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Communication for Patient Safety in the Operating Rooms

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Title: Communication for Patient Safety in the Operating Rooms


1
Communication for Patient Safety in the
Operating Rooms
  • Keystone CUSP
  • for the Operating Rooms
  • Module 1
  • September 2006

2
Effective Communication
Across all types of reported events
miscommunication was identified as the root cause
of more than 60 of the cases.
Radiology Today, March 17, 2003
3
Keystone
  • History
  • Michigan
  • 70 hospitals
  • In 15 months
  • 1578 patient lives saved
  • Over 81,000 hospital days saved
  • Over 165 million saved in health care
  • CUSP
  • Beaumont Hospitals

4
AORN Position Statement on Patient Safety
  • AORN is committed to promoting patient safety by
    advancing the professions through scholarly
    inquiry to identify, verify, and expand the body
    of perioperative nursing knowledge. AORN
    supports the establishment of an accountable,
    trusting, safety culture that reflects individual
    and collective values, beliefs, behaviors, and
    skills with a desire and commitment to patient
    safety.

5
Assertion
  • Questioning Care That Places a Patient at Risk

6
Assertiveness
  • Ability to speak up, and state information, with
    persistence, until there is a clear resolution.
  • An attitude and a way of positively relating to
    those around you skills set for effective
    communication.

7
When Patient Safety is at Risk
  • Question care which places patient safety at risk
  • Get the others attention
  • Use C U S
  • State the problem
  • Propose a solution
  • Get a decision
  • Appropriately politely
    persist until get a response
  • Use chain of command, if needed

8
Aggressiveness
  • The state of uncomplimentary, obtrusive, crass,
    forwardness or brass self confidence
  • Dr Jones, you will go back in the wound and check
    the sponge before I give you anything else!!

9
We do not need aggressiveness
  • We need assertiveness

10
Assertive Communication
  • Focus on the goal Safe, quality care
  • Focus on problem, not other person
  • Start from the heart What do you really want
    and are you acting that way?
  • Avoid right versus wrong, or being judgmental
  • Maintain respect and courtesy
  • Be mindful of confidentiality
  • Take care not to alarm patient/family

11
Assertive Communication
  • Pay attention to verbal and non verbal
    communication
  • Tone of voice
  • Use the word I
  • Body language/facial expressions
  • Take a deep breath, if nervous
  • Act confident in that what you have to say is
    important (questioning care that may cause harm
    is never wrong)

12
Assertion
Video
13
Questions?
14
Decision Making
15
AORN Guidance Statement
  • Creating a Patient Safety Culture

16
Clinical Decision Making
  • Ability to sift through and synthesize
    information, make decisions, appropriately
    implement and evaluate
  • Components for optimal decision-making
  • Experience
  • Knowledge
  • Ability to critically think
  • Some intuition

17
Barriers to Effective Decision- Making
  • Complexity of patient
  • Lack of knowledge
  • Lack of experience
  • Esteem issues
  • Minimal, or no support
  • Taking shortcuts
  • Stressors
  • Others?

18
Stress and Decision-Making
19
Tips
  • Ask for help before you are overwhelmed
  • Ask questions early
  • Does it really need to be done?
  • Can it be delegated to someone else?

20
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21
Team Communication
  • Team Communication

22
Clear communication, between all team
members, is imperative if patients are to receive
safe and effective care
23
Why is it Difficult to Effectively
Communicate Patient Care?
24
Crucial Concerns
  • Most common crucial concerns in healthcare
  • Broken rules
  • Mistakes
  • Lack of support
  • Incompetence
  • Poor teamwork
  • Disrespect
  • Micromanagement
  • Source Silencekills.com

25
What are the Ramifications of Poor Team
Communication ?
  • For patients?
  • For staff?
  • For Beaumont?

26
Communication
  • Communication is made up of
  • ? is verbal The words, or content
  • ? is paraverbal How we say it cadence, tone,
    volume
  • ? is nonverbal Body language, facial movement,
    gestures, etc.
  • People get more upset over what they perceive
    your intention to be, not the words you are using

27
Effective Communication
  • Share what you know, or what you have learned
  • Knowledge, skills and experiences of many far
    more powerful than of one
  • Use words such as, we, lets and
    ours, to promote a sense of team
  • Include patient/family

28
Team Communication
  • Know the team
  • Use assertion
  • Use the other persons name
  • Make eye contact
  • Clear and succinct wording
  • Do not rush what you are saying to save time
  • Communicate before a crisis, when possible

29
Team Communication
  • Leave room for questions and input
  • Respectfully listen to others
  • Avoid interrupting others
  • Give indication you are listening
  • Confirm what was said
  • When delegating, confirm the other person clearly
    understands what you want done

30
Team Communication
  • Effectively resolve conflicts in patients best
    interest
  • Create an environment where people feel safe and
    respected
  • Collaboration
  • Show appreciation of others
  • Know the chain of command

31
Keystone OR Communication
  • Site and side
  • Final verification
  • Patient handoffs
  • Pre-Op checklist

32
Teams Communicate
  • Team members also use the following to
    communicate for patient safety
  • Assertion
  • Briefing
  • Debriefing
  • Checklists
  • Handoffs
  • Repeat back verbal orders

33
Call-outs
  • Avoids misunderstanding or
    assumptions by having team members call-out when
    a task is completed
  • Asking RN to turn down ESU setting
  • Tourniquet time
  • Clamp time
  • Call-outs work in reverse IF you use team
    members name
  • Ann, can you check his blood sugar, now?
  • Tom, bring in the crash cart, now

34
Nurses and Physicians
  • Communication Styles

35
Nurses and Physicians
  • Doctors trained to expect give clinical
    bullets
  • May tune out as waiting for relevant clinical
    information
  • Need to elicit and listen more carefully to
    nurses unique perspective
  • Nurses trained to expect and communicate the
    story of the patient
  • Notice communication breakdown easier
  • Need to convey essential information more
    concisely

36
Communication
  • Between Men and Women

37
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38
Gender-Neutral Communication
  • Men need to
  • Listen without feeling responsible
  • Listen to objections and suggestions
  • Explain their reasons
  • Women need to
  • State message clearly and concisely
  • Eliminate unsure words
  • Speak up
  • Solve problems without personalizing them

39
If we feel safe and respected, then will
  • Speak up
  • Learn better
  • Help create better team

40

41
Situational Awareness
42
Situational Awareness
  • An accurate perception of factors and situations
    affecting the patient and medical team. It uses
    the entire team to remain aware of the patients
    condition and to anticipate future problems or
    concerns.
  • OR
  • All team members know whats going on and what
    is likely to happen next
  • OR
  • Surgical Conscience and Patient Advocacy

43
Knowledge is Key
  • Knowledge must be shared to improve
    communication and improve patient outcomes
  • Focus on
  • Tasks and goals of team
  • Individual tasks
  • Names, roles and responsibilities
    of team members

44
Red Flags of Diminishing SA
  • Things dont feel right, but no one questions
    it
  • Working in an unfamiliar environment or situation
  • Working with new equipment
  • Highly focused on a specific task
  • Emergency situations
  • Discrepancies in information

45
Red Flags
  • Human Factors
  • Distractions and interruptions
  • Verbal violence
  • New team member, student

46
Ineffective Communication and Teamwork
47
The potential for human error increases when
Situational Awareness is lost
  • So, how do we maintain Situational Awareness?

48
SA Requirements
  • Expertise
  • Keep current
  • Teamwork
  • Use perspective of all team members to remain
    aware
  • Include all members as you work together
  • Know skills, experiences, roles of team
  • Watch for signs of stress, fatigue, overwhelmed,
    etc. in team members and confront accordingly

49
Maintaining Situational Awareness
  • Effective communication may be most important
    factor in maintaining SA
  • Ask yourself, What actions, information do I
    need to give others to do their job and optimize
    patient care?
  • Include the whole

50
Maintaining Situational Awareness
  • Team members must continually assess and
    evaluate for actual or potential concerns
  • Anticipate next steps and possible events
  • Know policies and procedures
  • Use assertion, briefings, call-outs, etc
  • Cross check and verify
  • Clarify expectations of team members
  • Watch for performance changes in others

51
Situational Awareness in the ORExamples
  • All team members monitor noise in OR, including
    extraneous conversation, music
  • Circulator offers assistance when CRNA appears to
    be dealing with a problem with the patient
  • PA offers updates to CRNA on progress of
    procedure when there is limited view or when the
    procedure is unfamiliar
  • ST notices med student looks unwell while
    observing surgery

52
Questions?
53
Evidence-Based Practice
  • Conscientious, explicit and judicious use of the
    current best evidence in making decisions about
    the care of patients
  • Scientific findings
  • Clinician experience
  • Patient preference

54
EBP Examples
  • Waterless surgical hand scrub
  • Hand washing decreases transmission of infection
  • Hair removal, using clippers, has lower rate of
    surgical site infection, than shaving
  • Effects of normothermia on surgical site
    infections

55
EBP Examples
  • Artificial nails
  • Double wrap
  • Use of shoe covers

56
  • Indeed, if you look nationally, by far, the
    greatest opportunity to improve health in this
    country isnt from inventing some new wonder
    drug, its making sure that we deliver what we
    know works, safely and effectively.
  • -Peter Pronovost, MD

57
Who is the last patient that was not harmed
because of you?
58
You can, and you do, make a difference, every
single day
  • Never doubt the power that you have to create a
    safe environment for our patients

59
Questions?
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