Health service organisations implementing strategies for safe communication need to consider the role of family members in communicating with children; the widely varied levels of communication skills and understanding of children; and the involvement of children and their family at transitions of care.
Why does this standard need special consideration by health service organisations that provide care for children?
Health service organisations implementing strategies for safe communication need to consider:
- The role of family members in communicating with children
- The widely varied levels of communication skills and understanding of children
- The involvement of children and their family at transitions of care.60
Criterion: Correct identification and procedure matching
Systems to maintain the identity of the patient are used to ensure that the patient receives the care intended for them.
Correct identification and procedure matching
It is common for children to remove identification bands, either accidentally or intentionally. Removing identification bands is relatively easy for children because of their small size, the anatomy and muscle tone of their ankles and wrists, and patterns of movement during play. Health service organisations may consider having processes in place to:
- Ensure the correct and ongoing identification of each child
- Restore the identification band as soon as possible
- Restrict all procedures and treatments for children until the band is replaced and the child’s identity confirmed.
The organisation-wide patient identification and procedure matching system should outline policies, procedures and protocols for ensuring that children can be correctly identified when:
- Identification bands cannot be worn
- Identification bands are lost or accidentally removed
- Children do not have the capacity to identify themselves
- Children are unaccompanied by their family.†
There is a small but important risk of identification errors occurring whenever breastmilk is expressed and stored in a health service organisation.61 Several factors increase the risk of administration error when dealing with expressed breastmilk. These include the separation of women and their babies, babies of multiple births, and relocating infants to different bed spaces. The system for collection, storage and use of expressed breastmilk should include highly reliable processes for correct identification of mother and baby, including:
- Using rooming-in as a strategy for mother and baby so that they stay together throughout the patient journey
- Using double identification bands (for example, on wrist and ankle) with information that includes name, date of birth and patient number specific to the relevant state or territory
- Labelling and verification of containers at the time of collection and before use
- Using a double-check policy for breastmilk
- Obtaining and documenting consent from a parent or appropriate family member for the use of expressed breastmilk, including discussion of the effect that any medicines administered to the mother may have on the child.
† Mothers and babies should only be separated when clinically indicated.
Criterion: Communication at clinical handover
Processes for structured clinical handover are used to effectively communicate about the health care of patients.
Health service organisations should consider basing policies and procedures for clinical handover on a child-focused model of care that maximises opportunities for participation in handover by children and their families. To do this, health service organisations may support clinicians to:
- Assess the family’s ability to provide ongoing care and provide information in a way that ensures that it is understood
- Educate families to detect deterioration, administer medicines, and find relevant primary and community services
- Provide relevant information for families to pass on to schools and childcare services
- Develop handover processes that allow the child and family appropriate and effective participation in clinical handover.
To ensure that transitions of care are safe and effective, health service organisations must have standardised processes in place and may consider having specific systems in place, especially at high-risk transition points, such as from:
- Neonatal intensive care units or special care to the paediatric setting or home
- Paediatric services to services for adolescents and young people
- Services for young people to adult services.
Patient discharge summaries are important tools to ensure best care of paediatric patients; however, research shows that they are often incomplete or not available to primary care physicians at the first follow-up appointment after a child’s hospitalisation.62 Addressing the accuracy and timeliness of discharge documentation improves the transfer of information between clinicians, and can reduce adverse events.63,64 A suggested strategy to achieve this is to explain the contents and provide a copy of the discharge letter to the child and family at the time of discharge.
Criterion: Communication of critical information
Systems to effectively communicate critical information and risks when they emerge or change are used to ensure safe patient care.
Health service organisations should consider developing policies and procedures that outline:
- Types of critical information likely to be received and actions to be taken in response
- Methods for communicating critical information to the responsible clinician and multidisciplinary team
- Methods for communicating critical clinical information to families and carers
- Time frames for communicating critical information
- Standardised templates to support communication of critical information
- Methods for rapid escalation of concerns.