek, G., Butcher, H., Dochterman, J., & Wagner, C. (2013). Nursing Interventions Classification
(NIC). (6th
ed.). St. Louis, MO: Mosby Elsevier.
Cesta,T. (2013). Back to Basics:A Day in the Life of a Hospital Case Manager - Part 1. Hospital
Case Management, 21(8), 107-110.
Communication Models and Theories. (n.d.). retrieved from http://
www.praccreditation.org/secure/documents/APRSG_Comm_Models.pdf
Harkreader, H. (2007). Fundamentals of Nursing: Caring and Clinical Judgment. (3rd
ed.). St. Louis,
MO: W.B. Saunders Company Elsevier.
Harlan, G.A., Nkoy, F. L., Srivastava, R., Lattin, G.,Wolfe, D., Mundorff, M. B., & ... Maloney, C. G.
(2010). ImprovingTransitions of Care at Hospital Discharge-Implications for Pediatric
Hospitalists and Primary Care Providers. Journal For Healthcare Quality: Promoting
Excellence In Healthcare, 32(5), 51-60. doi:10.1111/j.1945-1474.2010.00105.x
24. REFERENCES
Kornburger, C., Gibson, C., Sadowski, S., Maletta, K., & Klingbeil, C. (2013). Using
“Teach-Back” to Promote a Safe Transition From Hospital to Home:An Evidence-Based
Approach to Improving the Discharge Process. Journal Of Pediatric Nursing, 28(3), 282-
291. doi:10.1016/j.pedn.2012.10.007
Lattimer, C. (2011).When It Comes toTransitions in Patient Care, Effective Communication
Can Make All the Difference. Generations, 35(1), 69-72.
Masters, K. (2014). Role Development in Professional Nursing Practice. (3rd
ed.). NewYork: Jones &
Bartlett.
Oxford University Press. (2014). Shannon andWeaver’s model. Retrieved from
http://www.oxfordreference.com/view/10.1093/oi/authority.20110803100459436
Reilly, J. B., Marcotte, L. M., Berns, J. S., & Shea, J.A. (2013). Handoff Communication
Between Hospital and Outpatient Dialysis Units at Patient Discharge:A Qualitative
Study. Joint Commission Journal On Quality & Patient Safety, 39(2), 70-76.
Rose, K., & Haugen, M. (2010). Discharge planning: your last chance to make a good
impression. MEDSURG Nursing, 19(1), 47.
