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July 2007

Adopt Patient Communication as the 6th Vital Sign

Why should we do this?

There is an abundance of literature that suggests that ineffective patient communication literally is the cause for many unsafe practices, unsafe conditions and jeopardizes the patient’s ability to negotiate a safe environment. This extends far beyond intubated patients and includes patients who are non-English speaking, have neurocognitive or physical disabilities that affect communication skills, etc. As to the former, the Joint Commission is currently releasing the results of a prospective study held at 60 health care institutions that clearly demonstrates that non-English speaking patients suffer from ineffective communication, lower quality of care and have poorer clinical outcomes. This is largely due to patient safety issues and hospital errors (identification, correct limbs, etc.) directly linked to communication barriers.[1] In addition, ineffective communication itself can cause states of being that have a direct effect on other vital signs (i.e., increased heart rate, blood pressure, respiratory rate), just
like pain.  

Vital signs are used to establish a base line for the patient throughout the hospital stay. Likewise, the whole concept behind making communication the 6th vital sign is increasing awareness that patient communication affects clinical outcomes, addressing that it may be a problem in a particular patient (regardless of the cause, i.e. Delirium), which would dictate that a proper source of the barrier be identified and appropriate interventions be taken and documented in the plan of care. The usefulness, therefore, just like other vital signs, lies in the ability to conduct a rapid assessment, formalize a plan of action when warranted and followed up with a documented plan of care in the admitting H/P or soap note. 

Patient communication as a vital sign should take no more than 30 seconds to assess and another 30 seconds to document. Any further time requirement is time that SHOULD be dedicated to this problem and EXACTLY why it needs to be formalized in the plan of care either in an admitting H/P or SOAP note if communication is identified as a problem during Vitals assessment. Further, the Hospital Pulse Report published by Press Ganey Associates, Inc. (2007) states that the NUMBER ONE area tied to the HCAHPS overall satisfaction score is “Attention to patient’s personal needs”. With future exposure of patient satisfaction, there could be no better opportunity to incorporate all patient-centered care initiatives that are supported by formalizing this process.

What does this mean?

Every time you assess your patients, engage your patient and their family.  Identify an effective means for communicating and ensure your patient and their family’s communication needs are met!

The Vidatak EZ Board that Briggs has to offer is the only clinical, research-based, communication intervention for the voice disabled patient. It was actually designed by mechanically ventilated patients! Clinical research at UCLA Medical Center has shown the EZ Board used with proactive nursing care that engages the patient and patient’s family can reduce patient frustration, increases overall satisfaction with health care, and most importantly, can improve the use of pain and anxiolytic medication.

If communication were adopted as a 6th vital sign, following Pain: The 5th Vital Sign’s format, health care providers would be required to assess and document the following aspects of patient communication management:

• Need Assessment (nurse directed, family directed, patient directed -at least one of these three required)

• Communication Need (yes, no, N/A: Patient non-responsive and family not present, patient asleep)

• Method (verbal, writing, communication board, interpreter, family)

• Barriers (foreign language, intubated, surgery, stroke, weakness, LOC, vision or hearing impairment)

• Intervention (communication tool, interpreter, glasses, hearing aid,  referral)

• Effectiveness (no ambiguity and patient/family need met, further clarification required)
  
  
• Evaluation (patient family satisfied, patient/family unsatisfied)

Use an Evidence Based Practice

If you would like to address the issue of patient communication at your hospital, the Vidatak EZ board is available now at Briggs in English, Spanish and several other languages upon request. It has large text that is easy to read, a color-coded pain scale, and full body illustrations to quickly identify and respond to areas of concern or pain. For more information on the Vidatak EZ Board for patient communication click on the product link above. 

Today, the EZ Board is used in over 1,000 hospitals throughout the US as well as health care facilities in Canada, United Kingdom, Australia and India.

[1] www.jointcommission.org/PatientSafety/HLC.

Vidatak, LLC

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