Meeting Patient Communication Needs

With Evidence-Based Practice

Its Time To Improve
Patient Communication Standards!

Unless we make substantial changes in the

organization and delivery of healthcare, all patients
- particularly the most vulnerable - will continue to
bear the burden of medical error.

Weingart SN, et al. Epidemiology of medical error. BMJ.

2000;320:774-777.
Objectives
I. Define the problem
A. Communication Vulnerable Populations
B. Highlight Complications Associated with Poor Communication
C. The Joint Commission Standards of Care

II. Providing an Evidence-based Solution

A. Standardizes a Point-of-Care Approach to Impaired Communication
B. Promotes Best Practice
C. Improves Patient Outcomes

III. Recommendations for Utilization

IV. References (slides 33-42)

Introduction
Patient communication is compromised due to:
nonverbal (surgery, trauma or stroke) & linguistic barriers

Ignoring the communication barrier causes:

misunderstanding and frustration
negative emotions of futility and dehumanization

Traditional nonverbal communication methods

require energy, are fatiguing and emotionally draining for patients
no standardization, greater chance for error

Solution: Evidence-based Patient Communication Board

patients can easily point to words, phrases, & pictures
designed in clinical research study to improve patient outcomes
The Problem
Patients who are unable to establish or maintain effective
communication with their providers are at greater risk of
medical error and poorer outcomes.

A patients right to effective patient-provider communication

is supported by accreditation standards, regulatory
guidelines, and patient rights declarations. Patients have the
right to be informed about the care they receive, make
educated decisions about the care, and have the right to be
listened to by their providers.
More about the Problem

Patient outcomes are substantially dependent on their

ability to participate in their care.
Patients who are communication-vulnerable
[unable to establish or maintain effective
communication with assistance or independently]
are consequently subjected to
unsafe practice
poorer education
poorer outcomes
More about the Problem
Weaknesses within the healthcare system which perpetuate this
alarming and urgent matter include

Inadequate health care standards and regulations

Lack of health care professional education
75% nurses feel their bedside methods are inadequate!!*
* Charles Reed study (slide 25-26)
Lack of value or recognition by organizations
Lack of health care professional collaboration
Multidisciplinary care teams that include experts trained to
mobilize effective communication resources and achieve
desired outcomes.
Factors associated with preventable adverse events

Bartlett, G. et al. CMAJ 2008;178:1555-1562

Who Is Most Vulnerable To Communication
Impairment?

Mechanically-Ventilated Patients
Trached Patients
Head & Neck Surgery Patients
Stroke Patients
Extremely Weak Patients (Hospice & Elderly)
Non-English Speaking Patients
Non-Verbal Patients
Clinically Significant Outcomes Related
to Ineffective Patient Communication
Twice more likely to experience medical physical harm
Increased risk of nonadherence to medication
Misreported abuse
Decreased access to medical care
Decreased use of medical care
Increased diagnosis of psychopathology
More likely to leave hospital against medical advice
Asthmatics more likely to receive intubation
Less likely to return for follow up appointments after
Emergency Room visits
Clinically Significant Outcomes Related
to Ineffective Patient Communication
(cont)
Higher rates of hospitalization
Higher rates of drug complications
Highest use of resources to provide care
Lowest levels of satisfaction with care
Increased risk of delayed care
Increased failure to treat and prevent devastating disease
states and death
Increased risk of malpractice
Increased length of hospital stay
Alterations in communication including interference with transfer
of information, reduced emotional support, and reduced rapport
Patient Quote
UCLA Study Patient Quote

I kept trying to tell them I had pain in the back and uh they
didn't understand what I was saying. Finally I just came to
the point where I stopped.

Patak L, Gawlinski A, Fung NI, Doering L, Berg J. (2006). Communication boards in critical care: A patient's view. Applied Nursing
Research,19(4),182-90.

Patak L, Gawlinski A, Fung NI, Doering L, Berg J. (2004). Patient's reports of health care practitioner interventions related to communication
during mechanical ventilation. Heart & Lung The Journal of Acute and Critical Care, 33(5), 308-320.
The Joint Commission Standards
Standard of Care RI.2.100 states "The organization
respects the patient's right to and need for
communication."

Elements of Performance for RI.2.100, No.4 stating, "The

organization addresses the needs of those with vision,
speech, hearing, language, and cognitive impairments."

Hosted a Webinar, Call to Action: Patient/Provider

Communication, on February 17, 2009 addressing the
nation on improving standards of care
Vidatak EZ Boards

The only evidence-based, patient designed

communication boards available today
Shown to reduce patient frustration
Shown to improve patient satisfaction
Available in 16 translations with English subtext
Available also as a picture board with research-
based picture drawings
Vidatak EZ Board
Vidatak EZ Boards

Endorsed by the Hospice and Palliative Nurses

Association (HPNA)
Distributed by the American Association of Critical-
Care Nurses (AACN)
Used in 6 different countries
Distributed to over 1,500 hospitals in the US
Vidatak EZ Board
Vidatak EZ Boards & Research

UCLA Study Qualitative & Quantitative, 29 subjects

86% reported board would have been helpful

62% reported high levels of frustration
14% reported no frustration
79% received anxiolytics
Patients who received anxiolytics = reported levels of
frustration
Patients were able to articulate their preferences in designing
the Vidatak EZ Board
UCLA Study Reported level of frustration
Patients who had received traditional methods for
communicating while ventilated reported their frustration
would have significantly decreased if they had used the
Vidatak EZ Board (p<.001) with nearly half (41%)
reporting they would have experienced no frustration
with the Vidatak EZ Board.
UCLA Study Reported level of frustration without
the Vidatak EZ Board (70% reported high levels of frustration)
UCLA Study Comparing w/ and w/o board
(70% with the Vidatak EZ Board reported low levels of frustration)
UCLA Study Facilitating Communication

Health care practitioner behaviors identified

as facilitating communication
Being kind and patient
Offering verbal reassurance and important information
Being present and available at the bedside
Letting patients write
Understanding what patients need
UCLA Study Impeding Communication

Health care practitioner behaviors identified

as impeding communication
Being mechanical, non-personal
Inconsistent
Inattentive and not present
Not being given the opportunity to perform as an individual
Imposing an agenda instead of learning about what the
patient wants to do, when they want to do it
Not letting patients write or throwing away written notes
UCLA Study Patient proposes its a
systematic problem

UCLA Study Patient Quote

It would create an interface between the patient & the staff that would formalize
the requirement that they pay attention to what the patient is trying to say. It
would be like a passport. The person, even if they didn't use it, could wave it,
say 'I matter. I can be heard. I have a stake in this. It's not just about you acting
on me. It's about my being able to tell you what I want, what I'm doing'. I
believe the concept itself is very strong, because it would both obligate the staff
to stop & listen with a fresh ear, instead of saying, 'Oh well, they're intubed.
They can't talk. Let's just write them off. It could inspire, to instill hope &
empower those who are not as strong willed as I am.
Vidatak EZ Boards Used in Research
Charles Reed, University of Texas Health Sciences Center
Surveyed and interviewed both nurses and patients
regarding methods used to communicate
75% nurses felt methods were inadequate!!
30% nurses felt they effectively understood their patient
59% patients reported being extremely frustrated with the
inability to communicate
Vidatak EZ Boards Used in Research
Charles Reed, University of Texas Health Sciences Center
Most beneficial methods reported by patients (in order)
Writing/Vidatak EZ Board (51%)
Hand gestures (28%)
Electronic communication board (14%)
Most beneficial methods reported by nurses (in order)
Vidatak EZ Board (58%)
Electronic communication board (21%)
Most common method reported by patients
Hand gestures (44%)
Vidatak EZ Boards Used in Research
(International Study)
Lydia David, Apollo College of Nursing, Chennai, India
Experimental control trial of 60 patients - randomized w/or
w/o communication board (30 each).
Without the Vidatak EZ Board, 73% reported their communication
process was inadequate; with the board, 80% reported it was adequate.
Without the Vidatak EZ Board, 63% reported being unsatisfied with their
communication process; with the board, 77% were satisfied.
Of those who used the Vidatak EZ Board 80% were satisfied with the
board, 20% moderately satisfied. Nurses, however, reported 53%
satisfied, 30% moderately satisfied and 17% unsatisfied.
Overall, the patients with the Vidatak EZ Board reported higher
satisfaction with communication (p<.001) and this was correlated to their
satisfaction with the Vidatak EZ Board (p<.01).
Vidatak EZ Boards Used in Research

John Costello, MA, CCC-SLP, Children's Hospital

Boston
Conducted clinical research over three years collecting
data on appropriate concepts to be depicted on a Picture
Board as well as designing the best representations of
these concepts with children ages 4-19.
Working together, we combined our clinical research data
and developed the Vidatak EZ Picture Boards.
Vidatak EZ Board - Ongoing Studies

Dr. Mary Beth Happ, University of Pittsburgh

SPEACS study 5 year longitudinal study comparing
routine care to non-tech and technological communication
devices as well as measuring outcome variables

Dr. Ruth Kleinpell, Rush University

Experimental study examining the impact of the Vidatak
EZ Board on specific variables
Goals for Implementing Vidatak EZ Boards
Hospital Wide
When used with proactive nursing care that prioritizes the
patients ability to actively participate and communicate
effectively, the EZ Board can provide outstanding results which
may include:
1. Decreased level of frustration
2. Improved pain management
3. Reduced sedation requirements
4. Improved staffing efficacy (1:1 ICU nurse/patient ratio 1:2)
5. Increased patient participation and satisfaction with healthcare
6. Expedited extubation and decreased length of ICU and hospital stay
The Vidatak EZ Board should be supplied to
patients in the following areas:
Preoperative Rooms
(preoperative teaching and for Time-Out Assessment prior to surgery
with intubated patients)
Recovery Rooms/Postoperative Care
Intensive Care Units (CCU, MICU, SICU)
Step Down Units
Long Term Care Facilities
Head and Neck Surgery
Outpatient Surgery
Rehabilitation Units
Speech-Language Pathology Departments
FOR OPTIMAL USE, PLEASE:
1) Orient your patient to the content on this board.
2) Add names of family members or other custom vocabulary as
needed.
3) Provide this board as part of preoperative teaching as it will
improve patients ability to navigate the board and use it more
effectively. By familiarizing themselves with the board and
individualizing the board, patients will have better use, improved
satisfaction, reduced anxiety and reduced anxiolytic medication
requirements, etc.
4) KEEP THIS BOARD WITH THE PATIENT AT ALL TIMES! We
provide bedside rail holder for this exact purpose.
5) For infection control, PLEASE DO NOT RE-USE THIS PRODUCT
BETWEEN PATIENTS.
References
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