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House Staff Orientation
June 2016
COMMUNICATIONS
Preventing Errors Associated With
Communication
Language Resources
Medication Reconciliation
S-B-A-R: Communication Model
Communications Module
• Glen Bianchini, Director, Pharmacy Operations
• Bruce Boxer, Director, Nursing Education &
Performance Improvement
• Raquel Diaz, Manager, Language Training
• Karyn Kelly, Manager, Regulatory & Accreditation
• Sherry Mazer, Corporate Regulatory Officer
• Angel Pagan, Director, Language & Cultural
Services
Objectives
• Understand the process needed to provide safe
care for limited English proficient (LEP) & deaf
Language
patients
• Understand a method to use to for handoffs of
care which will provide safe transitions
SBAR
Med
Safety
• Understand the reasons why medication
reconciliation is important
The Stats
• More that 20% of the US population speak a
language other than English at home
• Approximately 50% of all hospital related med errors
have been attributed to poor communication at
transitions and interfaces of care
• As many as 80% of the errors in healthcare involve
informational or personal miscommunication
generating diagnostic and treatment errors
The Video
What Happened?
What Went Wrong?
What Should Have Happened?
What is the Difference Between an
Interpreter and a Translator?
An Interpreter converts spoken
words into a different language
A Translator converts written
material to another language
Appropriate Language Resources
These Resources Are Available 24/7
By Federal and State Law & Hospital Policy:
 Interpreters must be “qualified” and approved by TUHS Language Services
The use of translator apps on electronic devices such as
cell phones, tablets, etc. is NOT permitted
What is available?
 TUHS Qualified/Approved:
 Professional Medical Interpreters
 Bilingual Staff (list available on TempleHealth Employee Intranet
Site)
 Dual Role Medical Interpreters
 Agency Interpreters (available through Nursing Clinical Coordinators
or Nursing Office)
 TUHS Approved Language Phones
 Over Video Remote Real Time Interpreters for American Sign Language
When is Qualified Language
Assistance Required?
•
•
•
•
Informed consent (The waiver does not apply)
Patient’s Rights
Advanced Directives and Powers of Attorney
Explaining:
– Diagnosis or prognosis of an illness or injury
– Procedures, tests, treatment options, side
effects
– Medications
– Discharge instructions
• Providing psychiatric evaluation and therapy
• Resolving billing or grievance issues
• Delivering community education services
Can Family and Friends Interpret?
NO. It causes issues with:
• Confidentiality
• Competence
• Conflict of interest
• Patient Safety
If patient insists:
• Patient must sign an Interpreter Waiver Form with the
assistance of a Qualified Language Assistance
• Available on TempleHealth Employee Intranet Site
• Our clinicians have the right to have an Interpreter present
to assist them at all times
• Document each time you use qualified language
assistance in the patient chart
How to Work with a
Professional Medical Interpreter
A professional Interpreter must interpret
everything that is said in the room.
To ensure accuracy and to avoid confusion, providers
should:
• Talk and look directly to the patient (not the Interpreter)
• Speak in first-person
• Use short sentences (avoid using acronyms or
abbreviations)
• Pause frequently to allow for interpretation
• All information exchanged is kept confidential
How to Access An
In-Person Interpreter
TUH, TUH-Episcopal, TUH-Northeastern Campus, TUP:
• Dial 2-1234: M – F 8:00 am to 7:00 pm
• After hours, weekends, and holidays contact the Clinical
Coordinator via the Operator at 2-4545
At Other TUHS facilities:
• Jeanes Hospital: Call the Nursing Office via the Operator
at 215-728-2000
• Fox Chase Cancer Center: Call the Nursing Office via the
Operator at 215-728-2000
• TPI: Contact the Regional Director
When calling for an Interpreter, provide the patient’s name,
medical record number, a contact person, location, room
number and the nature of interpretation
Language Phones are available 24/7
The Case
• A 45 year old Hispanic Female with limited English
Proficiency was admitted to the Intensive Care Unit with
intracranial bleeding. She was discharged on Coumadin
5 mg po, q day for status post DVT. She went to her
usual Pharmacy. On her prescription bottle, in English,
it read:
“Coumadin 5mg Take One Tablet Once a Day”
• The patient who spoke and read Spanish, followed the
instructions as
“Coumadin 5mg Take “Once” Tablets a Day”
Once in Spanish, means 11, therefore the patient
took 11 tablets of Coumadin in one day
What Happened?
What Went Wrong?
What Should Have Happened?
S-B-A-R Communication Model
Standardized Framework for Communication
• S-B-A-R
– Situation
• What is happening with the patient?
– Background
• What is the clinical background?
– Assessment
• What do I think the problem is?
– Recommendation
• What would I recommend?
•
•
•
•
•
An easy way to communicate critical information
Enhances predictability & fosters questions
Frames the conversation in seconds
Focuses on the problem, not the people involved
Avoids unclear or potentially confusing terms such as:
– “She’s a little unstable”
– “He’s doing fine”
– “She’s lethargic”
• Don’t use abbreviations or jargon that could be
misinterpreted
Follow These Steps Before
Patient “Hand-Off”
• Review the chart
• Examine and assess the patient
• Know the admitting diagnosis and date of
admission
• Review the most recent progress notes and
RN notes from prior shift
• Have the chart in hand and be ready to report
allergies, medications, IV fluids, lab & test
results, etc. when you make the call
Medication Reconciliation
• A dynamic process for obtaining and maintaining
accurate list of all medications a patient is taking
– Compares home medications to newly ordered
meds
– Identifies and resolves discrepancies
– An integral part of care transitions in all patient
care settings or levels of care and discharge
• Proper Med Rec reduced discharge med errors from
90% to 47% on a surgical unit and from 57% to 33%
on a medical unit of a large academic medical center
Causes of Communication
Breakdowns
• Common communication problems related to
– Incomplete patient information
– Unavailable information
– Miscommunication of medication and other
orders
– Technical issues: multiple information systems
that don’t communicate with each other
– Language and literacy barriers
Points To Remember
• Communication failures are the most common causes
of all adverse events
• Document complete patient information and thorough
and accurate histories (including allergies, over the
counter meds & nutraceuticals)
• Medication reconciliation must happen at every
transition in the patient’s care and across the continuum
• S-B-A-R frames the conversation in seconds, focuses
on the problem, provides an opportunity to read and
repeat back actions, fosters questions
•
Points To Remember
• Limited English Proficient patients and deaf
and hard of hearing patents must be provided
with qualified language assistance
• Document in the progress notes or on the
appropriate section/forms, in the computer, the
use of the qualified language assistance
• If it isn’t documented, it wasn’t done/used
• If it isn’t legible  it isn’t safe and can’t be read
We are glad you are here!