Publication/Presentation Date
7-25-2014
Abstract
Abstract
Replacement of non-template whiteboards strives to establish a standard of work around contents of bedside whiteboards across the Lehigh Valley Health Network. The overall goal of the boards is to improve communication, therefore increasing patient satisfaction and correspondence between caregivers. An initial prevalence audit was created and administered in 13 units and 4 Emergency Departments in July to gauge initial response to the new whiteboard system. HCAHPS scores were collected to establish a baseline measurement from fiscal year 2014 when non-template whiteboards were used. This data is to be compared with HCAHPS scores after standardized whiteboards are implemented, to evaluate change in communication between patients and caregivers.
Introduction
The use of communication whiteboards is common practice in many hospitals and health systems, but when boards are not standardized or blank, the information on them tends to be messy, difficult to understand, and generally makes communication experiences more confusing rather than improving clarity. Upon initial discussion of the whiteboard initiative, the team used literature to get a better idea of how other programs were using boards most effectively. According to a study by Dr. Niraj L. Sehgal (2010), “Most respondents also agreed that using template whiteboards (with predefined fields) to guide content would increase their use” (p. 236). The same study also suggested “patient whiteboards require defined goals, thoughtful planning, regular monitoring, and ongoing evaluation” (Sehgal 2010, p. 236). In relation to methods of use and measurement, Dr. Siddhartha Singh et al. (2011) strategized “patient satisfaction scores with communication were compared before and after placement of whiteboards” (p. 128), while Dr. Sehgal’s team recommended “one strategy to consider is having designated ‘auditors’ check whiteboards in each room, measuring weekly compliance and providing this feedback to nurse managers” (2010, p.238). Both teams’ reports advised that studies done in the future should focus on numerically confirming the effects of the newly implemented whiteboards using methods such as HCAHPS scores and Press Ganey responses.
Methods
A grand total of 1073 LVHN Communication Whiteboards will be implemented through this initiative. Multiple whiteboard templates were created to specifically address the needs of the unit in which they were being used. The project team consulted with administrators in each department to properly decide what was the most vital information to display on the whiteboards. The 12 templates created include Medical/Surgical, Critical Care, Transitional Skilled Unit, Pediatrics, Labor and Delivery, Labor and Delivery Triage, NICU, Emergency Department, ED-17th Street, ED-Children’s, Mom/Baby, and Perinatal. Another key component of the communication portion of the initiative was to ensure ease for patients and families more comfortable with other languages. The flipside of each English whiteboard is translated into Spanish. Another separate insert will be available in Arabic and Vietnamese, and can be switched into the mount when necessary. A license was also purchased to use the Wong Baker Faces Scale as a crucial pain-rating instrument.
Once the whiteboard plans were created and finalized, a schedule of installation was created. As of this time, the majority of the boards have been installed into the units with the exception of a few which experiences some minor technical and delivery problems. A prevalence audit of 125 whiteboards was performed on July 1, 2014 in 13 units: 4T, 5CP, 5K, 6B, 6K, 6T, 7BP, 7C, 7T, ICU-M, RHC-M, TOHU, and TTU. An audit was performed on one board in PEDS but the data was eliminated because the entire unit had not had all the new boards installed at the time of the audit. The survey created for the audit included seven questions with three “If no,” or “describe”, sub-questions as follows
Board had patient pain information completed (all 3 components).
Patient confirmed that is the current pain goal.
Today’s caregivers section is completed by every caregiver.
If no, the caregivers that did complete today’s section are:
Did non-nursing/provider (case management/therapy-PT-OT, etc.) complete their portion of the whiteboard when applicable?
If no, list the discipline
Auditor confirmed via assignment sheet that information is correct.
Is the patient on any new medications?
Please describe how often your nurse discussed you new medications and their side effect with you
Please describe how satisfied you are with the explanation of your plan of care each shift.
A separate audit of 33 boards was performed for ED-PEDS, ED-CC, ED-M, and ED-17. These audits applied the following questions:
Board had patient score completed.
Today’s caregivers section is completed by every caregiver.
If no, the caregivers that did complete today’s caregiver section are:
Auditor confirmed via assignment sheet that information is correct.
“Awaiting” section has checkmarks.
Auditor reviews status to see if board is up to date.
Is there consistency between the “fall risk noted on board” and patient interventions (yellow socks and/or yellow wrist band)?
Please describe how satisfied you are with the explanation of your plan of care.
HCAHPS scores for fiscal year 2014 (prior to whiteboard installation) were collected and organized to create a baseline for comparison with scores after installation of the whiteboards. From the overall HCAHPS question, our baseline focused on the following categories:
Communication with nurses
Courtesy/Respect
Listen carefully
Explain well
Communication with doctors
Courtesy/Respect
Listen carefully
Explain well
Pain Management
Well controlled
Medicine
Explain meds
Side effects
Discharge
Results
A prevalence audit was done on July 1, 2014 in 13 units for a total of 125 completed surveys. Units are 4T, 5CP, 5K, 6B, 6K, 6T, 7BP, 7C, 7T, ICU-M, RHC-M, TOHU, TTU. There was some variation in the number of boards audited per unit, but all units ranged from 9-11 boards audited with the exception of ICU-M, which looked at 4 boards. A PEDS audit was done but has been removed due to lack of data and not all boards being placed at the date of audit. This audit is a preliminary look at response to the changing system, and it will be repeated regularly once all boards are in place and after to ensure consistent use.
Auditor Confirmation
Across the boards in all 13 units, the auditors confirmed via assignment sheet that the collected information was correct on 125/125.
Pain – “Board had patient pain information completed (all 3 components)”
40/125 boards had all 3 components of patient pain information completed. TOHU had the best with 90% information completed, 5K and RHC-M had the worst outcome both reporting 0% information completed.
79/125 reported that the patient did confirm that their current pain goal was accurately recorded; TOHU had 100% correct pain goals recorded, 5K and 7BP had the worst outcomes with 18% correct pain goals recorded.
Caregiver Section – “Todays caregivers section is completed by every caregiver”
73/125 reported all caregiver’s sections were completed. TTU and TC had the best outcome with 100% of caregiver section completed, while 7BP had the worst with 0% of the section completed.
“If no, the caregivers that did complete today’s caregivers section are”:
2 boards were filled out doctor only, 44 nurses and tech only, and 6 tech only.
Unit
Doctor Only
Nurses and Tech
Tech only
4T
0
0
1
5CP
0
4
1
5K
0
6
1
6B
0
6
1
6K
0
1
0
6T
0
3
0
7BP
0
9
2
7C
0
0
0
7T
1
4
0
ICU-M
0
3
0
RHC-M
0
8
0
TOHU
1
0
0
TTU
0
0
0
74/125 non-nursing/providers completed their portion of the whiteboard when applicable. 5CP, 6K, and 7C had the best outcome with 100% completed; RHC-M had the worst outcome with 0% completed.
New Medication – “Please describe how often your nurse has discussed your new medications and their side effects with you”
67/125 patients were on new medication when the audit was conducted. When asked “how often your nurse has discussed your new medications and their side effects with you” 11/67 answered always, 12/67 answered frequently, 24/67 answered occasionally, 20/67 answered never.
Plan of Care – “Please describe how satisfied you are with the explanation of you plan of care each shift”
60/125 surveys reported patients feeling always informed about their plan of care; 7C had this highest reporting with 9/10 patients feeling always informed. 39/125 answered frequently informed, 18/125 answered occasionally informed, and 9/125 answered not informed.
Emergency Departments
ED-17, ED-CC, ED-M, and ED-PEDS were audited separately for a total of 33 boards. ED-PEDS had only 3 boards audited; the other 3 emergency departments had 10 boards each.
Auditor confirmation
The auditor confirmed via assignment sheet that 33/33 boards had the correct information, and the auditor confirmed 16/16 boards to be up-to-date.
Pain
13/33 boards did had patient pain score completed
Caregivers
23/33 boards had every caregiver section completed
7/11 caregiver sections were filled out by nurses only
Awaiting Section
16/33 boards had an “Awaiting” section check-marked
Fall Risk Consistency
9/33 surveys reported that there was consistency between “fall risk on board” and patient intervention.
Plan of Care
20/33 patients felt always informed with their explanation of care
Baseline HCAHPS
HCAHPS scores for fiscal year 2014 (prior to whiteboard installation) were collected and organized to create a baseline for comparison with scores after installation of the whiteboards is completed. From the overall HCAHPS question, our baseline measurements focused on the following categories:
Communication with nurses
Courtesy/Respect
Listen carefully
Explain well
Communication with doctors
Courtesy/Respect
Listen carefully
Explain well
Pain Management
Well controlled
Medicine
Explain meds
Side effects
Discharge
4/10 of the section subcategories were above target for the YTD at Muhlenberg; Side effects were the lowest under target at 12.79 points under the Medicine category target for the year. 4/5 overall categories were above target for YTD; Communication with doctors came in 5.38 points under target for the year.
6/10 of the section subcategories were above target for the YTD at Cedar Crest; Side effects were the lowest under target at 13.49 points under the Medicine category target for the year. 4/5 overall categories were above target for YTD; Communication with doctors came in 1.58 points under target for the year.
Discussion
With the implementation of the communication whiteboards, the team expects to see improvements in the HCAHPS scores designated as relevant to whiteboard use. Along with HCAHPS scores, results of future prevalence audits should improve as staff gets more accustomed to using the board as a part of their regular routine. Based on the baseline HCAHPS report and the prevalence audit, the areas most necessary to improve are communication with doctors and discussion of new medications and side effects. The communication boards aim to aid in these areas by having information available for the patient to see at all times, and provide a visual reminder to the caregiver that these are topics that need to be attended to. Filling out the whiteboard will guide a two fold interaction for the patient/family and caregiver in which the information will be verbally conveyed, followed by visually displayed using images and categorized sections of information.
Works Cited
Singh, Siddhartha, Fletcher, Kathlyn E., Pandl, G. John, Shapira, Marilyn M., Nattinger, Ann B., Biblo, Lee A., et al. It's the Writing on the Wall: Whiteboards Improve Inpatient Satisfaction With Provider Communication. American Journal of Medical Quality, 2011 26(2): 127-131. Retrieved June 10, 2014, from http://ajm.sagepub.com/content/26/2/127
Sehgal, Niraj L., Adrienne Green, Arpana R. Vidyarthi, Mary A. Blegen, and Robert M. Wachter. Patient Whiteboards as a Communication Tool in the Hospital: A Survey Of Practices And Recommendations. Journal of Hospital Medicine, April 2010 Vol 5, No 4: 234-239. Retrieved June 10, 2014, from Society of Hospital Medicine DOI 10.1002,jhm.638
Published In/Presented At
Johnston, E., (2014, July, 25) Communication Whiteboards: Enhancing Patient, Family, and Care Team Communication. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley Health Network, Allentown, PA.
Department(s)
Research Scholars, Research Scholars - Posters
Document Type
Poster
Comments
Mentor: Jacqueline Fenicle