Posted by: ayrshirehealth | April 30, 2014

Improving Communication with the Ventilated Patient by @ninamcg77

Adaptive communication

In August 2013, Crosshouse Hospital Intensive Care Unit were successful in their bid to NHS Education for Scotland (@NHS_Education) ; Effective practitionerEffective Practitioner department in gaining funding of £2000 to help conduct a project that would hopefully Improve the patient experience in ICU through adaptive communication strategies.

Background

Communication in Intensive care (ICU) is compromised due to non-verbal barriers (Endotracheal and Tracheostomy ventilation). These barriers can have a negative impact to patient care, resulting in frustration and misunderstanding between patient and staff. Endo TrachBy introducing a new education and resource tool our aim was to improve standards in communication with the ventilated patient.

Furthermore we planned to improve multi-disciplinary collaboration, patient outcomes and gain the best possible ICU environment for ‘Every patient, every time

Reflection

Having previously worked in a High Care area, my move to Intensive Care in September 2011 was a natural progression. Clinically I was gaining new skills and the education programme was exemplary. However I was faced with new barriers. I had to learn to communicate with my patient who couldn’t effectively communicate with me. This was both testing for me as a practitioner and for the patient. I felt that we lacked the skills and resources to improve the basic communication needs of the patient. It was this frustration, I believe, that gave me thirst for making improvements. Having spoken to my Senior Charge Nurse, David Kimmett, we agreed that we could embark on creating a new resource tool which would hopefully have a positive impact on patient care.

As a 21st century gadget girl, my initial thoughts were “GO BIG”. I wanted to introduce the use of Hi-tech devices; iPads and eye sensory devices. I was initially blinded to the basic communication skills that we possess. CommunicationI contacted the Speech and Language Team who I felt we under-utilised to see if they could assist me. They were very helpful and directed me to the Augmentative and Alternative Communication (AAC) Department, in particular Linda Page (@lindamarionpage).

It was on this introduction that our project suddenly began to take off.

Back to Basics

Our initial meeting, in October 2012, was extremely positive. We were embarking on a multi-disciplinary improvement project which could potentially make a difference to patient care. We made a successful bid to NES/ Effective Practitioner and this facilitated us with the resources to make change.

Initially we conducted a survey of our ICU staff and also all other NHS Scotland Intensive Care Staff. The results of which highlighted the lack of resources and skills to effectively communicate with the ventilated patient not just locally but nationally.

My initial Hi-tech dreams were quickly forgotten, as we went “Back to Basics”.

Clock 2We introduced new communication boards and purchased software to personalise them for individual patient use. By creating an educational resource staff have become more aware of the importance of non-verbal prompts. Additionally we have looked at ways at improving the unit environment and have introduced the use of visual aids; Day/Night clocks and sensory aids. Relatives of patients with a Cognitive Impairment are encouraged to contribute to complete the “Getting to Know Me” booklet which we have recently introduced. This allows staff to gain insight to the patient and enable them to talk to them about familiar and personal interests thus enhancing individualised, person centred care.

Innovation

On the 4th April 2014, we trialled the use of an Electrolarynx on a ventilated patient. As far as we are aware this had not been done in the UK prior to this date.

Electro-larynxThe Electrolarynx is an artificial larynx, usually used by patients following Laryngectomy. It is a hand held device which generates an artificial voice using vibration of the patient’s articulation.

We had great success using this device and it made a huge impact on the patient. She was able, for the first time in 15 days to “speak” to her husband. She was quoted as saying “This is brilliant”. For me this was a key moment in our study. I felt veryproud that simply utilising a multi-disciplinary approach had enabled us to collectively make an impact on patient psychosocial wellbeing. We as a team, had allowed a patient to communicate with her family and it was overwhelming to watch how a small device could make such a big difference.

I may have even let out a little shriek of joy!

Integration and Collaboration of Patient Care

Historically Intensive Care has always been considered and indeed is, a specialised unit caring for critically ill patients and their families. However working on this improvement project has made me realise that our skills and resources are transferrable organisation wide. Adopting The Scottish Government (2010) The Healthcare Strategy for NHS Scotland ‘A change in culture across Scotland in the way that we deliver and engage in our healthcare’

Getting to know meBy working alongside the Clinical Improvement Team’s Stephanie Frearson (@stephw2001), it quickly became apparent that our work was actually becoming part of a collaborative with other pockets of ongoing improvement work. The Older People in Acute Hospital (OPAH) work stream intends to offer assurance that older people are treated with compassion, dignity and respect while they are in an acute hospital and is an organisational priority within NHS Ayrshire and Arran. People with a Dementia face barriers to communication similar to those in ICU and we discovered that basic techniques used in Dementia care could also be transferrable to our patients and vice versa. Simple communication strategies and images can assist in orientation to time and place and distraction techniques used in Dementia care could also be used with the medically sedated patient.

As previously mentioned the ‘Getting to Know Me’ document had never previously been considered for use in the ICU setting – now it is the hope that it will become an fundamental part of individualised care planning for many patients.

The Way Forward

We are still only at the beginning of creating, what could be, an integral part of the ICU toolbox. We have, in a short few months, made beneficial changes to patient care and this was reciprocated by patient/staff feedback. We now have benefited from gaining a close working relationship with the AAC team and without their assistance couldn’t have come so far. We hope to disseminate our findings, on completion of our project, to other Intensive Care Units. With the aim of improving the patient experience in what is a very frightening time for both them and their relatives.

The Patient has The Right to Speak, let’s give them a voice.

Further Reading

www.nes.scot.nhs.uk/making-commuincation-even-better/

www.nes.scot.nhs.uk/effective practitioner/

This week’s blog was written by Staff Nurse Nina McGinley (@ninamcg77), Intensive Care Unit, Crosshouse Hospital

Comments:

Comments on this blog and any other of our blogs are welcome, simply click on the comment box below.

 

 

 

Advertisements

Responses

  1. What a fantastic blog! It’s a great reminder of how the perceived ‘little things’ can make such a big difference. It’s also good to see the sharing of ideas from other specialities that traditionally might be viewed as worlds apart from ICU. Working with the elderly, stroke survivors and those with dementia/delirium I know first hand how important communication is.

    • Thank you Claire. I have enjoyed working alongside SLT and AAC, just the beginning of a close working relationship. I think its good to share ideas from other specialities as it can shed new light on areas where we may not have looked previously.

  2. At this moment in time my mother is undergoing major emergency surgery and folllowing this she will need the care of ITU/HDU.
    This blog was so comforting to me, as nurses or healthcare providers we go about or daily practice almost on automatic pilot it is not until a very personal health care issues within your immediate family occurs that you see first hand from a relatives prespective the high quality of care that is performed.
    To read this blog made me proud of our profession, it is really great to read about the good work and new developments that we as a profession continue to strive to achieve in out patients interest.

    Well done and thank you.

    • Thank you Liz.
      Its nice to hear good feedback from the patient/relative perspective. Our aim is to ease “your” experience.
      Best wishes to your mum

  3. Nina,what a powerful message to all of us that high quality nursing care is alive and well. Your enquiring mind and eagerness to find a solution that makes such a big difference to the care we provide to people is an asset to Ayrshire’s Nurses. Thank you and well done; I’ll highlight this work to the NHS Board

    • Thank you very much.
      I am proud to be a part of yours and the ICU team.
      Our aim is to improve the patient/relative experience.

  4. Very encouraging to read. Congratulations – excellent. Thank you for sharing

  5. Thank you for taking your time to think of patients. As someone who had a tracheostomy with closed stent in for 2 weeks whilst an inpatient in London (then took months to get my voice back) it is extremely frustrating not being able to speak. I also wish I had known about the printable sheets from http://www.speakingofspeech.com that have pictures for patients to point to; these would have been great whilst I was intubated

    • Thank you Gillian,
      We have devised a patient communication board that incorporates pictures and hopefully, in time, we will be able to import relatives photographs on to these boards too. Making each one personalised.

  6. Fantastic, well done.

    • Thanks

  7. my faith in humanity has been restored well done

    • Thanks

  8. Great blog Nina and such an inspiring message. The skills we utilise when caring for people with dementia are transferable across all care sectors. Fantastic use of “Getting to Know Me ” document which was introduced for all vulnerable patients. Small changes can have such a massive impact on patient experience and outcomes.

    • Thank you. Sharing our learning and experiences is integral to our long term goal. I’ve enjoyed gaining insight into other specialties and how our skills are transferable organisation wide.

  9. Well done Nina, communication is vital within our interventions as we know. I have lady (within mental health setting) who has virtually no verbal communciation due to her psychological distress – she does try to speak but the volume and strength of her words is poor . Would like to “pick your brain” re the use in this lady’s case or if only when there is a physical cause.

    • Thank you for your feedback. In relation to the lady you mentioned I would , in the first instance, refer you to your local Speech and Language Team / Alternative and Augmentative Communication Team. They are experts in their field and will be able to assist you.

  10. We are really proud of the work being undertaken in this project and are convinced that it is having a positive experience in ICU. Nina’s project is the first step in a focussed improvement project within our ICU that we hope will improve patient care and outcomes. We intend to share our learning as our project progresses.

  11. […] I was holding my breath as I read Nina McGinley’s post for the Ayrshire Health blog – Improving Communication with the Ventilated Patient, until I read of her excited reaction to enabling a patient to communicate (it made me laugh). It […]


Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Categories

%d bloggers like this: