Thursday, December 3, 2009

Improving Communication To Reduce Medical Mistakes

To Err Is Human Blog Series Logo

This post is part of our two-week series commemorating the 10-year anniversary of the seminal IOM Report "To Err Is Human." To see all posts in the series, please click here.

A man in the intensive care unit (ICU) kept trying to communicate a message to the nurses but he was on a ventilator and it was difficult to speak. The nurse thought he was saying that he was in pain and got him a painkiller. But that’s not what the man was saying and the painkiller was a mistake.

When patients can’t communicate clearly, nurses and doctors can get the wrong message. That miscommunication can lead to unneeded procedures, medication or a lapse in care—all of which can harm patients, says Mary Beth Happ, a nurse researcher at the University of Pittsburgh.

In this case, the man was lucky. Nothing serious happened. But a miscommunication like this could have led to a longer period on the ventilator, or a serious medical complication – all of which are unnecessary and increase hospital stays and health care spending.

Ten years ago the IOM report “To Err is Human” focused attention on egregious medical mistakes like the case in which a surgeon amputated the wrong leg. But Happ and her team that includes co-principal investigator Dr. Amber Barnato have focused on subtle mistakes that can arise when a patient can’t talk easily.

Lots of patients, like the man in the ICU, are on ventilators and can’t talk because they have a tube in their throat, Happ says. Others are on medicine that makes them groggy and still others are too sick to communicate clearly to the nurse or doctor.

The IOM report also raised the bar on quality of care and patients who cannot communicate clearly can get frustrated and that can also lead to sub-optimal care, Happ says. She says agitated patients in the ICU can pull out tubing or disrupt medical devices and that’s a big problem for nurses trying to provide the best care.

With INQRI funding, Happ and her colleagues are studying if techniques used to improve nurse-patient communication will enhance the quality of care at the bedside. She’s testing a system in which nurses are trained to ask confused or very sick patients a simple question with a response tagged on the end.

For example, instead of asking “are you in pain?” the nurse will ask “are you in pain--yes or no?” Happ says that a yes/no tag at the end of the sentence focuses the patient’s attention on the question at hand and even very ill patients will respond and then can be treated appropriately.

In other cases, a nurse will use an alphabet board to help the patient point to words that can clarify a request or a symptom.

The INQRI study will compare the intervention to the standard communication between patients and nurse, which can be haphazard and unclear. There’s no data yet to say whether such communication tools will help improve care or reduce the risk of medical errors or mistakes. Still, Happ says that an immediate benefit of such training may be that patient’s are less likely to be frustrated or agitated and that can lead to a smoother, faster recovery.

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