Glen Bianchini, Director, Pharmacy Operations

Glen Bianchini, Director, Pharmacy Operations

• Glen Bianchini, Director, Pharmacy Operations

• Bruce Boxer, Director, Nursing Education & Performance Improvement

• Raquel Diaz, Manager, Language Training

• Karyn Kelly, Manager, Regulatory & Accreditation

• Sherry Mazer, Corporate Regulatory Officer

• Angel Pagan, Director, Language & Cultural Services

More that 20% of the US population speak a language other than English at home

• More that 20% of the US population speak a language other than English at home

• Approximately 50% of all hospital related med errors have been attributed to poor communication at transitions and interfaces of care

• As many as 80% of the errors in healthcare involve informational or personal miscommunication generating diagnostic and treatment errors

An Interpreter converts spoken words into a different language

• An Interpreter converts spoken words into a different language

• A Translator converts written material to another language

By Federal and State Law & Hospital Policy:

• By Federal and State Law & Hospital Policy:

• Interpreters must be “qualified” and approved by TUHS Language Services

• What is available?
• TUHS Qualified/Approved:
• Professional Medical Interpreters
• Bilingual Staff (list available on TempleHealth Employee Intranet Site)
• Dual Role Medical Interpreters
• Agency Interpreters (available through Nursing Clinical Coordinators or Nursing Office)
• TUHS Approved Language Phones
• Over Video Remote Real Time Interpreters for American Sign Language

• To ensure accuracy and to avoid confusion, providers should:

• Talk and look directly to the patient (not the Interpreter)

• Speak in first-person

• Use short sentences (avoid using acronyms or

• abbreviations)

• Pause frequently to allow for interpretation

• All information exchanged is kept confidential

A 45 year old Hispanic Female with limited English Proficiency was admitted to the Intensive Care Unit with intracranial bleeding. She was discharged on Coumadin 5 mg po, q day for status post DVT. She went to her usual Pharmacy. On her prescription bottle, in English, it read:

• A 45 year old Hispanic Female with limited English Proficiency was admitted to the Intensive Care Unit with intracranial bleeding. She was discharged on Coumadin 5 mg po, q day for status post DVT. She went to her usual Pharmacy. On her prescription bottle, in English, it read:

• “Coumadin 5mg Take One Tablet Once a Day”

• The patient who spoke and read Spanish, followed the instructions as

• “Coumadin 5mg Take “Once” Tablets a Day”

• Once in Spanish, means 11, therefore the patient

• took 11 tablets of Coumadin in one day

Standardized Framework for Communication

• Standardized Framework for Communication

• S-B-A-R

• Situation
• What is happening with the patient?
• Background
• What is the clinical background?
• Assessment
• What do I think the problem is?
• Recommendation
• What would I recommend?

An easy way to communicate critical information

• An easy way to communicate critical information

• Enhances predictability & fosters questions

• Frames the conversation in seconds

• Focuses on the problem, not the people involved

• Avoids unclear or potentially confusing terms such as:

• “She’s a little unstable”
• “He’s doing fine”
• “She’s lethargic”

• Don’t use abbreviations or jargon that could be misinterpreted

Review the chart

• Review the chart

• Examine and assess the patient

• Know the admitting diagnosis and date of admission

• Review the most recent progress notes and RN notes from prior shift

• Have the chart in hand and be ready to report allergies, medications, IV fluids, lab & test results, etc. when you make the call

A dynamic process for obtaining and maintaining accurate list of all medications a patient is taking

• A dynamic process for obtaining and maintaining accurate list of all medications a patient is taking

• Compares home medications to newly ordered meds
• Identifies and resolves discrepancies
• An integral part of care transitions in all patient care settings or levels of care and discharge

• Proper Med Rec reduced discharge med errors from 90% to 47% on a surgical unit and from 57% to 33% on a medical unit of a large academic medical center

Common communication problems related to

• Common communication problems related to

• Incomplete patient information
• Unavailable information
• Miscommunication of medication and other orders
• Technical issues: multiple information systems that don’t communicate with each other
• Language and literacy barriers

Communication failures are the most common causes of all adverse events

• Communication failures are the most common causes of all adverse events

• Document complete patient information and thorough and accurate histories (including allergies, over the counter meds & nutraceuticals)

• Medication reconciliation must happen at every transition in the patient’s care and across the continuum

• S-B-A-R frames the conversation in seconds, focuses on the problem, provides an opportunity to read and repeat back actions, fosters questions

Limited English Proficient patients and deaf and hard of hearing patents must be provided with qualified language assistance

• Limited English Proficient patients and deaf and hard of hearing patents must be provided with qualified language assistance

• Document in the progress notes or on the appropriate section/forms, in the computer, the use of the qualified language assistance

• If it isn’t documented, it wasn’t done/used

• If it isn’t legible  it isn’t safe and can’t be read