Communication Strategies To Promote Resident Safety

Slide 1: Communication Strategies To Promote Resident Safety

Slide 2: Objectives

After participating in the session, attendees will be able to—

• Identify possible barriers to effective communication within a facility culture.
• Describe how staff can use the CUS technique (concerned-uncomfortable-safety issue) to promote resident safety.
• Explain how the Two-Challenge Rule can be used to ensure resident safety concerns are clearly articulated and understood.

Slide 3: Remember T.E.A.M.S To Improve Culture¹

Excellent Communication - Infographic that outlines characteristics of excellent communication and describes how the AHRQ Safety Program for Long-Term Care helps facilities improve communication.

Assess What's Working - Infographic that describes how a facility can assess what's working in its current culture and figure out how to improve.

^1. AHRQ Safety Program for Long-Term Care: Preventing CAUTI and Other HAIs T.E.A.M.S. Mnemonic Infographic. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 4: What Does Communication Have To Do With Resident Safety?²

According to Sentinel Event data compiled by the Joint Commission between 1995 and 2005, ineffective communication was identified as the root cause of 66% of reported errors.

^2. The Joint Commission. Root Causes by Event Type, 2004-2Q 2014. Sentinel Event Data. http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2Q_2014.pdf. Accessed on December 9, 2014.

Slide 5: TeamSTEPPS® Can Help!³

• TeamSTEPPS stands for Team Strategies and Tools to Enhance Performance and Patient Safety.
• TeamSTEPPS focuses on team structure and the teamwork system, leadership, situation monitoring, mutual support, and communication.

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 6: Effective Communication³

Effective communication - Effective communication is complete, clear, timely, and brief

Effective communication is complete. Communicating all relevant information while avoiding unnecessary details that may lead to confusion and leaving enough time for residents, families, and staff to ask questions, and answer questions completely helps ensure complete communication.

Effective communication is clear. Using information that is plainly understood should be a priority when speaking with residents and their families; medical jargon should be avoided in these conversations. And when communicating with all members of the team, common or standard terminology should be used. Strategies to ensure that intending message was received including validation or acknowledgement and validating or checking that the information received was the intended message of the sender.

Effective communication is brief—when messages are concise, they are more effective.

And finally, effective communication is timely. Effectively communicating requires dependability about offering and requesting information and avoiding delays in relaying information that could compromise a resident's situation.

Times of observations and interventions should always be noted in the resident's record, and residents and their families should be updated frequently.

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 7: Challenges in Effective Communication

What are some challenges that may limit the effectiveness of communication?

Slide 8: Mutual Support³

Mutual Support

Overlapping circles showing six benefits of mutual support:

• Prevents errors
• Minimizes strain
• Builds trust
• Increases effectiveness
• Fosters team adaptability
• Strengthens the team

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 9: Resident Scenario #1⁴

• A physical therapy aide (PTA) is working with Mr. Larkin in the gym
• Mr. Larkin is working at a slower pace and breathing harder than usual
• The PTA's level of concern leads her to interrupt the physical therapist (PT) and report the changes in Mr. Larkin's status
• The PT responds that she will assess Mr. Larkin when she finishes with the resident she is currently working with

^4. Team Formation Success Video - Sub-Acute Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 10: CUS Words³

Please use CUS Words but only when appropriate!

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 11: CUS Words³

CUS Words

• I am Concerned
• This makes me Uncomfortable
• This is a resident Safety issue

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 12: Resident Scenario #1 With the Use of CUS⁴

Image from Team Formation Success Video, showing a patient using exercise equipment while being evaluated.

Image of TeamSTEPPS penguin dressed as a director and sitting in a director's chair.

Source: Team Formation Success Video - Sub-Acute Care: TeamSTEPPS® Long-Term Care Version.

^4. Team Formation Success Video - Sub-Acute Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 13: Recap of the Video of Resident Scenario #1 With the Use of CUS Words^3,4

How was the "challenge" presented?

• The PTA stated, "I'm concerned…"
• The PTA was uncomfortable with the resident's breathing
• She feared that his safety was at risk

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.
^4. Team Formation Success Video - Sub-Acute Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 14: Resident Scenario #2

• Mary, a nursing assistant, asks her colleague, Jessica, to help her reposition two residents in bed
• The two residents, Mrs. Cali and Mrs. Peck, are roommates
• Following repositioning Mrs. Cali, Jessica begins to work with Mrs. Peck while Mary is washing her hands

Slide 15: Resident Scenario #2 With the Use of CUS³

CUS Words

I am Concerned
This makes me Uncomfortable
This is a resident Safety issue

Jessica, I am concerned about spreading germs from Mrs. Cali to Mrs. Peck.

I am uncomfortable without both of us washing our hands before repositioning Mrs. Peck.

It could be a safety issue if we don't wash our hands first and Mrs. Peck gets sick or an infection.

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 16: Two-Challenge Rule³

Conflict Resolution - llustration demonstrating two people who have different sets of information.

Information Conflict (We have different information!)

↓

Two-Challenge Rule

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 17: The Two-Challenge Rule³

• Advocate and assert your statement at least twice if the initial assertion is ignored
• Two attempts may come from the same or different team members
• If no response, take a stronger course of action

^3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 18: Resident Scenario #3⁵

Image from Team Formation Success Video showing two medical providers talking

TeamSTEPPS penguin dressed as a director and sitting in a director's chair

Source: Team Formation Success Video - Long-Term Care: TeamSTEPPS® Long-Term Care Version.

^5. Team Formation Success Video - Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 19: What if You Are Challenged by a Team Member With the Two-Challenge Rule?

• Don't ignore it; acknowledge the concerns instead of ignoring the person
• Stop
• Resolve the safety issue

Slide 20: Scenario #3⁶

• As you watch a brief video about Mary Smith, please make note of when the use of CUS or the Two-Challenge Rule could have been used to improve Mary's safety
• After the video, chat about it

^6. Opportunity to apply TeamSTEPPS technique to improve outcome in Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.

Slide 21: Remember T.E.A.M.S. To Improve Culture

TeamSTEPPS image - Three TeamSTEPPS cartoon penguins portraying doctors and other medical providers talking.

As we wrap up, I'll leave you with this image of the penguins that you'll see all over the TeamSTEPPS materials. Today's session was really intended to introduce you to just two TeamSTEPPS techniques that can really be helpful for your team with consistent use, and you can see how these very, very easy techniques can be used in order to build the team, in order to enhance safety culture.

When I say they're very easy techniques, they do take some practice to start with. They might be simple techniques but change can be awkward at first, so we encourage you to try them and, importantly, to have everyone together to understand what the role of the person who's presenting that challenge is, and what the role of the person who's receiving that challenge is.

With that, I'd like to thank all of you for attending. We hope that you enjoy this program and found it beneficial. Keep doing great things to make nursing homes better and safer and happier places to live.

Slide 22: References

1. AHRQ Safety Program for Long-Term Care: Preventing CAUTI and Other HAIs T.E.A.M.S. Mnemonic Infographic. Rockville, MD: Agency for Healthcare Research and Quality.
2. The Joint Commission. Root Causes by Event Type, 2004-2Q 2014. Sentinel Event Data. http://www.jointcommission.org/assets/1/18/Root_Causes_by_Event_Type_2004-2Q_2014.pdf. Accessed on December 9, 2014.
3. Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.
4. Team Formation Success Video - Sub-Acute Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.
5. Team Formation Success Video - Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.
6. Opportunity to apply TeamSTEPPS technique to improve outcome in Long-Term Care: TeamSTEPPS® Long-Term Care Version. April 2013. Rockville, MD: Agency for Healthcare Research and Quality.