Improving Ineffective Communication in Long Term Care Settings

Abstract

Background Ineffective communication contributes to medical errors and sentinel events in healthcare, leading to fatalities and billions in malpractice cost. Nurses have a leading role in communicating patient information. In long-term care, ineffective communication and poor teamwork contributes to adverse events. Adverse events in our older adults can lead to hospitalizations, injuries, and death. Effective communication and teamwork are key components to providing safe patient care. Implementing a standardized handoff tool and team building curriculum can improve communication and teamwork.

Local Problem Ineffective communication was a verbalized, observable practice problem at a long-term care facility in a suburban location in the Mid-Atlantic region. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum with a standardized handoff tool to improve communication and teamwork between nurses at this long- term care facility.

Interventions During this quality improvement project, six nurses at a suburban long-term care facility learned two TeamSTEPPS modules: communication and team structure. Modules included strategies such as use of the Situation-Background-Assessment-Recommendation communication framework and used a validated handoff tool, Safer Sign Out.

This quality improvement project occurred over 14 weeks. During week one, the nurses were informed about the practice change. During week two, the DNP project leader administered pre-surveys and educated the nurses on the TeamSTEPPS’s curriculum and handoff tool. During weeks three through thirteen, the nurses utilized the Safer Sign Out handoff tool to give report. Nurses were observed during each shift change during the first week on implementation. The project leader reviewed the handoff log for compliance and gave feedback. During week fourteen, nurses completed post- surveys. Lippitt’s Change Theory was used to guide this practice change.

Results (Impact of change) The post- TeamSTEPPS Teamwork Attitudes Questionnaire revealed an increase in overall scores on the team structure and communication category but these changes were not significant, thus indicating only a limited overall improvement in the nurse’s attitudes about teamwork and communication. The post- TeamSTEPPS Teamwork Perceptions Questionnaire, revealed an overall slight increase in the scores from the team structure category and a slight decrease within the communication category; however, neither were found to be statistically significant. The data revealed that use of TeamSTEPPS did not result in significant improvements in the staff’s attitudes and perceptions on teamwork and communication.

Conclusion Ineffective communication and poor teamwork in long-term care continues to lead to adverse events. Information is often lost during shift handoff. In this quality improvement project, several limitations may have impacted the results: a small sample size, a lack of involvement of an organizational champion or internal change agent, limited space to free text information on the handoff tool, and many internal organizational changes. Barriers must be addressed before implementing a communication and team-building curriculum. If barriers are addressed, then utilizing the TeamSTEPPS curriculum with nurses to teach teamwork and communication strategies, along with a validated handoff tool, may help to improve communication during shift hand-off.