COMMUNICATION
ESSENTIALS: Interdisciplinary Discharge
Planning
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)
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; and
RECEIVER – receives and decodes the message;
FEEDBACK – Receiver provides back to Sender to signal effective
reception of intended message (Oxford University Press, 2014;
Communication Models and Theories, n.d.).
COMMUNICATION:PROCESS CYCLE
Sender
Message
Chanel/MediumReceiver
Feedback
(Oxford University
Press,2014).
NURSE-PATIENT
COMMUNICATION: SUCCESSFUL INTERACTION
Scenario: During Admission Intake, Nurse Hope Soeiltry would like to
obtain a medication list from Patient Will 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!
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.).
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
Request Feedback – ask the receiver is they understood the message delivered; exercise a repeat-back and verify process to ensure successful delivery
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).
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).
RN DISCHARGE ACTIVITIES:
OVERVIEWNURSING 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).
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 Interdisciplinary Treatment Plan – monitor expected outcomes, begin arranging post-discharge arrangements, re-evaluate discharge destination if needed
Evaluate Patient Care Outcomes – based on plan of care progress towards achieving outcomes; round with the attending physician to obtain progress feedback (Cesta, 2013).
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).
DISCHARGE PLANNING TEAMS:
MULTIDISCIPLINARY INTERVENTION
STUDY Based on a study conducted in a Progressive Care Unit (PCU) in a
Midwestern Hospital
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 (Rose & Haugen, 2010).
DISCHARGE PLANNING TEAMS:
IDENTIFYING KEY MEMBERS
Physician
Physician Assistant (P.A.)
Nurse Manager
Registered Nurse
Pharmacist
Social Worker
Discharge Planner
Secretary
Continuous Improvement Specialist (Rose & Haugen, 2010).
DISCHARGE PLANNING TEAMS:
ACTIVITIES PER DISCIPLINE Physician & P.A.
Education on pathology and surgical reports
Writes discharge prescriptions the night before discharge
Completion of discharge summaries
Registered Nurse
Education on post-discharge care requirements night before discharge and on the day
Coordinate follow up for outstanding discharge items to be completed
Pharmacist
fills prescriptions at Hospital Outpatient Pharmacy
Verifies insurance information as soon as possible (Rose & Haugen, 2010).
DISCHARGE PLANNING TEAMS:
JOINT ACTIVITIES – AUDIT & SURVEY
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
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
Patient Satisfaction – 100% perceived a smooth process by 2007 (Rose &
Haugen, 2010).
DISCHARGE PLANNING TEAMS:
KEYS TO SUCCESSFUL
IMPLEMENTATIONCommunication 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
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).
STANDARDIZING COMMUNICATION:
RATIONALES FOR IMPLEMENTATION
Good Communication is characterized by:
Timeliness
Standardization of Content
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 Patient Trust
Increased Risk for Litigation (Bagnasco et al., 2013; Reilly et al., 2013).
STANDARDIZED COMMUNICATION:
PROPOSED METHODS
S.B.A.R – Situation, Background, Assessment, &
Recommendations
Recommended as a Standardized Communication Tool
Has Written and Verbal components for Communication at Patient
Hand-off and Transfer (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
Optimizes communication timing via Standardized reporting
procedure (Bagnasco et al., 2013).
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 to Verify 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).
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
Step 4: Continue the Process until Concept or Skill is Understood
Nurse Competencies – Understand Health Literacy Principles:
Encourage Patient/Family Questions
Use Plain Language
Limit Teaching to 3-5 Concepts
Document “Teach-Back” education in the identified form (Kornburger et al.,
2013).
SUMMARY & CONCLUSION
Communication
Is a vital function to ensure Patient Safety
Failures occur mostly during points of Transfer of Care
Failures carry a significant potential for Adverse Patient Events
Is best when Standardized Communication methods are utilized
Discharge Planning
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
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).
REFERENCESBagnasco, 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). Improving Transitions 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
REFERENCESKornburger, 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 to Transitions 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.). New York: Jones & Bartlett.
Oxford University Press. (2014). Shannon and Weaver’s model. Retrieved fromhttp://www.oxfordreference.com/view/10.1093/oi/authority.201108031004594
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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.
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