Healthcare policies play an important role in patient care delivery. They dictate how money is spent and who/where and how care is delivered (Finkelman & Kenner, 2016). Nurses can have a big impact on how these policies are developed, whether it is through research, sitting on a hospital committee, or being involved in a nursing organization ((Finkelman & Kenner, 2016). A nursing policy can start with just a simple idea to make the unit more efficient with better patient outcomes. One policy that comes to mind that was simple that made a big impact on patient-centered care is the use of whiteboards in all patient rooms. This approach is being used across the United States. In some hospitals, these boards are called care boards (Mackie, Shannon, Howard, & Subia, 2015).
The whiteboard policy's goal is for the nursing department to be committed to patient-centered care. The way to achieve this is to have effective communication between the patient, family, and the health care team. How this policy was achieved, the nurse would have had to go through the five critical steps of policy making. These steps are; to define the problem, specify the criteria, identify solution options and select the best, implement the policy, and lastly, monitor and evaluate the policy (Finkelman & Kenner, 2016). I will explain these steps more in-depth as it relates to the development of the whiteboard policy. The first step was started when poor communication was noted between the patient, family, and the health team. This poor communication can lead to missed orders, medication errors, and unidentified primary caregivers. This issue propelled the nurse to look into a better way to communicate so the patient could achieve holistic care and feel included in the decision-making (Massaro & Murphy, 2013).
One identifier used to show poor communication was on the Press Ganey survey. This survey showed the areas of communication that needed to be improved (Massaro & Murphy, 2013). These scores impact a hospital's HCAHPS, which are monitored by Medicare and Medicaid, which in turn can affect the hospital's reimbursement ('Communication boards,' 2016) Once communication is identified, we move to step two, which is collecting specific data needed to support why communication is a problem. During this time, the nurse can form a small committee that supports the proposed idea. This committee can be made up of other nurses and ancillary staff, but it is also important to involve the other disciplines so you can have their support and input (Mackie et al., 2015). A unit survey can be conducted to collect satisfaction data. These surveys can be given to both patients and staff. Having five questions on each, focusing on communication of daily services and goals, awareness of pain medication schedule, discharge planning, and do they know who their health care team is (Tan, Hooper Evans, Braddock III, & Shieh, 2013).
After the data is collected, we move to the third step of the policy-making process, by evaluating the information against the cost-benefit. This step is completed during a shared governess meeting or a hospital committee meeting where they discuss new unit improvement proposals. The data that was collected in-house is reviewed. After reviewing the in-house data, the committee will collect outside information from other facilities, such as cost, patient and staff satisfaction, and overall patient outcomes, such as the effect of length of stay in the hospital. An example of this is in one of the articles I read about a hospital that looked at three facilities using whiteboards for communication and used their positive outcomes as one of their driving factors for piloting the whiteboard (Mackie et al., 2015).
Another way the hospital can address costs is to consult different supply companies in regard to purchasing the boards. As I looked over the literature, I saw there were many different companies with different styles of boards, but none of the literature showed any cost concerns. Once the hospital committee reviews all the data and decides that the whiteboard would be an excellent patient-centered care policy due it meets Centers for Medicare & Medicaid Services HCAHPS standards ('Communication boards,' 2016), and it also is compliant with patient-centered care under the Joint Commission (Mackie et al., 2015), we move to step four, implementation. During the committee meeting, the chief officers will decide whether the policy will go hospital-wide with the whiteboard or start with a few units and pilot it for a period of time, then re-evaluate.
As in the two articles I read, both decided on pilots first. Once the boards were up, and the staff was trained, they started the pilots, and one article did a three-week pilot. They used 56 patients on two units with whiteboards and 48 patients on two units without (Tan et al., 2013). During this time, they performed a survey before the whiteboard and then performed one after the three weeks were over (Tan et al., 2013). The other article piloted 96 patients in different units. The pilot lasted 90 days and had monthly updates. The whiteboard was used as the patient's care plan (Mackie et al., 2015). The last step of the policy process is evaluation and monitoring. It works in tandem with the prior step of implementation. Because you are constantly evaluating, updating, and re-evaluating the chosen policy as healthcare changes and the needs of the patient change. Examples of evaluating outcomes were seen in the two articles that piloted the whiteboards.
In article one, the data showed there was a significant increase in patients knowing who their care team is, in patient satisfaction, and in knowing their discharge plan (Tan et al., 2013). The end result was the healthcare team, and the patient had improved communication which improved patient satisfaction (Tan et al., 2013). The second article, it showed that patients actively participated in their care plan due to it being developed in their room, making the patient feel that they could self-manage their care better by seeing their care plan on the whiteboard (Mackie et al., 2015). After the data was reviewed, it was clear that whiteboards were effective in communicating goals and updating families, patients, and team members, while giving them an area to engage (Mackie et al., 2015).
Due to the positive outcomes, the Health system went hospital-wide with having the whiteboards installed in every patient's room (Mackie et al., 2015). Even though there are many positives in using the whiteboards, there were a few challenges, such as the board needs to be constantly updated and which pulls the nurse away from her patients, having the supplies to use the board, such as markers and erasers, and cultural and social aspects of the patient that can have an effect on what they want to be written on the board. Another issue to consider is the education level and literacy of the patient. One of the biggest issues is when the patients are in a semi-private room.
How much do you put on the board to maintain HIPAA standards? Now they are looking to improve whiteboards by using informatics and making them digital. Making it easier for the nurse to update them because they would be now linked to the EHR system would increase patient privacy. At present, this is still only being tested, and only some hospitals are using it. Who knows what the next whiteboard will be? Whiteboards put patients at the center of their care, give them information, and allow them to feel connected. It also keeps the interdisciplinary team aware of what is going on with the patient. When you think about how whiteboards were started, it was a nurse's idea to promote patient-centered care. That is why it is important for nurses to be empowered to advocate for our patients as well as for our profession.
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