Whiteboards across the system

A Standardized Tool for Nurse-Patient Communication

and Patient-Centric Care

Mari Dee Sandra Cid RN, PCCNUniversity of San Diego

Master’s of Science in Nursing

Maria Sudak RN, MSN, CCRN NEA-BCPalomar Pomerado Health

Transformation

Background• Patient/ Customer Quality of care and Satisfaction is undoubtedly on the minds

of hospitals and healthcare systems.

• Patient satisfaction is tied to reimbursements.

• One of the things that patients value is good communication.

• The Joint Commission states that 65% of reported sentinel events were caused by communication errors.

• In 2007, one of the National Patient Safety Goals (NPSG) declared by The Joint Commission was to engage patients in their care.

PICO Question

Does the use of a standardized or structured whiteboard versus a blank board result in increased nurse-patient communication and increased patient/family engagement with their care?

Goals of the Project• Standardize “whiteboards” across the system

• Provide a tool for better communication between caregivers and patients.

• A mechanism for patient /family engagement in their care and education.

• Increase patient satisfaction scores / Improve HCAHPS survey scores.– HCAHPS ( Hospital Consumer Assessment of Healthcare Providers and Systems)

• A standardized survey instrument designed to produce data about patients’ perspective of care.

• Publically reported data

SWOT ANALYSIS Strengths:• Improve patient- centered care• Improve teamwork• Increase nurse/patient

communication• Increase patient

education/engagement in their care• “Shared” communication tool.

Weakness:• Controversy over nurses burdened

with “one more task” to their responsibilities.

Opportunities:• Improve nurse-patient

communication• Increase patient participation with

their care• Standardization of information

written on the board• Increase patient satisfaction rating• Improve HCAHPS scores

Threats:• Nurses’ compliance• Whiteboards not completed due to

missing markers and erasers

Challenges to implementing whiteboards:

• Standardization across the system…”special needs”• Compliance • Privacy• Valid and accurate information• Expectations• Accountability• Patient involvement• Who’s “GOAL” is it?

Strategies and Solutions to Challenges?

Recruit Input - Direct care providers - Ancillary team members - Customer Advisory Panel - Leadership - Professional Practice Committee

Education and communication - in-services will be provided to staff - staff awareness through “huddles” - provide “Inpatient Communication Board” handouts to the team

Participation and involvement

Current State….

DATE/DAY:

RN:

CNA:

SUPERVISOR:

PLAN OF CARE:

Figure 1 Category 1: Nurses wrote Date/Day/ Names; Category 2: Nurses added plan of care ; Category 3: No plan of care; Category 4: No entry on whiteboard

0

5

10

15

20

25

30

35

Category 1 Category 2 Category 3 Category 4

Day 1

Day 2

Day 3

Evidence Summary• Standardized templates

• Structured format = more inclusive of relevant/accurate information

• Direct Care Provider accountability

• Whiteboards should be placed in clear view of patients

• Erasable markers should be readily available – greatest barrier

Financial Projection

Size of whiteboard: 24 x 3618 x 36 for space challenges

$ 110/whiteboard X 30 (# rooms/unit) = $ 3,300 approximate cost per Inpatient unit

Steps taken to standardize whiteboard format,utilization and expectations:

Literature reviewed / unit rounds completed to evaluate current stateTemplate created and searchedPresentation to Service Excellence work groupTemplates combinedUnit rounds at PMC & POM to recruit end user input/feedbackSuggestions incorporated into templateTemplate to marketing for quoteRecruit fundingTemplate sent out to Directors to share with UPC’s and recruit input/feedbackVisit to Mother Baby and ED to assess special needsTemplate taken to Community Advisory Panel for input form the “Customer”Care Delivery 1/28/2011Clinical Leadership Committee & Professional Practice Committee 2/2011Pilot units…30 days…any last minute revisions 3/2011Education and Deployment 6/2011

Room Number:

Patient Name:

Please Call Me:

Patient’s Priority Today:

Health Care Team:

RN:

CNA:

Charge Nurse:

Doctor:

Diet:

Activity:

Safety Alerts/Special Needs:

Phone #:

Today’s Date/Day:

Anticipated Discharge Date/Time:

Plans and Goals for the Day: (Tests/Treatments)

Pain Management Goal:

My Pain Goal:

Family/Patient Comments/Notes:

NameNurseCNAMDDietVital SignsPain ScoreHearing/Visual limitationsInterpreter needsGlassesDenturesHearing AidIntake/OutputPatient Goal/Discharge PlansCase ManagerRespiratory RxPatient and Family Communication

Palomar Pomerado Health System: Specializing in you

Palomar(Pomerado) Hospital (Unit Location ) (Room Number)

Your name preference:

Your priority/goal for today:

Health Care Team & Contact #

Charge RN:Doctor:

Diet:Activities:Safety Alerts/ Special Needs:

Your room phone #Today's Day/Date:Anticipated Discharge Date:

Tests/Treatments for Today:

Your pain management goal:

Pain Scale

Patient /Family Comments & Notes

7am____7pm____

8am____8pm____

9am____9pm____

10am___10pm___

11am___11pm___

12pm___12am___

1pm____1am____

2pm____2am____

3pm____3am____

4pm____4am____

5pm____5am____

6pm____6pm____

HourlyRounding

Next pain medication due:

(Magnet Logo)

Inpatient Communication Board

Purpose, Guidelines, and Entry Examples

Purpose: The inpatient communication board is used as a tool to increase nurse-patient communication and patient-family education.

Guidelines:

Always keep the information on the whiteboards about the patient.

Update the board at the start of the shift and throughout the day.

Write legibly and big enough so the patient can read it from the bed.

Only use erasable markers and keep them with the whiteboards.

Do not use abbreviations or medical jargons.

Entry Examples

Patient’s Priority

My pain level maintains at a 3

Get out of bed and ambulate

Wean from oxygen

Will get at least 5 hours of sleep

Diet

NPO

Clear liquid

Cardiac Persantine diet

Regular diet

Activity

Up in the chair for all meals

Get out of bed only with assistance

Ambulate in the hallway with PT

Safety Alerts/Special Needs

Fall risk

Ambulate with walker

Legally blind

Two person assist

Anticipated Discharge Date/Time

Today before noon

Tomorrow after negative stress test result

Pending – Ask my doctor

Plans and Goals for the Day (Tests/Procedures)

Stress test in AM

Chest x-ray

Pacemaker placement

Morning blood draw

Patient-Family Comments:

Contact person phone #

Questions for the doctor

“ Wishing you well”

Evaluation

• A post-intervention 5-questionnaire survey will be given to the patients upon discharge on the pilot units regarding usefulness of patient whiteboards.

• A post-intervention audit will be conducted to check for staff compliance and identification of removable barriers at 3 and 6 months

• Outcome= to increase nurse-patient communication/education and patient engagement in their care.– Increased patient satisfaction scores (Press Ganey) that reflects

• nurses’ attention to patients’ special/personal needs• nurses kept patients informed.

• Improve HCAHPS survey scores in 3 months post-intervention.

Whiteboard Survey

Please answer the questions in this survey about the usefulness of the whiteboard in the patient’s room.

1. Did you notice the whiteboard in your room?

YES NO

2. Did the whiteboard help keep you informed about your care?

3. Did the staff explain to you what’s written in the whiteboard?

4. Did the staff update the whiteboard at the start of the shift and throughout the day?

5. Is the writing on the whiteboard legible and big enough for you to read?

4 Evidence Based

Standards &

RBC

Questions?

Thoughts?

Ideas?