House Staff Orientation June 2016

1. COMMUNICATIONSPreventing Errors Associated With CommunicationLanguage ResourcesMedication ReconciliationS-B-A-R: Communication Model House Staff Orientation June 2016

2. 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

3. Objectives

4. 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

5. The Video

6. What Happened?What Went Wrong?What Should Have Happened?

7. 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

8. Appropriate Language ResourcesThese Resources Are Available 24/7 By Federal and State Law & Hospital Policy: • Interpreters must be “qualified” and approved by TUHS Language Services 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 The use of translator apps on electronic devices such as cell phones, tablets, etc. is NOT permitted

9. 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

10. Can Family and Friends Interpret? NO. It causes issues with: • Confidentiality • Competence • Conflict of interest • Patient Safety If patient insists: • Patient must sign anInterpreter Waiver Formwith 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

11. How to Work with a Professional Medical Interpreter A professional Interpreter must interpret everythingthat 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

12. 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

13. 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

14. What Happened?What Went Wrong?What Should Have Happened?

15. 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?

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. Thank You & Welcome to Temple buena suerte We are glad you are here!