Standard 6: Communicating for Safety Standard

Communicating critical information

Action 6.9

Clinicians and multidisciplinary teams use clinical communication processes to effectively communicate critical information, alerts and risks, in a timely way, when they emerge or change to:

a. Clinicians who can make decisions about care

b. Patients, carers and families, in accordance with the wishes of the patient

Intent

Emerging or new critical information, alerts and risks are communicated in a timely manner to clinicians who can make decisions about care, and to the patient, family and carer, to ensure safe patient care.

Reflective questions

What processes are used to identify the clinician(s) who can make decisions about care and take action if needed?

How do clinicians communicate critical information to other clinicians who can make decisions about care, and patients and carers, in a timely way?

Key tasks

  • Define what ‘critical information’ and ‘risks to patient’s care’ mean for the service context.

  • Implement processes to identify the clinicians who are responsible for a patient’s care and can make decisions about care at any given time.

  • Identify when and to whom communication of critical information, alerts or risks should occur, including communication with patients, carers or families.

  • Develop and implement standardised processes that describe how communication of critical information, alerts or risks should occur.

Strategies for improvement

Hospitals

Identify critical information

The nature of critical information or a risk to patient care for the organisation depends on a number of factors, including clinical discipline and patient condition. In defining what critical information means in the service context, consider the type of services the organisation provides and the needs of the local population.

Types of critical information could include:

  • Changes to medicines
  • New critical results of diagnostic tests, including pathology tests, radiology exams or ultrasound procedures, and results from any diagnostic test that is conducted at the point of care (for example, at the bedside)
  • Missed results
  • Wrong diagnosis
  • Change in patient goals
  • Allergies or adverse drug reactions
  • Issues with equipment or medical supplies
  • Information that requires follow-up with another clinician or the patient (or family or carer, if appropriate).

Review policies for communicating critical information

Ensure that policies and processes clearly define:

  • The types of critical information that need to be communicated
  • The method for communicating critical information to the responsible clinician or multidisciplinary team
  • The method for communicating critical information to the patient (or family or carer, if appropriate)
  • The expected time frames for this communication
  • How the information is documented (see Action 6.11).

Policies for communicating critical information to patients, carers and families should also consider whether open disclosure is relevant. Organisations are required to have open disclosure processes as a part of Action 1.12.

Use specific strategies and frameworks

Strategies to enable clinicians to communicate critical information could include:

  • Implementing daily or triggered ‘safety huddles’ or team rounds, which are a mechanism for everyone to discuss potential risks and identify safety issues
  • Having in place ‘critical language’, which is an agreed set of terms or common language that indicates to all members of the team that there is a problem or concern – for example, phrases such as ‘I need some clarity’ or ‘I am worried about’; teams that respond to critical language know that, when this type of phrase is spoken, they need to stop, take a moment, pay attention and ensure that everyone on the team is on the same page
  • Establishing agreed communication processes and pathways between clinicians, multidisciplinary teams, and pathology, biochemistry and radiology, to ensure that members of the workforce are clear about who to communicate new critical results to, and who is responsible for the action or follow-up.

The SHARED framework may be a helpful structure to use when communicating a critical situation or change in patient condition (developed by Mater Health Services Brisbane as part of the Commission’s National Clinical Handover Initiative).

Day Procedure Services

Identify critical information

The nature of critical information or a risk to patient care for the organisation depends on a number of factors, including the type of procedure and any identified patient risks. In defining what critical information means in the service context, consider the type of services the organisation provides and the needs of the patients using the service.

Types of critical information could include:

  • Changes to medicines
  • Missed results
  • Wrong diagnosis
  • Change in patient goals
  • Allergies or adverse drug reactions
  • Issues with equipment or medical supplies
  • Information that requires follow-up with another clinician (for example, the general practitioner) or the patient (or family or carer, where appropriate).

Review policies for communicating critical information

Ensure that policies and processes clearly define:

  • The types of critical information that need to be communicated
  • The method for communicating critical information to the responsible clinician or multidisciplinary team
  • The method for communicating critical information to the patient (or family or carer, if appropriate)
  • The expected time frames for this communication
  • How the information is documented (see Action 6.11).

Policies for communicating critical information to patients, families and carers should also consider whether open disclosure is relevant. Organisations are required to have open disclosure processes as part of Action 1.12.

Use specific strategies and frameworks

Strategies to enable clinicians to communicate critical information could include:

  • Implementing daily or triggered ‘safety huddles’, which is a mechanism for everyone to discuss potential risks and identify safety issues
  • Having in place ‘critical language’, which is an agreed set of terms or common language that indicates to all members of the team that there is a problem or concern – for example, phrases such as ‘I need some clarity’ or ‘I am worried about’; teams that respond to critical language know that, when this type of phrase is spoken, they need to stop, take a moment, pay attention and ensure that everyone on the team is on the same page
  • Establishing agreed communication processes and pathways between admission, operating theatre and recovery so that the workforce is clear about who to communicate new critical results to, and who is responsible for the action or follow-up.

Examples of evidence

Select only examples currently in use:

  • Policy documents that outline the
    • types of critical information that are likely to be received and actions to be taken in response
    • method for communicating critical information to the responsible clinician and the multidisciplinary team
    • method for communicating critical information to the patient, carer and family
    • time frames for communicating critical information
  • Policy documents for identifying the clinicians responsible for a patient’s care, and for notifying the workforce, the patient, carers and family
  • Schedule of regular multidisciplinary team meetings in which new critical information alerts and risks are discussed and actions are agreed, such as ‘safety huddles’, bed rounding or patient journey board meetings
  • Standardised templates to support communication of critical information, such as doctor communication books, shared crisis management plans, email alerts or discharge summaries that are updated in line with identified risks, consumer feedback and committee recommendations
  • Evidence of communication methods or systems for alerting clinicians who can make decisions about care when there is a change in a patient’s condition or new critical information is received
  • Audit results of workforce compliance with policies relating to communicating critical information.
MPS & Small Hospitals

MPSs or small hospitals will need to:

  • Define what ‘critical information’ and ‘risks to patient’s care’ mean for the service context
  • Implement processes to identify the clinicians who are responsible for a patient’s care and who can make decisions about care at any given time
  • Identify when and to whom communication of critical information, alerts or risks should occur, including communication with patients, carers or families
  • Develop and implement standardised processes that describe how communication of critical information, alerts or risks should occur.

The nature of critical information or a risk to patient care for the organisation depends on a number of factors and could include:

  • Changes to medicines
  • New critical results of diagnostic tests, including pathology tests, radiology exams or ultrasound procedures, and results from any diagnostic test that is conducted at the point of care (for example, at the bedside)
  • Missed results
  • Wrong diagnosis
  • Change in patient goals
  • Allergies or adverse drug reactions
  • Issues with equipment or medical supplies
  • Information that requires follow-up with another clinician or the patient (or family or carer, if appropriate).

Review policies for communicating critical information

Ensure that policies and processes clearly define:

  • The types of critical information that need to be communicated
  • The method for communicating critical information to the responsible clinician or multidisciplinary team
  • The method for communicating critical information to the patient (or family or carer, if appropriate)
  • The expected time frames for this communication
  • How the information is documented (see Action 6.11.

Policies for communicating critical information to patients, carers and families should also consider whether open disclosure is relevant. Organisations are required to have open disclosure processes as a part of Action 1.12.

Use specific strategies and frameworks

Strategies to enable clinicians to communicate critical information could include:

  • Implementing daily or triggered ‘safety huddles’ or team rounds, which are a mechanism for everyone to discuss potential risks and identify safety issues
  • Having in place ‘critical language’, which is an agreed set of terms or common language that indicates to all members of the team that there is a problem or concern – for example, phrases such as ‘I need some clarity’ or ‘I am worried about’; teams that respond to critical language know that, when this type of phrase is spoken, they need to stop, take a moment, pay attention and ensure that everyone on the team is on the same page
  • Establishing agreed communication processes and pathways between clinicians, multidisciplinary teams, and pathology, biochemistry and radiology, to ensure that members of the workforce are clear about who to communicate new critical results to, and who is responsible for the action or follow-up.

The SHARED framework may be a helpful structure to use when communicating a critical situation or change in patient condition (developed by Mater Health Services Brisbane as part of the Commission’s National Clinical Handover Initiative).

Action 6.10

The health service organisation ensures that there are communication processes for patients, carers and families to directly communicate critical information and risks about care to clinicians

Intent

Patients and carers can communicate critical information and risks about their care to clinicians.

Reflective questions

What processes are in place to support patients and carers to communicate critical information about their care to clinicians?

What feedback processes are in place to let patients and carers know that they have been heard and action has been taken, if necessary?

Key tasks

  • Develop and implement processes for patients and carers to communicate critical information and risks about their care
  • Support patients and carers to understand and use these processes.

Strategies for improvement

Hospitals

Consider actions in the Partnering with Consumers Standard when implementing this action.

Ensure that policies describe the processes for patients, carers and families to communicate critical information that has emerged or changed to the clinicians who are responsible for the patient’s care.

This could include:

  • Informing patients, carers and families about what could be considered critical information
  • Informing patients, carers and families about their role in communicating this information
  • Providing access to resources or communication tools to support patients, carers and families to communicate critical information to clinicians.

Examples of mechanisms could include information provided on admission, posters, notices in wards or patient rooms, or messages on waiting-room TVs and the organisation’s website. Ensure that information is displayed in a way that can be easily noticed and read by patients, carers and families.

Processes to inform patients, carers and families about who they can communicate critical information to when it emerges or changes, at any time, are also important. This may involve displaying information about how, and to whom, patients, carers and families can communicate critical information in patient rooms and common areas. The information could include:

  • A photo board of care team members with contact details
  • A phone number (and available phone) for patients, carers and families to call if they are concerned
  • A section on the patient whiteboard that identifies who is responsible for their care at any given time and how they can contact them
  • Information about how patients and families may request a meeting with their clinician, or an integrated team meeting.

Where possible, allocate specific times for patients, carers and families to communicate with their care team, rather than leaving patient and family queries to random encounters with the workforce.

An example of a tool for implementing this action is the REACH model (Recognise, Engage, Act, Call, Help is on its way) developed by the NSW Clinical Excellence Commission to enable patient- and family-activated escalation.

Day Procedure Services

Consider actions in the Partnering with Consumers Standard when implementing this action.

Ensure that policies describe the processes for patients, carers and families to communicate critical information that has emerged or changed to the clinicians who are responsible for the patient’s care:

  • Before admission
  • At different points of care
  • After discharge.

This could include:

  • Informing patients, carers and families about what could be considered critical information
  • Informing patients, carers and families about their role in communicating this information
  • Providing access to resources or communication tools to support patients, carers and families to communicate critical information to clinicians.

Examples of mechanisms could include information provided on admission, posters, notices around patient areas, and messages on waiting-room TVs and the organisation’s website. Ensure that information is displayed in a way that can be easily noticed and read by patients, carers and families.

Processes to inform patients, carers and families about who they can communicate critical information to when it emerges or changes, at any time, are also important. This may involve displaying information about how, and to whom, patients, carers and families can communicate critical information in patient rooms and common areas. The information could include:

  • A photo board of care team members with their names and responsibilities
  • A phone number for patients, carers and families to call if they are concerned, particularly if they have been discharged from the organisation.

Examples of evidence

Select only examples currently in use:

  • Policy documents that outline how patients, carers and families are informed about the processes for communicating concerns to clinicians
  • Examples of information provided to patients, carers and families about processes for communicating concerns to the clinicians responsible for care
  • Resources or tools for patients, carers or families to use to communicate with clinicians, such as bedside whiteboards and dedicated free telephone services in waiting areas
  • Patient notes that identify critical information provided by the patient or family and how this information was acted on
  • Records of patient focus groups or minutes of patient-initiated team meetings
  • Results of a patient experience survey or patient, carer and family feedback about their communication with clinicians and, where necessary, how these results have informed improvement strategies.
MPS & Small Hospitals

MPSs or small hospitals will need to:

  • Develop and implement processes for patients and carers to communicate critical information and risks about their care
  • Support patients and carers to understand and use these processes.

Ensure that policies describe the processes for patients, carers and families to communicate critical information that has emerged or changed to the clinicians who are responsible for the patient’s care:

  • Before admission
  • At different points of care
  • After discharge.

This could include:

  • Informing patients, carers and families about what could be considered critical information
  • Informing patients, carers and families about their role in communicating this information
  • Providing access to resources or communication tools to support patients, carers and families to communicate critical information to clinicians.

Examples of mechanisms could include information provided on admission, posters, notices in wards or patient rooms, and messages on waiting-room TVs and the organisation’s website. Ensure that information is displayed in a way that can be easily noticed and read by patients, carers and families.

Processes to inform patients, carers and families about who they can communicate critical information to when it emerges or changes, at any time, are also important. This may involve displaying information about how, and to whom, patients, carers and families can communicate critical information in patient rooms and common areas. The information could include:

  • A photo board of care team members with contact details
  • A phone number (and available phone) for patients, carers and families to call if they are concerned
  • A section on the patient whiteboard that identifies who is responsible for their care at any given time and how they can contact them
  • Information about how patients and families may request a meeting with their clinician, or an integrated team meeting.

If possible, allocate specific times for patients, carers and families to communicate with their care team, rather than leaving patient and family queries to random encounters with the workforce.

An example of a tool for implementing this action is the REACH model (Recognise, Engage, Act, Call, Help is on its way) developed by the NSW Clinical Excellence Commission to enable patient- and family-activated escalation.

Last updated 30th May, 2018 at 12:28am
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