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Jan
29

Pass It On

If there is one thing I have realized after two years as an RN, it is the importance of communication to patient safety. On my very first Med-Surg rotation, I remember my clinical instructor telling me to over-communicate. And that has stuck with me. I’m sure it makes me a pest to some, but so be it. We work in a field where we are responsible for the health and safety of people for a limited time period and then someone else takes over. It is critical that when we hand off care, we do so effectively.

So when it came time to decide on a final quality improvement project at my clinical site, communication gaps jumped out at me left and right. And the more I broached the topic with the staff, the more positive feedback I got that this was a need. Not to mention my preceptor was over the moon about this.

One of the lovely things about the VA is that it provides a built-in infrastructure, replete with offices of patient safety and tools. Lots and lots of tools. So in designing this project, I didn’t have to reinvent the wheel.

We settled on utilizing clinical crew resource management (CRM). This is a patient safety model based on principles developed by the aviation industry. It emphasizes checklists, focus during critical events such as take off and landing (or in our case, clinical handoffs), and above all, communication, communication, communication.

So we’re taking these concepts and running with them. I’ll reflect on the experience over the new few months, but here are a my first few tips for implementing change at the microsystem level:

  1. Start planning early. There will be delays. I promise.
  2. Find a champion on your unit. Someone who will not only be an early adopter, but who will also help you implement from the ground up. You need buy-in from a local respected figure.
  3. Listen to the staff. If you are set in your ways and don’t actively seek out input, nothing you suggest will be well-received.
  4. Be present. Before, during and after you make a change. Before so that you can get to know everyone and establish a positive relationship. During so that you can be available and show enthusiasm. After so that you can keep getting feedback and show that you are still open to adjusting the process.
  5. Observe, observe, observe. Learn before you do. Understand what is already working. Find out where gaps exist. Don’t rush into a new microsystem, guns blazing, and expect to receive anything besides return fire.
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