Worklist Project Improves Communication and Handoffs
A team of nurses at Massachusetts General Hospital developed a way to improve communication between nurses and patient care associates (PCAs) that helped reduce falls and infections.
The effort decreased falls by 25%, catheter-associated urinary tract infections (CAUTIs) by 50%, and hospital-acquired pressure injuries (HAPIs) by 33%.
The nurses were participating in the American Association of Critical-Care Nurses Clinical Scene Investigator Academy (AACN CSI) leadership training program when they developed the Stop, Communicate and Listen initiative for White 10, the 20-bed adult inpatient unit that receives patients from the ED or ICUs.
Feedback from PCAs indicated they did not have enough information to provide the best care for patients, leading to lower patient safety scores for handoffs and transitions, explain Jennifer Mills, RN, nursing director of White 10, and Christina Carmody, RN, AACN CSI participant and a nurse in White 10.
Working with the PCAs, they and other team members created a worklist communication tool for the PCA desk area. The tool informs PCAs about necessary tasks, safety concerns, and patient information. Nurses on the night shift would complete the worklist, which the charge nurses and PCAs would use the next morning during the huddle.
The effort was intended to improve communication, with a secondary effect on improving work environment, job satisfaction, and patient satisfaction due to continuity of care, Mills says. PCAs are vital to the care team, valuable nurse extenders, and great assets for their units.
“The staff, especially our PCAs, were extremely positive about the new handoff communication process. They felt included and a more valuable part of the team,” Mills says. “It helped immensely identifying patient’s needs earlier. The most important thing is that it improved camaraderie between the roles.”
The staff had noted overall frustration among nurses, PCAs, and unit coordinators regarding the lack of communication, Carmody says. The tool helped facilitate communication between nurses and PCAs for tasks that often were not completed.
“During the project, we also tracked how responsive staff was to patient calls, including whether a patient called multiple times; staff communication via our internal messaging system; and the length of time after a call to when a staff member went into the patient’s room,” Carmody explains.
Although the staff soon saw the benefits, they were initially resistant to the change, Carmody says. Nurses were hesitant to fill out the tool, seeing it as simply more paperwork.
“They soon realized that it helped the PCAs to complete the tasks needed and allowed everyone’s shifts to flow better,” she explains. “The culture of the unit was another challenge in that PCAs had their own style of working.”
The unit launched the project in March 2019. They hosted an ice cream social to get everyone on board and excited about it, while also educating them about the new tool and what was needed to ensure success.
As the project continued, the tool was revised to add details under each section, making it easier to complete.
“Throughout the project, we would recognize a star of the week, in which staff would nominate a colleague for showing good use of the communication tool,” Carmody says. “Recognizing staff for a job well done can really go a long way in making someone’s overall morale. Shift handoff among PCA to PCA is crucial in our patient population to provide the best care possible.”
As communication improved, staff were noticeably happier, which increased job satisfaction. Staff, leadership, and patients noticed staff working together to provide the best possible care, including prevention of falls and pressure injuries.
“Our advice for others would be to stay consistent and have a positive attitude. There will be naysayers, but as a unit, you will need to rise above any negativity,” Carmody suggests. “We are all here to accomplish the same goal — to provide the best care possible for our patients. We need the best and open communication to accomplish this task.”
SOURCES
- Christina Carmody, RN, White 10, Massachusetts General Hospital, Boston. Phone: (617) 726-2000.
- Jennifer Mills, RN, Nursing Director, White 10, Massachusetts General Hospital, Boston. Phone: (617) 726-2000.
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