Language Services:
The Why and the How
April 2013
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Objectives
• Recognize the importance of providing
culturally and linguistically appropriate
services
• Explain the role of the patient and
companion in determining what services
are required for effective communication
• Identify the laws governing language
services
• Identify four ways to access spoken language interpreter services at Inova
• Describe the five steps to follow in providing services to the Deaf or Hard of
Hearing
• Explain how to arrange for sign language interpreters and/or auxiliary aids at
Inova
ATTENTION!
PLEASE NOTE: This module details the
processes required in using the paper forms. Use of
the related Epic flows will be taught separately at
each OU or other entity and to the appropriate staff
as Epic rolls out across the System.
Northern Virginia: An International Community
• Highly diverse community of
approximately 2,623,079 people
• 45% of the people identify with a
minority group
• Approximately 24% are foreign born
• Over 33% speak a language other than
English at home; 12% speak English
“less than very well”
• Among the most common foreign
languages spoken at home in Northern
Virginia are:
–
The region we serve
Spanish
– Amharic
– Chinese
– Korean
–
Vietnamese
– Arabic
– Farsi
– Urdu
* Census 2010 and ACS 2011, 5-year estimate
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Office of Health Equity (OHE)
Vision:
• A community where all residents have access to resources that promote
and sustain health and well being.
Mission:
•
To create a community where
• systemic and avoidable health disparities are steadily reduced, so that
the gap between the best and worst off is narrowed;
• all residents have equitable access to a full range of high-quality
healthcare and support;
• all have equal opportunities for optimal health and well being
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Office of Health Equity
Selected Office of Health Equity Programs and Services
•
•
Language Services
•
Spoken language interpretation
•
Sign Language interpretation and the provision of other services for
the deaf or hard of hearing
•
Translation of vital documents
Training and Education
•
Diversity, Cultural Competence and Health Equity Education
•
21st Century Leadership Development
•
Now We’re Talking! Bi-lingual staff interpreter training
Patient-Centered Care and
Effective Communication
Patient-Centered Care and Cultural Competence
Patient-Centered Care
• Is by definition culturally and linguistically
appropriate
you
you
• Ensures that patients, companions and providers
partner in care and explore all health options
• Is delivered in a manner that meets patient
preferences
• Is deeply respectful of patient and family
values, beliefs and traditions
Experiences
Perceived Reality
The “truth”
The “truth”
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Patient-Centered Care & Effective Communication
• Patient centered care requires effective
communication
• Effective communication requires that
information is understood by all parties
involved in care
AND
• Understood thoroughly enough that the
parties can use or act upon information
exchanged
This is true for all patients regardless of race, ethnicity, age, gender, education,
religion, socio-economic status, language spoken, etc.
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Laws Governing
Language Services
Spoken Language
Title VI of the Civil Rights Act of 1964
No person in the United States shall, on the ground of race, color or
national origin, be excluded from participation in, be denied the
benefits of, or be subjected to discrimination under any program or
activity receiving Federal financial assistance.
• Language is considered a proxy for national origin.
(precedent, beginning 1926)
• We must provide the same quality care regardless of and language spoken
• Enforced by the Office for Civil Rights (OCR)
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Spoken Language: Highlights of Title VI
• Trained medical interpreters must be provided to our Limited English
proficient patients at no cost to the patient
• A person who is limited English proficient either does not speak English
or speaks English “less than very well.”
• Vital documents must be translated and communicated in patient’s
language, including:
• application and enrollment forms
• letters or notices regarding eligibility or changes in benefits
• anything requiring a response
• patient consent forms
• documents of a legal or financial nature
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Sign Language/Services for Deaf or Hard of Hearing
Title III of the Americans with Disabilities Act (ADA)
No individual may be discriminated against in the full and equal
enjoyment of goods, services, facilities, privileges and accommodations
in privately operated commercial facilities that are open to the public.
• ADA ensures equal access to goods and services for persons who are
deaf or hard of hearing
• ADA requires effective communication, and the provision of
appropriate auxiliary aids and services (including qualified interpreters)
when necessary to ensure effective communication for patients with
disabilities
• Enforced by the Department of Justice (DoJ)
What is a Companion under the law?
•
Companions must be offered language assistance
•
The term “Companion” means: a person who is limited English proficient or
deaf or hard of hearing and needs to communicate with the staff about the
patient’s care
•
Includes but is not limited to:
•
Someone who assists in providing care or comfort
•
Someone who assists in decision-making
•
Legal guardian
•
Power of Attorney
•
Disclosure of information to the Companion is governed by HIPAA
•
If there is a question as to whether the individual meets the definition
above, consider the individual a companion
Interpreter Policy Summary
• Any patient and/or companion who is limited English
proficient or deaf or hard of hearing must be offered
interpreter services or auxiliary aids free of charge
• Interpreter services must be provided by trained
interpreters
• Friends and family may not be used as interpreters
unless specifically requested by the patient and
charted accordingly
• Minor children should never be used as interpreters
• In an extreme emergency, render any necessary and appropriate medical
treatment and use your best efforts to provide the most effective communication
possible until the interpreter arrives
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Language Services:
Spoken Language:
Your Responsibilities
Spoken Language: Your Responsibilities
1. Complete a communication assessment
2. Secure needed interpreters
3. Complete the necessary documentation
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Step 1: Spoken Language Assessment
All Patients must be asked their language preference
•
The question to ask is: “In what language do
you prefer to talk with your doctors or nurses?”
•
Rely on the patient’s or companion’s own
assessment of his/her English proficiency in
determining the need for an interpreter.
•
Document the patient’s preference in the
patient’s record.
Step 2: Secure Interpreter Services
If a patient or companion indicates a
language preference other than English
Staff Interpreters (Spanish)
• Inova staff interpreters in Spanish are available
on all Inova hospital campuses
• A complete list with hours of coverage and
phone numbers can be found on InovaNet:
http://inovanet.net.inova.org/?id=1615&sid=1
• Call the appropriate extension to obtain a staff
interpreter at your location
Step 2: Secure Interpreter Services
If patient or companion prefers a language other than English
Services available at ALL Inova
facilities in multiple languages:
• Contracted, On-Site Interpreters
• To pre-schedule an interpreter,
access the “Inova Interpreter
Request” on InovaNet
• If the request requires an
immediate response, use the
Language Bank, the interpreter
phones or call the Scheduler at
703-776-7641 (Option 2)
Inova Interpreter Request
https://wlcapps.net.inova.org/langreq/Lang
Request/LangRequest.html
Step 2: Secure Interpreter Services
If patient or companion prefers a language other than English
Services available at ALL Inova facilities in multiple
languages:
• Volunteer Interpreters who have completed 40-hour
medical interpreter training.
• Search “Language Bank” on InovaNet
• Over 600 volunteer interpreters in 45 languages
• Telephonic Interpretation (Interpreter phones)
• Available 24/7 in 170 languages
Step 3: Documentation
In the patient record, document:
• Language preference/ requests for service
• Note name or identifying number of interpreter used
• Refusals of service and how you respond
• Note name of individual chosen to interpret by patient and
relationship to patient
• Emergency situation necessitate the start of care before a trained
interpreter arrives.
• Any unusual circumstances
If it isn’t documented, it didn’t happen.
Services for
Deaf
or Hard of Hearing:
Your Responsibilities
Services for the Deaf/HoH: Your Responsibilities
Understanding the patient’s
perspective will help you understand
the need to rely on the patient to
tell us what services or aids are
needed for effective
communication.
We must identify and assist 100% of our patients and
companions who are deaf or hard of hearing.
There is a 0 tolerance policy
Deaf/HoH: Your Responsibilities
1. Complete the necessary communication assessment
2. Secure needed resources
3. Undertake steps until an interpreter arrives
4. Adhere to necessary steps when an interpreter arrives
5. Complete all required documentation
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Step 1: Communication Assessment
Deaf or Hard of Hearing Communication Request Form (CRF)
Purpose: Allows patients and companions
to identify as deaf or hard of hearing and
request or decline specific services
• Must be completed by ALL patients
At the first opportunity to assess:
• Provide the CRF to ALL patients
• ALL patients must answer two
questions:
1. Are you or any of your
companions deaf?
2. Are you or any of your
companions hard of hearing?
Step 1: Communication Assessment
Deaf or Hard of Hearing
Communication Request Form
•
Patient may indicate that the form
stands for the current course of
treatment
• This refers to certain hospital-based
series accounts
• These accounts reset at the first of
each month.
• If a patient is readmitted after the
account resets, he or she will be
required to complete a new CRF
Step 1: Communication Assessment
If neither patient nor companion(s) is deaf or hard of hearing:
•
Only the top section of the CRF
needs to be completed.
•
The patient must sign and date
the form and note the time.
•
Hospital personnel must also sign
and date the form and indicate
contact information.
•
The process is complete.
•
Maintain the completed form in the
patient record (fax to Medical
Records)
Step 1: Communication Assessment
Deaf or Hard of Hearing Communication Request Form:
When a Patient or Companion is
Deaf or Hard of Hearing
• Any patient or companion who is
deaf or hard of hearing must
complete the middle section of
the CRF.
• Purpose: This allows the individual
who is deaf or hard of hearing to:
• Request specific services
and/or auxiliary aids
• Decline services
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Step 1: Communication Assessment
Deaf or Hard of Hearing Communication Request Form
• The request MUST be based on the patient or companion preferences
• Never try to dissuade a patient or companion from requesting a specific
service or aid
• If circumstances do not allow for the form to be completed by the patient or
companion, you may assist in completing the form
•
The patient or companion must sign and date the form and indicate the
time of completion
•
Hospital personnel must also sign and date the form and include contact
information
•
Maintain the completed form in the patient record (fax to Medical
Records)
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Step 1: Communication Assessment
Deaf or Hard of Hearing
Communication Request Form
•
The CRF has a second page, the
FAQ’s/Complaint Resolution
Process
•
Detach page 2 and provide this to
the patient or companion
•
For any paper chart, you must also
complete and affix to the chart the
Deaf/HOH Chart Flag (yellow 8 ½ x
14” form)
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Step 1: Communication Assessment
Deaf/HoH Patient and/or Companion Identifier
•
Any patient or companion who is deaf or hard of hearing must be
offered a visual identifier.
•
Use orange wrist bands for this purpose.
• Patient or companion is deaf: Use the band with the symbol
indicating deafness.
• Patient or companion is hard of hearing: Use the band that has
“HOH.”
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Step 1: Communication Assessment
Deaf or Hard of Hearing Communication Request Form
• If a patient identifies a deaf or hard of hearing companion who is not at
the hospital, but will require service upon arrival, staff must:
• Provide the patient with the contact information for anyone on the
unit who can assist the companion in completing the Deaf or Hard
of Hearing Communication Request Form (CRF) and/or
• Provide the CRF to the companion when he/she identifies
him/herself
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Step 1: Communication Assessment
In a public area:
•
If you are approached by an individual who is deaf or hard of hearing in a public
area of the hospital, help the person locate appropriate staff to assist in
completing forms and getting services.
•
Examples of how you may help include:
• Accompany the patient/companion to an appropriate unit in the hospital (for
example, assigned unit, registration, information, etc.)
• Locate clinical or registration staff or unit secretaries, etc., who may be able
to assist
• Locate a NexTalk unit that may help to facilitate discussion
• Exchange written notes , if appropriate, to answer immediate questions (for
example, to provide directions)
Rely on one another!
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Step 2: Secure the Needed Resources
Within 15 minutes from the time the completed Deaf or Hard of Hearing
Communication Request Form is signed, staff must:
• Call 703-776-7641 to obtain a Sign Language Interpreter
– System-wide phone number
– Answered 24/7/365
– Use for scheduled and emergent needs
– Time frame to have a Sign Language interpreter on site for emergent
needs: within 2 hours signing of the Communication Request Form
Within 30 minutes from the time the completed CRF is signed, staff must:
• Secure NexTalk video remote interpreter when requested (where available),
and/or
• Secure the appropriate auxiliary aids/services
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Step 2: Secure the Needed Resources
These devices and services are available free of
charge to patients or companions:
•
Sign Language and Oral Interpreters
•
Video Remote Interpreters (NexTalk)
•
TTY’s
•
Pocketalkers (assistive amplification devices
NexTalk
best used for moderately hearing impaired people)
•
Written materials
•
Telephone handset amplifiers
•
Telephones compatible with hearing aids
•
Closed captioning of hospital programs
•
Virginia Relay Service -711
TTY
Pocketalker
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Step 3: Until the Interpreter Arrives
•
Communicate by writing notes
• Use multiple means of
communicating
• Chart all notes exchanged
•
Use NexTalk (Video Remote
Interpreting) where available
• In EDs, L&Ds and for check-out
from Administrative Director
•
Do not rely on lip reading
• Unless the patient insists it is
his/her preferred method of
communication
•
Document what you do!
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Step 4: When the Interpreter Arrives
Sign Language Interpreter Schedule
Within 90 minutes after the interpreter
has been provided AND when a patient is
expected to remain in the hospital 12 or
more hours:
• Patient and/or companion must
determine the Sign Language
Interpreter Schedule for the expected
duration of stay
• Base the Schedule exclusively on the patient’s and/or companion’s wishes
• Staff must provide information to assist
Step 4: When the interpreter arrives
Sign Language Interpreter Schedule
•
The patient or companion and hospital personnel must sign and date the
Interpreter Schedule
•
Call 703-776-7641 to activate the completed schedule, AND
•
Maintain the completed schedule in the patient’s medical record
•
Provide a hard copy to the patient/companion
•
Patients and/or companions have the right to request a change to their schedule
at any time
•
As conditions change, staff should periodically consult the patient and/or
companion to assess the Interpreter Schedule and modify, if necessary.
•
Revised schedule(s) must be called in to 703-776-7641 and maintained in the
patient record (fax to Medical Records)
Step 4: When the interpreter arrives
Sign Language Interpreter Schedule
•
Staff must assist the patient and/or companion in completing the schedule
by providing the following information (to the extent that it is both
reasonably ascertainable and allowed under HIPAA):
i.
the anticipated period of time that the patient will be in the Hospital;
ii.
the nature of the patient’s condition, including its seriousness and
stability;
iii.
the likelihood of needing to communicate with the patient or
companion at unexpected or unforeseen times;
iv.
the most common hours that hospital personnel will need to
communicate with the patient or companion
v.
the availability of 24-hour interpreter services and auxiliary aids free
of charge
Step 5: Documentation Requirements
• In the patient chart document:
• All requests for or refusals of service (documented on the CRF)
• Your response to the such requests for or refusals of service
• Any notes exchanged
• Types of services or auxiliary aids used
• Any unusual circumstances
If it isn’t documented, it didn’t happen.
Monitoring and Compliance
•
Compliance with policies and procedures for the Deaf and Hard of Hearing
is monitored by Inova’s ADA Compliance Officer
•
Results of random chart audits are shared with departmental leaders for
continuous ongoing quality improvement
•
If you become aware of an instance where patients or companions did not
receive their requested deaf or hard of hearing services within the required
timeframes, please report this to the ADA Compliance Officer
•
Please note: Contact information for Office of Health Equity Staff
and the ADA Compliance Officer can be on InovaNet:
http://inovanet.net.inova.org/?id=1861&sid=1
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Additional Information
INTERPRETER SERVICES