Nursing Discussion Reply
Nursing Discussion Reply
I work in a busy ambulatory surgery center (ASC) in Palm Springs, California. Mostly, my duties are performed in the
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general surgery PACU. Occasionally, I work the GI PACU. In trying to pinpoint a problem worthy of an EBP proposal, I realized there were many. At first, my project topic was focused on post-operative GI patients, who are low English proficient (LEP), and who cannot read English written instructions. About 40% of the ASC’s patient population is Spanish-speaking, and so my target population is most obviously, Latino. However, the center also does not provide written discharge instructions in Spanish or any other language for all other surgeries. Some Spanish instructions are available in a filing cabinet, but when staffing is low, and the patient load and turnover rates are swift, few nurses take the time to retrieve a Spanish document for their patients in need. In addition, the few documents in Spanish that the ASC does have, are focused on pediatric ENT discharge. One day, after performing numerous routine follow-up calls to Spanish-speaking patients, I discovered that the post-op cataract patients’ lack of understanding of English discharge instructions was putting them more at increased risk for negative outcomes and decreased patient satisfaction, than the GI patients. With my mentor, I researched through my manager’s files, negative outcomes, complications, and poor satisfaction that had been gleaned on previous post-op follow-up calls. When I compared the potential negative outcomes that could ensue in GI versus Cataract patients, I decided the risk my surgery center is taking in not providing native language instructions to post-op cataract patients, was greater than with the GI patients. The solution is to, on pre-operative screening calls, ask patients their preferred language. If the patient fills out the form online through One Medical Passport(OMP), he/she will have the option to click their preferred language. OMP site managers have already equipped the software to, now, automatically provide consents and discharge instructions in the patients indicated preferred language on assembly of their chart. This way, when an LEP patient is discharged, in addition to receiving verbal instructions in Spanish, he/she will also receive them in Spanish written form. The only aspect that has changed since the inception of my proposal was the surgical population. I decided to narrow it down to simplify this project, but eventually, I plan to do same for all other categories of patients. My initial plan on implementing bedside report was just to discuss the new implementation at a staff meeting and just have the nurses start doing it. I planned on presenting the science behind it, the way in which my mentor would like to see it implemented (using SBAR and AIDET) and then conducting rounding to monitor the effectiveness of the implementation. What I have learned thus far is making a change isn’t that easy. I am still presenting the evidence at our next staff meeting, at the request of my mentor, but what is changed is the format in which the staff will be asked to use it. To make it as successful as possible, feedback from our biggest stakeholder group, the nurses, will be gathered and a bedside reporting tool will be developed. While AIDET and SBAR will still be key aspects to the form, special check lists regarding key lab values, checking the telemetry parameters, checking IV infusion settings, wounds, drains, tubes and central lines/IV’s will be added. A suggestion I have made, based on evidence from one of my research studies, is getting initials on the form from either family members or the patient (if they are able to) that they witnessed or participated in the bedside report. According to the study conducted by Gillam, Gillam, Casler & Cook in 2017, patients have a better recall of bedside report if they have some sort of activity that reminds them they took part in the practice while the nurses confirm that they are doing bedside report. Part of this project is getting patients to remember that bedside report has taken place. Having a tangible interaction with the patients or the family members is key to helping them recall the event once they are home and the satisfaction survey is conducted. I am sure there are still going to be some minor tweaks and changes coming down the pipeline, and I am learning to roll with the setbacks that are coming our way. I do believe that if I can get the staff nurses on board and develop a tool that they have input on, I will have better outcomes and success with the implementation of bedside report. My goal is to improve communication between nurses and the patients, and having this tool where we are able to make sure pertinent information is discussed at the bedside will help the process. My hope is that after a good amount of practice the tool will only be required for occasional rounding and occasional quality control to be sure bedside report remains a routine and thorough practice. References Gillam, S. W., Gillam, A. R., Casler, T. L., & Cook, K. (2017, December). Increasing patient recall of nurse leader rounding. Applied Nursing Research,38, 163-168. http://dx.doi.org/10.1016/j.apnr.2017.10.013
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