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A tool to improve communication in the neonatal unit.

ABSTRACT: Frequent and sensitive communication from neonatal staff is important to alleviate parental stress and to ensure that parents understand their baby's condition and progress. It also consequently empowers and involves parents in their baby's care. A lack of regular and informative communication from neonatal staff is a common reason for parental complaint. We sought to assess whether the implementation of a baby diary used as a communication tool would improve parent-staff communication and optimise the parental experience of neonatal care. In this study, parents and carers of babies on our neonatal unit were invited to complete a questionnaire to assess their level of satisfaction with communication by neonatal staff before and after the implementation of the diaries. The diary was designed to act as an aid to improve communication to parents about their baby and thereby complementing face-to face communication and encouraging parental involvement. The study design was a retrospective parental satisfaction questionnaire based on the Department of Health [1] and the National Institute for Health and Care Excellence (NICE) [2] quality standards for specialist neonatal care on communication and parental involvement (n=44, response rate 57%). Following implementation of the diary, the questionnaire was repeated on two occasions: one month post implementation (n=17, response rate 23%) and 15 months post implementation (n=44, response rate 65%). More parents in the post-intervention cohort felt they were receiving regular communication from staff, that their questions and concerns were being addressed, and felt involved in their baby's care than in the pre-intervention cohort. In addition, 100% of parents said they liked reading the diary and 94% felt it added to their understanding of how their baby was doing. Our project demonstrates an improvement in parents' satisfaction with communication from neonatal staff following the implementation of individual baby diaries. The diary is a simple, practical, and cost-effective tool to enhance communication between parents and staff in a neonatal unit.

SUBMITTER: van de Vijver M

PROVIDER: S-EPMC4645918 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionThe discharge conversation is a critical component of the emergency department encounter. Studies suggest that emergency medicine (EM) residency education is deficient in formally training residents on the patient discharge conversation. Our goal was to assess the proficiency of EM residents in addressing essential elements of a comprehensive discharge conversation; identify which components of the discharge conversation are omitted; introduce "DC HOME," a standardized discharge mnemonic; and determine whether its implementation improved resident performance and patient satisfaction.MethodsThis was a prospective observational pre- and post-intervention study done by convenience sampling of 400 resident discharge encounters. Resident physicians were observed by attending physicians who completed an evaluation, answering "yes" or "no" as to whether residents addressed six components of a comprehensive discharge. The six components include the following: diagnosis; care rendered; health and lifestyle modifications; obstacles after discharge; medications; and expectations - or "DC HOME." Didactics introducing the mnemonic "DC HOME" was provided to resident physicians. Patient feedback and satisfaction were collected after each encounter, and we recorded differences between pre-intervention and post-intervention encounters.ResultsResident physicians improved significantly in all six components of "DC HOME" from pre-and-post intervention: discharge diagnosis (P = 0.0036) and the remaining five components (P<0.0001). There was a statistically significant improvement in patients' perception for health and lifestyle modifications, obstacles after discharge, medications, expectations after discharge (P<0.0001), and discharge diagnosis (P = 0.0029). Patient satisfaction scores improved significantly (P = 0.005). Time spent with patients during discharge increased from 2 minutes and 42 seconds to 4 minutes and 4 seconds (P<0.0001).ConclusionEM residents frequently omit key components of the discharge conversation. The implementation of the "DC HOME" discharge mnemonic improves resident discharge performance, patient perception, and overall patient satisfaction.

Project description:BackgroundHand hygiene (HH) is the most critical measure in the prevention of nosocomial infections in the neonatal intensive care unit (NICU). Improving and sustaining adequate HH compliance rates, however, remains a significant challenge. Using a behavioral change framework and nudge theory, we developed a design-based concept aimed at facilitating and stimulating HH behavior.MethodsConcept development was initiated by selecting a theoretical framework after which contextual field studies aimed at discovering causes for poor compliance were conducted. Potential solutions were brainstormed upon during focus group sessions. Low-fidelity prototypes were tested regarding feasibility, usability, and acceptability. A final concept was crafted drawing from findings from each design phase.ResultsComplying with recommended HH guidelines is unrealistic and infeasible due to frequent competing (clinical) priorities requiring HH. The concept "Island-based nursing," where a patient room is divided into two geographical areas, namely, the island and general zone, was created. HH must be performed upon entering and exiting the island zone, and after exposure to any surface within the general zone. Reminding of HH is prompted by illuminated demarcation of the island zone, serving as the concept's nudge.ConclusionsIsland zone demarcation facilitates and economizes HH indications in an innovative and intuitive manner.ImpactAlthough hand hygiene (HH) is the single most important element in the prevention of nosocomial infections in neonates, improving and sustaining adequate HH compliance rates remains a significant challenge. Complying with recommended HH guidelines was found to be unrealistic and infeasible due to the significant amount of time required for HH in a setting with a high workload and many competing (clinical) priorities. The concept of "Island-based nursing," under which the primary HH indication is upon entering and exiting the island zone, facilitates and economizes HH indications in an innovative and user-friendly manner.

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A tool to improve communication in the neonatal unit.

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