Working on how to communicate in facilities
Eleanor Feldman Barbera, Ph.D.
Poor communication and coordination between staff members contribute to medication errors and adverse events. These problems are more likely to occur during a transition of care from one setting to another.
AMDA, The Society for Post-Acute and Long-Term Care Medicine, working with the National Transitions of Care Coalition (NTOCC), recently released its free Transitions in Care in the Long-Term Care Continuum guideline. The goal of the document is to identify areas where problems in transitions occur and to offer methods to avoid these common errors.
Reading through the guideline got me thinking about the in-house communication glitches I've noticed in my role as a psychologist. While we clearly need to address communication and coordination between settings, we also can look within our own facilities to see if there are areas where communication could be improved.
Below are examples of problems I've observed in some high-quality facilities. (Imagine how much better the care would be if these problems were addressed!) While I mentioned my concerns to the relevant staff members, interdepartmental communication issues can sometimes fall into that gray area between job descriptions and don't always receive the attention they deserve.
• Each floor of one facility had a notebook where staff members could leave messages for the social worker. Except that the social workers never looked at those notebooks. New staff members would leave notes in there until they learned it was pointless. But nobody took the notebooks away.
• There are communication books for the attending physicians at most nursing stations, but the doctors vary in their diligence about looking at the information. Sometimes I'd check the log to see the status of something I'd previously reported and see that nothing had been checked off in the book for a month or even several months. While very urgent information should be reported directly to the charge nurse, many staff members don't have the training to know what's urgent.
• Along those lines, I once mentioned to a charge nurse that I wrote a note in the communication book and she said, “Oh, Dr. Smith never looks in there. If you have something important to tell him, you let me know and I'll write it on a sticky note and tell him when he comes in.” She pointed to the ledge of the desk filled with scrawled memos. Things I pondered: What if the sticky note loses its “stick,” falls to the floor, and is swept up by the porter? Who else is leaving notes in the logbook without realizing they're never seen? What if the nurse is off from work on the day the physician comes in? The nurse retired shortly thereafter. I wonder what they're doing now.
• In one nursing home, a well-meaning decision was made to reduce noise by eliminating the use of the overhead paging system. Unfortunately, no other system was put in place, so staff members looking for coworkers had to phone each floor to see if they could locate the person they needed and nurses were repeatedly interrupted in their work to answer the phone with comments like, “No, she's not here. Try the third floor.”
• Consultants are a vital part of the functioning of most long-term care organizations, yet they're rarely made part of the organization's internal email or phone system. They miss out on important information and it's more challenging for staff members to contact them and for them to reach each other. Adding an email address for consultants would be a simple way to include them in the organizational loop.
Perhaps you've seen similar examples of communication failures in your organization. Or maybe your facility has appointed a “Communication Czar” to banish unused logbooks and train doctors to check for staff messages regularly. If so, please share your experiences in the comments section below. We'd all like to learn and get better.
Eleanor Feldman Barbera, PhD, author of The Savvy Resident's Guide, is a 2014 Award of Excellence winner in the Blog Content category of the APEX Awards for Publication Excellence program. She also is the Gold Medalist in the Blog-How To/Tips/Service category of the 2014 American Society of Business Publication Editors Midwest Regional competition. A speaker and consultant with nearly 20 years of experience as a psychologist in long-term care, she maintains her own award-winning website at MyBetterNursingHome.com.