What are challenges you perceive that effect interdisciplinary communication in the hospital setting? by Kristen Llamas https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq Post your response on the padlet and respond to at least en-us 2020-06-04 23:30:27 UTC 2020-06-26 00:19:51 UTC hello@padlet.com A lack of closed-loop communication can lead to misunderstandings in acute care settings, especially during critical patient scenarios and codes. kristen_llamas https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/612105975 2020-06-05 00:19:59 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/612105975 missmotown13 https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/632733162 Patient/family in/ability to effectively communicate their  concerns to their nurse/interdisciplinary team. Also, patient rounding outside of the pt room.. keeping voices low due to HIPAA. ]]> 2020-06-18 20:28:26 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/632733162 It works well in a NICU setting with weekly Interdisciplinary rounds. The challenge was the format for sharing updates, first given verbally to the team then charted update for each patient. Charting was inconsistent from team members. https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639530882 2020-06-25 04:16:07 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639530882 Challenges in Communication https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639538199 I have found that, in the ICU, there are multiple teams that round on any given patient and their communication with one another is extremely poor. This leaves the nurse confused as to who they should call for certain orders. Matters become worse when one team gets upset with the nurse for calling them for orders when another team should be in charge. Additionally, the patient and family members often are unsure of the plan of care due to the many opinions from each team. It is important for the nurse to advocate for their patient and explain to the teams that their communication with one another is vital for a clear plan of care. ]]> 2020-06-25 04:27:33 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639538199 I'll share a personal, private story - Recently my husband had his (third!) surgery at Mission Hospital. It was a 3rd because the surgical team left a "tool" in his back that should not have been there plus the surgeon did his surgery "unconventionally" according to the new surgeon. He was supposed to have emergent surgery in April. Well, COVID happened, so that was delayed. He had the surgery once things reopened May 8th. It was eerie - I dropped my husband off on May 8th in the front of Mission Hospital for his surgery. I was not allowed in. He had his surgery and I received ZERO (yup, all caps because I'm not happy) communication from ANY nurses AND I received ZERO communication from his surgeon as to how the surgery was going AND NEVER received ANY phone call from his surgeon OR his OR nurse team that his surgery went well. This was extremely distressing to me as the wife and for my children as we were not allowed in at all due to COVID. I called the neuro unit he would be transferred to and met by the receptionist with his room number. I asked for an update from his primary nurse and given her cell phone number to call. I called it and she told me she was busy and would call me back - No call back. I never knew what happened to my husband until he came to from anesthesia at 2am the next day and he called me to say he was alive. Needless to say - I wasn't happy with this lack of communication. I do not think that COVID should be an excuse for the health care system to totally absolve themselves of appropriate patient and family care. But this is what I experienced and what I assume many patients and families experienced during COVID. I painfully wonder what happened to the many patients and families who succumbed to COVID - did the health care system fail them as they failed me? Did they absolve themselves of their responsibility of what is appropriate and professional communication to families with the excuse of COVID? I absolutely wonder how much of health care quaintly was completely pushed under the rug and blamed on "COVID". https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639545071 Thank you for listening to my (very) personal story - DR Fraley


]]> 2020-06-25 04:39:24 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639545071 Lack of time. Takes away from patient care. https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639558928 Some team members aren't engaged (on cell phones) and only pay attention to complex patients.
Some team members complain about the time/negative.
Hierarchy, MD and CNS, can be intimidating and belittle staff.
Some staff don't come prepared with data they might be asked (Dietitian-each patient's current diet, wt, labs) and waste time.
Unsupportive leadership, not providing enough staffing (extra) during rounds, and team members who complain to the manager, not their team members if they are unhappy with an aspect of rounds (too long). 
Patient privacy: open-bay unit
Despite these I'm a huge advocate for multidis rounds. I helped facilitate multdis rounds in my unit for 12 years. I tried so hard to make it positive, beneficial,important. It's important to have positive leadership who supports the importance of multidis rounds and the members working together as a team. ]]> 2020-06-25 05:01:16 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639558928 Time/Threats of Being Written Up! If we spend too much time giving report and clock out late we get management's attention and told to be better with time management and threatened w/ a write-up. Some of our patients are in the unit for weeks and have complex issues that need to be reported to for the oncoming shift. However, report is often rushed so we can clock out on time. https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639817933 2020-06-25 09:59:27 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/639817933 Lack of effort https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/640007141 Busy units, busy nurses.
Orders get put in without little comment or direction from interdisciplinary teams (this drives me crazy) because sometimes the nurses are left to figure things out (oh! Why are they NPO After midnight ?).  The reality is: 
Time flies by and we miss the doctors or teams when they round.  I really respect the surgeons or MD’s, etc.  who ask to consult the primary nurse when they finish rounding.  

Also, I hate to keep firing on travel nurses but hospitals are full of them.  Don’t get me wrong, some travelers are absolutely amazing but a lot don’t know the hospital, doctors, or the staff. So overall,  I think either time restraints (poor staffing, prioritization skills etc.) and/or lack of communication efforts.  (Vanessa T) ]]> 2020-06-25 13:49:10 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/640007141 RN = Middle man! https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/640270274 Interdiscplinary team members make rounds at different times of the day. Instead of going directly to the doctor for their concerns or recommendations, they ask the nurse to communicate it for them. This can be difficult when the nurse is already busy with his/her patients & frustrating to have to call the doctor multiple times for something the team member should have called about themself.]]> 2020-06-25 17:57:18 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/640270274 Lack of time! When interdisciplinary rounds occur nurses are expected to leave the bedside in some units to attend have no coverage for this. Lack of cohesiveness and standardization in practice also sometimes prohibits progression of care as new teams of docs come on and the entire plan is changed because they disagree with the previous team's plans... patients are left unsatisfied and confused and staff is unable to effectively educate patients on the trajectory of their stay. https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/640359062 2020-06-25 19:36:42 UTC https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/640359062 Lack of standardization https://padlet.com/kristen_llamas/z9soxk0lncqpq2qq/wish/640549986 Often times, multidisciplinary team members communicate using different styles and methods. Standardization such as SBAR helps to keep communication structured and ensure that information is not lost between members of the healthcare team. 

- Audrey Lewis

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