542420
research-article2014
AJMXXX10.1177/1062860614542420American Journal of Medical QualityAponte-Patel and Sen
Article
Improved Perception of Communication and Compliance With a Revised, Intensive Care Unit-Specific Bedside Communication Sheet
American Journal of Medical Quality 2015, Vol. 30(6) 578–583 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860614542420 ajmq.sagepub.com
Linda Aponte-Patel, MD1 and Anita Sen, MD1
Abstract Although many pediatric intensive care units (PICUs) use beside communication sheets (BCSs) to highlight daily goals, the optimal format is unknown. A site-specific BCS could improve both PICU communication and compliance completing the BCS. Via written survey, PICU staff at an academic children’s hospital provided recommendations for improving and revising an existing BCS. Pre- and post-BCS revision, PICU staff were polled regarding PICU communication and BCS effectiveness, and daily compliance for completing the BCS was monitored. After implementation of the revised BCS, staff reporting “excellent” or “very good” day-to-day communication within the PICU increased from 57% to 77% (P = .02). Compliance for completing the BCS also increased significantly (75% vs 83%, P = .03). Introduction of a focused and concise BCS tailored to a specific PICU leads to improved perceptions of communication by PICU staff and increased compliance completing the daily BCS. Keywords communication, daily goals sheet, intensive care unit, pediatrics, patient care planning In the last decade, beside communication sheets (BCSs) have been described as tools to facilitate communication between staff within intensive care units (ICUs).1,2 Ideally, they help synthesize discussions of multiple issues for complicated patients into a concise action plan.3 Using BCSs has been shown to increase compliance with clinical practice guidelines such as ventilatorassociated pneumonia prevention measures,4 deep vein thrombosis, peptic ulcer disease prophylaxis,5 and prevention of catheter-related bloodstream infections.6 Despite many examples of such sheets within the literature, the best format of such a communication sheet is unknown and possibly institution specific. BCSs at the study institution had been used for approximately 10 years in the pediatric ICU (PICU) and pediatric cardiac ICU (PCICU) as a communication tool during rounds. Over time, new items were added, such that the sheet grew increasingly cumbersome to complete. It was suspected that completing the BCS and using it as an adjunct communication tool during rounds was sporadic as a result of its increased complexity. The research team sought to streamline the BCS, using suggestions from ICU physicians and nurses to design a more effective tool. The team hypothesized that a revised, tailormade BCS would improve communication within the
study institution ICUs and would be completed more routinely. To solicit specific feedback for improvement of the BCS, a representative selection of nursing and physician ICU providers were surveyed. The research team aimed to assess opinions regarding communication in the ICUs pre and post implementation of the revised BCS. The team also assessed the compliance rate for completing the BCS pre and post implementation of the revised form and general satisfaction with the newly revised BCS.
Methods Two periods of surveying occurred: preintervention (February 2013, pre implementation of the revised BCS), 1
Pediatric Critical Care Medicine, Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY Corresponding Author: Linda Aponte-Patel, MD, Department of Pediatrics, Columbia University Medical Center, 622 West 168th St, Vanderbilt Clinic, Rm 503, New York, NY 10032. Email: [email protected]
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Figure 1. Two versions of the bedside communication sheet (BCS).
Left: Original BCS. Right: Revised BCS. The revised BCS simplifies the demographic and reminder sections, provides prompts for goals, and adds a box for plans for the following day to better include night nurses in the daily goals.
and postintervention (June 2013, post implementation of the revised BCS). The original BCS was divided into 3 sections: demographics, goals, and reminders (Figure 1). Providers were surveyed specifically about each of these sections so that the sections could be tailored to best serve the needs of the staff. In an effort to abbreviate the demographic section, providers were asked what information was absolutely necessary to include in the BCS. For the goals section, providers were asked if they thought that having categorical sections (eg, sedation, inotrope goals, fluid status) would help the organization of the BCS, and if so, which categories should be included. For reminders, providers were asked how many reminders should be included (0-2, 3-4, 5-6, 7-8) and then asked to select their top choices (eg, extubation readiness, removal of lines, antibiotic length). Additionally, providers were asked if the original BCS improved communication between nurses on different shifts and if a specific section for night nurses would be useful. All revisions of the BCS were then agreed on by the 2 investigators before implementation. The newly formatted BCS was introduced in March 2013, and PICU fellows and ICU hospitalists were
reeducated about the importance of completing the BCS. To minimize the effect of the novelty of the new sheet, 12 weeks elapsed between introduction of the revised BCS and the postimplementation survey concerning the revised BCS. During each survey period, 5 individual weekdays over a 2-week period were randomly selected. Participants, evenly distributed among 7 groups (ie, day and night PICU nurses, day and night PCICU nurses, ICU fellows, ICU attendings, ICU hospitalists), were asked to complete a written survey with the goal of obtaining a collection of opinions representative of the PICU and PCICU staff. Participants were asked to indicate their role (eg, nurse, fellow) and were informed that any information they provided would be analyzed and reported anonymously. No incentives were given, and if people declined participation, they were not included. Participants were selected based on availability and were not necessarily identical for both surveys. The preintervention survey (available in online Appendix A at http://ajmq.sagepub.com/supplemental) included 22 multiple-choice questions, including a
Downloaded from ajm.sagepub.com at University of York on June 4, 2016
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American Journal of Medical Quality 30(6)
Table 1. Qualitative Pre- and Postintervention Comparisonsa. Question
Response
How would you rate day-to-day communication between MDs and RNs in the PICU? At the end of rounds, I understand goals set by the team for my patient How would you rate the overall quality of the current BCS? How often do you use the current BCS in your daily routine? (Always, Most of the time, Sometimes, Hardly ever, Never) The BCS improves overall care of PICU patients The BCS improves communication between MDs and RNs The BCS improves communication between RNs on different shifts
Pre (%)
Post (%)
P Value
Excellent/Very good
57
77
.02
Strongly agree/Agree
94
91
NS
Excellent/Very good Always
33 26
73 48
research-article2014
AJMXXX10.1177/1062860614542420American Journal of Medical QualityAponte-Patel and Sen
Article
Improved Perception of Communication and Compliance With a Revised, Intensive Care Unit-Specific Bedside Communication Sheet
American Journal of Medical Quality 2015, Vol. 30(6) 578–583 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860614542420 ajmq.sagepub.com
Linda Aponte-Patel, MD1 and Anita Sen, MD1
Abstract Although many pediatric intensive care units (PICUs) use beside communication sheets (BCSs) to highlight daily goals, the optimal format is unknown. A site-specific BCS could improve both PICU communication and compliance completing the BCS. Via written survey, PICU staff at an academic children’s hospital provided recommendations for improving and revising an existing BCS. Pre- and post-BCS revision, PICU staff were polled regarding PICU communication and BCS effectiveness, and daily compliance for completing the BCS was monitored. After implementation of the revised BCS, staff reporting “excellent” or “very good” day-to-day communication within the PICU increased from 57% to 77% (P = .02). Compliance for completing the BCS also increased significantly (75% vs 83%, P = .03). Introduction of a focused and concise BCS tailored to a specific PICU leads to improved perceptions of communication by PICU staff and increased compliance completing the daily BCS. Keywords communication, daily goals sheet, intensive care unit, pediatrics, patient care planning In the last decade, beside communication sheets (BCSs) have been described as tools to facilitate communication between staff within intensive care units (ICUs).1,2 Ideally, they help synthesize discussions of multiple issues for complicated patients into a concise action plan.3 Using BCSs has been shown to increase compliance with clinical practice guidelines such as ventilatorassociated pneumonia prevention measures,4 deep vein thrombosis, peptic ulcer disease prophylaxis,5 and prevention of catheter-related bloodstream infections.6 Despite many examples of such sheets within the literature, the best format of such a communication sheet is unknown and possibly institution specific. BCSs at the study institution had been used for approximately 10 years in the pediatric ICU (PICU) and pediatric cardiac ICU (PCICU) as a communication tool during rounds. Over time, new items were added, such that the sheet grew increasingly cumbersome to complete. It was suspected that completing the BCS and using it as an adjunct communication tool during rounds was sporadic as a result of its increased complexity. The research team sought to streamline the BCS, using suggestions from ICU physicians and nurses to design a more effective tool. The team hypothesized that a revised, tailormade BCS would improve communication within the
study institution ICUs and would be completed more routinely. To solicit specific feedback for improvement of the BCS, a representative selection of nursing and physician ICU providers were surveyed. The research team aimed to assess opinions regarding communication in the ICUs pre and post implementation of the revised BCS. The team also assessed the compliance rate for completing the BCS pre and post implementation of the revised form and general satisfaction with the newly revised BCS.
Methods Two periods of surveying occurred: preintervention (February 2013, pre implementation of the revised BCS), 1
Pediatric Critical Care Medicine, Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY Corresponding Author: Linda Aponte-Patel, MD, Department of Pediatrics, Columbia University Medical Center, 622 West 168th St, Vanderbilt Clinic, Rm 503, New York, NY 10032. Email: [email protected]
Downloaded from ajm.sagepub.com at University of York on June 4, 2016
579
Aponte-Patel and Sen
Figure 1. Two versions of the bedside communication sheet (BCS).
Left: Original BCS. Right: Revised BCS. The revised BCS simplifies the demographic and reminder sections, provides prompts for goals, and adds a box for plans for the following day to better include night nurses in the daily goals.
and postintervention (June 2013, post implementation of the revised BCS). The original BCS was divided into 3 sections: demographics, goals, and reminders (Figure 1). Providers were surveyed specifically about each of these sections so that the sections could be tailored to best serve the needs of the staff. In an effort to abbreviate the demographic section, providers were asked what information was absolutely necessary to include in the BCS. For the goals section, providers were asked if they thought that having categorical sections (eg, sedation, inotrope goals, fluid status) would help the organization of the BCS, and if so, which categories should be included. For reminders, providers were asked how many reminders should be included (0-2, 3-4, 5-6, 7-8) and then asked to select their top choices (eg, extubation readiness, removal of lines, antibiotic length). Additionally, providers were asked if the original BCS improved communication between nurses on different shifts and if a specific section for night nurses would be useful. All revisions of the BCS were then agreed on by the 2 investigators before implementation. The newly formatted BCS was introduced in March 2013, and PICU fellows and ICU hospitalists were
reeducated about the importance of completing the BCS. To minimize the effect of the novelty of the new sheet, 12 weeks elapsed between introduction of the revised BCS and the postimplementation survey concerning the revised BCS. During each survey period, 5 individual weekdays over a 2-week period were randomly selected. Participants, evenly distributed among 7 groups (ie, day and night PICU nurses, day and night PCICU nurses, ICU fellows, ICU attendings, ICU hospitalists), were asked to complete a written survey with the goal of obtaining a collection of opinions representative of the PICU and PCICU staff. Participants were asked to indicate their role (eg, nurse, fellow) and were informed that any information they provided would be analyzed and reported anonymously. No incentives were given, and if people declined participation, they were not included. Participants were selected based on availability and were not necessarily identical for both surveys. The preintervention survey (available in online Appendix A at http://ajmq.sagepub.com/supplemental) included 22 multiple-choice questions, including a
Downloaded from ajm.sagepub.com at University of York on June 4, 2016
580
American Journal of Medical Quality 30(6)
Table 1. Qualitative Pre- and Postintervention Comparisonsa. Question
Response
How would you rate day-to-day communication between MDs and RNs in the PICU? At the end of rounds, I understand goals set by the team for my patient How would you rate the overall quality of the current BCS? How often do you use the current BCS in your daily routine? (Always, Most of the time, Sometimes, Hardly ever, Never) The BCS improves overall care of PICU patients The BCS improves communication between MDs and RNs The BCS improves communication between RNs on different shifts
Pre (%)
Post (%)
P Value
Excellent/Very good
57
77
.02
Strongly agree/Agree
94
91
NS
Excellent/Very good Always
33 26
73 48
