Communication Compliance of Nightingale Community Hospital

Nightingale Community Hospital as an organization has a schedule of tasks to facilitate the delivery of quality services. Even so, these routine activities need to be inspected, monitored, and reviewed continuously to be useful to prevent minor problems that if allowed to escalate can cause harm to the entire patient care. Therefore, the Joint Commission, which is the institution tasked with the auditing, inspection, and validation of the healthcare provider activities, has to accredit it from time to time. Consequently, while the commission will conduct another audit review for the hospital, NPSG data on communications of the hospital indicate that Nightingale lacks the required standard level of communications. Evaluation of Nightingale’s communication compliance with the Joint Commission reveals the following results.

UP.1.01.01: Elements of Performance

The commission expects all hospitals to ascertain that the procedure is being performed correctly on the right patient and that it should be verified at a particular interval depending on its complexity. The process should seek to confirm and gather more information regarding both the patient and the procedure before employing it on patients. Additionally, the healthcare providers should ensure that any related information, documents, and equipment are available before starting to enhance communication using the following elements of performance.

1. Implementing a pre-procedure process that verifies that the right procedure is used for the right patient.

From the pre-procedure handoff and site identification document provided, Nightingale complies with this element of performance as it has consents, and verifies that the right person for the procedure. While NPSG data reveals that Nightingale's current accuracy in identifying patients has improved as compared to the previous data, improvement is required since it is just 42%. Moreover, using abbreviations and incorrect verbal orders can cause miscommunication making the verification process difficult. Thus, with the patients’ involvement and consents required in making health care decisions and ascertaining the procedure, the pre-procedure process will face challenges in the hospital (Grady, 2015).

2. Identification and verification of the documents, items, and equipment to be used.

While Artifact_3 document indicates that the hospital verifies the documents of the patients by outlining the protocol that is used, Nightingale does not comply with this element of performance, and there is no clear procedure to verify the equipment to be used for the procedure. Even so, with the verification process of the correct person involving the patient when awake, the pre-procedure handoff document contains only a few items and has no equipment that is to be used for the following procedure.

3. Matching the items verified to the patient’s procedure area.

From the NPSG data, the Commission should be worried about communication of the health practitioners when matching the items due to poor documentation revealed on the 60 minutes scope of reporting critical results, verbal orders, and the use of unacceptable abbreviations.

UP.01.02.01: Elements of Performance

While site marking is not necessary if only a single person performs the procedure continuously, still the commission expects that the following elements of performance are complied with to ensure better communications during the procedure.

1. Identifying procedures whose insertion or incision site should be marked for easy locating later. Using permanent markers, and using X-rays and need localization for references ensures that the hospital meets the standards set by the Joint Commission if the personnel use the site marking procedure that it has documented in Artifact_3.

2. The procedure site should be marked before being performed, and involve the patient if possible. Nightingale complies with this element of performance, as the Artifact_3 document of the hospital indicates that the patient is involved in identifying and marking the invasive site before it is used.

3. The marking is conducted by an independent practitioner who is licensed and is held accountable. He or she should be present during the procedure and if unavailable must delegate. The site verification and identification protocol outlined by the hospital stipulates that the marking site must be justified. Moreover, the marking is done by surgeons meaning they must be licensed, complying with this element of performance in the process.

4. The marking method used by any hospital should be consistent in the entire hospital.

Nightingale Community Hospital strives to ensure that all sites are marked and uses common letters such as LT for left, RT for the right, BIL for bilateral, or C for cervical, L for lumbar, and S for sacral in the entire facility. However, its inability to improve communication effectiveness by ordering the verbs or read backs correctly is a setback to accurate marking. Moreover, the constant use of other abbreviations, like qd, sc, you, ss, among others, confuses marked sites. While Isles and Pearn in their study to determine the impact of acronyms on the pediatric research argue that they cause misconceptions and misunderstandings of the marked incisions (Isles & Pearn, 2014). With the hospital’s NPSG data indicating the use of unacceptable abbreviations to 63%, Nightingale's efforts on the universal protocol of site marking may not be sufficient, as most of the markings will be confusing.

5. There should be an alternative process for site marking that is written to be used in instances that the patients refuse or unable to mark the site. While Artifact_3 indicates that there should be justification for a patient failing to mark the site, the hospital does not comply with this element of performance, as there is no alternative process given by the hospital.

UP.01.03.01: Elements of Performance

The Commission expects hospitals to use time-outs to carry final assessments on the identification of patients, procedures, and marked sites. During these periods, the team members should communicate in cases where any of those mentioned above are violated. The elements of performance that hospitals should comply with are listed below.

1. Conducting a time-out immediately before starting the marking site procedure. In the time-out procedure provided by the hospital, Nightingale complies with the commission's standards as the technologist or nurse's responsibility is to call for a time-out immediately before the start of the procedure.

2. It should be standardized by the hospital, involves immediate members to carry the procedure, and must have been initiated by one of them. With all members being able to request for a time-out, one of them initiates it, and the approval by the surgery leadership committee of Nightingale hospital's time-out procedure ensures that it complies with the standards of the commission if the outline sequence is followed.

3. In case a patient requires two or more procedures if the person who was performing them changes there must be a time-out before each procedure. The hospital does not comply with the Joint Commissions set standard, as it lacks this on its time-out procedure.

4. Team members should agree on the identity, procedure, and site. The procedure provided by the hospital ensures that it complies with this element of performance, as it stipulates that all the involved personnel should verbally and audibly agree on the patient identity, site, procedure, patient position, as well as equipment. However, with the hospital lacking the fundamental standards that facilitate a flawless communication, it follows therefore that there are disagreements, as evidenced by the increased time-outs in the NPSG data. Moreover, given there are flaws in their container labeling gives room for disagreements during time-outs.

5. At the end of the time-out, it should be documented.

The inability of Nightingale to document critical results incidents after a sixty-minute period pinpoints to the hospitals' poor documentation. As a result, the communication may not be clear especially when one patient requires two or more procedures to be performed. Consequently, Nightingale Community Hospital does not meet the Joint Commission’s elements of performance in any of the three Universal Protocols including having successful time-outs.

Corrective Action Plan

Communications can be improved in Nightingale Community Hospital by reviewing the NPSG data provided by the hospital and ensuring that all communication areas are corrected, adjusted, and enforced using practical methods.

First, the hospital needs to improve on its documentation and recording to ensure a flawless communication. Effective communication between healthcare providers plays a significant in delivering safe care for patients. Hence, documentation of any information, procedure, site, items, or equipment that they utilize is essential in the passing or transfers of information and compromises the patient safety, as well as outcomes(Braaf, Manias, & Riley, 2011). Due to the human nature’s forgetfulness and poor memorization, eliminating this by documenting and recording of events, procedures, and results helps reduce the error, as they can be referenced later. For example, healthcare providers at Nightingale Community Hospital should document when they report the critical results after 60 minutes, record all patients that require specific care such as cardiac catheterization, to avoid the shambles noted of patients having care minus the required documentation.

The second communication area that should be corrected in Nightingale is their verb orders, which cause errors in service delivery. I believe that every health practitioner at the hospital should be held accountable for his or her wording and verbal order. Multiple errors that arise from misplacing of words are because of misunderstandings of the ordering. Moreover, the different diversities available at a workplace such as a hospital follows that an incorrect verbal order will cause miscommunication. For example, a life-threatening situation can be caused by a nurse failing to pass information regarding a patient not to use say metal plates when eating, to the second nurse when his or her shift is over. It is undeniable that if such order had been documented correctly, other nurses would be able to review the information and such an incident cannot occur. As a result, by taking everyone at the hospital responsible for his or her written orders and signing at the end, such an error can be prevented.

Thirdly, the use of unacceptable abbreviations is frequent in this hospital. With the facility adopting some letters such as C for cervical, RT for the right, and BIL for bilateral among others when marking procedure sites, their use in the setting is just absurd. Unfortunately, the increase in electronic media messaging and social media platform chats in the current generation promotes the use of short words and multiple acronyms. Even so, any healthcare professional should know that such communications within the hospital is wrong and leads to the patient’s safety being compromised and can cause deaths(Brunetti, Santell, & Hicks, 2007). Therefore, the hospital should avoid using abbreviations like "SS," and still use "S" to mark a site for sacral, as it can easily confuse. Also, the management should post reminders and signs in working stations of hospital employees that warn them of using such abbreviations.

Still, any correction plan should be goal oriented, have a measurement scale, and be implemented and continuously monitored to be successful. Consequently, the issues mentioned earlier in communication should have a period, a goal, and measurement goal. For this action plan to be flawless to meet the standards for communication, a collective effort is required from every Nightingale's personnel. For example, the documentation of the 60 minutes of analytical results should be a rule, and every nurse should keep records. In fact, patients should not be transferred to another care unit without the caregiver handing the necessary documentation to the patient. Moreover, evaluation and monitoring of record keeping, as well as the unification of the verbal order is in order after 30 day and 90 days respectively, if 100% flawless communication is to be achieved.

Communications Importance in Healthcare and Justifications

With the information from the NPSG data revealing the shambles in communication that has been stated in this paper, it can be concluded that Nightingale Community Hospital lacks effective leadership that can enforce and implement effective communications in the facility. One such example is the results obtained from nurses that claimed the leaders had not communicated to them regarding the policy related criteria for screening. Consequently, the personnel lacks a practical education on methods of communication, and the hospital's leadership should be held accountable. That said, it is evident that correcting the mentioned issues will promote the organization’s overall patient safety, as well as quality service delivery.

Extensive research reveals that despite the knowledge of the caregiver, still, his or her communication skills play a significant in caring or helping a patient(Anwar, 2017). With communication being able to break or make the bonding between the patients and the healthcare givers, hospital employees should effectively communicate to pass information, solutions, problems, decisions, facts, feelings, as well as ideas to make it perform better(Raman, 2016). Therefore, healthcare professionals’ communications skills should be of high priority and stellar as it is useful in communicating with teammates and management. Also, the expressive behaviors exhibited by the physicians to the patients influence the health outcomes including functional status, appointment keeping, and patient satisfaction.

Additionally, effective communication in the healthcare industry can help in death and injury preventions, increasing patient-caregiver trust, and strengthens the staff-to-staff relationships. Moreover, excellent communication in the hospital setting is crucial in discussions of patient needs, procedures, marked sites, and other patient information such as medical histories that are important for the treatment(Jackson, Coleman, Schnipper, & Kripalani, 2007). Besides, health practitioners should not risk miscommunication as it leads to patient injuries, malpractice, and death.

Conclusively, Nightingale Community Hospital can improve the quality service delivery and ensure patient safety by having proper records, documenting the incidents of analytical results after 60 minutes, use only acceptable abbreviations, and have verbal unifications by eliminating the orders. Even so, full implementation of the corrective action plan provided can assist in preventing deaths or injuries that may occur because of the miscommunications.

References

Anwar, S. (2017). Impact and importance of effective

communication in healthcare delivery. The Daily Star. Retrieved from: https://www.thedailystar.net/health/impact-and-importance-effective-communication-healthcare-delivery-1433701.

Braaf, S., Manias, E., & Riley, R. (2011). The role of documents and documentation in communication failure across the perioperative pathway. A literature review. International Journal of Nursing Studies, vol. 48, no. 8, pp. 1024-1038.

Brunetti, L., Santell, J. P., & Hicks, R. W. (2007). The impact of abbreviations on patient safety. Joint Commission Journal on Quality and Patient Safety, vol. 33, no. 9, pp. 576-583.

Grady, C. (2015). Enduring and emerging challenges of informed consent. New England Journal of Medicine, vol. 372, no. 9, pp. 855-862.

Isles, A. F., & Pearn, J. H. (2014). Acronyms confuse everyone: combating the use of acronyms to describe pediatric research studies. Journal of Pediatrics and Child Health, vol. 50, no. 10, pp. 756-758.

Jackson, A. T., Coleman, E. A., Schnipper, J. L., & Kripalani, S. (2007). Promoting effective transitions of care at hospital discharge: a review of key issues for hospitalists. Journal of Hospital Medicine, vol. 2, no. 5, pp. 314-323.

Raman, M. (2016). Importance of Effective Communication in Healthcare Settings: Proceedings of the 81st Annual Conference of the Association for Business Communication, (pp. 1-13). Albuquerque, New Mexico.