Whiteboards across the system
A Standardized Tool for Nurse-Patient
Communication
and
Patient-Centric Care
Mari Dee Sandra Cid RN, PCCN
University of San Diego
Master’s of Science in Nursing
Maria Sudak RN, MSN, CCRN NEA-BC
Palomar Pomerado Health
Transformation
Background
• Patient/ Customer Quality of care and Satisfaction is undoubtedly on the minds
of hospitals and healthcare systems.
• Patient satisfaction is tied to reimbursements.
• One of the things that patients value is good communication.
• The Joint Commission states that 65% of reported sentinel events were caused
by communication errors.
• In 2007, one of the National Patient Safety Goals (NPSG) declared by The Joint
Commission was to engage patients in their care.
PICO Question
Does the use of a standardized or structured
whiteboard versus a blank board result in
increased nurse-patient communication and
increased patient/family engagement with
their care?
Goals of the Project
• Standardize “whiteboards” across the system
• Provide a tool for better communication between caregivers and
patients.
• A mechanism for patient /family engagement in their care and
education.
• Increase patient satisfaction scores / Improve HCAHPS survey scores.
– HCAHPS ( Hospital Consumer Assessment of Healthcare Providers and Systems)
• A standardized survey instrument designed to produce data about patients’ perspective of
care.
• Publically reported data
SWOT ANALYSIS
Strengths:
•
•
•
•
•
Improve patient- centered care
Improve teamwork
Increase nurse/patient
communication
Increase patient
education/engagement in their care
“Shared” communication tool.
Weakness:
•
Controversy over nurses burdened
with “one more task” to their
responsibilities.
Opportunities:
•
•
•
•
•
Improve nurse-patient
communication
Increase patient participation with
their care
Standardization of information
written on the board
Increase patient satisfaction rating
Improve HCAHPS scores
Threats:
•
•
Nurses’ compliance
Whiteboards not completed due to
missing markers and erasers
Challenges to implementing whiteboards:
•
•
•
•
•
•
•
•
Standardization across the system…”special needs”
Compliance
Privacy
Valid and accurate information
Expectations
Accountability
Patient involvement
Who’s “GOAL” is it?
Strategies and Solutions to Challenges?
Recruit Input
- Direct care providers
- Ancillary team members
- Customer Advisory Panel
- Leadership
- Professional Practice Committee
Education and communication
- in-services will be provided to staff
- staff awareness through “huddles”
- provide “Inpatient Communication Board” handouts to the team
Participation and involvement
Current State….
DATE/DAY:
RN:
CNA:
SUPERVISOR:
PLAN OF CARE:
35
30
25
20
Day 1
Day 2
15
Day 3
10
5
0
Category 1
Category 2
Category 3
Category 4
Figure 1 Category 1: Nurses wrote Date/Day/ Names; Category 2: Nurses added plan of care ; Category 3: No plan of care;
Category 4: No entry on whiteboard
Evidence Summary
• Standardized templates
• Structured format = more inclusive of relevant/accurate
information
• Direct Care Provider accountability
• Whiteboards should be placed in clear view of patients
• Erasable markers should be readily available
– greatest barrier
Financial Projection
Size of whiteboard:
24 x 36
18 x 36 for space challenges
$ 110/whiteboard X 30 (# rooms/unit) = $ 3,300
approximate cost per Inpatient unit
Steps taken to standardize whiteboard format,
utilization and expectations:
Literature reviewed / unit rounds completed to evaluate current state
Template created and searched
Presentation to Service Excellence work group
Templates combined
Unit rounds at PMC & POM to recruit end user input/feedback
Suggestions incorporated into template
Template to marketing for quote
Recruit funding
Template sent out to Directors to share with UPC’s and recruit input/feedback
Visit to Mother Baby and ED to assess special needs
Template taken to Community Advisory Panel for input form the “Customer”
Care Delivery 1/28/2011
Clinical Leadership Committee & Professional Practice Committee 2/2011
Pilot units…30 days…any last minute revisions 3/2011
Education and Deployment 6/2011
Room Number:
Phone #:
Patient Name:
Please Call Me:
Today’s Date/Day:
Patient’s Priority Today:
Anticipated Discharge Date/Time:
Health Care Team:
Plans and Goals for the Day: (Tests/Treatments)
RN:
CNA:
Charge Nurse:
Pain Management Goal:
Doctor:
Diet:
My Pain Goal:
Activity:
Safety Alerts/Special Needs:
Family/Patient Comments/Notes:
Name
Nurse
CNA
MD
Diet
Vital Signs
Pain Score
Hearing/Visual limitations
Interpreter needs
Glasses
Dentures
Hearing Aid
Intake/Output
Patient Goal/Discharge Plans
Case Manager
Respiratory Rx
Patient and Family Communication
Palomar(Pomerado) Hospital
Your name preference:
Your priority/goal for today:
(Unit Location )
(Room Number)
Your room phone #
Today's Day/Date:
Anticipated Discharge Date:
Hourly
Rounding
7am____7pm____
8am____8pm____
Tests/Treatments for Today:
9am____9pm____
10am___10pm___
Health Care Team & Contact #
Your pain management goal:
Charge RN:
Doctor:
Pain Scale
Next pain medication due:
Diet:
Activities:
Safety Alerts/ Special Needs:
Patient /Family Comments & Notes
11am___11pm___
12pm___12am___
1pm____1am____
2pm____2am____
3pm____3am____
4pm____4am____
5pm____5am____
6pm____6pm____
(Magnet Logo)
Palomar Pomerado Health System: Specializing in you
Inpatient Communication Board
Purpose, Guidelines, and Entry Examples
Purpose: The inpatient communication board is used as a tool to increase nurse-patient
communication and patient-family education.
Guidelines:





Always keep the information on the whiteboards about the patient.
Update the board at the start of the shift and throughout the day.
Write legibly and big enough so the patient can read it from the bed.
Only use erasable markers and keep them with the whiteboards.
Do not use abbreviations or medical jargons.
Entry Examples
Patient’s Priority




My pain level maintains at a 3
Get out of bed and ambulate
Wean from oxygen
Will get at least 5 hours of sleep



Today before noon
Tomorrow after negative stress test
result
Pending – Ask my doctor
Plans and Goals for the Day
(Tests/Procedures)
Diet




Anticipated Discharge Date/Time
NPO
Clear liquid
Cardiac Persantine diet
Regular diet




Stress test in AM
Chest x-ray
Pacemaker placement
Morning blood draw
Activity



Patient-Family Comments:
Up in the chair for all meals
Get out of bed only with assistance
Ambulate in the hallway with PT
Safety Alerts/Special Needs




Fall risk
Ambulate with walker
Legally blind
Two person assist



Contact person phone #
Questions for the doctor
“ Wishing you well”
Evaluation
• A post-intervention 5-questionnaire survey will be given to the
patients upon discharge on the pilot units regarding usefulness of
patient whiteboards.
• A post-intervention audit will be conducted to check for staff
compliance and identification of removable barriers at 3 and 6
months
• Outcome= to increase nurse-patient communication/education and
patient engagement in their care.
– Increased patient satisfaction scores (Press Ganey) that reflects
• nurses’ attention to patients’ special/personal needs
• nurses kept patients informed.
• Improve HCAHPS survey scores in 3 months post-intervention.
Whiteboard Survey
Please answer the questions in this survey about the usefulness of the
whiteboard in the patient’s room.
YES
1. Did you notice the whiteboard in your room?
2. Did the whiteboard help keep you informed
about your care?
3. Did the staff explain to you what’s written in
the whiteboard?
4. Did the staff update the whiteboard at the start
of the shift and throughout the day?
5. Is the writing on the whiteboard legible and
big enough for you to read?
NO
4 Evidence
Based
Standards
&
RBC
Questions?
Thoughts?
Ideas?