Practice Expectation Spotlight: Effective Communication

COVID-19 has in many ways changed our work routines and processes. Social distancing requirements, new technology uses, personal protective equipment requirements and temporary measures related to non-essential services as well as prescribing of narcotics and controlled drugs are all examples of changes that impact the way we practice. At the same time our clients have been placed in the position of needing to learn how to navigate this new environment while experiencing changes to their own routines and circumstances. As we all adjust, the potential for miscommunication is high. Taking time to reflect on how our communication has changed or might need to change is an important first step to reducing the risk of miscommunication.

Take a moment to reflect on a change that you have made in your practice in relation to COVID-19. How has this change impacted your communication with your client? Your colleagues? Can you identify any new barriers to communication? What strategies can/do you use to ensure that you are communicating effectively? Do you take the time to repeat back information or ask for clarification even if you think everyone else understands what is being said?

As RNs, it is our responsibility to take action to mitigate the risk of miscommunication. One way we can do this is by identifying where the risks for miscommunication are in a process and then incorporating actions into that process to decrease those risks.

Take for example the use of verbal orders. Under normal circumstances verbal orders are not recommended except in emergent situations. However, due to social distancing measures, verbal orders are sometimes being considered as a temporary measure to enable care when no other options are available. While verbal orders may reduce the risk of transmission of COVID-19, they have their own risks that can result in patient harm. Verbal orders can be misunderstood, misheard and transcribed incorrectly. In order to reduce the risk of miscommunication, a verbal order process should incorporate actions aimed specifically at mitigating these risks. For example, a verbal order process could include actions that enable clarification, understanding and transcription accuracy by:

• Requiring both the sender and receiver not use abbreviations.
• Creating a common understanding between the sender and receiver of key information needed: full name, birth date, allergies, indication, single dose versus daily dose etc.
• Incorporating solutions to remove environmental (e.g. noise) and technological barriers.
• Enabling direct transcription onto the client record.
• Setting expectations for clarification: patient verification; use of phonetic alphabet; receiver read back of the transcribed order to the sender to confirm its accuracy.
• Facilitating the reporting of near misses and errors to both the employer and patient.

More information about verbal orders and safe medication practice can be found on the Institute for Safe Medication Practice website.

If you would like to discuss specific communication challenges in your practice, please contact the Quality Practice Team for a practice consultation at practice@crnm.mb.ca.