INQRI Funded Study: More than Half of Ventilated ICU Patients Have Ability to Communicate

Assistive communication tools could benefit more than half of patients in intensive care units (ICU) who are using ventilators to help them breathe, according to a new study co-funded by the INQRI program.

“Our findings challenge the commonly held assumption of many clinicians and researchers that these patients are unable to communicate or participate in their care,” INQRI grantee and study co-author Mary Beth Happ said in a statement. Happ is a professor of nursing at The Ohio State University.

The study found that 53.9 percent of the patients screened met basic communication criteria and could possibly benefit from the use of assistive communication tools and speech language consultation, including such simple tools as notepads and pens.

“Establishing lines of communication is the first step in a patient being able to make his or her needs known and have accurate symptom assessment and management, and contributes to an overall better patient experience. We know from interviews with patients who remember their critical care experience that the inability to communicate is anxiety producing and, in some cases, terrifying,” said Happ.

The study, which involved screening nearly 3,000 mechanically ventilated patients over a two year period, appears in the January/February 2015 issue of the journal Heart & Lung and is co-authored with Happ’s colleagues from the University of Pittsburgh. The study is co-funded by the National Institutes of Health.


Happ’s previous INQRI work includes the study “SPEACS2: Improving Patient Communication and Quality Outcomes in the ICU,” which examined the value of a nurse-generated and nurse-led innovation by testing the impact of a computer-based nurse communication training and materials program (SPEACS-2) on intensive care unit patient care outcomes. The interdisciplinary research team included Amber Barnato, who also co-authors Happ’s current research.

Incorporating Patient-Reported Outcomes in Care Plans Beneficial

Improving two-way communication between patients and caregivers can improve outcomes for cancer patients in palliative care, particularly in the area of patient-reporting, according to an oncology nurse specialist and nurse scientist Jeannine M. Brant of the Billings Clinic in Montana.

During the American Society of Clinical Oncology’s inaugural Palliative Care Symposium Brant told participants “we really have a propensity to underestimate symptoms – not only the incidence, but also the severity of the symptom, and also what type of distress that symptom is causing for that individual patient. We need to incorporate patient-reported outcomes [PROs] into our clinical practice,” according to an article in The Oncology Report.

There are numerous reasons for a breakdown in communication between a care provider and patient, including patients’ embarrassment to disclose certain symptoms, the article notes. Physicians and nurses may not ask about specific symptoms due to gaps in their knowledge or time constraints.

Brant presented findings from a pilot study with the semi-automated care planning system On Q that uses both patient-reported and clinical data to generate a customized draft patient care plan. More than 90% of patients in the pilot reported being satisfied with the system and said they would recommend it to others, with one participant commenting that it provided a reminder to bring up issues they were dealing with.

An INQRI study, Nursing's Specific Contributions to Quality Palliative Care within the Context of Interdisciplinary Intensive Care Practice, explored the relationships between quality palliative nursing care delivered in intensive care units and patient and family outcomes. The study also explored how to measure and to improve these outcomes. This interdisciplinary team was led by Lissi Hansen and Richard Mularski.

Hospital’s Communications, Medical Teams Join Forces to Highlight Medical Errors

By combining the expertise of a multi-disciplinary medical team and the Communications Department, the University of Texas MD Anderson Cancer Center is creating visual story-telling presentations to highlight medical errors, ClinicalOncology.com reports.
 
The Center, based in Houston, Texas, produces “video stories,” which contain recommendations based on adverse drug-related events, in combination with photos, audio recordings and video re-enactments. The presentations are shown during staff and committee meetings and are available on the hospital’s intranet site.

The presentations illustrate gaps in everyday medical processes that can lead to medical errors. For example, a presentation may explore the drug use processes ranging from prescribing to administration and analyze where errors might occur.

Errors are identified every month by a multidisciplinary team that includes a nurse, pharmacist, and patient safety specialist. The group selects three events or topics and then another larger multidisciplinary group of nurses, pharmacists, and mid-level providers choose one topic to be developed into a visual presentation.

Between October 2012 and June 2013, hospital leaders accessed the eight once-monthly videos nearly 3,500 times, according to ClinicalOncology.com. The response from hospital leaders, as well as front-line nurses, pharmacist and physicians, has been overwhelmingly positive, according to the project’s administrators.

An INQRI-funded study led by Linda Flynn and Dong-Churl Suh examined the “Impact of Nursing Structures and Processes on Medication Errors.” The multidisciplinary research team identified changes in nursing care processes needed to prevent medication errors as well as adjustments in nurse staffing and the practice environment that can facilitate interception of such errors.

Good Communication Is Just as Important As Good Care

In an opinion piece for the New York Times, Theresa Brown, an oncology nurse and author, discusses the importance of clear communication between doctors, nurses, and patients to ensure that patients comprehend diagnosis and treatment, and have a positive experience. These factors can ultimately improve patients’ health outcomes.

“A growing body of literature suggests that these clinical miscommunications matter, because the success of physician-patient interaction has a real effect on patients’ health,” Brown writes. “In a 2005 article … researchers at the University of Washington, claim that treatment outcomes are better when doctors show more empathy and take the time to make sure patients understand what’s going on.”

Brown, who authored Critical Care: A New Nurse Faces Death, Life, and Everything in Between, has often seen situations where even when quality care is provided, a patient feels that they received poor care because the process of diagnosis and treatment was not handled properly and they became confused.

“Interestingly, patients in hospitals report more satisfying interactions with physicians when doctors sit down during rounds instead of standing,” Brown writes, citing a 2012 article co-written by nurse practitioner Kelli J. Swayden in Patient Education and Counseling. “Sitting gives the message ‘I have time,’ whereas doctors who stand communicate urgency and impatience.”

Hospitals are very busy and focused on “volume and flow” and billable procedures, however providers need to remember that taking time for the “human” element can ultimately improve patient outcomes, Brown concludes.

An INQRI-funded study “A Quality and Cost Analysis of Nurse Practice Predictors of Readiness for Hospital Discharge and Post-Discharge Outcomes” looked at how improving the hospital discharge process can improve patient outcomes and reduce unnecessary readmissions. Researchers at Marquette University, led by Marianne Weiss and Olga Yakusheva identified the contributions that nursing staff make to the quality of discharge teaching and the impact of that teaching on patient outcomes, readiness and readmission rates of patients who are discharged home.

They found that when units had more RN hours per patient day, fewer overtime hours and fewer vacancies, the discharge teaching was of higher quality, patients reported greater readiness for hospital discharge, and post-discharge utilization of readmission and emergency room visits was lower. The project findings are presented in a research brief on the Robert Wood Johnson Foundation's website.

INQRI Project Provides New Online Communication Tools to Improve ICU Patient Care

ICU patients who can’t communicate because they are ventilated or using artificial airways can become anxious, frustrated and possibly even panic, putting them at risk for adverse events. Now, new evidence-based online training materials are available to help nurses and other health care providers communicate with these patients.

An interdisciplinary research team funded by INQRI developed and tested SPEACS-2 (Study of Patient-Nurse Effectiveness with Assisted Communication Strategies), a program that includes web-based communications training for nurses, resources to use with patients, and bedside teaching rounds provided by a speech pathologist. The program improves nurses’ knowledge of, comfort with, and satisfaction communicating with mechanically ventilated patients. It also helps patients avoid the frustration and stress of being unable to communicate.

Now the SPEACS-2 communications training program is available online. It consists of tools, resources, and six ten-minute interactive learning modules, which include:

• Introduction to the SPEACS-2 program and assessment to determine how best to use the communications strategies and tools;
• Techniques to help patients better understand questions and instructions, assessing patients’ ability to communicate and establishing communications with patients;
• Techniques to help patients who are cognitively impaired understand and communicate;
• Techniques to better support and understand patients’ “unaided” communications, such as gestures or mouthing words;
• Techniques and materials to assess and support patients’ written communications; and
• Demonstrations of communications strategies to use with patients with impaired movement or attention, and a presentation of the role of a speech language pathologist in assisting with communication.

The INQRI-funded research team that developed and tested SPEACS-2 was led by Mary Beth Happ and Amber Barnato. The study was conducted at the University of Pittsburgh.