Importance of Clinical Risk Management for Patient Safety
Question:
Discuss about Leadership and clinical governance.
Clinical risk management has become an important priority within the health care environment to improve quality and prevent situations leading to harm or safety issues for patient. As nurses spend the maximum time with patient, nurses have a vital role in clinical risk management and coordination with diverse health care professional. Sherwood & Zomorodi, (2014) emphasize that nurses should develop quality and safety competency to have a leading role in safety of the health care system. A nurse can display his/her leadership skill to identify hazards and implement strategies to minimize them. Currently, incidence of medical errors or adverse event has become a major issue and poor communication practices among health care staff is regarded as the major cause of such errors (Carayon, Xie & Kianfar, 2014).This report is based on the scenario of the Nurse Unit Manager, who has identified incidence of patient due to poor communication practices among staffs for the past few months. Hence, in response to this, the main purpose this report is to identify strategies that a Registered Nurse can use to improve communication practices and critically discuss about its role in increasing patient safety. The report also describes the method to implement the identified strategy on the ward and its implication for professional nursing practice.
In high risk industry, effective team work and coordination between team members is crucial to achieve desired outcome. Health care is also a high risk industry where poor communication is regarded as the most common cause of adverse event within the health care environment (Gluyas, 2015). O’Daniel & Rosenstein, (2008) shows that effective clinical practice is the process where critical information is communicated accurately across team members. However, faulty communication practices increases risk of patient safety related issues. Hence, it can be said that lack of communication is the main factor that leads to medical errors and severe injury for patient. As a registered nurse (RN), the most crucial step would be to identify relevant strategies to improve communication between staff members.
To make effective collaborative practice a reality, structured communication tools or strategy is most important resource to provide specific framework to all health care staffs for communication. Briefing sessions or short discussion between team members is a structured communication strategy to promote sense of collaboration and set the tone for open communication between health staffs (Rodriguez et al., 2015). In the context of the scenario of RN to improve communication practices on the ward, the strategy is to implement short briefing strategy where team can meet for 10-15 minutes and stay informed about their work and plans. The advantage of such huddle within the health care environment is that it provide opportunities to both bedside caregivers as well as front-line staff to collect information, engage in decision making and prioritize their work. Implementation of such huddle will ensure that health care team meets frequently and they are proactive in addressing needs and demands of patient (Leykum et al., 2014). The core purpose of communication between health care staffs is to be aware about the patient situation and their circumstances. Evidence proves that situation awareness among team is enhanced by safety huddles and briefings. It explained that safety huddles and briefing process enable continuity of care and achieving communication practice improvement in health care setting (Cornell eet al., 2014).
The Role of Nurses in Clinical Risk Management
Apart from daily briefing before rounds, Leykum et al., (2014) also proposed use of the Situation Task Intent Concern Calibrate (STICC) framework during rounds to help the health staff related to patient and understand their issue. This is essential as it guides clinicians and others staffs to come to an understanding about patient and their critical condition. In the context of scenario, where incidence of error was the main reason for registered nurse to develop strategies for communication improvement, the STICC can be useful communication template for nurses when time pressures lead to mistakes for them. The STICC tool was developed by the US Forest Service to provide guidance to firefighters. The STICC enabled staff to consider the situation (S), the task (T), intent (I), concern (C) and calibrate (C). Currently health care providers are also training nurses and physician to use the tool. This tool will enable staffs to anticipate complication in patient and communicate those changes effectively with the staffs during care transitions (Leykum & O’leary, 2017).
From the above discussion, it can be affirmed that briefing sessions before rounds along with use of STICC framework before round is the strategy identified to address communication failure and improve communication practices among staffs in the ward. This strategy is also part of the PRISm intervention implemented by Leykum et al., (2014) thus proving its effectiveness in clinical setting. The STICC framework has been specifically chosen because it has been designed to assess and control communication failures that lead to inpatient adverse event (Leykum et al., 2015). Hence, for the goal of improving communication practice, the implementation of this tool will clarify RN regarding how teams are making sense of team discussion during daily rounds.
Incidence of medical error or adverse event was the main trigger for changing communication practices in the ward. Various evidences also prove that poor communication among health care staff is the leading cause of medical errors in health care setting (Heale & Douma, 2016; Haynes & Strickler, 2014). Insufficient and poor collaborative communication between nurses and clinicians increases rate of adverse event, duration of hospital stay and resource utilization for patient (Heale & Douma, 2016). Although appropriate team communication and collaboration is the expectation form multi-professional team, however this process is challenged by many inter-related dynamics. For instance, variety of disciplines needs to provide care at diverse time thus preventing regular synchronized interaction. Power distance factor between physician and other staffs also act as a barrier in communication process (Dingley et al., 2016). Hence, considering such challenges, the strategy of team huddle before each shift is considered effective in addressing such barriers in the communication process.
Klipfel et al., (2014) has showed that team huddles creates a microsystem, where team members can meet with a specific focus to share and exchange information related to a particular unit or ward. By the process of concurrently sharing and communicating information with the team before the shift, it promotes awareness about health status, care needs and treatment process for each patient. It minimizes any confusion or interruptions that become the main cause of adverse event. Hence, briefing strategy is found beneficial for patient safety and keeping all staff on the same page.
The Consequences of Poor Communication Practices in Healthcare
The STICC tool along with briefing strategy has been specifically chosen to improve communication practices among staffs on the ward because this tool facilitates practice improvement and reduction of adverse event in patient. Leykum et al., (2014) implemented both these strategies on a team of physicians in South Texas Health Care System as part of the PRISm intervention (Physician relationship, improvising and sense-making) and assessed its impact on adverse events in the hospital. In case of participants, their relationship, sense-making and improvising behavior was examined. The review of the methods implemented in the study revealed that the PRISm intervention can be useful in reducing the cost and frequency of adverse event. The process of improvising and sense-making will also enhance collaboration with team process which in turn will promote safety of patient in health care setting. Leykum et al., (2015) also found association between sense-making practices of team and hospitalized patient outcome. The assessment of patient discussion among health care team using the STICC framework revealed that such purposeful rounds were associated with reduced complication rates.
The Australian Commission also emphasize on quality and safety in health care by the implementation of the National Safety and Quality Health Service Standards (NSQHS). The main aim of this standard is to protect patient from any harm and improving the standards of healthcare. It has provided guidance to health care staffs regarding the level of care needed to deliver quality and safe care. It has a total of ten standards to achieve the goal of safety and quality in health care (Australian Commission on Safety and Quality in HealthCare, 2017). The strategy of briefing session or team huddle along with STICC framework is related to the standard 6 (clinical handover) and the standard 9 (recognizing and responding to clinical deterioration in acute health care) of the NSQHS standard. This can be said because standard 6 explains the needs for improvement in clinical handover process by the use of appropriate procedure, agreed tools and implementing best practices for collaboration between health care team (National Safety and Quality Health Service Standards, 2017). The briefing strategy enables fulfilling this standard as it focus on regular collaboration with staffs to prioritize care plan and share information about patient. In addition, the identified strategy also related to standard 9 as STICC framework will support staffs in responding appropriately to patient deterioration (Leykum et al., 2015). It will help to escalate care for patients with complications.
Implementing briefings and structured communication tool within the ward can be a challenging task for RN. This is because it will involve changing the normal workflow and the process that staffs followed for communication with inter-professional team. Hence, firstly, it will be important for RN to establish a culture to support communication between them. The RN can do this by exchanging information related to key role and responsibilities of each staff and encouraging accountability for patient care. This is crucial to set the tone for patient safety (Weller, Boyd & Cumin, 2014). In terms of behavioral and professional standards needed within health care, zero-tolerance policy will also be rolled out so that staffs comply with professional standards and ethical code of conduct. The next critical step would be to change staff’s attitude towards team communication and make them understand the need for following new communication strategies and protocol within the ward (Mitchell, 2013). Such practice is beneficial to reduce barrier in the process and increase the chances of success of the strategy. This can be done by having a meeting with the staffs regarding the purpose and benefits of implementing the new briefing protocol and STICC framework for communication between staffs. All staffs will made aware about the importance of hurdle to share information and solve staff concern regarding patient or other issues.
Strategies for Improving Communication Practices in Clinical Risk Management
While implementing the briefing strategy before round, it will be essential to develop common checklist on the basis of which nursing and other health care staffs can proceed with their briefing or huddle session. A standard time for the huddle will be fixed for each day and the duration will be for 10-15 minutes. In order to keep the same structure for every day, t is planned to include the following component in the checklist for the briefing session:
- Key admission/care priorities of the day
- Identification of the patient with complicated clinical status or outcome
- Detail about care needs and intervention for each patient
- Assessment of team’s awareness about all vital information for the day (Leykum et al., 2015)
The above mentioned approach will be useful in preparing staffs for the day and taking timely response to solve critical issues in the ward. Such checklist is likely to enhance the success of the briefing strategy in improving teamwork and communication practices in the staff.
After preparing the health care team for briefing sessions by distribution of briefing checklist, the next step for implementing the strategy would be to train the staffs to use STICC tool for discussion about critical patient. For each of the elements of the STICC tool, the health care staffs can use the following questions or statement to discuss about individual patient:
Situation: ‘We are current dealing with the …… patient with …….issue’
Task: ‘What are we going to do for the patient?’
Intent: Discussion on the specific diagnostic and purpose of specific intervention for patient
Concern: Discussion on challenges in the process and specific components that needs to be monitored in patient
Calibrate: Clarifying regarding the process or any step that is unclear
The above mentioned process will be the right approach to successfully implement the strategy in the ward. Furthermore, the effectiveness of new communication practices can be enhanced by having a clear objective for each huddle and reviewing the work done based on the team discussion and new information acquired during the session (Provost et al., 2015). Furthermore, the success of the strategy will also be evaluated by monitoring the rate of adverse event after the implementation of tool.
The implementation of the identified strategy of briefing session along with STICC framework can have many positive and negative implications for professional nursing practice. Firstly, many barriers may come during the implementation of this process. For instance, many nurses man favor the previous method of communication or they may not understand the need for adapting structured communication strategy. This issue can be addressed by meeting with the staff and clarifying them about the purpose of change (Grol et al., 2013). Secondly, lack of knowledge about the briefing strategy and the use of STICC framework can lead to resistance from nurses. Hence, this issue can be addressed by the disseminating checklist and key procedure to all nursing staffs. Furthermore, a short period of training regarding the new strategy may also change the motivation of nurse to adapt the new strategy for communication among staff.
Apart from barriers, there are many positive implication of the implementation process for nurses. For instance, structured briefing process will enable nurse to share proper information to team members regarding the identity of patient, informed context, verbalization of procedure and other documentation process. During the briefing session, they can clarify regarding the actions needed to handle patient in a safe manner. The team huddle will particularly enhance the handoff process in nursing practice. It will enhance the transfer of information during transitions in care and clearing any doubts regarding the process (Coleman et al., 2015).
The Advantages of Briefing Sessions in Healthcare Communication
The briefing process will set the tone for nurse to share and exchange information about patient to multi-professional team. In addition, the STICC framework will have implications for nurses in strengthening their critical thinking skills to handle patient with clinical deterioration. Vertino, (2014) also supports the fact that poor team communication has direct impact on preventable medical errors, high nurse turnover rate and low morale of nurse. Hence, the identified strategy can act as solution to reduce stress level of nurses and improve their communication practices in a multi-professional team. The new strategy of team huddles and using evidenced based tool to handle complex patient will enable nurses to overcome the daily challenges in the job. It will enhance their confidence and support them to openly discuss about any concerns to other team members (Pfaff et al., 2014). Hence, the strategy will positively influence the nursing profession as it will enhance efficiency in daily work and clarity in roles. It will support nurse to disclose challenges and learn useful approach to handle complex situation. This will eventually improve the quality of nursing care and reduce the rate of medical errors too.
Conclusion:
In response to the issue of medical error due to communication failure among staff, the main purpose of this report was to identify one strategy to improve the communication practice in the ward. The strategy of briefing session along with STICC framework has been identified to improve communication practice because it is a structured communication tool that prepares all the health care team to be on the same page and have clear information regarding duties for the day. Another advantage of the framework is that it has been specifically designed to address communication failure in health care setting and reduce adverse event. Hence, proper implementation of this tool with focus on dissemination of checklist and procedure to all staffs will bring efficiency in care and support the nurse and other staff to provide safe and quality care to patient.
References
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