HCAHPS

HCAHPS articles, podcasts, ebooks, and downloads from Always Culture.


How Today’s Patients See Care Teams

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Today’s patients see care teams differently than they once did. In the past, patients played more of a child-like role to their physicians and nurses. However, in today’s more patient-centered market, there has been a shift to patients wanting more information and control over their own care—they want to be a member of their own care team.

patient centric care teams

Introducing the Healthcare Consumer

We all know the patients who would rather sit uncomfortably than call their nurses to help them or the patients who don’t want to ask the doctor too many questions because they are so busy.

Today’s modern healthcare consumer is empowered. They want to take an active role in their own healthcare because they not only want to know what they are paying for, but they want to be part of the decision-making process.

The modern patient does not sit by the sidelines as members of a care team makes choices for them. Instead, they are active participants – actual members of their care teams. They are involved in:

  • Decision-making
  • Care team conversations
  • Treatment planning

So, how can healthcare professionals help patients feel more a part of their own care teams? Nurses and other members of the healthcare community need to readily embrace this shift in attitude and find ways to bring the patient on board. A great way to start is with the bedside shift report.

Engaging Bedside Shift Reporting

In the old days, the bedside shift report was a discussion between the off-going nurse and the oncoming nurse that took place in front of the patient—not with them.

Bedside shift reporting today takes a complete approach. The goal of the report is the same, but the information comes directly from the patient—making them part of the team. A key tactic to use here is the teach-back method, where the outgoing nurse prompts the patient to explain their care to the oncoming nurse. This puts the patient, and their family members, in the driver’s seat on issues such as pain management, treatment planning, and scheduling.

When it comes down to it, the patient is ultimately in charge, so why not work with that to empower them?

Changing Roles in Discharge Planning

improved hcahps scores

The final step is to involve both the patient and family members in planning their discharge to the next level of care. Discharge planning goes into effect immediately when the patient is admitted to the hospital. Nurses should prompt the patients and family members to think ahead to when they will be going home, and to begin planning what they will need to continue their care.

This advanced planning gets them thinking ahead about the discharge process and how to prepare for it. They will begin constructing questions in their mind to ask prior to discharge, and it will give them plenty of time to gather the necessary information to take over their care.

The parent/child dynamic that once existed between a healthcare provider and patient failed in many ways. The healthcare landscape today supports more of a peer-to-peer scenario, giving each party the respect they deserve and the information they need for better outcomes. Patients are no longer sideline observers in their own health care strategies. Today, they are members of the care team and able to take an active role in their own care.5 Areas of Focus for HCAHPS eBook

[PODCAST] How Nursing Leadership Can Move Surveys from Usually to Always

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Nurses and nurse managers, strive to provide safe care along with an excellent patient experience. If your organization has attained that goal, then you may have found your hospital in the upper 25th percentile of the national database. That’s an accomplishment, so congratulations – high fives all around. The problem is once you meet that milestone, how can nursing leadership continue to improve?

Listen to the podcast to learn more: How Nursing Leadership Can Move Surveys from Usually to Always

5 Areas of Focus for HCAHPS eBook




How Nursing Leadership Can Move Surveys from Usually to Always

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As a nurse or nurse manager, you strive to provide safe care along with an excellent patient experience. If you have attained that goal, then you may have found your hospital in the upper 25th percentile of the national database. That’s an accomplishment, so congratulations – high fives all around. The problem is once you meet that milestone, how can nursing leadership continue to improve?

nursing leadership in busy hospital

Taking the next step means moving those patient survey responses from “Usually” to “Always”. The idea is to provide care that will encourage your patients to pick “Always” on the HCAHPS survey in every domain, presenting you with top marks for your care, but how?

FREE DOWNLOAD:  HCAHPS Tactical Guide

Adding Definition to Your Strategies

Consistency is the key to quality care and improved scores on the HCAHPS survey. It seems to make sense to dedicate your department to a “flavor of the month” enhancement like patient safety, communication, and responsiveness, but are you consistent in the way you deliver them?

To provide care that will make an impact on your patients, nursing leadership must be consistent in practicing core principles such as safety, communication, and responsiveness. This means focusing on a few basic tactics, that can make an impact on both your patient’s experience and how they score you on the HCAHPS survey.

Bulking Up Your Score with Regular Rounding

There are two major tactics to factor in consistently to further enhance your nurse to patient communications skills. Start by initiating regular rounding or hourly rounding. This is good for many reasons, but, ultimately, it sets the patient’s expectations. They never feel deprived or alone when they know you, their nurse, are coming around in regular intervals.

From the nurse’s standpoint, if they know you are coming back on a schedule, it keeps your patient from getting up over and over without assistance. That’s a point for patient safety. For nurses, it adds certain efficiency to the work, as well.

Making Use of the Communication Boards

Another underused but highly effective communication tool is the communication boards. This is powerful and engaging information for the nurse, regular staff, and the patient. Communications boards clearly state:

  • Upcoming appointments
  • Medications
  • Nurse’s name

By keeping that information current, nurses reduce patient and family anxiety and foster effective communication all around.

Nursing Leadership Can Get Better Responses with Enhanced Responsiveness

Consider two tactics that work well in the domain of responsiveness:

  • The “Five Foot Rule” states that a nurse should never be more than five feet away from a call coming in at the nurses’ station. It’s a simple concept that ensures the patient never has to wait once that button is pushed.
  • Establish a department-wide policy that states no member of staff should walk by an engaged patient’s assistance light without checking to see what the patient needs.

Those two enhancements really focus the entire staff’s attention on responsiveness to the patient’s needs.

The trick is to learn to improve those scores by figuring out what works for you and your hospital. Ask the nursing managers to talk about enhancement tactics like the ones listed here during meetings. Bring them up any chance you get, really, maybe at larger group meetings, as well. Promote the idea of a skills lab that video tapes staff working with mock patients to see what works and what doesn’t and improve skill sets. Staff can provide feedback to promote consistent delivery.

Instead of just picking out new tactics with each patient or each shift, focus relentlessly on the basics listed here and soon you will find yourself moving up to the “Always” rank.5 Areas of Focus for HCAHPS eBook

An L&D Story: How a Good Patient Experience Could Have Been Great

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Patient Experience and L&D

In March, my wife and I were thrilled to welcome our second child to the world. Our baby boy was born healthy and we could not be more thankful. I did catch myself taking notes, however, as I’ve been working closely with Always Culture and learning about best practices for providing an optimal patient experience. Our overall experience was good, but there were some areas of opportunities that, if addressed, could have made it great.

Our son was a big boy – over 9 pounds, and my wife is very petite, so a few days before the due date her doctor advised that we schedule a cesarean. We gratefully accepted. My wife’s water broke with our first child, and it was like one of those movie scenes where you rush to the hospital, so it was weird just showing up at a certain time to have the baby. Weird, but nice. We stayed for two nights.

COMMUNICATION

We didn’t have any really bad interactions with nurses, but we could tell a difference between the providers that were just going through the motions, trying to get through their shift, and the ones that were actually engaging with us. Right off the bat, they were asking some intake questions and mixed in with medical history, medications, and the like, was this one: “Have you ever thought of hurting yourself or anyone else?” The nurse asked it in the same casual tone that she asked about cigarette smoking. I couldn’t help but think that if the answer was “yes”, would anyone feel comfortable saying so? What would the follow-up be? It just seemed like a very personal and intimate detail that should have been approached with a bit more care.

After the baby came, we were like many parents with newborns; exhausted, delirious, and looking for the staff to assure us that our son was doing well. We may actually be a bit more sensitive than many parents. I know I tend to look for things to worry about when it comes to my kids. That’s why I replayed every word I heard from the care team over and over in my mind.

There is no “routine” for patients and their families

I remember at one point the pediatrician came in and asked us how the baby’s blood sugar was. I was thinking “I don’t know… let me ask the doctor!” The question was completely out of left field. I felt like there was something going on that we didn’t know about. I pestered the next few people who came in the room about “have you heard anything about his blood sugar?” They hadn’t. It was fine. I don’t know why the doctor asked the question, but I learned that routine communication is not routine for patients and caregivers.

Empathy goes a long way

We had a couple of nurses that I wish I could give a million dollars each. They were truly caring toward my wife. They listened, asked questions to discover what was important to her, and had empathetic responses that made us feel like we were in good hands. Breastfeeding was something that we were especially focused on because we had struggled with our first child. We knew we wanted to get as much advice as we could while we were in the hospital. Even though the nurses and lactation consultants didn’t have all the answers, the time spent with us “in the trenches” meant the world to us.

The last thing I would say about communication is that I wish that all of the staff had utilized the communication boards. Some did, but most didn’t. Time doesn’t seem to exist those first few days, so it’s helpful to know what meds you can have when, remember who your nurse is now, and how she can be reached if needed.

RESPONSIVENESS

There were only a couple of times during our stay when I got upset. They both had to do with responsiveness. After my wife’s catheter was removed, it took a while before she could go to the restroom on her own. While she waited, her pain (and anxiety) continued to build until it became unbearable. She had been told not to try and use the restroom on her own, but she really wanted to try so she could relieve the pain. We were unable to get help to the restroom. Multiple calls using the call light didn’t work. The staff that answered the call seemed indifferent and a little put off that they had been bothered.

Eventually, I helped her to the toilet and she was able to relieve her pain (and bladder). The nurse arrived while she was in the restroom, and I was a little surprised that she didn’t stay to help her back to bed. In general, the call lights seemed to be completely ineffective. There were several occasions when she needed pain meds that I eventually went out to the nurse’s station because it was the only way we could get help. I don’t know what she would have done had she been alone.

Shift Reports and Rounding set the tone for attentive care

We never experienced a bedside shift report or regular rounding. We often found ourselves just hoping someone would show up soon, and often expecting to have to track someone down. Several hours after one shift change I went to the nurse’s station asking if we could get some medication and they asked who my nurse was. I had to respond, “I don’t know, we never met her.” Despite having some sub-par experiences, it’s amazing how one person can turn it around. It was the nurse at the station who asked me who my nurse was. She understood that the ball had been dropped and she picked it up. She got my wife’s medication and set clear expectations for when we could expect to see her again. After finding the nurse assigned to us, she had taken over our care personally. Each shift change we had been hoping that we would get a nurse who was paying attention. She was a breath of fresh air.

Any inpatient stay is a vulnerable time for patients and their families, even on joyous occasions like childbirth. Having a caregiver who is truly paying attention makes all the difference in the world. Implementing best practices like bedside shift reports, regular rounding and communication boards can help make a patient feel like they are being cared for and make a good experience an exceptional one.

5 Areas of Focus for HCAHPS eBook

Fostering Patient Loyalty in the Age of Value Based Care

How loyal are your patients? That depends on who you ask. According to a consumer study from Accenture, patients nationwide are as likely to switch doctors as they are hotels or airlines if they do not receive the service and experience they expect.

Additional findings from the study include:

  • 61% of patients are willing to change providers to get an appointment more quickly
  • 52% of patients would change providers to get an appointment in a more convenient location
  • 47% of patients would switch for a stronger understanding of care costs
  • 50% of patients are willing to pay more for weekend or after-hours appointments, or to have more personal time with their clinician

value based care

While many providers and healthcare organizations assume that if they offer excellent quality of care, patient loyalty will follow. This may not always be the case. Times have changed, and a large majority of consumers expect convenience, quick access, and prompt responsiveness from all of their business interactions whether banking, travel, retail, or healthcare.

Two additional findings from the research that were important to note, include:

  • Patients want responsiveness and convenience – As patients are paying more out of their pocket for healthcare services due to higher deductibles, they are expecting more for their money. Healthcare providers and organizations that are able to offer patients value in terms of convenience and a superior experience will ultimately be most successful in gaining patients loyalty. In today’s digital age this can mean simply making it easy for consumers to schedule their appointments through online scheduling, and online bill pay. Providing more information regarding the cost of care has become increasingly important.
  • Patients will pay more for services they value – More than half of the healthcare consumers surveyed, said they would pay more for experiences they considered valuable such as weekend or after-hours appointments, or additional time spent with the doctor. Others expressed an interest in paying more to see a provider virtually and paying more to be notified for a follow-up visit.

Those who are able to offer patients quick access, convenience, cost of care transparency, and personalized quality of care will be best positioned for success in this highly competitive ever-changing marketplace. Providing a better patient experience will not only help increase patient loyalty it also benefits a practice financially. Most importantly these providers and healthcare facilities will build long-lasting relationships with patients, which is the foundation of every medical practices success.

Jerry Stone is the co-founder of MedicalGPS, which provides real-time patient experience tools that help foster patient loyalty and reduce medical malpractice risks.

Staff Wellbeing is a Major Driver of Patient Experience

When discussing the patient experience, we focus a great deal, of course, on the patient. But it is important to remember that the wellbeing of your staff is a major driver of the patient experience.

The sense of being appreciated and cared for comes from the administrators themselves and trickles down through the front-line staff managers. This top-down feeling of being fulfilled in the work that you do directly influences the caregiver and, therefore, the way the patient responds to his care in the hospital.

If you want your hospital to offer a great patient experience, the employees there must feel appreciated, engaged, and fulfilled. Below are approaches to ensure that your staff feels appreciated, and in turn, provide the kind of care that will positively influence the experience of your patients.

patient experience staff wellbeing

Appreciated

Staff members need to feel that they are recognized and know that they are appreciated. This can be addressed in both big and small ways. Large, one-time events like banquets and Employee of the Year recognitions are a great way to express a grand sense of appreciation, but there are smaller gestures that can be made throughout the year. Personal words of encouragement or handwritten thank you notes to managers and front-line staff boost employee morale.

Recognitions that involve the patients themselves are also a huge bolster to the internal spirit within the hospital. Allow patients to share their thoughts on commendable employees that they have come into contact with during their stay. These “shining stars” can be recognized within their own departments or within the hospital as a whole.

These small acknowledgments make your staff feel recognized and appreciated. This feeling of appreciation will encourage employees to take pride in their work, which ultimately affects the patient. But, organizations cannot stop at here – this is a good start, but it cannot be all that is done.

Engaged

Staff recognition is important, but it is just as important to have constant communication with the staff at your hospital. One way this can be accomplished is by surveying employee satisfaction regularly – annually at minimum. Asking for their input is a great way to get a feel for the environment in which your employees work, but the communication cannot end there.

It is important to not only survey your employees, but to act. Look at what members of your staff are saying. Listen to the topics that come up frequently. Once you have identified the main areas where improvement is needed, act on them. After you understand the results of your survey, set goals, make concrete plans of action, and create expectations to work on for the next year.

You can also use a staff survey to ascertain the high points of your hospital. Take the time to explain to the staff what your organization does well in addition to opportunities for improvement. Report back to your staff regularly on how your plans for improvement are going. By making employees feel engaged in their workplace, they are more likely to serve their patients better.

Fulfilled

It is important to ensure that every employee at your health center feels fulfilled. You do this by reminding them of just how important their role within the hospital is. Make sure that your staff understands the “whys” of what they do. Every position within a health system impacts patient care and the patient experience. Emphasize that every member of your staff – from EVS to dietary services to billing – leaves an impression on the patients in the hospital where they work.

This type of encouragement takes regular communication with the front line staff. Use an open dialogue to inform managers on information and inspiration that they can take back their front line team members. Explain to them the importance of encouraging the staff working under their leadership and how much every action ultimately affects the patients, even if not directly.

Conclusion

By making sure every employee at your hospital feels appreciated, engaged, and fulfilled, you will create an environment that ultimately creates a better experience for the patient. While it may seem obvious, every employee has a role to play in the patient’s experience. Appreciated, engaged and fulfilled employees will provide a much more positive patient encounter within your facility.





5 Areas of Focus for HCAHPS eBook




Opportunities for Collaborative Care in Pain Management

collaborative careWhen it comes to improving pain management scores, and improving pain management in general, we must consider that there is not one singular solution. Hospitals that are willing to work together inter-departmentally to assure their patients feel that their pain is being addressed, will be rewarded with an increase in positive feedback from the people they serve.

Often times, this requires putting departmental pride aside and reaching out to other health professionals to create an environment that allows our patients to hear the same information from several sources. By encouraging interaction with and reiteration by physicians, nurses, pharmacists, and other healthcare professionals, patients have a better chance to receive, understand, and truly learn the information being shared. In this way, patients become a part of their own care and healing and have insight into both their treatment and the likely duration of their discomfort.

Physicians

Doctors are typically the first person that a patient thinks of when he is suffering from an ailment or disease. Your patient in the hospital has had at least some interaction with a physician on his path to his current condition. Patients also tend to understand, though, that while doctors may round occasionally, they will not be their main contact during their hospital stay.  Most patients, however, trust the physician’s word more than any other he will hear during his stay.

When the physician does arrive in a patient’s room, it is imperative that she spends time truly listening to her patient, answering questions, and explaining methods to address the patient’s pain. Beyond these basics, physicians must manage up the nursing staff as partners in their pain management, and discuss their pain goals with the patient as an active member in their care. This interaction with the doctor assures the patient that his primary contact is still involved in his care and that the nurses, who are in more constant contact with him, are working in agreement with the physician.

Nurses

Patients will have more interaction with their nurses than with anyone else in the hospital. This first line of care is one of the most important components in determining the patients’ perception of their hospital stay. Nurses have the opportunity and responsibility to educate their patients when it comes to medications. By communicating often and honestly, nurses are in the best position to help a patient set realistic goals about his pain management. The reiteration of the name of their medication, the reason the medication was prescribed, and the potential side effects help educate the patient and include them in their own healing.

Nurses also have the chance to reiterate the suggestions of other health professionals – it is the nurse who can remind the patient to call for help before attempting to walk alone (“like your physical therapist told you”) or to try to eat (“remember your doctor wanted to you to drink 8 ounces by mouth”). This unique position of offering care while managing up your fellow healthcare workers puts nurses at the forefront of the collaborative care effort.

Of course, the other health professionals that interact with the patient should also be repeating information about medication, precautions, and goals as necessary. While that may seem redundant, knowing that the there is a team of health care experts collaborating together on their behalf offers an assurance that is invaluable to the patient.

Pharmacists

Pharmacists are an essential part of increasing a patient’s confidence in her healthcare and, as such, should be included as a patient educator whenever possible.

Pharmacy is defined as the art, practice, or profession of preparing, preserving, compounding, and dispensing medical drugs. Taking a prescription from a physician and delivering the exact medication to treat a patient truly is an art form. And, while we, as healthcare providers, interact and distribute medication every day, the pharmacist is the best choice to explain to the patient the reasons for and ramifications of any medicines he is taking.

Research has shown that rounding by pharmacy managers improves education and minimizes errors from non-compliance. In hospitals where pharmacists round, patients have a better perception of their pain management and medication communication. The idea that they are receiving a collaborative effort in regards to their healthcare increases patients’ overall outlook of their hospital stay.

Other Health Professionals

Patient interactions are not limited to physicians, nurses, and pharmacists – there are scores of other health professionals who will spend time with the patient during her time in the hospital. Therapists, technicians, and dieticians will all take part in a patient’s care plan and should be working with the other healthcare providers to create a cohesive plan. They should be reiterating parts of the plan that have already been established and communicating additions to the care of the patient that fall under their expertise.

A patient who sees and experiences the collaborative care of all her health professionals working together with her will have a much more positive outlook on her care. She will also have a better understanding, albeit with more realistic expectations, of her healing and pain management. 

Administrative Responsibility

This environment of interdepartmental cooperation must start from the top down. A culture shift within a hospital must be lead by an administration who appreciates the benefits of collaborative care for their patients. Administrators must understand that cooperative care changes the outlook of patients on their overall stay in the hospital by making them feel considered and valued.

There must be leadership in creating a patient-centered culture. Hospital administration has to lead the charge in making resources, training, and focus on the patient experience a priority. Once it is clear that the patient has become the heart of the hospital, staff will adopt and embrace this belief. Slowly, this philosophy will trickle down to directors, managers, and front-line staff and create an Always Culture for every patient who enters your doors.
5 Areas of Focus for HCAHPS eBook




How to Make Your Pain Management Efforts More Honest and Human

pain management - honest and humanWhen patients are admitted into our hospital, not only do they come in with their own expectations of the care they should receive, but most of the time our patients’ time spent in the hospital is accompanied by pain.

Whether they have this pain before they come in, or after they undergo a procedure, pain can affect our patients’ mind, body, and spirit. Pain also influences how patients perceive their pain management and overall care. Effective pain management is essential to maintaining a positive patient experience, as well as a basis for comprehensive and compassionate care.

Listen

The first step in setting expectations is taking the time to listen to the patients. As providers, we are bombarded with tales of pain and woe throughout every shift we work, but for your patients, the pain they are experiencing is new, foreign, and frightening. By truly listening to their complaints, you will be able to better understand how to treat their specific needs.

Involve the family of the patient in this step as well. While some patients want to tell us every ache and pain they experience throughout the day, others are hesitant to “trouble” us. Patient families are excellent sources of information in these circumstances.

Managing Expectations

Before you administer a medication, take the time not just to let your patient know what you are giving them and why, but really take that time to set their expectations. As a basis, you should explain the medication you are giving, the dosage, why it is being given, and possible side effects. Additionally, let your patient know how long she will need to wait until the medication takes effect, and set a time that you will return to check on how her pain is progressing.

Repeating this information every time you administer the medication may seem like a redundant waste of time, but your patients are not health professionals. Their medications have unfamiliar names and it takes them time to learn the purpose behind each drug they are taking. By reciting the name, dosage, reasons given, and possible side effects each time you administer it, you are empowering the patient to learn more about her treatments and take ownership of her own healthcare.

Set Goals

Once you have heard what your patient is experiencing, work with the patient and his family to set realistic pain goals. Medications and treatments are not going to eliminate pain, instead, they are designed to control it. When creating a pain control plan with the patient, avoid statements like, “This will take care of that pain…” or “This medication will knock that pain right out…” These only serve to patronize our patients. Patients don’t want to be placated or dealt with as if they were a problem to solve; instead, they appreciate honest communication.

Trust your patient’s assessment of his own pain, and develop his pain goals with him and his family. Whether the pain goal is to decrease the pain to a certain level, or to decrease their pain by a certain amount, work with the patient to create common expectations.

Use this opportunity to set other goals as well. These goals can include functional goals about mobility, goals about sleeping, or even emotional goals. As long as you work together with your patient and his family in creating the goals, everyone involved in his care will be on the same page and work towards the same goals.

Alternative Pain Management

While, for many patients, their idea of pain management includes using pain medication, others may appreciate the suggestion of alternative or non-pharmacological, methods. These can include everything from simple efforts such as repositioning, heat or ice, or even hand-holding; environmental changes like aromatherapy or music therapy; skilled modalities such as massage or acupuncture; or even simple distraction techniques like exercise, using a mobile device, reading, or welcoming visitors.

The particular method of alternative pain management is not really the issue here. The idea is that, by suggesting alternative methods in addition to pain medication, you will drive home the idea that you are doing everything you can to manage your patient’s pain.

Conclusion

Patient education is probably the single best practice you can employ to improve your patients’ perception of their pain management. Studies have shown that patient education and patient involvement in setting goals not only impacts the patient’s perception of their pain management, but patients have even reported decreased and more tolerable levels of pain.

By listening closely, working with your patient to set goals, maintaining expectations, and offering alternative options when it comes to pain management, you will be able to create an Always Culture in your healthcare facility.
5 Areas of Focus for HCAHPS eBook




Give Scripting a Chance in Medication Administration

medication administrationConsistency is the hallmark of a culture focused on safety and quality, but it should also come as no surprise that consistency is one of the most difficult qualities of care to maintain. It is all too easy for organizations to be distracted by a new method or metric in trying to accomplish quality or satisfaction goals, and what gets overlooked are the basics of patient care:  the basics of clear explanations, the basics of listening, the basics of responding to call lights, and the basics of effective pain management (just to name a few).

When it comes to pain management, nothing could be more basic than the process of administering medications to our patients. The essentials of this process are telling the patient four things: the medication’s name, the dosage, the medication’s purpose, and any side effects they might experience. The idea here is that these four pieces of information should be repeated EVERY TIME for EVERY PATIENT. Now if that sounds repetitive…it is…and it is for a reason.

Patient Education

It’s all about patient education, and repetition is a great tool for learning—especially for patients whose main job in the hospital is to learn: learning about their diagnosis, learning how to manage pain, learning about their medications and side effects. Don’t forget that all of this information can be new and scary to patients. Not to mention that most of it is effectively in a foreign language. Repetition is key to make sure a patient’s medication information is heard and remembered, and this won’t all happen on the first telling. The first time they got their meds, maybe they caught the name; at the third administration, maybe they heard the side effects and made a connection with how they had felt earlier.

Repetition in the medication administration process is also helpful to family members. Not only can they hear, remember and remind the patient about their medications, but family members can frequently change over the course of a stay. Repeating these same four items for each medication can help different family members pick up and reinforce different parts of a patient’s medication education.

Push Back

As soon as you start talking about processes and “scripting” there is usually a very vocal group of frontline staff that balk at the idea. I have read and heard comments saying that it relegates them to “robots” and takes away their relationship with their patients. Of course, no one wants nurses to have their own individuality and style of care controlled from on high, but comments like these are an oversimplification of scripting—focusing too much on the letter of the law and not the spirit of the law. The idea behind this process is so that the patient hears what they need to hear every time, so that they might be educated by the time they leave your care.

Let’s not forget to approach our patient interactions and medication administration experiences with a sense of empathy. We must remember that while this is the 40th time we’ve explained the name, dosage, purpose and side effects of Lortab today, it’s the first time your patient has heard it—or maybe it’s the third time you’ve told them, but it will be the first time they truly hear you.

We don’t need to look at scripting or a process as something that removes or replaces our personal interactions with our patients—rather, the process is there to make sure we communicate with our patients effectively and educate them correctly.

The Process

So, if we can agree that a process doesn’t kill our individuality as care providers, and that it can be extremely beneficial to patient education and safety, then we should lay out that process. Fortunately, it’s simple.

Our patients want to be educated. They want to know what they are taking and why, and there is no better time to educate them than when you are administering their medications. Our patients expect to be partners in their own care, and they deserve to be educated on precisely why they are taking their medications.

For every medication, at every administration, there are four main subjects that should be covered: the medications name, the dosage, the purpose of the medication, and the possible side effects.

NAME

When telling your patient the name of a medication, use the name as ordered to avoid any confusion later.

DOSAGE

Tell the patient dosage amount that they might hear their providers use or read on their bottle at home.

PURPOSE

Use a brief, clear explanation of why their doctor is ordering the medication or how it will help.

SIDE EFFECTS

Keep the terminology on their level, and begin by describing the more common side effects and then the more serious side effects. Let them know that these side effects can be managed to put them at ease, and most importantly, make sure they know to contact you or their nurse if they need the side effects addressed.

The basic statement might look like this: “Mr. Cumberbatch, here is your Lortab for your pain, it’s ten milligrams and you might feel some drowsiness or light-headedness.”

Final Thoughts

If you’re struggling with this process because you feel forced in communicating with your patients, try leaning into the repetition. Try saying, “I know I say this every time but…” or “Here it is again…” before you give them the four points for their medications. While the repetition might initially feel cumbersome or annoying to you, the winning result will be when your patient can tell you the name, dosage, purpose, and side effects of each of their medications. When it comes to patient education and patient safety, there is no substitute for a simple process consistently delivered to every patient.
5 Areas of Focus for HCAHPS eBook




3 Keys to an Effective Pain Management Culture

effective pain management cultureI recently took my family to one of the new “escape room” experiences that seem to be popping up everywhere. Upon entering we were introduced to our Escape Room Professional (let’s call him Carl), and as he walked us over to our particular room he began explaining the process and rules of the game. However, it was obvious from how quickly Carl was muttering under his breath, that this must have been the 1347th time he had given this particular speech. In fact, it took a minute for me to realize that not only was he talking to us, but he was giving us instructions on how to play the game. At one point I actually had to stop Carl and ask him to speak more slowly, but even this didn’t help much. In the end we played, figured out the clues and got out within an hour—we had a great time. But, the whole thing was a bit hampered for me by our initial experience.

For my family and I, this was our very first escape room experience—we had no idea what we would see or do. For Carl, he was 5 hours into a Saturday shift and this was number 14 of the 30 appointments that would come through that day. He knew the speech he was supposed to give, and in his mind, the quicker he could get the speech out, the quicker he could get to the next group of hopeful escapees. But, while Carl was busy checking off his “gave the speech” box, my family and I were left off-balance, confused, and a little frustrated.

While this fun outing in no way comes close to a healthcare or patient experience, what is comparable is the absence of treating a new customer or patient as if each new experience is new to them. What this requires is true empathy.

Empathy

For the thousands of patients we will see in our careers, we must never forget that for them, this could be their first time for everything. For us, we are 5 hours into a 12 hour shift, we have 6 other patients, and this is literally the 1347th admit we have done in our career—but for the patient in the bed, and for the family in the room, this is a brand new experience. An experience tied to anxiety, fear, uncertainty, and in many cases, pain. Our patients and their families deserve a fresh attitude from us that calms their fears and anxieties, and lets them know that they are being cared for by someone who can empathize with them. Pain is a nearly universal symptom for our patients, and our first method of treatment should be true empathy for their situations.

Checking Our Assumptions

Our attitudes towards our patients can affect their stay greatly, and when it comes to pain control and pain management strategies we need to do some serious self-evaluation and ensure we are approaching each patient with compassion.

Empathy is the first step to making sure our mindset is correct as we interact with our patients, but to take it a step further, we need to treat each patient as an individual and not compare them to every patient or case that has come before. After treating hundreds or thousands of patients, it is understandable that we could become skeptical of patients’ complaints of pain, but we need to eliminate giving our patients the tags of “drug-seeking” or “addicts” before we learn about their cases.

While it is a reality that some patients falsify or exaggerate their claims of pain, we must respect our patients’ pain complaints or we run the risk of going from being skeptical to dismissive. If we really are going to do everything we can to address our patients’ pain, then we must begin by listening to them openly and without judgment.

Giving Our Patients Some Credit

Our patients are not children. Well…at least metaphorically. Even if you do treat pediatric patients, this can still apply to you. As caregivers we can sometimes fall into the trap of treating our patients like children—patronizing them and over-simplifying certain details of their care.

This can be especially true in pain management, when open and honest communication is essential. We must give our patients the benefit of the doubt that they can accept a realistic view of pain control—that pain control does not mean the elimination of pain. This requires a concerted effort to not only be honest and set realistic and functional pain goals, but it requires that we give each patient a clean slate as they begin their stay.

Yes, there will always be those patients who expect the impossible and have completely unrealistic views of pain management, but these patients must present themselves to us—we cannot use a patient’s background, history, or appearance to dictate how we view them before their treatment begins.

Back to the Room

So, did Carl’s rushed and half-hearted introduction ruin my family’s escape room experience? No. But, if he had assumed that this was our first game and put some time and effort into his introduction, would it have made our experience better? Absolutely.

How much more could efforts like these affect our patients and their families? Having a mindset of true empathy, putting aside our pre-conceived notions and assumptions, and giving our patients some credit can make all the difference in creating an effective pain management culture.
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