Improving Nurse to Patient Communication on Antepartum Special Care

Purpose for the program:  Upon review of recent patient satisfaction results of a 35-bed Antepartum Unit, it was suggested by a bedside nurse and member of the Unit Nurse Practice Council that a formal written plan of care may help improve communication between the nurse and patient. After a thorough search of the literature and discussion amongst other units within the organization, it was discovered that a cardiac unit within the organization demonstrated improvements in their nurse to patient communication scores after initiating a pilot which provided each patient with a computer-generated plan of care for the day.

Proposed change:  Information Services’ Clinical Informatics team and the Antepartum Unit Practice Council collaborated to develop a computerized plan of care utilizing information automatically transferred from the electronic medical record.  The computerized plan of care was then distributed to every patient each morning.  During Unit Nurse Practice Council meetings, shift huddles, and staff meetings, staff was educated on the implementation of the plan of care pilot including its purpose and how to present it to the patient.

Implementation, outcomes and evaluation:  To implement the change we: 1) Educated staff about change at huddles, staff meetings, Nurse Practice Council meetings and through education boards. 2) Held separate education for secretaries on how to access and print plan of care. 3) Followed up on participation in the initiative. 4) Spoke with management and Charge Nurses to obtain feedback from patient rounding. 5) Re-educated staff periodically to maintain momentum.  Discharged patient satisfaction surveys were analyzed after the initiation of the written plan of care.  The survey included questions related to the patient’s perception of effective communication. The results of the survey prior to and after the initiation of the pilot were compared. Feedback from both nurses and patients was very positive. An increase in two scores directly related to nurse patient communication was seen after the initiation of the computer-generated daily plan of care.

Implications for nursing practice: Involving patients in their care by reviewing a printed daily plan of care can make a huge difference in a patient’s knowledge, hospital experience and outcome. The team did feel that customizing the plan of care to the obstetric population could increase the patient’s understanding and compliance.

Keywords: plan of care, nurse patient communication.