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Agenda for Today

•  Presentation: Engaging Patients and
Families at the Bedside
•  Team Sharing and Questions
•  Upcoming Due Dates

Engaging Patients and Families
at the Bedside
Tara Bristol Rouse
Director of Patient and Family Partnerships
PQCNC

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What is it like being a patient?
Clinicians  and  hospital  staff  

Patients  and  family  members  

•  Know  how  the  hospital  works  
and  how  to  get  things  done  

•  Are  strangers  in  this  environment  
•  Do  not  understand  the  system  or  culture  
•  Know  about  their  body  and  life  situation  better  than  
hospital  staff  

•  Know  who  hospital  staff  
are  and  what  they  do  

•  Do  not  know  who  different  staff  are  and  what  they  do  
•  May  want  family  or  friends  to  support  them  
•  Want  to  know  the  name  and  phone  number  of  the  one  
person  to  call  if  they  have  problems  

•  Are  busy  and  under  a  lot  
of  stress  

•  Are  often  in  pain  or  uncomfortable,  vulnerable,  or  afraid    
•  Are  worried  and  want  to  do  what  they  can  for  the  patient  
(family  members)    
•  May  not  understand  all  the  written  information  they  
receive  related  to  discharge  
•  May  feel  rushed  on  the  day  of  discharge  
•  Aware  that  hospital  staff  are  busy  and  may  not  
want  to  bother  you  

•  Want  to  provide  high-­‐quality  
and  safe  care  

•  May  not  know  all  the  questions  they  should  ask  or  what  
they  need  to  know  when  they  are  home  
•  Trust  hospital  staff  to  provide  safe  and  high-­‐quality  care  

AHRQ Guide to Patient and Family

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Communicating to Improve Quality –
What will you need to do?
•  Before  you  enter  the  room:  
–  Read  the  patient’s  chart  

•  When  you  enter  the  room:  
–  Make  eye  contact  with  the  patient  
–  Smile,  if  appropriate  
–  Introduce  yourself  by  name  and  role  
–  Introduce  new  people  in  the  room  by  name,  role,  and  
what  they  will  do  
–  Have  conversations  at  eye  level  

AHRQ Guide to Patient and Family

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Communicating to Improve Quality –
What will you need to do? (continued)
•  When  you  first  assess  the  patient:  
–  Ask  how  the  patient  prefers  to  be  addressed  
–  Identify  family  who  should  be  partners  in  care  
–  Highlight  main  points  of  communication  tools  
–  Invite  the  patient  and  family  to  use  the  white  board  to  
“talk”  with  clinicians  

AHRQ Guide to Patient and Family

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Communicating to Improve Quality – What you
will need to do throughout the hospital stay?
•  Include  the  patient  and  family  as  members  of  the  health  
care  team:  
–  Welcome  the  patient  and  family  and  acknowledge  their  
expertise  
–  React  positively  when  people  ask  questions,  volunteer  
information,  share  concerns,  or  want  to  take  part  in  
treatment  decisions  

AHRQ Guide to Patient and Family

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Communicating to Improve Quality – What you
will need to do throughout the hospital stay?
(continued)
•   Ask  about  and  listen  to  the  patient  and  family’s  needs  
and  concerns:  
–  Use  open-­‐ended  questions  
–  Try  to  see  the  experience  through  their  eyes  
–  Listen  to,  respect,  and  act  on  what  the  patient  
and  family  say  
–  Help  them  articulate  their  concerns  when  needed  

AHRQ Guide to Patient and Family

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Communicating to Improve Quality – What you
will need to do throughout the hospital stay?
(continued 2)
•  Help  the  patient  and  family  understand  the  diagnosis,  
condition,  and  next  steps:  

–  Give  timely  and  complete  information  
–  Take  every  opportunity  to  educate  the  patient  and  family  
–  Use  teach  back  to  make  sure  you  explained  clearly  
–  Find  out  how  much  information  they  want  to  know  
–  Speak  slowly  
–  Use  plain  language  
–  Invite  them  to  take  notes  
–  Find  someone  who  can  answer  a  question  if  you  cannot  

AHRQ Guide to Patient and Family

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PFE Strategies and Tools – What is teach back?
•  An  opportunity  to  assess  how  well  clinicians  explained  a  
concept,  and,  if  necessary,  re-­‐teach  the  information  
•  Ask  the  patient  and  family  to  repeat  back  in  their  own  
words  what  they  need  to  know  or  do  to  be  sure  you  
explained  things  well  
•  Tips  for  teach  back:  
–  Start  slowly  
–  Do  not  ask  yes  or  no  questions    
–  Chunk  information  when  explaining  more  than  one  concept  and  
use  teach  back  after  each  concept  

AHRQ Guide to Patient and Family

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PFE Strategies and Tools – What is bedside shift
report?
•  Nursing  staff  conducts  shift  change  reports  
at  the  patient’s  bedside  
•  Patient  can  identify  a  family  member  
or  close  friend  to  participate  
•  Report  should  take  about  5  minutes  per  patient  
•  Purpose:    
–  To  engage  the  patient  and  family  in  hospital  care    
–  To  share  accurate  and  useful  information  between  nurses,  
patients,  and  families  

AHRQ Guide to Patient and Family

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PFE Strategies and Tools – What is IDEAL
Discharge Planning?

•  Include  the  patient  and  family  as  full  partners    
•  Discuss  with  the  patient  and  family  five  key  areas  
to  prevent  problems  at  home  

•  Educate  the  patient  and  family  throughout  
the  hospital  stay  

•  Assess  how  well  doctors  and  nurses  explain  the  diagnosis,  
condition,  and  next  steps  in  their  care  and  use  teach  back  

•  Listen  to  and  honor  the  patient  and  family’s  goals,  
preferences,  observations,  and  concerns  

AHRQ Guide to Patient and Family

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More Information on IDEAL Discharge Planning

http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/index.html

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Potential Challenges of Bedside Engagement
•  New  diagnosis  or  information  patient  is  not  yet  aware  of  
(e.g.,  waiting  for  doctor  to  discuss)  
•  Patient  is  “noncompliant”  and  you  need  to  share  
information  with  oncoming  nurse  
•  Patient  or  family  has  a  complex  question  or  needs  a  
lengthy  clarification  
•  Semi-­‐private  rooms  and  HIPAA  concerns  
•  Difficult  to  identify  family  members  who  will  be  caregivers  
•  Discharge  plans  change  immediately  before  discharge  
•  Patient  unable  to  read,  write,  or  articulate  questions  or  
concerns  
AHRQ Guide to Patient and Family

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Using Scenario-Based Learning to Address
Potential Challenges of Bedside Engagement
•  Offers  an  opportunity  to  practice  
•  Allows  clinicians  and  staff  to  become  comfortable  with  
partnership  language  
•  Provides  an  opportunity  to  look  at  a  situation  through  the  
patient  and  family  perspective  
•  Allows  for  a  safe  place  to  express  discomfort    
•   Provides  the  opportunity  to  receive  instant  feedback  in  a  
safe  learning  environment  

PFCC Partners – Completing

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Final Thoughts
•  Your  hospitals  are  committed  to  patient  and  family  
engagement  –  everyone  plays  a  critical  part  
•  Your  job  is  to  make  it  safe  for  them  to  be  here,  not  just  as  
patients  but  as  partners  in  their  care  
•  Patients  and  families  won’t  engage  if  they  believe  that  you  
don’t  want  them  to—it  is  simply  too  risky  for  them    

AHRQ Guide to Patient and Family

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Team Sharing/Questions

Thank you!