Excerpt from Course #21-59 Preventing Medical Errors & Improving Patient Safety by, Leo Christie, PhD
According to The Joint Commission (2023), communication errors are the leading root cause of reported sentinel events. Such errors can occur between the clinician and the client, among various clinicians, or within written communications such as medical records or patient instructions. Among the causes of miscommunication are inadequate time spent with the patient, inadequate communication about patients between healthcare professionals, failure on the part of the healthcare professional to document treatment data in a timely and accurate fashion, or use of language that the client does not understand.
Communication among Professionals
Patient “handoff,” when a patient is handed off to another healthcare professional for further care, is prone to errors in communication. Handoff, which occurs not only between shifts in hospital environments, but also every time one healthcare professional refers a patient to another, creates opportunities for missed communication.
Many factors may be involved when handoff communication is inadequate. These include the healthcare professional’s training, cultural considerations, depth of training, language barriers, time pressure, and poor documentation (The Joint Commission, 2017).
Different professions can have different communication styles and different vocabularies. For example, when a speech-language pathologist and an occupational therapist are treating the same client and have occasion to communicate treatment information, they need to have a way of using the same descriptive words so that important treatment information is communicated accurately.
Professionals’ use of different styles can result in miscommunication or omission of key patient care information that may jeopardize patient safety. For example, Stewart and Hand (2017) point out that nurses and doctors have generally been taught to communicate using styles suited to the needs and thought processes of their respective professions. Physicians tend to communicate tersely in an action-oriented style. Nurses often use a narrative style that reflects their direct care responsibilities.
Research shows that many professionals work hard to effectively collaborate across disciplines. One of these is bridging gaps. This refers to the differences in professional perspectives in the most effective way to treat patients. Another is setting up opportunities for different disciplines to communicate informally in social settings, leading to improved transfer of information. Another interesting way to enhance communication is to “translate” the information in terms the other person understands. This is especially important with specialized jargon for a particular discipline, or when helping patients understand what the physician just told them (Schot et al., 2020). In view of the vital necessity for accurate and timely exchange of patient care information, there is a clear need for employing a common vocabulary that is understood the same way by both/all parties. Healthcare professionals should actively contribute to interprofessional collaboration.
Case Example The following example of successful communication and collaboration between an OT and an SLP is from the Leader Live (Sigal, 2016), an online publication of the American Speech-Language-Hearing Association (ASHA).
A father of a client we both saw asked us to collaborate. “Ethan,” age 2, worked on fine and sensory motor skills with Michelle, an occupational therapist, while I worked with him on articulation and oral motor skills.
Michelle and I instantly clicked and started carrying over each other’s treatment activities to meet Ethan’s goals. Michelle helped emphasize speech goals by addressing target articulation sounds in play. She already used Chewy Tubes for sensory purposes, but now, instead of asking Ethan to simply chew on the tubes, he followed regimented rules to improve jaw strength, stability, symmetry, and tongue retraction.
In addition, Michelle taught me positioning and seating necessary for increasing Ethan’s core strength and posture. These modifications increased his breath control for speech. I began using a therapy ball for sensory-based input to improve overall affect, attention, and speech. We addressed Ethan’s goals more consistently each week because of our collaborative approach to treatment.
The two professionals were able to teach each other about fine and sensory motor skills – an OT therapeutic activity – and articulation and oral motor skills – an SLP therapeutic activity for use with a common client. The differing terms and procedures used by two practitioners from different specialties, which might have caused miscommunication and potential treatment gaps, instead were creatively employed by the two in collaborative methods to benefit their shared client.
Communication with Clients
When clients do not understand information or terminology communicated to them by their treating professionals, negative outcomes are likely. It is always the responsibility of the healthcare professional to gauge the level of understanding of the client and ensure that communicated words and instructions are accurately understood. There are three areas that can impact clinician-client communication and the occurrence of medical errors: health literacy, health consumerism, and cultural competency.
Health Literacy and Patient Safety
Many organizations, such as The Joint Commission and the American Medical Association, have recognized the link between patient safety and clearly communicating with patients about health-related issues. Healthy People 2030 notes that health literacy involves “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (National Library of Medicine, ND). Health literacy includes three categories: personal, organizational, and digital.
Personal health literacy includes the ability to understand instructions on prescription drug containers, appointment slips, medical education brochures, doctor’s instructions and consent forms, and the ability to negotiate complex health care systems. Health literacy is not simply the ability to read. It requires a complex group of reading, listening, analytical, and decision-making skills, and the ability to apply these skills to health situations. High general literacy does not guarantee high health literacy. 90% of adults have problems with health literacy. This is not surprising when you consider that health literacy is usually needed when a person is sick, stressed over a family member’s symptoms, or fatigued from caring for an ill spouse.
Mor-Anavy et al. (2021) surveyed physicians, administrators, and administrative staff to assess health literacy. The survey included examples of a consent form, a nutrition label, and a brochure included in medical packaging. The survey further asked the participants where to find patient rights information and if they knew how to make an appointment. Study results found the following:
The health literacy level was high among 53% of providers, sufficient among 22%, average among 17%, problematic among 2%, and inadequate among 6%. Additionally, 22% of administrators and 14% of physicians reported difficulty in understanding informed consent documents, and 13% of administrators and 8% of physicians had difficulty understanding how to get an appointment.
It can be easy for a healthcare professional to concentrate on clinical matters, and not pay attention to consent forms or other administrative parts of patient care. However, this can negatively affect patient care and outcomes (CDC, 2023).
Organizational Health Literacy and Occupational Therapy
Organizational health literacy involves helping patients understand and use health-related information appropriately. It can include, for example, an easier scheduling process, brochures that are easy to read, and using the Teach Back method to assure the patient understands (NLM, ND).
The American Occupational Therapy Association’s (AOTA) Societal Statement on Health Literacy (2017) states that people with inadequate health literacy are more likely to experience adverse health outcomes. “Occupational therapy practitioners can assist in ensuring that all health-related information and education provided to recipients of occupational therapy or other health-related services match each person’s literacy abilities; cultural sensitivities; and verbal, cognitive, and social skills” (p. 1). Further,
The American Occupational Therapy Association strives to ensure that occupational therapy practitioners have appropriate communication and education skills to help enable all people gain access to and understand occupational therapy and other health-related services. This effort includes information and education that promote self-management for optimum health and participation. In addition, occupational therapy practitioners may facilitate clients’ health literacy. (AOTA, 2017, p. 1)
The emphasis on health literacy is carried out within the AOTA’s specialty groups. The Rehabilitation and Disability group notes that occupational therapists should “understand health literacy and why it is important, and…identify what occupational therapy practitioners (OTPs) can do to increase patient understanding for improved health outcomes” (Montgomery, 2023).
Health Consumerism
In contrast to the issue of low health literacy among patients is that of health consumerism. Due largely to the ease of obtaining information from the internet, consumers are becoming increasingly proactive in their own healthcare. Researchers call this “e-health information consumerism” (Seckin, 2020).
This is a positive aspect of the growing health consumerism – that it challenges practitioners to stay current on clinical issues, which they should be doing, to meet their professional and ethical responsibilities as licensed health care providers. It is for this reason that licensing boards and accrediting bodies require continuing education for renewal.
Another positive aspect of the growing consumerism in healthcare is that it empowers patients. Knowledge allows them to become more involved in treatment and make more informed decisions, which improves compliance and ultimately satisfaction. More problematic is deciphering the vast amount of information that is available, particularly when it is confusing and, often, contradictory. You may spend more time explaining why a “miracle treatment” found on the internet has not been proven safe or effective. There is also an issue with consumers attempting to self-diagnose. The best defense moving forward is a good offense. Be prepared and stay current on clinical issues. It may help to do internet searches on topics you work with frequently to anticipate questions you may encounter. You will also need to be able to distinguish science from pseudoscience, both for yourself and for your patients.
How can healthcare professionals and facilities make an impact on the problem of medical errors at the grass roots level? Visit http://www.pdresources.org to access the course, Preventing Medical Errors & Improving Patient Safety, to find out.
https://www.pdresources.org/course/index/5/1450/Preventing-Medical-Errors-Improving-Patient-Safety
Course 21-59 | 2024 | 40 pages | 15 posttest questions
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