bonnie c. desselle, md program director lsuhsc pediatric residency program strategies and tools to...
TRANSCRIPT
BONNIE C. DESSELLE, MDPROGRAM DIRECTOR
LSUHSC PEDIATRIC RESIDENCY PROGRAM
Strategies and Tools to Enhance Communication Among Health
Care Providers
Communication Series
Part 1: Hand – offsPart 2: Formal PresentationsPart 3: Communication during Emergencies
Hand - Offs
Mechanism of transferring information, responsibility and/or authority from one set of care-givers to another
Sentinel Events
Root Causes of Sentinel Events(1995-2005) -The Joint Commission of Accreditation of Hospitals
Organization culture
Care planning
Continuum of care
Leadership
Environ. Safety/security
Procedural compliance
Competency/credentialing
Availabilty of info
Staffing
Patient assessment
Orientation/training
Communication
0 10 20 30 40 50 60 70
Call to Improve Handoffs
Joint Commission, 2006 National Patient Safety Goal
World Health Organization, 2006 Prevention of handover errors part of “High Fives” patient
safety solutionsInstitute of Medicine, 2008
Teaching programs “should train residents in how to hand over their patients using effective communication.”
ACGME, 2010 Programs must ensure and monitor effective, structured
hand-over processes Must ensure that residents are competent in the hand-over
process
Group Discussion
Characteristics of Worst and Best
Sign-offs
Group Discussion
Live demonstrations of sign-offs
Essential Elements for Pediatric Sign-out List
Demographics Name MRN Unit/room number Age Weight Gender Allergies Admit date
Attending physician/Service/Consults Phone numbers and covering physician
History and Problem List Primary diagnosis(es) Chronic problems (pertinent to this admission/shift)
Current condition/status
Essential Elements for Pediatric Sign-out List
System based Pertinent Medications and Treatments
Oral and IV medications IV fluids Blood products Oxygen Respiratory therapy interventions
Pertinent lab dataTo do list
Check x-ray, labs, wean treatments Include rationale
Essential Elements for Pediatric Sign-out List
Contingency Planning What may go wrong and what to do
If this…then do this Include rationale What has/ has not worked before (e.g. responds to nasal
suctioning)
Code status/family situations Difficult family or psychosocial situations Code status, especially recent changes or family
discussions
Practice a sign out
Essential Elements for Receiver
Readback/Summation: co-orientationQuestions/clarificationsCollaborative cross check
Other Essential Elements
Proper Environment: sterile cockpit No distractions Quiet place Always face to face
Start with sickest patientNever say “ This is not my patient….I am just
covering for the night”
PGY- 1
Essential Elements of Sign-out Giver Mastery Patient identification Patient background Current conditions or current physical exam Contingency plans Overall general treatment plan
PGY-2
3 Essential Elements for Sign-out Receiver Mastery Readback/summation: Co-orientation Questions/clarifications Solicit other overnight tasks for patient
PGY-3
Has mastered giving and receiving sign-outWorking towards:
Collaborative cross checkOff topic discussion that include teaching
points
Summary
Effective exchange of information is vital during sign-outs
Both the giver and receiver have specific roles and responsibilities
Hopefully we have given you some tools to make your hand-offs more effective
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