Communication with Families from PACU

1. Communication with Families from PACU Sacred Heart Medical Center (SHMC) at Riverbend

2. Purpose of Presentation To outline an evidence-based proposal to change communication with families and significant others waiting for patients recovering in the phase I Post Anesthesia Care Unit (PACU)

3. The Communication Dilemma • Hospital Consumer Assessment of Healthcare Providers • Centers for Medicare and Medicaid Services new reward system • Joint Commission statement • Increase length of Stay in PACU at SHMC Riverbend • American Society of Perianesthesia Nursing position (ASPAN) statement

4. Problem Statement In PACU patient family and/or significant others (SO), how does communication with PACU staff within one hour of arriving, compared with present standard communication process, influence/predict improved patient satisfaction during perioperative period?

5. “Does my wife/husband know I’m okay?” Weeks (2000) Paavilainen et al.(2001) Majasaari et al. (2005) • Satisfaction did not change based on who talked to families • Emergency surgery patients’ feel coping enhanced with family centeredness • 10% Out patient surgery patients report families not included further 18% could not say family involved

6. Research Costa (2001) Leske (1996) • Hermeneutic study showing three themes: fear, not knowing and desire for connectedness • Quasi-experimental study comparing Mean Arterial Pressure, heart rate and anxiety levels of family members waiting. Showed decreases in all measures with any communication.

7. Research Ekwall et al. (2009) Beckett et al (2009) • Study of Emergency Department (ED) accompanying persons. Satisfied persons had significantly lower anxiety levels. Communication ↓anxiety • Parents satisfaction ↑ with number of perceived communication events

8. Research Health Registration Journal Rhodes et al.(2006) • ED patients same levels of satisfaction whether waited one hour or six hours with communication. • Satisfaction levels influenced by patient and family expectations

9. Proposed Solution • Enhance communication by making a phone call to waiting family/SO. • Use of light duty nurse to liaison with Those waiting • Advances ideals of SHMC mission statement “We carry on the healing mission of Jesus Christ by promoting personal and community health, relieving pain and suffering, and treating each person in a loving and caring way.”

10. Potential Barriers Solutions • Historic Lack of attention to those in waiting room • Patients that are doing poorly in the PACU • Involvement of other staff involved in patient’s care before and after PACU • Lack of staff • Expanding vision of PACU staff to include care of those waiting • Obtain assistance of anesthesiologists /surgeons to communicate with those waiting • Make others aware of change in plan of communication • Manager commitment to plan and increase staff able to make call

11. Change Plan • Develop a sense of urgency • Form a guiding coalition • Create a vision • Communicate the vision

12. Continuing Change • Empower others to act • Plan for short term wins • Consolidate the improvements Producing more change • Institutionalize change

13. Final step to every EBP project Sharing results and experiences

14. Contact information • RuRice@peacehealth.org, • 541-222-3040

15. References • American Society of Perianesthesia Nursing. (2009). Position Statement 8: A Position Statement on Visitation in Phase I Level of Care. Retrieved June 25, 2011, from http://www.aspan.org/Portals/6/docs/ClinicalPractice/PositionStatement/1012/Pos_Stmt_8_Visitation_PhI.pdf • Anonymous (2011). Communication is critical to patient satisfaction. Health Registration, 20(5), 8-10. Retrieved from ProQuest document ID: 2266495261 • Beckett, M., Elliot, M., Richardson, A., & Mangione-Smith, R. (2009). Outpatient satisfaction: Role of nominal versus perceived communication. Health Research and Educational Trust, 44(5p1), 1735-1749. doi: 10.1111/j.1475-6773.2009.01001.x • Center Medicare and Medicaid Services. (2011). Special Open Door Forum: Hospital Value Based Purchasing Proposed Rule Overview For Facilities, Providers and Suppliers. Retrieved from http://www.cms.gov/HospitalQualityInits/downloads/0210_Slides.pdf

16. References • Costa, M. (2001). The lived experience of ambulatory surgery patients. Association of Operating Room Nurses, 74(6), 874-881. • Ekwall, A., Gerdtz, M., & Manias, E. (2009). Anxiety as a factor in influencing satisfaction with Emergency Department: Perspectives on accompanying persons. Journal of Clinical Nursing, 18(24), 3489-3497. doi: 10.111/j.1365-2702.2009.02873.x • Healthcare at the Crossroads: Guiding Principles for the Development of the Hospital of the Future. (2008). Retrieved from http://www.jointcommission.org/assets /1/18/Hosptal_Future.pdf • Johansson, P., Oleni, M., & Fridlund, B. (2002). Patient satisfaction with nursing care in context of health care: a literature study. Scandinavian Journal of Caring Sciences, 16(4), 337-344. Retrieved from URL: www.cinahl.com/cgi-bin/refsvc?jid=474&accno=2003163027 • Kotter, J. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 73(2), 59-67.

17. References • Leske, J. (1996). Intraoperative progress reports decrease family member’s anxiety. AORN, 64(3), 424-436. doi: ASN: 00000703 199609000-00018 • Majasaari, H., Sarajarvi, A., Koskinen, H., Autere, S., & Paavilainen, E. (2005). Patient’s perceptions of emotional support and information provided to family members. Association of Operating Room Nurses, 81(5), 1030-1039. • Melnyk, B., & Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing and Healthcare (2nd ed.). Philadelphia: Lippincott Williams & Wilkins • Paavilainen, E., Seppanen, S., & Kurki, P. (2001). Family involvement in perioperative nursing of adult patients undergoing emergency surgery. Journal of Clinical Nursing, 10(2), 230-237.

18. References • Peace Health (2011). Our Mission and Core Values. Retrieved April 1, 2011, from http://www.peacehealth.org/about-peacehealth/pages/mission-values.aspx • Rhodes, L., Miles, G., & Pearson, A. (2006). Patient subjective experience and satisfaction during the perioperative period Day Surgery setting: systematic review. International Journal of Nursing Practice, 12(4), 178-192. doi: 10.1111/j.1440-172X.2006.00575x • Robinson, K., & Watters, S. (2010). Bridging the communication gap through implementation of patient navigator program. Pennsylvania Nurse, 65(2), 19-

19. References • Sacred Heart Medical Center at Riverbend. (2011). U. S. News and World Report. Retrieved from http://health.usnews.com/best-hospitals/sacred-heart-medical-center-at-riverbend-6920051/details • Santamour, B. (2009). Reducing patient anxiety, increasing satisfaction. Hospitals and Health Networks, 83(7), 16. • Schweitzer, S. (2007). Health Care Savings Accounts: leveraging new patient as consumer. Managed Care Outlook, 20(10), 1-7 • Smykowski, L., & Rodriquez, W. (2007). The Post Anesthesia Care Unit experience: A family centered approach. Journal of Nursing Quality Care, 48(1), 5-15.

20. References • Wagner, D., & Bear, M. (2008). Patient satisfaction with nursing care: a concept analysis within a nursing framework. Journal of Advances Nursing, 65(3), 692-701. doi: 10.1111/j.1365-2648.2008.04866.x • Walker, E. (2011). Hospitals to be paid for quality, not quantity, CMS says. MedPageToday. Retrieved from http://www.medpagetoday.com/Washington-Watch/Reform/26200 • Walls, M. (2009). Staff attitudes and beliefs regarding family visitation after implementation of a formal visitation policy in PACU. Journal of Perianesthesia Nursing, 24(4), 229-232. doi: 10.1016/j.jopan.2009.03.015 • Weeks, T. (2000). Behind the Red Line: The Intraoperative Experience of Those Who Wait (Doctoral dissertation). Retrieved from ProQuest document ID: 729250241