{"id":13570,"date":"2021-05-19T12:00:31","date_gmt":"2021-05-19T19:00:31","guid":{"rendered":"https:\/\/www.passy-muir.com\/?page_id=13570"},"modified":"2021-05-19T11:43:27","modified_gmt":"2021-05-19T18:43:27","slug":"journal-3-1-improving-communication","status":"publish","type":"page","link":"https:\/\/cloudfront.passymuir.com\/es\/journal-3-1-improving-communication\/","title":{"rendered":"<a href=\"\/wp-content\/uploads\/2019\/11\/AH_2019.pdf#page=18\">\nLos protocolos ayudan a mejorar la comunicaci\u00f3n de los pacientes con traqueotom\u00eda y dependencia del ventilador<\/a>"},"content":{"rendered":"<div class=\"l3-header-con no-banner\">\n<div class=\"l3-header-icon\">\n\t\t<img decoding=\"async\"  src=\"\/wp-content\/uploads\/2017\/05\/Clinicians_0.png\" alt=\"journal\" \/>\n\t<\/div>\n<div class=\"l3-header-text\">\n\t\t\tAerodigestive Health\n                         <\/div>\n<\/p><\/div>\n<div style=\"clear:both\"><\/div>\n\r\n<ul class=\"breadcrumb\">\r\n\t<li class=\"active\">Clinician&apos;s Corner<\/li>\r\n\t<li class=\"dropdown\">\r\n\t\t<a href=\"#\" class=\"dropdown-toggle\" data-toggle=\"dropdown\">See All Articles <b class=\"caret\"><\/b><\/a>\r\n\t\t<ul class=\"dropdown-menu\">\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-ethical\">Impacting Patient Care and Ethical Considerations\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-management\">Understanding the Management of Patients Undergoing Prolonged Weaning...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-trach-tube-cuff\">Tracheostomy Tube Cuff: Purpose and Practice through Team Management\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-complications-management\">Case Study: Management of Complications Following SCI and the Role of SLPs...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-high-flow\">High Flow Oxygen Therapy and the PMV\u00ae<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-2-1-international-research\">Articles Representing International Research on Tracheostomy...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-protocol\">Having a Protocol for Clinical and Research Use of the Passy Muir\u00ae...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-candidacy\">Assessment Considerations for PMV\u00ae Candidacy in the Pediatric Population\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-assessment\">Candidacy for Passy Muir\u00ae Valve Placement in Infants and Young Children...\r\n<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-1-1-casestudy\">Keys to Success: A Pediatric Respiratory Therapy Case Study<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-perspective\">Physicians\u2019 Perspective on the Passy Muir\u00ae Speaking Valve<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-evidence\">Evidence Based Support for Using a PMV\u00ae In-line...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-effects\">Effects of PMV\u00ae In-line with Mechanical Ventilation...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-mechanical-vent\">Speaking Valve Use During Mechanical Ventilation...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/talkmuir-6-1-current-research\">Current Research Related to Mechanical Ventilation and Speaking Valve Use<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-dependence\">Infants and Children with Tracheostomy and Ventilator Dependence<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-protocol-transitioning\">From ICU to Home Care: A Protocol for Transitioning<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-complex-care\">Delivering Complex Care for Complex Children: A Multidisciplinary Approach<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-improving-communication\">Protocols Assist with Improving Communication for Patients...<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-patient-outcomes\">Having Protocols for Clinical Use to Improve Patient Outcomes<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-oxygen-therapy\">Using the Passy Muir\u00ae Valve in Conjunction with High Flow Oxygen Therapy<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-pressure-swallow\">The Role of Pressures in Swallowing and Impact of the Passy Muir\u00ae Valve<\/a><\/li>\r\n\r\n\t\t\t<li class=\"\"><a href=\"\/journal-3-1-relevance\">Clinical Relevance of the Sensorimotor Pathways in Dysphagia...<\/a><\/li>\r\n\r\n\t\t<\/ul>\r\n\t<\/li>\r\n<\/ul>\r\n\n<h2 class=\"journal--title\"><a href=\"\/wp-content\/uploads\/2019\/11\/AH_2019.pdf#page=18\">Protocols Assist with Improving Communication for Patients with Tracheostomy &#038; Ventilator Dependence<\/h2>\n<p><\/a><\/p>\n<h3 class=\"journal--speaker\">Carmin Bartow, MS, CCC-SLP, BCS-S | Meredith Oakey Ashford, MS, CCC-SLP<\/h3>\n<div class=\"about_author\">\n<strong>About the Authors<\/strong><br \/>\n \t \t<img decoding=\"async\" alt=\"Carmin Bartow\" class=\"small_speaker\" src=\"\/wp-content\/uploads\/2019\/11\/carmin-bartow.jpg\"\/><\/p>\n<div class=\"about_text\">\nCarmin Bartow,<br \/>\nMS, CCC-SLP, BCS-S<br \/>\nSpeech-Language Pathologist<br \/>\nVanderbilt University<br \/>\nMedical Center<br \/>\nNashville, TN, USA\n<\/div>\n<div style=\"clear:both;\"><\/div>\n<div id=\"content_spacer\"><\/div>\n<p> \t \t<img decoding=\"async\" alt=\"Meredith Oakey Ashford\" class=\"small_speaker\" src=\"\/wp-content\/uploads\/2019\/11\/meredith-oakey-ashford.jpg\"\/><\/p>\n<div class=\"about_text\">\nAbout the Author<br \/>\nMeredith Oakey Ashford,<br \/>\nMS, CCC-SLP<br \/>\nSpeech-Language Pathologist<br \/>\nVanderbilt University<br \/>\nMedical Center<br \/>\nNashville, TN, USA<\/p><\/div>\n<\/div>\n<div class=\"tom-image\"><img decoding=\"async\" alt=\"patient\" src=\"\/wp-content\/uploads\/2019\/04\/patient_O2.jpg\"\/><\/div>\n<h4>Introduction<\/h4>\n<p>For patients with tracheostomy and ventilator dependence, communication in the intensive care unit can be difficult to achieve but having a reliable means of communication is imperative for health, safety, and well-being. The Speech-Language Pathology (SLP) team at Vanderbilt University Medical Center (VUMC) recently launched a six-month quality improvement initiative to promote early intervention for this patient population. The project, \u201cImproving Communication for Patients with Tracheostomy and Ventilator Dependence,\u201d had a primary goal of establishing consistency with communication for these patients by having the entire SLP department trained in a newly developed protocol. Prior to this project, only some of the SLPs in the department were fully confident and competent in providing intervention to these patients. With the development and implementation of this program, patients may participate more readily in their medical plan, which can improve efficiency of care by all staff, preventing unnecessary delays in their care, which may have occurred secondary to the earlier difficulties with communication and patient participation.<\/p>\n<h4>Purpose<\/h4>\n<p><i><b>Impaired communication can lead to safety concerns, violation of patient rights, poor quality of life, and may contribute to ICU delirium (Freeman-Sanderson, Togher, Elkins, &#038; Kenny, 2018). Some of the reasons for addressing communication are:<\/i><\/b><\/p>\n<ul>\n<li>Safety concerns: Patients with communication problems were three times more likely to experience preventable adverse events than patients without such problems (Bartlett, Blais, Tamblyn, Clermont, &#038; MacGibbon, 2008). Serious medical events have been reported for patients with impaired communication (Cohen, Rivara, Marcuse, McPhillips, &#038; Davis, 2005).<\/li>\n<li> Patient rights: The Joint Commission set new standards which focus on all patients having their communication needs met, making communication a priority. The Joint Commission upholds that patients have a \u201cright and need to effective communication.\u201d In the Elements of Performance for R1.2.100, No. 4 states, \u201cThe organization addresses the needs of those with vision, speech, hearing, language, and cognitive impairments\u201d (The Joint Commission, 2010).<\/li>\n<li>Quality of life: Inability of the ICU patient to communicate can lead to frustration, anger, withdrawal from interaction, and reduced participation in treatment (Magnus &#038; Turkington, 2006).<\/li>\n<li>ICU Delirium: Two out of three patients in ICUs experience delirium (Grossbach, Stranberg, &#038; Chlan, 2011). In a Joint Commission webinar, Call to Action: Improving Care to Communication Vulnerable Patients, it was reported that communication-vulnerable patients have an increased diagnosis of psychopathology (The Joint Commission, n.d.).<\/li>\n<li>The Vanderbilt Promise: \u201cAs an institution, VUMC promises to include you [the patient] as the most important member of your healthcare team\u201d and \u201ccommunicate clearly and regularly, which is paramount during times of critical illness.\u201d <\/li>\n<\/ul>\n<p><\/p>\n<h4>Implementation Methods and Communication Access<\/h4>\n<p>To improve the consistency and standardization of assessment and treatment for the patient with tracheostomy and ventilator dependence, the SLP team members who were competent with this patient population:<\/p>\n<ul>\n<li>Developed a protocol to standardize assessment of both verbal and non-verbal communication.<\/li>\n<ul>\n<li>This protocol starts with a readiness screening. If the patient passes the screening, it then provides a workflow for a collaboration between the speech-language pathologist and the respiratory therapist (RT) during phonation trials.<\/li>\n<li>Collaboration would involve basic assessment of speech, language, and cognition and the need for a simple AAC (Augmentative and Alternative Communication) tool.<\/li>\n<\/ul>\n<li>Disseminated this protocol to the acute speech pathology staff through didactic teaching, oneon-one training, and competency check offs.<\/li>\n<li>Met with the Director of the VUMC Critical Illness, Brain Dysfunction, and Survivorship Center to discuss the importance of communication for patients following tracheostomy and mechanical ventilation to potentially minimize delirium.<\/li>\n<li>Provided in-services to the interprofessional disciplines that collaborate on the care for these patients, including:<\/li>\n<ul>\n<li>Respiratory therapists.<\/li>\n<li>Medical Intensive Care Units (MICU) attendings and fellows (physicians).<\/li>\n<li>Nursing staff throughout VUMC.<\/li>\n<\/ul>\n<li>Created a poster presentation for a hospital-wide Strategy Share Program in order to further disseminate the improvement process. The theme for the 2019 Strategy Share was \u201cDesign for Patients and Families.\u201d This CQI project fit perfectly with this theme and the VUMC goals of enhanced patient, clinician, and staff experiences. <\/li>\n<\/ul>\n<p><\/p>\n<h4>Results<\/h4>\n<p>This qualitative process and review of its impact provided a means of training personnel and reviewing the impact on staff confidence and workflow. Review of interview data demonstrated that implementing the improvement process through additional training increased the confidence of the SLP team when serving this population. After the departmental in-service trainings, SLPs commented:<\/p>\n<ul>\n<li>\u201cThe in-service enabled me to gain skills and confidence to feel more prepared to treat these complex patients.\u201d<\/li>\n<li>\u201cI feel better equipped to manage our trach\/ vent patients.\u201d<\/li>\n<\/ul>\n<p>Furthermore, respiratory therapists and speech-language pathologists demonstrated improved teamwork to establish communication for these patients. A pre-project staff survey was completed to ascertain staff comfort and efficiency when treating these patients. A post-training survey is in process. Preliminary results indicate that staff has the improved confidence, knowledge, and skills to work with these complex patients.<\/p>\n<p>In addition to improvement in patient care, the SLP team also benefitted from this initiative by receiving increased recognition within the medical center. The poster, which provided education on the protocol for working with patients to enhance communication, was well-received at the VUMC Strategy Share event. This initiative also led to an invitation for the SLP team to participate in the VUMC Critical Illness, Brain Dysfunction, and Survivorship Center.<\/p>\n<p>Most importantly, the patients who have benefited from this program consistently report appreciation for being able to express themselves and actively participate in their care. One patient stated, \u201cIt has been so frustrating trying to tell my husband what I want. He couldn\u2019t read my lips so I tried to write, but he couldn\u2019t read my writing. Now, I can just talk to him, and it\u2019s so much better.\u201d<\/p>\n<div class=\"tom-image\"><img decoding=\"async\" alt=\"Trach Consult Service\" src=\"\/wp-content\/uploads\/2019\/11\/vanderbilt.jpg\"\/><\/div>\n<h4>Conclusions<\/h4>\n<p>In collaboration with physicians, ICU nurses, the Trach Consult Service, and respiratory therapists, the Adult Acute Speech-Language Pathology team is making verbal and non-verbal communication accessible for these otherwise non-communicative patients. Hospital staff will now interact more efficiently with patients from this intervention by using the newly implemented head-of-bed sign, directing them on how to facilitate verbal communication with their patient (see Figure 1). This simple form improves consistency in communication across the interdisciplinary team for these vulnerable patients. Improving communication with this population has resulted in improved safety, quality of life, and compliance with Joint Commission regulations, ADA laws, and the VUMC Patient Promise.<\/p>\n<p>This article is from the Fall 2019 Protocol Issue of Aerodigestive Health. <a href=\"\/wp-content\/uploads\/2019\/11\/AH_2019.pdf#page=18\">Click here<\/a> to view Protocols Assist with Improving Communication for Patients with Tracheostomy &#038; Ventilator Dependence.<\/p>\n<hr>\n<p>&nbsp;<br \/>\n&nbsp;<\/p>\n<h4>References<\/h4>\n<ol>\n<p>Bartlett, G., Blais, R., Tamblyn, R., Clermont, R. J., &#038; MacGibbon, B. (2008). Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association Journal, 178, 1555-1562. doi: 10.1503\/cmaj.070690<\/p>\n<p>Cohen, A. L., Rivara, F., Marcuse, E. K., McPhillips, H., &#038; Davis. R. (2005). Are language barriers associated with serious medical events in hospitalized pediatric patients? Pediatrics, 116(3),575-9.<\/p>\n<p>Freeman-Sanderson, A. L., Togher, L., Elkins, M. R., &#038; Kenny, B. (2018). Quality of life improves for tracheostomy patients with return of voice: A mixed methods evaluation of the patient experience across the care continuum. Intensive Critical Care Nursing, 46,10-16. doi:10.1016\/j.iccn.2018.02.004<\/p>\n<p>Grossbach, I., Stranberg, S., &#038; Chlan, L. (2011). Promoting effective communication for patients receiving mechanical ventilation. Critical Care Nurse, 31(3): 46-61.<\/p>\n<p>The Joint Commission. (2010). Advancing effective communication, cultural competence, and patient- and family-centered care: A roadmap for hospitals.[brochure]. Retrieved January 15, 2019 from https:\/\/www.jointcommission.org\/ assets\/1\/6\/ARoadmapforHospitalsfinalversion727.pdf<\/p>\n<p>The Joint Commission. (n.d.). Call to Action: Improving care to communication vulnerable patient. [brochure]. Retrieved January 15, 2019 from http:\/\/www.patientprovidercommunication.org\/files\/CommunicationVulnerableWebinar.pdf <\/p>\n<p>Magnus, V. &#038; Turkington, L. (2006). Communication interaction in ICU-patient and staff experiences and perceptions. Intensive Critical Care Nursing, 22, 167-180.<\/p>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"Aerodigestive Health Protocols Assist with Improving Communication for Patients with Tracheostomy &#038; Ventilator Dependence Carmin Bartow, MS, CCC-SLP, BCS-S | Meredith Oakey Ashford, MS, CCC-SLP About the Authors Carmin Bartow, MS, CCC-SLP, BCS-S Speech-Language Pathologist Vanderbilt University Medical Center Nashville, TN, USA About the Author Meredith Oakey Ashford, MS, CCC-SLP Speech-Language Pathologist Vanderbilt University Medical [&hellip;]","protected":false},"author":85,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"yst_prominent_words":[3798,3787,1168,3784,3771,3799,3796,3775,3797,569,209,450,3772,3859,3786,3785,80,3773,3789],"class_list":["post-13570","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages\/13570","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/users\/85"}],"replies":[{"embeddable":true,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/comments?post=13570"}],"version-history":[{"count":16,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages\/13570\/revisions"}],"predecessor-version":[{"id":16266,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/pages\/13570\/revisions\/16266"}],"wp:attachment":[{"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/media?parent=13570"}],"wp:term":[{"taxonomy":"yst_prominent_words","embeddable":true,"href":"https:\/\/cloudfront.passymuir.com\/es\/wp-json\/wp\/v2\/yst_prominent_words?post=13570"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}