Scott Wight (Safe Handover Project Manager)and Sonya Kemp (Patient & Family Representative)
Peterborough Regional Health Centre received honourable mention for the 2017 Patient Safety Champion Award for organizations. Presented annually by the Canadian Patient Safety Institute, HealthCareCAN, and Patients for Patient Safety Canada, the Patient Safety Champion Award recognizes volunteers and organizations that are taking a leadership role in ensuring that clients and families are at the centre of patient safety initiatives.
The Joint Commission (2010) estimated that 80 per cent of sentinel harm events are the result of miscommunication between caregivers and between caregivers and patients. In 2016, two key projects were implemented at Peterborough Regional Health Centre (PRHC) with the aim of improving safety through enhanced patient partnership and communication.
The Safe Handover project involved the redesign of nursing transfer of accountability to a bedside model that integrates patient and family input and applies a standardized approach to safety checks. To enhance staff awareness and skills working across cultures, the Clinical Cultural Competence project included the development and implementation of mandatory training on health disparities, and approaches to assessment and communication that would support patient safety and health equity. The core aim of both projects was to foster a culture that values and seeks to understand what matters most to patients and families. Focusing on relationships and communication in a more meaningful way was the key to improve patient safety in every interaction.
Patients and families were engaged throughout the Safe Handover project. In the planning phase, patient advisors provided input on the standardized approach, design of patient communication boards, and content of associated policies and processes. During the implementation phase, every patient and nurse on the inpatient units was surveyed over a two-week period. Now in the sustainability phase, patients and nurses continue to provide feedback through post-discharge phone calls and surveys conducted on a bi-weekly and monthly basis. The input received is provided to the staff on the unit and discussed at the Nursing Professional Practice Council.
Safe Handover Leadership Team (left to right): Sean Martin, Director Collaborative Practice, Quality & Ethics; Barb Huggins, Manager, Collaborative Practice; and Scott Wight, Clinical Technology Project Manager
Patient communication boards were introduced to facilitate two-way communication from the team to the patient and family, and also for the patient and family to communicate back to staff. On each shift change, nurses introduce themselves, complete a standardized safety check, ask the patients and families if they have any questions, and update the care board with the nurse's name and any other pertinent information.
PRHC staff are now directly engaging patients and families in two-way communication at every transfer in nursing care. The transition to include patients and families in nursing transfer of accountability, at shift change and when being transferred between units, has resulted in improvements in patient safety, and nurse and patient satisfaction. Safe Handover has reduced medication errors, averted falls, and provided early identification of changes in clinical status. Patient surveys and post-discharge phone calls indicate that patients feel more informed, involved, safer and valued. Nurses say that they feel more prepared for their shift, have an increased awareness of safety-related priorities for their patients and that patient needs are being met in a timelier manner.
Currently, at the one-year mark, 80 per cent of inpatient units have adopted the standardized approach and by the fall of 2017, work will begin to transition outpatient units to the new model for safe handovers to ensure consistency across the hospital. The model is also being considered to enhance the physician handover process.
A need to focus on cultural competence within PRHC was identified through community input, post-discharge phone calls, feedback through Patient Relations and other means. Input was sought from local community groups in order to improve the quality of care provided to populations at-risk of experiencing health disparities, including the elderly, impoverished, mental health and addictions and First Nations. In the first step of a phased approach, initial awareness training was provided by nurse educators and social workers; the second phase will see a partnership with patients, families and community groups to facilitate more targeted content.
Lori Darrington, RN and Brianne Callaghan, RN performing bedside handover with a patient
PRHC has helped its staff to understand and integrate what patients value and why. More than 1,000 clinical staff have been trained in a two-hour Clinical Cultural Competence workshop to increase awareness of their own biases and stereotypes, and how those factors can influence the provision of care in a manner that decreases safety and leads to health disparities. The focus was not to teach about specific cultures, but rather to take an approach that helps staff understand that everyone is unique and that to understand their values and beliefs, you need to ask specific questions in a respectful way. The Cultural Competence training program is being integrated as a core component for all new hires. An e-learning module is now being developed for non-clinical staff.
The Clinical Cultural Competence project also included the implementation of a new interpreter service that provides 24/7 access to qualified medical interpreters in over 200 languages. This has been of particular benefit to refugee patients and families and their community support groups.
PRHC is a member of a recently formed Peterborough Community Cultural Competence Working Group and will be hosting a Cultural Competence Train-the-Trainer workshop for its community partners. The group has collectively identified culture-related training resources available locally and uploaded them to a public website to help build capacity through education across all sectors within the community.
"Ultimately, what is important is how we engage patients and families in their care on a daily basis," says Sean Martin, Director, Collaborative Practice, Quality & Ethics and Chair of the Nursing Professional Practice Council. "Our commitment to partner with patients and families in all respects will build stronger relationships, improve communication and will result in more patient-centred and effective care plans."
The Patient Safety Champion Awards recognize Peterborough Regional Health Centre for its meaningful integration of patients and family as members of the care team, and for opening a dialogue internally and externally that will continue to drive patient safety through engagement. Congratulations!