Loeslie Vicki, Abcejo Ma Sunnimpha, Anderson Claudia, Leibenguth Emily, Mielke Cathy, Rabatin Jeffrey
Vicki Loeslie, DNP, APRN, CNP, is a Nurse Practitioner supervisor in the Medical Intensive Care Unit and Respiratory Care Unit, Division of Critical Care, Mayo Clinic, Rochester, Minnesota. Ma Sunnimpha Abcejo, MSN, RN, is the Nurse Manager of the Respiratory Care Unit, Department of Nursing, Mayo Clinic, Rochester, Minnesota. Claudia Anderson, APRN, CNP, is a Nurse Practitioner for the Palliative Care Service, Palliative Medicine, Mayo Clinic, Rochester, Minnesota. Emily Leibenguth, APRN, CNP, is a Nurse Practitioner in the Medical Intensive Care Unit and Respiratory Care Unit, Division of Critical Care, Mayo Clinic, Rochester, Minnesota. Cathy Mielke, APRN, CNS, is a Clinical Nurse Specialist of the Respiratory Care Unit, Department of Nursing, Mayo Clinic, Rochester, Minnesota. Jeffrey Rabatin, MD, is the Medical Director of the Respiratory Care Unit, Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, Minnesota.
Dimens Crit Care Nurs. 2017 May/Jun;36(3):157-163. doi: 10.1097/DCC.0000000000000241.
Substantial evidence in critical care literature identifies a lack of quality and quantity of communication between patients, families, and clinicians while in the intensive care unit. Barriers include time, multiple caregivers, communication skills, culture, language, stress, and optimal meeting space. For patients who are chronically critically ill, the need for a structured method of communication is paramount for discussion of goals of care.
The objective of this quality improvement project was to identify barriers to communication, then develop, implement, and evaluate a process for semistructured family meetings in a 9-bed respiratory care unit.
Using set dates and times, family meetings were offered to patients and families admitted to the respiratory care unit. Multiple avenues of communication were utilized to facilitate attendance. Utilizing evidence-based family meeting literature, a guide for family meetings was developed. Templates were developed for documentation of the family meeting in the electronic medical record.
Multiple communication barriers were identified. Frequency of family meeting occurrence rose from 31% to 88%. Staff satisfaction with meeting frequency, meeting length, and discussion of congruent goals of care between patient/family and health care providers improved. Patient/family satisfaction with consistency of message between team members; understanding of medications, tests, and dismissal plan; and efficacy to address their concerns with the medical team improved.
This quality improvement project was implemented to address the communication gap in the care of complex patients who require prolonged hospitalizations. By identifying this need, engaging stakeholders, and developing a family meeting plan to meet to address these needs, communication between all members of the patient's care team has improved.
重症监护领域的大量证据表明，在重症监护病房中，患者、家属和临床医生之间的沟通在质量和数量上都存在不足。障碍包括时间、多名护理人员、沟通技巧、文化、语言、压力以及理想的会面空间。对于长期处于重症状态的患者而言，采用结构化的沟通方法对于讨论护理目标至关重要。
本质量改进项目的目的是识别沟通障碍，然后制定、实施并评估一个适用于拥有9张床位的呼吸科病房的半结构化家庭会议流程。
利用设定的日期和时间，为入住呼吸科病房的患者及其家属提供家庭会议。采用多种沟通途径以促进参会率。利用基于证据的家庭会议文献，制定了一份家庭会议指南。开发了用于在电子病历中记录家庭会议的模板。
识别出了多种沟通障碍。家庭会议的召开频率从31%提高到了88%。工作人员对会议频率、会议时长以及患者/家属与医疗服务提供者之间护理目标一致性讨论的满意度有所提高。患者/家属对团队成员之间信息的一致性、对药物、检查和出院计划的理解以及解决他们对医疗团队关切问题的效果的满意度有所提高。
实施本质量改进项目是为了解决在照顾需要长期住院的复杂患者时存在的沟通差距。通过识别这一需求、让利益相关者参与进来并制定一个家庭会议计划来满足这些需求，患者护理团队所有成员之间的沟通得到了改善。
