8 - Communicating Safely Flashcards
Opportunities for Miscommunication
•Elderly patient sees 7 physicians across 4 different practices every year
•Patients recall ~40% of medical information provided to them
–~1/2 of what they thought they remembered was incorrect
•MDs interrupt patients’ chief complaint 77% of the time
–Ave time to interruption: 18 sec
Implications of Miscommunication
•Communication failure involved in:
– 30% of malpractice cases
•$1.7 billion in malpractice costs
–37% of malpractice cases involving serious injury (including death)
•~2000 deaths
~80% of serious medical errors
•$4 million/year lost
–44,000 to 98,000 patient deaths / year
•Many likely preventable
–$236 billion/year unnecessary health care expenses due to patient misunderstanding
SBAR
Definition / Use?
Tool for COMMUNICATING CHANGES in patient STATUS
Situation
Background
Assessment
Recommendation
I-PASS
Definition / Use?
Communication tool for patient TRANSITIONS
Illness severity
Patient Summary
Action List
Situation Awareness & Contingency Planning
Synthesis by Receiver
ISHAPED
Definition / Use?
Communication tool for patient TRANSFERS
Intro
Story
History
Assessment
Plan
Error Prevention
Dialogue
Other Processes to Prevent Miscommunication Errors
that arenot:
SBAR
ISHAPED
IPASS
TEACH BACK
improves patient comprehension & information retention
Medication Labeling
tsp vs mL
Medication Reconciliation
should occur at EVERY TRANSITION POINT
MyICU - Patient Portal
Medication Reconciliation
Process to prevent Miscommunication Errors
should occur at EVERY TRANSITION POINT within the healthcare system
should include:
obtaining a complete medication list
Assessment of: compliance + side effects
Discussion of patient’s medication understanding
Why do COmmunication Failures Occur?
Closed Loop Communication
Processes to Prevent Miscommunication Errors
deliver CONCISE info
VVV
confirm RECEIPT of INFO
VVV
acknowledge UNDERSTANDING of Info
Communication Failure Between
Providers and Patients
Common Errors
–Instructions written higher than the 5th grade level
•Font size should be at least 12 point
–Unnecessary use of medical jargon
–Referring patients to the internet for more information
–Using abstract examples to explain concepts
–Taking understanding for granted
–Being culturally unaware and insensitive
Instructions should be in the patient’s 1st language
–Not allowing time for questions
–Not explaining the meaning of prescription labels
Communication Failure Among Healthcare Professionals
VERBAL ORDERS
Potential for:
•Miscommunication of order
•Misunderstanding of order
Incorrect transcription
–Factors associated with the risk of error:
•Interruptions
•Multiple verbal orders given at the same time
•Multiple physicians giving orders at the same time
•Variations in physicians’ practices
•Familiarity with patient for whom verbal orders are given
•Multiple transcriptions
–Read back and verify
