Visual triggers promote continuity in care

Staff have patient information at a glance

Faced with the challenge of providing continuity of care around the clock, the rehabilitation department at Kernan Hospital in Baltimore came up with visual triggers at the bedside, on the wheelchair, and at the receptionist’s desk so each staff member can know instantly what the patient needs.

The tools were developed as a way to enhance communication among all levels of employees on all shifts and to make sure that everything a staff member does helps reinforce the patient goals set by the team, says Linda Hutchinson-Troyer, MGA, CRTS, patient therapy manager of the brain injury unit.

"We take the approach that staff need to share and reinforce what patients are learning at all hours of the day and night, whether it’s bowel and bladder training, the special diet they are on, or the splinting schedule. Everybody has to understand what each patient needs," she says. (For details on how Kernan uses the Nursing Kardex to communicate between shifts, see story, p. 166.)

When staff go into patient rooms, they automatically glance at the Quick Bedside Evalu ation (QBE), a legal-size sheet of paper posted in the room that gives staff capsulized information about the patient. Included is information on swallowing, diet, cardiac precautions, fall prevention precautions, transfer status, orthopedic issues, activities of daily living status in terms of independence, and a section for "other" which includes any information the team needs to share that isn’t listed on the chart. (See sample QBE, p. 165.)

Anyone coming into the room has immediate information about the patient without having to track down the nurse. For instance, if a patient care associate (PCA) answers a call bell light and the patient has to go to the bathroom, the PCA can glance at the QBE and know immediately how to transfer the patient.

Recently, Hutchinson-Troyer happened on a situation in which a family member brought in pizza for a patient and offered a slice to the patient’s roommate. The roommate was on a restricted diet and couldn’t eat pizza. The fam ily member wasn’t aware of the diet restriction. Hutchinson-Troyer glanced at the QBE and explained why the roommate couldn’t eat it.

The QBE is useful when staff such as the PCAs flex between units. Even when they enter the rooms of patients they’ve never seen before, PCAs know by glancing at the charts what the patients can and can’t do.

When appropriate, the brain injury unit uses sitters for patients who are highly agitated and not easily directed. If the sitters are agency staff and unfamiliar with the patients, the QBE gives instant information at bedside. "The sitters receive orientation, but this is more information posted right in the room," she says.

The staff update any changes as they occur and review the QBE every week. The therapy staff also use the QBE as a quality improvement monitor by tracking the accuracy and completeness of the tool. This tracking is done on a weekly basis.

The QBE contains only the patient’s first name and last initial to retain confidentiality.

"The fact that we use only the first name and post the QBE in the room, not in the hallway in public view, addresses the issue of maintaining confidentiality," Hutchinson-Troyer says.

Color-coded belts

Another visual cue to communicate patient status among staff are color-coded wheelchair seat belts to communicate patient status. A red seat belt means, "Stop. Don’t let this patient beyond your grasp." A yellow seat belt denotes a patient can be supervised from a greater distance. A green seat belt indicates an independent patient who needs a staff on hand because of impulsiveness.

"The color-coded seat belts are a small precaution, but they are effective in letting staff know the patient status," she explains.The intershift communication tools were made as part of the merger between Montebello Hospital and Kernan Hospital into a new organization. Both hospitals had been part of the University of Maryland Medical System but were located across town from each other.

An interdisciplinary transition team of staff from both hospitals wanted to make sure there were easy written and visual communication triggers so every staff member knows what each patient needs. "When we merged the staff of the two hospitals, we looked at it as a time to sort things out. We didn’t necessarily want to adopt procedures from one side of town to another, but to use those we identified as most appropriate to what is going on in the health care environment," Hutchinson-Troyer says.