650 / Implementation and evaluation of a communication plan in an Intensive Care Unit

SPAIN
Classification of the PSP
Type of Patient Safety Practice Safe
 
Clinical Practice (CP)
Related practices from PaSQ database
"Best fit" category of the reported practice
Communication
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Topic of the reported practice
Patient safety system
Aim and the benefit of the Patient Safety Practice
 
Team communication is critical in health care and defects in communication can have consequences for patients and their care teams. Safe and effective care requires clear communication among all health care team members.
The aims of this study were to implement and evaluate a Communication Plan that was based on a daily goals worksheet and a daily Intensive Care Unit (ICU) team meeting.
Description of the Patient Safety Practice
 
Prospective observational study. During one year period (January 11-January 12) a daily goals worksheet and a daily meeting were implemented in our ICU. We elaborated a daily goals worksheet to record: neurological, cardiovascular, respiratory and renal situation, sedation and pain control, nutrition, infectious disease, family communication, diagnostic tests or procedures, safety parameters and medication changes. We held a daily ICU team meeting to discuss patient´s condition and events from the preceding hours, share perspectives, determine the specific goals for the day and the best practice safety measures and we elaborated a care plan. The patient´s daily care plan was left in the bedside chart and acted as a quick reference for all caregivers throughout the day. We developed indicators of the compliance with the worksheets and meetings, and monitored them each three months. We designed a survey to evaluate ICU team´s perceptions of the usefulness and effectiveness of the Communication Plan.
Evaluation:

- We reviewed patient´s clinical history and evaluated the compliance with the worksheets and meetings every three months.
- We elaborated a survey to evaluate ICU team´s perceptions of the usefulness and effectiveness of the Communication Plan. The questions were:
-Do you think that the daily worksheets and meetings are useful and in what way ?
    -Do you think that the elaboration of a plan of care is useful and in what     way ?
    -Do you think that the Communication Plan is useful to avoid errors ?
    -Do you think that your adherence with the guidelines has increased ?
    -Has your satisfaction with your work improved ?
- We monitored some Quality Indicators pre and post-implementation of the Communication Plan

RESULTS
A total of 300 patients were included and in all of them the daily goals worksheet was filled out and a plan of care was elaborated and discussed in a meeting. We analysed the results of the survey and all the members of the ICU team answered that the daily worksheets and meetings were useful to structure information sharing, increase awareness of daily goals and how to achieve them, make the daily care plan clear, standardize the delivery of care, reduce variability, avoid errors, promote adherence with evidence-based guidelines (catheter-related bloodstream infection, ventilator bundle, urinary tract infection) and improve team satisfaction.
The implementation of a Communication Plan has promoted higher quality and safer patient care in our ICU. Quality indicators monitored:
- Catheter related bloodstream infection per 1000 catheter days: 1.66 (Pre-implementation Year 2010) vs 0 (Postimplementation Year 2011)
- Ventilation-acquired pneumonia per 1000 ventilator days: 6.83 vs 4.87
- Catheter associated urinary tract infection per 1000 urinary catheter days: 3.34 vs 1.79
- Pressure ulcers per 1000 patient days of ICU stay: 13.5 vs 4
- Percent of adverse events: 21% vs 11%
    
CONCLUSION
The implementation of a Communication Plan has improved teamwork and has promoted higher quality and safer patient care in our ICU.
Attachment of relevant written information and/or photos, as appropriate
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Effectiveness of the Patient Safety Practice
 
Degree of implementation of reported practice
Yes, fully
Level of implementation of reported practice
Unit or ward level
Specific and measurable outcome for the reported practice were defined
Yes
A baseline measurement before implementation of the reported practice was obtained
Yes
A measurement after full implementation of the reported practice was obtained
Yes
Evaluation of a "positive" effect of the reported practice on Patient Safety
The evaluation showed improvements in Patient Safety outcomes
Type of before-and after evaluation
Both/mixed (qualitative and quantitative)
Enclosure of a reference or attachment in case of published evaluation's results
Int Care Med 12; 38(S1):S161
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Health care context where the Patient Safety Practices was implemented
 
Hospital
Transferability
 
Successful implementation of this Patient Safety Practice in other health care settings than above stated
No
Specification of implementation in another health care setting(s)
There is no specified text here
Successful implementation's level  of this Patient Safety Practice across settings
There is no specified text here
Involved health care staff
 
Physicians
Nurses
Patient Involvement
 
Direct service user's involvement as integral part of this Patient Safety Practice
No
Specification of the service users or their representatives' involvement in the implementation of this Patient Safety Practice
There is no specified text here
Point of time in which service user or their reprasentatives' involvement takes place
There is no specified text here
Active seeking of service users' opinion, feedback, experience, etc. as integral part of this Patient Safety Practice
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Short description of the service users' level of involvement
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Public accessibility of information regarding this Patient Safety Practice to patients and citizens/service users
No
List of sources where public information is accessible
There is no specified text here
Implementation of the Patient Safety Practice
 
Existing collaboration with other countries or international organisations related to implementation of this Patient Safety Practice
No
Problems encountering in the implememntation course of this Patient Safety Practice like lack of motivation, no management support, etc.
No
List of the most prevelent difficulties encuntered during implementation of this Patient Safety Practice
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List of the most prevalent drivers for a successful implemetation of this Patient Safety Practice
Regular data feed back to involved staff
Use of any specific incentives to enhance motivation while implementing this Patient Safety Practice
No
Description of used incentives, if any.
There is no specified text here
Existence of support or approval by the clinical or hospital management or any other hihg level authority in the implementation process of this Patient Safety Practice
Yes
Costs of the Patient Safety Practices
 
Completion of cost calculation related to this Patient Safety Practice
No
Total number of person days required to implement this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total number of person days required for training as preparation for implementation of this Patient Safety Practice
Clinical staff: There is no specified text here
External consultants: There is no specified text here
Support staff: There is no specified text here
Managerial staff: There is no specified text here
Others: There is no specified text here
Not relevant: There is no specified text here
Total cost in Euro of specific equipment (machines, software, communications supplies, etc.) needed to support implementation of this Patient Safety Practice
There is no specified text here
Associated cost with a work reduction or foregoing in order to deliver this Patient Safety Practice
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Contact information
 
Name: concepcion valdovinos mahave
Country: SPAIN
Organisation: Hospital Obispo Polanco, Aragon
E-mail: mcvaldovinos@salud.aragon.es
Phone: 667966260
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