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Quality care in hco
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- 2. Scope of Services Scope Not in scope – life saving treatment Each dept PMRN – one time IP Number OP Number Prioritization Triaging Estimated cost form/ financial consent
- 3. Initial Assessment Emergency,OPD, IPD Vitals – pain Weight and height (paed) IPD – doctors and nurses Time frame – 24 hours documented, emergency – 1 hour, begin – 4-6 hours, ½ an hour - emergency History, examination, vital signs, drug allergies, provisional diagnosis Nursing assessment Screen all for nutritional assessment – doctor/nurse – OPD/IPD/Emergency
- 4. Care plan– main treating doctor needs to countersign within 24 hours – junior doctor can initiate
- 5. Reassessments Once dailyby treating consultant Twice daily by SR Thrice daily by JR/PG Every shift – nursing staff OPD – next follow up date is must IPD – vitals, examination findings, medication orders Doctors progress notes – each visit Round notes – countersign by consultant within 24 hours No CST/ continue same treatment
- 6. LAB Services Forsample collection – PMRN and lab number Turn around time for each test is defined and displayed Biological reference values Critical values Critical values communicate to clinician – register Each report – name and signature of person reporting the test
- 7. Recall ofreports – error, mark as recalled/amended in records, date and time for recall, give new report with – CAUTION – please ignore earlier one Lab quality assurance – internal / external Internal – peer review External – exchange sample with outside lab Calibration certificates - yearly
- 8. Imaging AERB clearance Dosimeters, lead shields, lead aprons TLD badges – technicians, nurses, doctors, class IV Display and signages RSO Turn around time – for all tests Waiting time/ time taken to perform test/ time taken to prepare report Critical results reporting Recall/Amended reports
- 9. Peer review– 10% reports – external/ internal with CAPA Appropriateness of investigations asked – discuss with clinician Calibration Pre exposure screening of patients by radiologist – USG/CT/MRI Lead aprons – screen once a year for cracks Train nurses, helpers, housekeeping, security on MRI safety
- 10. Patient care Onedoctor – SR/PG responsible for every patient Structured clinical handover – doctor and nurse – register Inter department transfer – form – documented handover Patient record – nursing station – confidential Referral – form – opinion/ takeover IPD patient – waiting time noted – OPD, lab, radiology Critical value alert register – wards, action report - file
- 11. Discharge process MLC– police information LAMA/DOR – reason to be documented, patient counseling documented, patient declaration, give discharge summary and reports as usual Every discharge summary signed by doctor, acknowledged by patient/relatives Copy retained in file
- 12. Every dischargesummary – reason for admission, findings, diagnosis, patient condition at time of discharge, investigation results, procedures, medications, name of primary clinician, follow up and medication orders No BD, OD, TDS, QID When and how to obtain urgent care – contact number Death – cause , PM - findings
- 13. Emergency Patient identificationbands Triaging – Disaster (code yellow) – if more than 6 patients Red – 1st priority – most urgent – life threatening shock, hypoxia Yellow – 2nd priority – can wait 10-15 min, significant injuries Green – non urgent – can wait 30 minutes – localised injuries Black – dead patients
- 14. MLC –police information Decision – Physician Beds – 25 , resuscitation – 5 All staff including attendants – BLS, selected – ACLS Dead on arrival – registration, breaking bad news, police information, PM, storage Death certificate/summary – even if brought dead Code blue – cardiopulmonary arrest Announce – code activated x location x 3 times Deactivated
- 15. Mock drillfor disaster – twice a year Crash cart – similar CPR protocols – display in emergency, ICU CPR team – ACLS training Shift wise duty All other hospital staff – BLS trained Mock drill record
- 16. Procedures Identify thepatient – PMRN, Name Site – surgical safety check list Informed written consent PPE Disinfectants/ sterilisation Intra procedure monitoring – pulse, BP, RR and post procedure for 2 hours – another person Documentation – steps, post procedure care Sign with name, date, time
- 17. Blood transfusion Transportationof blood Verification of blood and patient Consent for blood transfusion and donation – can be valid if multiple transfusion during that admission Chronic blood disorders – 6 months once, but endorsed each visit Consent – risks, benefits, complications Leaflets and booklets – patient and family education – blood bank, wards Report – for every patient for transfusion reaction feedback from patients Training of doctor/nurse/technician - record
- 18. ICU Admission anddischarge criteria – displayed Staff trained for criteria Monitor – infection rate, readmission rate within 48 hours, reintubation rate within 48 hours, Cauterisation associated infection, ventilator associated pneumonia Patient and family counseling by doctor once a day, when condition changes – documented Nurse patient ratio – venti 1:1, non venti 1:2
- 19. Vulnerable patient Elderly> 65 years, child < 12 years, physically or mentally challenged, comatosed, under sedation, abused Yellow bands (others – white bands) Monitor – twice a normal patient Risk of falls – bed railing, ramp railings Consent – guardians/ relatives Training of all hospital staff for vulnerable patients
- 20. Obstetrics Assessment –nutrition, immunisation, education Display – WE CARE FOR HIGH RISK PREGNANCIES near OPD Priveleged nursing staff NICU
- 21. Paediatrics Well babyclinic NICU PICU Some posters promoting breast feeding Privileged staff Breast feeding room – OPD and IPD Immunisation, nutrition, growth, development Code Pink – child abduction CCTV cameras – labour room, NICU, PICU
- 22. Family education– nutrition, immunisation, safe parenting Growth chart and Immunisation chart displayed in OPD and IPD plus in each patient file In patient language Child < 12 years Infant < 1 year
- 23. Moderate sedation Consent Sedation by doctor or nurse Not by one performing the procedure Intra procedure monitoring Discharge from recovery area Emergency resuscitation equipment Anaesthesist on call
- 24. Anaesthesia PAC –pre anaesthesia check up – before entering OT or before admission Should contain anaesthesia plan – pre medication, type of anaesthesia, medication and investigations review Immediate pre op evaluation – in pre op room – any change in plan Consent for anaesthesia – risks, benefits, alternatives Separate from surgical consent During anaesthesia monitoring – documented – temp, HR, PR, RR, BP, SpO2, ETCO2 Cardiac rhythm – on monitor – only abnormality to be documented
- 25. Recovery area– patient shifting – bon basis of physiological parameters Please mention – type, anaesthesia medication, name of anaesthesist Sign with date and time and name Adverse anaesthesia events – documented Change in anaesthesia plan
- 26. Surgical procedure Preop assessment Provisional diagnosis Consent by operating surgeon If procedure changed intra op – fresh consent Surgical safety checklist Privelege Operative notes detail steps and post op care Look for post operative complications, surgical site checklist compliance, surgical site infection, change in surgery plan
- 27. OT No mixtureof sterile and unsterile patients Humidity control Temperature control Pressure differential monitoring Filter integrity monitoring – in 6 months Look for rational use of antibiotics
- 28. End of lifecare Training of staff Pain and palliative Respect religious/ social/ cultural beliefs REHABILITATIVE SERVICES Physiotherapy Speech therapy Antenatal and post natal exercises
- 29. Patient under restraint Physical or chemical Who can authorize Consent – relatives Can be at stretch for 4 hours Reason for restraint to be documented Signed by clinician or within one hour RESEARCH – Ethics committee, consent, right to withdraw from research
- 30. Pain Management Allpatients screen for pain 5th vital sign Detailed assessment – if required All post op – detailed assessment Reassessment – cancer pain , neuralgia, arthritis Not included – chest pain, labor pain Patient and family education If pain – reassess – every 4 hours Pain scale 0 to5 0 – no hurt, 5 – hurts lot
- 31. Nutritional therapy Fooddistribution – temp control Dietician Type of diet in consultation with treating doctor Written orders for diet Kitchen – nothing stored on floor Control flies, insects and pests Refrigerator – temperature check Own food – patient and family counseling
- 32. Drugs Drug formulary– approved by DTC Reviewed annually if required quarterly Non formulary drugs – added on request sent to the MS 24 hours duty roaster for pharmacy Only prescription by doctor accepted – signed Display plan for drugs in racks – on computer Restricted entry in pharmacy Computerized stock register Daily stock check
- 33. Drug storage Firstin first out Store in alphabetical order of generic/ trade name Room temp – 15 -30 degree C Cold temp – 2-8 degree C, vaccines at -20 degree C Temp monitoring – twice a day Crash cart – uniform Nothing on floor – but 6 inches above floor Pest and termite control
- 34. High riskmedicines (risk of adverse outcomes, medication errors, abuse) – stored in red colour boxes – stored under lock and key Look alike medicines – stored in yellow colour boxes Sound alike medicines – stored in green colour boxes LASA – stored apart from each other
- 35. Prescription writing Drugs– capital letters Name – drug name/trade name, dose, route, frequency – timing If 2 drugs – dose of both should be written Time of examination Signature with name and registration number At least MBBS No CST, Repeat all, repeat 1,4… Clear and legible Food drug interactions
- 36. At alltransit areas – admission, transfer, discharge – medications have to be verified by nursing staff Verbal orders – emergency – verified by consultant in 24 hours Read back No verbal orders for high risk medicines, narcotics, blood, children, neonates and antenatal High risk medicines – verified by 2 nursing staff before giving to patient
- 37. Check expirydate before administration of drug Withdraw expiry drugs 3 months prior Identify patient Verify dosage, route, timing Signature, name and time of who administered Infusion – start time, rate of infusion, end time
- 38. Alternative brands– authorized by doctor If prescription not legible – pharmacist should contact the doctor on phone Maintain stock – give requirement atleast 1 month prior Recall of drug – adverse health consequences, drug reaction – MS – circular Self administration – patient and family counseling, under supervision
- 39. Counseling –cash memo Expiry date Avoid cut strips not having expiry date/ open or tampered bottles Drug - drug interactions Drug – food interactions
- 40. Near miss Medication error Adverse drug reaction – dose related All such incidents should be reported LABELLING OF DRUG IN SYRINGE – name of medicine, strength, quantity, expiry date, patient name and PMRN
- 41. Narcotics License Specificarea for storage Double locking facility – pharmacist and doctor Prescription by doctor Duplicate of prescription to be preserved Double check by 2nd pharmacist Consumed ampules to be returned to pharmacy Record register Disposed off – running water, witness
- 42. Implants Patient andfamily counseling regarding implant and cost – documented Batch and serial number of implant - recorded in patient file, discharge summary and OT register If no pre labeled sticker – manufacturer name, batch number and serial number
- 43. Unacceptable practices Alcoholand smoking Offensive language Inappropriate behaviour with women Disrespect Fighting Talking bad about colleagues Asking for money Bad communication Abuse
- 44. Patient rights Bilingualdisplay Respect for personal dignity and privacy during examination Protection from neglect and abuse – trolley and wheel chair belts, bed railing Confidentialty – avoid discussion in public places, patient information not to be revealed HIV status – cant be written on front of file, OPD slip, cant be revealed
- 45. Right torefuse treatment – counsel and document and take acknowledgement Right to second opinion – within or outside, give assess to all records Written Informed consent – surgery, anaesthesia, procedure, blood transfusion, admission Right to know about expected cost of treatment Right to assess his records – for closed files within 72 hours Right to know the names of health care professionals – I cards and dress code
- 46. Right forinformation about care plan, progress Inform about alternatives, expected outcomes, possible complications Inform about results of diagnostic tests Inform about change in patient condition Right over worship and dietary preferences
- 47. Consent Risk Benefits Alternative Consequences of not undergoing Who will perform If patient cant give consent – spouse, son/daughter/parents, brother/sister, legal guardian Life threatening no one available – doctor Sign, doctor, witness Multiple sittings – once in 6 months, endorse each time
- 48. If noconsent – defer – document counseling and take acknowledgement Court consent – if serious condition and consent not given – vulnerable patient , 3rd trimester pregnancy
- 49. Feedback Right andresponsibilities – explained by admission clerk, PRO, nursing staff Any grief – hospital administration Right to voice their complaint Feedback – experience, communication with doctor, pain management, hospital enviroment, responsiveness of hospital staff, communication about medication and overall rating Mechanism of lodging complaint – complaint box – every monday
- 50. Tariff Uniform billingpolicy Tariff available at billing counters and registration area Explain estimated cost in written – cost form and take acknowledgement – resident doctor/ nursing staff Explain costs when change in patient condition
- 51. Patient education Medicationand side effects Diet and nutrition Immunisation – influenza, typhoid and hep B Diseases, complications Life style modifications, dietary changes In form of leaflets/ print Inform about preventing health care associated infections – handwashing, avoid patient bed In patient language
- 52. Hospital infection control HIC team – ICO, ICN ICO – Microbiologist, privelege ICN – privelege – trained HIC committee – monthly basis meet High risk areas – ICU, OT, Blood bank, CSSD, Dialysis, Labs, Kitchen, Mortuary High risk procedures – surgeries > 2 hours, endoscopies Antibiotic policy – based on c/s, reviewed once in 3 months (antimicrobials – antibiotics and antifungal) – identify clinical conditions where used Notify all notifiable diseases to govt
- 53. Staff trainingregarding HIC – once a year Induction training within 15 days of joining Policies, procedures and practices of infection control programme Separate budget for HIC OT – Time gap b/w 2 surgeries – 20 minutes Antibiotic – 2 hours before surgery Fumigation – gas or smoke – 24 hours – sealed with tape – Bacilo acid HIV/HBV/HCV – red colour band with black dots TB – blue colour band
- 54. Hand hygiene Handhygiene guidelines – displayed near hand washing area Hand washing Surgical – no nail polish, short nails, no ornaments, soap and water/ scrub – above elbow – 4-6 minutes Hygienic – soap and water - 20-30 sec – before procedure Social – food, toilet – 10 sec Steps of hand washing
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- 57. Barrier Nursing Allhuman blood and other bodily fluids are considered infectious regardless the patient having infection – blood, secretions, excretions except sweat, non intact skin, mucous membrane Use of PPE – gloves, gowns, face masks, eye wear/ goggles, foot wear (biomedical waste), apron, cap/ hair cover Safe handling and disposal of sharps – needles, scalpels and broken glass, use forceps instead of hand to guide suturing, don’t recap needles – white container puncture proof, needle destroyer One needle one syringe only one time
- 58. ICU –controlled traffic New disposable gown, masks, gloves, caps for each person entering ICU and disposed off within before leaving Dialysis – separate machines for positive patients Screen patients for HIV, HBV, HCV then every 3 months CSSD – Central Sterilization Supply Department Critical – surgical/ contact with patient sterile parts/ body fluids – sterilized Semi critical – contact much mucous membrane – GI endoscopes – high level disinfection Non critical – in touch with intact skin – low level disinfectants
- 59. CSSD Unidirectional flow Separate areas for receiving, washing, cleaning, packing, sterilization, sterile storage, issue Sterilization of all instruments, equipments Validation tests for sterilization department – bacteriological strips Biological tests – weekly Physical and chemical tests – daily Each load should have number, content description, temp, pressure and time chart Breakdown of sterilization/ change in colour – withdrawl/ recall of such items
- 60. Blood Bank/Labs – white coat, PPE, restricted entry Kitchen – refrigerator – 3-7 C Periodic screening of kitchen staff for parasites, salmonella typhi every 6 months or if rejoin after 15 days leave or more Vaccinated – Hep B, Typhoid, TT Before any procedure – clean the site – alcohol swab, savlon, betadine Minimum distance b/w beds – 1- 2 m No seepage – fungal growth Any renovation – approved by IC committee
- 61. House Keeping NOBROOMING/ DRY DUSTING Disinfectants/detergents/soap and water Mopping should be done/ wet cleaning/ dust attract mops If soiled – disinfectants For infected areas – mop laundrised before re use Dirty water and used disinfectant solution – discarded Walls and ceiling – cleaned when dirty While cleaning – area condoned off – with wet floor signage
- 62. Isolation rooms– contact/ droplet/ air borne infections Closed doors with negative pressure Prophylaxis – pre and post exposure , Hepatitis B
- 63. Spillage Hazardous material– blood, body fluids, microbial cultures, mercury, medical gases, ETO, steam Any material which due to its physical characterstic, quantity or concentration can cause real harm to a individual Hazmat kits – handle spills MSDS – Material safety data sheets Code orange/ hazmat Spill – minor - < 30 cm – clean using PPE and 1% sodium hypochlorite Major - > 30 cm – Code, hazmat kit Spillage – cover with paper towel, blotting paper, use 1% sodium hypochlorite poured all around and covered with paper for 10 minutes
- 64. Laundry Used linen– hand washed/ machine with gloves Infected/ soiled linen – disposable gloves, plastic aprons PEST CONTROL Rats, flies, mosquitoes, termites Fogging Spraying Glue pads Outsourced
- 65. Bio medical waste Outsourced Visit to site once in 6 months PPE Colour coded bags Collected morning 7-8 am, 1-2 pm, 7-8 pm Liquid – no container Sharps – needles, blades, scalpels – puncture proof white box containing 1% sodium hypochlorite Glass, slides, syringes, vials – Blue bags/bins Plastic syringes, IV set, tube, catheter, drains, gloves – Red bags/bins Blood/body fluid soaked cotton swab, linen dressing, microbiology and other lab waste, discarded medicines, expiry drugs, anatomical waste – Yellow plastic bags, bins
- 66. General waste,eatables, plates, glass, cups – Black bag/bin Human anatomical waste – deep burial/ incinerators Lab waste - autoclave
- 67. Employee rights andresponsibilities Employee – regular, Staff – contractual Respect and dignity Terms and conditions in appointment letter Clarity about targets to achieve/job to perform Benefits from organisation to be clear Responsibilities – discipline, duties, ethics, aware of hospital policies, plan leaves in advance, care about equipments under him/her, discrete, patient interest, wear uniform , I card as required
- 68. FMS Hand bars,trolley and wheel chair belts, grab bars, bed railings Separate toilet for physically disabled NO SMOKING AREA Facility round – twice a year in patient areas, once a year – non patient areas Safety committee Safety education programmes – fire safety, lab safety, occupational safety, radiation safety Controlled assess – I Cards Round the clock maintenance staff Complaint register – date and time of complaint, confirmation of completion of job
- 69. GREEN HOSPITAL– rain water harvesting, solar panels, recycling, energy efficient lighting Cleaning of water storage tanks, RO unit, STP Dialysis water – endotoxin testing, PH, hardness Maintenance of lifts, Chiller unit, air conditioners Equipment inventory – UIN to each equipment, calibration – once/twice a year as required, quality certificates to be retained, manufacturers certificates/ manual to be retained Training of staff in usage of equipment Coding of all equipment – Dept/ name of equipment/ serial number
- 70. Condemnation ofequipment – condemnation committee If cost of repair/ renewal exceeds 50% of original value Outdated version – cant compete with new version Buy back/ sold/ scrap/ retained for spares Recall of equipment – letter from company – immediate action Complaint about equipment after repair – acknowledged by department
- 71. Medical gases Centraloxygen plant D type oxygen cylinders – 47 liters – 63 B type oxygen cylinders – 10 liters – 80 A type oxygen cylinders – 5 liters – 13 A type nitrous – 30 A type carbon dioxide – 15 Oxygen – black with white neck Nitrous – blue Carbon dioxide - grey Separate empty, use and full cylinders – mark them Gas pipeline – uniform colour code policy
- 73. Sentinel events Eventscause harm to patient in hospital not related to patient disease for a minimum of 2 weeks of disability or death Surgery – wrong patient, wrong site, wrong surgery, death due to surgery, adverse anaesthesia events Device – contaminated medication/drug, failure/breakdown of medical equipment Protection – discharge of infant to a wrong mother/person, suicide or attempted suicide, no gas/oxygen, nosocromial infection Enviroment – blast, fall, slip, electric shock Criminal – abduction, sexual assault Medical error – medication error All sentinel events to be analysed within 24 hours of occuring CAPA
- 74. Fire safety Codered Mock drills twice a year Safe exit plans – each floor – displayed Alarm activated by pulling down the handle Disconnect medical gas flow and put off electric equipments Close the doors and windows to prevent fire and smoke from spreading Avoid lifts 1st horizontal – then – vertical evacuation 1st evacuate closure to dangerous area – then ambulatory – then non ambulatory (stretcher or cloth sheet)
- 75. USE FIREEXTINGUISHER- P – Pull the pin in the nozzle of extinguisher A – Aim the nozzle at the base of fire S – Squeeze the handle S – Sweep from side to side to contain the fire Dial 444 – to activate Code Red PREVENTION OF FIRE No smoking No loose wire No inflammable materials – Petrol, LPG, Kerosene oil, candles
- 76. Put offlights, fans, electrical equipment when not in use Remove the equipment connection from the plug CODE VIOLET Fights/ violence CODE YELLOW Disaster CODE BLACK Terrorist attack/ Bob threat
- 77. Quality Quality committeeor core committee meets every 3 months – decides the mission, vision, quality policy, quality objectives and service standards Quality coordinator/ Quality manager/ Accreditation coordinator Audits Performance Committee meetings Hospital clinical audit – once in 6 months Patient safety committee – doctors, nurses, engineers, management, security, house keeping
- 78. Adverse events– injury related to medical management or failure to manage No harm – error is not recognised, deed done but no adverse even happened Near miss – error realised in last nick of time and prevented
- 79. HRM Employee/ Staff Criminal/ negligence background check Induction training within 15 days at hospital & departmental level Induction record – list of trainers and trainees with signature, content of training Feedback is must Pre and post test Also when job change/ new equipment Pre employment medical check up Regular free health check up – once a year
- 80. Documented Credentials– qualification Privelege – skills Priveleging after 1 month of joining Nurse: Patient = 1:5 Needle stick injury – don’t squeeze or suck, wash with soap and water, report to emergency
- 81. IMS Daily censusreport Birth and death statistics Every entry – named, signed, dated, timed – patient file Cardiac and respiratory arrest are event of death – not cause Copy of PM - file MRD Restricted access Tracer card Pest and rodent control Fire fighting equipment
- 82. Retention ofrecords 10 years all IPD MLC – permanent MTP – permanent Birth and death reports - permanent
- 83. Patient responsibilities Properhistory and credentials To be on time To take medications regularly, follow advise Respect towards staff and other No alcohol, smoking, weapons No violence To share insurance data Follow up regularly Pay bills Give priority to emergencies
- 84. Clinical Audit Evaluationof data, documents and resources to check if performance of systems meets specified standards Audit of structure – staff, equipment, patient and their records Audit of process – procedures, investigations treatment, history taking, BMW, hand hygiene, infection control, communication Audit of outcomes – response to treatment, pain relief, sugar/BP control Audit atleast every 6 months, desirable 3 months Patient name – never to be disclosed
- 85. Assessment –time for initial assessment(OPD), documentation of care plan, signed by clinician, nutritional assessment, nursing care plan Medical records – discharge summary, ICD coding, consent, missing records, error prone abbreviations, medicine prescription in capitals Lab/Radiology – reporting errors, redos, reports correlation with clinical diagnosis, adherence to PPE Redos – HP/CT/MRI Medical management – medication errors, adverse drug reactions, pain relief following intervention, non availability of consultant on call
- 86. Anaesthesia –modification of plan, unplanned ventilation, anaesthesia related death, adverse anaesthesia events, reintubation rate Adverse anaesthesia events – hypoxia, arrythmia, cardiac arrest during anaesthesia Surgery – unplanned return to OT in same admission, rescheduling of surgeries – cancelled, prolonged beyond 4 hours, Surgical safety checklist adherence, appropriate antibiotic given within 2 hours, timely cesation of antibiotics, cs rate
- 87. Blood –transfusion reactions, wastage of blood and blood components, blood component usage, turn around time for issue of blood and blood components Infection control –catheter associated UTI, Ventilator associated pneumonia, central line associated blood stream infection, surgical site infection, hand hygience compliance Ventilator associated events – hypoxemia – deterioration in oxygen (>20%) if hypoxemia > 2 days – event, > 4 days – condition, WBC seen on gram stain of respiratory secretions - VAP
- 88. Return toICU within 48 hours, return to emergency within 72 hours Clinical research – percentage of research activities approved, percentage of patients withdrawing from study, protocol violations, serious adverse effects Patient safety – communication errors icluding handover, patient identification errors, timely refilling of fire extinguishers, sentinel events, near misses, falls Pharmacy – turn around time for dispensing medicines, percentage of drugs purchased outside formulary, percentage of stock outs
- 89. Patient satisfaction– OPD satisfaction index, IPD satisfaction index, waiting time for OPD and diagnostics (registration – check up), time taken for discharge ( writing discharge summary – final billing) Employee satisfaction – employee satisfaction index, attrition index, absenteeism rate, awareness about employee rights and responsibilities Employee safety – blood and other body fluids exposure, needle stick injuries, provision of pre exposure prophylaxis Variations in mock drills
- 90. Bed occupancyrate, average length of stay, OT utilisation rate, ICU utilisation rate, critical equipment downtime Nurse patient ratio
- 91. Communication in HCO HCW – Physicians, surgeons, anaesthesiologist, dentists, nursing staff, technicians, therapists, pharmacist, dietician – Interprofessional Team Supporting staff – engineers, public health, electricians, plumber, security staff, transport, house keeping, attendants, clerical, health workers How to communicate? b/w health care team themselves b/w health care team and patients/relatives Not included in any curriculum
- 92. Good communication– good outcome Bad communication – errors, financial loss, litigation Need – Doctor patient interview Consent Nursing assessment Problematic areas – breaking bad news, disclosing death, handling aggressive patient/ families, emergency/ disaster, disclosing adverse events, managing angry employee, patient and staff argument handling
- 93. Greetings, establishthe rappot Listen patiently Favorable body language – dressing up, sitting posture, eye contact, hand movements Show empathy – be in patient position Avoid unnecessary medical jargon Don’t be judgemental Be clear in your talk Be brief and specific
- 94. Have apositive attitude with a smile Be calm but assertive Adapt to audience Understand body language and non verbal clues Be open minded BREAKING BAD NEWS – by treating consultant, separate room, give time, should have knowledge of case, in patient language, no jargons, use experience, plan out before with team
- 95. IP SET UP IP Team to work together To communicate effectively with each other To take decisions together – shared decision making Division of roles Leadership Problem areas – education difference, age difference, gender difference, cultural difference, ego Don’t understand the roles and responsibilities of each other Fatigue, lack of interest, language barrier
- 96. To worktogether – need to learn together as IP team Team work Centre point – patient IP concept – IPE, IPP Group discussions Role plays Videos Patient feedback Patient complaints Direct observation by peers – peer feedback