Congress Abstracts 2006

137

IMPROVING COMMUNICATION FOR CRITICALLY ILL ONCOLOGY PATIENTS THROUGH THE USE OF A "DAILY GOALS" COMMUNICATION TOOL: ADHERENCE TO JCAHO PATIENT SAFETY GOAL 2. Tracy Douglas, RN, MSN, OCN^®, Brenda Shelton, RN, MS, AOCN^®, CCRN, and Allison Murter, RN, MSN, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; William Matsui, MD, and Rex Yung, MD, Johns Hopkins School of Medicine, Baltimore, MD; and Kathy Shane, RN, BSN, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD.

One unique feature of the Sidney Kimmel Comprehensive Cancer Center (SKCCC) is the capacity for all inpatient beds to be converted into critical care rooms. This allows patients to remain in the SKCCC and maintain continuity of care with the oncology multidisciplinary staff. In these instances, critically ill patients are co-managed by a pulmonary/critical care attending and fellow in conjunction with the primary medical oncology team. Communication is imperative for safe and quality critical care, and this concept has been emphasized by the 2006 guidelines provided by the Joint Commission on Accreditation of Healthcare Organizations. Goal 2 of these guidelines is to improve the effectiveness of communication between caregivers, more specifically to standardize processes of communication and allow questions and answers of the caregivers. Similarly, the Johns Hopkins Hospital has developed eight safety goals. One of these is to improve communication, and another is to improve teamwork. Furthermore, safety literature supports that improvements in process are equally important as technical improvements in dictating critical care outcomes.

Our team focused on improving communication and processes among the pulmonary, oncology, nursing, and respiratory staff during the care of critically ill patients within the SKCCC. Importantly, the goals of these measures are to better and more uniformly implement the technical choices made for critical patients.

We developed a Daily Goals Sheet (DGS) to formalize and document discussions made during morning patient rounds. The charge nurse or a clinical nurse specialist completes the DGS that specifically addresses the patient's therapeutic goals. The Oncology and Pulmomary/Critical Care Fellows read the DGS, agree or make corrections, and sign it. The DGS is then given to the nurse who can monitor the patient's progress for each of the listed goals. The DGS is reevaluated each evening by the pulmonary fellow, an oncology team member, and the patient's nurse to assess whether the daily goals have been met and/or to identify barriers that have prevented attainment of these goals.

Evaluation is ongoing and will be presented at the ONS Congress.

Using a DGS as a tool to formalize communication will improve multidisciplinary teamwork and patient care outcomes.