Contrasting discourse styles and barriers to patient participation in bedside nursing handovers

2017 ◽  
Vol 13 (1) ◽  
Author(s):  
Suzanne Eggins ◽  
Diana Slade
Keyword(s):  
Discourse Analysis ◽  
Public Hospital ◽  
Systemic Functional Linguistics ◽  
Improve Patient Safety ◽  
Clinical Information ◽  
Communication Training ◽  
Communicative Practice ◽  
Bedside Nursing ◽  
Improve Patient ◽  
Shift Change

This paper applies qualitative discourse analysis to ‘shift-change handovers’, events in which nurses hand over care for their patients to their colleagues. To improve patient safety, satisfaction and inclusion, hospitals increasingly require nursing staff to hand over at the patient’s bedside, rather than in staff-only areas. However, bedside handover is for many a new and challenging communicative practice. To evaluate how effectively nurses achieve bedside handover, we observed, audio-recorded and transcribed nursing shift-change handovers in a short stay medical ward at an Australian public hospital. Drawing on discourse analysis influenced by systemic functional linguistics we identify four handover styles: exclusive vs inclusive and objectifying vs agentive. The styles capture interactional/interpersonal meaning choices associated with whether and how nurses include patients during handover, and informational/ideational meaning choices associated with whether or not nurses select and organise clinical information in ways that recognise patients’ agency. We argue that the co-occurrence of inclusive with agentive and exclusive with objectifying styles demonstrates that how nurses talk about their patients is powerfully influenced by whether and how they also talk to them. In noting the continued dominance of exclusive objectifying styles in handover interactions, we suggest that institutional change needs to be supported by communication training.

scholarly journals The feasibility of implementing an electronic prescribing decision support system: a case study of an Australian public hospital

2006 ◽  
Vol 30 (3) ◽  
pp. 380 ◽  
Author(s):  
David Bomba ◽  
Tim Land
Keyword(s):  
Decision Support ◽  
Public Hospital ◽  
Improve Patient Safety ◽  
Public Hospitals ◽  
Electronic Prescribing ◽  
System A ◽  
South Wales ◽  
Area Health ◽  
Improve Patient

Medication errors are common in public hospitals, with the majority at the prescribing stage of the medication pathway. Electronic prescribing decision support (EPDS) is a rules-based computer system that can be used by clinicians to warn against such errors to improve patient safety and support staff workflows. Despite its apparent advantages, this technology has not been widely adopted in Australian public hospitals for inpatient prescribing. A case study using Sauer?s (1993) Triangle of Dependencies Model was conducted in 2003 into the feasibility of implementing an EPDS system at an Australian public hospital in New South Wales. It was found not feasible to implement an EPDS at the hospital studied due to the legacy patient administration system, low availability of information technology on the wards, differing stakeholder views, legislation, and the Independent Pricing and Regulatory Tribunal of NSW report recommendations. A statewide standard was preferred, with an agreed specification framework identifying basic core data items and functions that an EPDS must meet which can then be used by area health services to: (i) choose a solution which best meets their contextual needs; and (ii) engage vendors to tender for building an open source (non-proprietary) system based on the specification framework.

scholarly journals Pelayanan Jasa Keperawatan: Tingkat Kepuasan Pasien pada Unit Rawat Inap Rumah Sakit Umum “dr. Slamet” Garut

2019 ◽  
Vol 1 (2) ◽  
pp. 93-97
Author(s):  
Lindayani Lindayani
Keyword(s):  
Patient Satisfaction ◽  
Regular Education ◽  
Public Hospital ◽  
Improve Patient Safety ◽  
Medical Personnel ◽  
Diagnostic Tools ◽  
Nursing Service ◽  
Descriptive Approach ◽  
Improve Patient ◽  
And Training

The present study looks at in-patient nursing service at Garut Regional Public Hospital dr. Slamet and patient satisfaction as viewed from the gap between service performance and patient expectations. Using a descriptive approach, the influence of in-patient nursing service on patient satisfaction was analyzed. Research data were collected through observation and questionnaires addressed to the patients. The results of the study lead to a conclusion that patients were satisfied with the in-patient nursing care they received. It is suggested that the hospital improve their responsiveness to patient complaints, provide information in simple and easy to understand language, improve the skills of medical personnel by providing regular education and training, improve patient safety and trust, improve service personnel skills such as knowledge in using disease diagnostic tools, hospitality skills, and communication skills.

The Cognitive Task of Medication Reconciliation - Clinicians’ Approaches to the Arrangement of Medical Condition and Medication History Information

2016 ◽  
Vol 60 (1) ◽  
pp. 538-540 ◽  
Author(s):  
Yuval Bitan ◽  
Yisrael Parmet ◽  
Geva Greenfield ◽  
Shelly Teng ◽  
Mark Nunnally
Keyword(s):  
Medication Reconciliation ◽  
Medical Information ◽  
Medical Condition ◽  
Improve Patient Safety ◽  
Cognitive Task ◽  
Clinical Information ◽  
Card Sorting ◽  
Medication History ◽  
Disease Information ◽  
Improve Patient

We report the results of a study which aims to improve our understanding of how clinicians make sense of medication and disease information (medical reconciliation), performed by clinicians in a major US hospital. A card sorting simulation experiment running on an Android tablet was utilized to record the steps taken by 130 clinicians to reconcile and better understand the clinical information they received about a simulated patient. Evaluating the order in which the clinicians processed the information shows that most clinicians sorted medical condition information before medication history. Clinicians use diverse strategies to arrange the information. This study allows us to expend our understanding of the cognitive task of medication reconciliation, adding to the knowledge that might assist in data presentation in future medical information software. Such an understanding has the potential to provide clinicians with better tools to capture and reconcile clinical information which may ultimately improve patient safety.

299 Implementing A Formal Surgical Handover Tool for Junior Doctors – A QI Approach

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Gill ◽  
S Quested ◽  
J Lim ◽  
M Mohsin
Keyword(s):  
Improve Patient Safety ◽  
Clinical Information ◽  
Surgical Patient ◽  
Junior Doctors ◽  
Post Intervention ◽  
Perceived Safety ◽  
Surgical Department ◽  
Safe Patient Care ◽  
Improve Patient ◽  
Patient Handovers

Abstract Introduction An informative medical handover facilitates safe patient care. It was recognized that insufficient clinical information at handover resulted in unsafe communication in the general surgical department at Pinderfields General Hospital (PGH). We aim to utilise the Royal College of Surgeons’ (RCS) and British Medical Association’s (BMA) guidelines to improve the existing handover system, facilitate an efficient and relevant handover, and furthermore improve patient safety. Method General surgical foundation doctors (FDs) (n = 15) at PGH were surveyed to establish their perspectives of existing handover documentation. Subsequently a handover tool was iteratively designed, using tests of change, combining RCS and BMA guidelines with FDs’ suggestions of patient information required for safe handover. At two time points, FDs in the department were re-surveyed to measure improvement. Results Prior to implementation of a formal document, only 20% of FDs reported sufficient patient identifiers of the handover. This improved to 67% post intervention. Pre-intervention, 0% perceived the handover as ‘Excellent’, 20% as ‘good’. Post-intervention, these improved to 34% and 60% respectively. Conclusions Over six months, we improved the FD’s handover document, resulting in positive feedback of perceived safety of surgical patient handovers. However, recognised time constraints have highlighted the need for more efficient handover documentation.

‘Do not Do’ Recommendations in Hemophilia

2020 ◽  
Vol 20 (3) ◽  
pp. 168-174
Author(s):  
Hortensia De la Corte-Rodriguez ◽  
E. Carlos Rodriguez-Merchan ◽  
M. Teresa Alvarez-Roman ◽  
Monica Martin-Salces ◽  
Victor Jimenez-Yuste
Keyword(s):  
Improve Patient Safety ◽  
Health Resources ◽  
Fresh Frozen Plasma ◽  
Factor Ix ◽  
Levels Of Care ◽  
Fresh Frozen ◽  
History Of ◽  
Improve Patient ◽  
Different Levels ◽  
Frozen Plasma

Background: It is important to discard those practices that do not add value. As a result, several initiatives have emerged. All of them try to improve patient safety and the use of health resources. Purpose: To present a compendium of "do not do recommendations" in the context of hemophilia. Methods: A review of the literature and current clinical guidelines has been made, based on the best evidence available to date. Results: The following 13 recommendations stand out: 1) Do not delay the administration of factor after trauma; 2) do not use fresh frozen plasma or cryoprecipitate; 3) do not use desmopressin in case of hematuria; 4) do not change the product in the first 50 prophylaxis exposures; 5) do not interrupt immunotolerance; 6) do not administer aspirin or NSAIDs; 7) do not administer intramuscular injections; 8) do not do routine radiographs of the joint in case of acute hemarthrosis; 9) Do not apply closed casts for fractures; 10) do not discourage the performance of physical activities; 11) do not deny surgery to a patient with an inhibitor; 12) do not perform instrumental deliveries in fetuses with hemophilia; 13) do not use factor IX (FIX) in patients with hemophilia B with inhibitor and a history of anaphylaxis after administration of FIX. Conclusions: The information mentioned previously can be useful in the management of hemophilia, from different levels of care. As far as we know, this is the first initiative of this type regarding hemophilia.

scholarly journals Writing’s on the wall: improving the WHO Surgical Safety Checklist

2021 ◽  
Vol 10 (1) ◽  
pp. e001086
Author(s):  
Claire Cushley ◽  
Tom Knight ◽  
Helen Murray ◽  
Lawrence Kidd
Keyword(s):  
Patient Safety ◽  
Online Survey ◽  
Improve Patient Safety ◽  
Surgical Safety Checklist ◽  
Surgical Safety ◽  
Time Out ◽  
Mandatory Requirement ◽  
Who Checklist ◽  
Improve Patient ◽  
Theatre Team

Background and problemThe WHO Surgical Safety Checklist has been shown to improve patient safety as well as improving teamwork and communication in theatres. In 2009, it was made a mandatory requirement for all NHS hospitals in England and Wales. The WHO checklist is intended to be adapted to suit local settings and was modified for use in Gloucestershire Hospitals NHS Foundation Trust. In 2018, it was decided to review the use of the adapted WHO checklist and determine whether improvements in compliance and engagement could be achieved.AimThe aim was to achieve 90% compliance and engagement with the WHO Surgical Safety Checklist by April 2019.MethodsIn April 2018, a prospective observational audit and online survey took place. The results showed compliance for the ‘Sign In’ section of the checklist was 55% and for the ‘Time Out’ section was 91%. Engagement by the entire theatre team was measured at 58%. It was proposed to move from a paper checklist to a wall-mounted checklist, to review and refine the items in the checklist and to change the timing of ‘Time Out’ to ensure it was done immediately prior to knife-to-skin.ResultsFollowing its introduction in September 2018, the new wall-mounted checklist was reaudited. Compliance improved to 91% for ‘Sign In’ and to 94% for ‘Time Out’. Engagement by the entire theatre team was achieved 100% of the time. Feedback was collected, adjustments made and the new checklist was rolled out in stages across all theatres. A reaudit in December 2018 showed compliance improved further, to 99% with ‘Sign In’ and to 100% with ‘Time Out’. Engagement was maintained at 100%.ConclusionsThe aim of the project was met and exceeded. Since April 2019, the new checklist is being used across all theatres in the Trust.

scholarly journals Understanding safety in healthcare: the system evolution, erosion and enhancement model

2013 ◽  
Vol 2 (3) ◽  
pp. 25 ◽  
Author(s):  
Jane Carthey
Keyword(s):  
Patient Safety ◽  
Complex Systems ◽  
Human Error ◽  
Improve Patient Safety ◽  
New Model ◽  
System Evolution ◽  
Accident Causation ◽  
System Migration ◽  
Improve Patient

The paper summarises previous theories of accident causation, human error, foresight, resilience and system migration. Five lessons from these theories are used as the foundation for a new model which describes how patient safety emerges in complex systems like healthcare: the System Evolution Erosion and Enhancement model. It is concluded that to improve patient safety, healthcare organisations need to understand how system evolution both enhances and erodes patient safety.

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