Are you ready for the new patient-centered communication standards?
After reading this article, you will be able to:
- Identify standards addressed under patient-centered communication
- Identify implementation schedules for patient-centered communication requirements
- Describe changes to existing elements of performance for patient-centered communication
- Discuss data collection requirements for these new and updated requirements
Editor’s note: This feature examines Joint Commission standards in greater detail with expert advice from BOJ advisors. This month, Elizabeth Di Giacomo-Geffers, RN, MPH, CSHA, a healthcare consultant in Trabuco Canyon, CA, and former Joint Commission surveyor, discusses The Joint Commission’s new patient-centered communication standards.
Starting in 2011, Joint Commission surveyors will begin looking at—but not scoring—new standards for patient-centered communication. These standards were approved in December 2009 and published to the field for review the following January.
Findings during this pilot stage will not affect accreditation decisions for hospitals surveyed, but surveyors will collect these data in order to track and prepare for potential problems, questions, concerns, and challenges after implementation.
The standards and elements of performance (EP) will appear in the Comprehensive Accreditation Manual for Hospitals in the 2011 edition. We will not be expected to comply with the standards until January 2012 at the earliest.
So why prepare now? Because these standards will be scored and required in 2012, and also because your facility is very likely doing much of this data collection already—it’s a matter of demonstrating good practices and compliance in most cases rather than starting from scratch.
Let’s take a look at the affected standards and how they will relate to your facility.
This standard requires hospitals to define staff qualifications.
Under HR.01.02.01, the hospital must define, specific to job responsibilities, staff qualifications (with specific requirements targeting infection control). With the creation of patient-centered communication, however, a new note had been added under this standard. This new note (Note 4) requires that the qualifications for language interpreters/translators be met through:
- Language proficiency assessment
The note also mentions that the use of qualified translators or interpreters is supported by the Americans with Disabilities Act.
How do we proceed with compliance with this standard?
Consider the following questions in your review:
- Does the job description for your interpreters include defined competencies? Skills and training required?
- Does your HR department maintain evidence of interpreter or translator competencies and training in its files?
- Have you discussed training, education, and other qualifications with your translators/interpreters?
- Do you use contracted services for translation or interpretation? If so, how does that contractor track and verify the qualifications of its staff?
This standard requires hospitals to effectively communicate with its patients regarding care, treatment, and services provided.
This is a new standard specifically addressing patient-provider communication. Effective communication between patient and provider is pivotal for patient safety, and the standard goes on to cite several sources demonstrating that communication problems between provider and patient can lead to a higher risk of adverse events.
In fact, patients with limited English skills are, according to several studies cited by The Joint Commission, more likely to undergo adverse events than their English-speaking counterparts.
To that end, The Joint Commission has created two EPs for PC.02.01.21:
• EP 1: The hospital must identify the needs of the patient’s oral and written communication. This also includes the patient’s personal preferences for language when discussing aspects of their care. As was noted at Executive Briefings in New York, although some patients may be completely competent in English, they may prefer to hear difficult or complex information such as diagnoses or care instructions in their native language.
This EP also addresses non-language communication needs, such as hearing aids, glasses, and materials used for communication.
• EP 2: The hospital communicates with the patient in accordance with those written and verbal communication needs during the course of care, treatment, and services.
It is recommended that you look at how the hospital provides services and how the verbal and written communication needs are met. Talk to patients after their stay—were their needs met? How could things be improved? Are you collecting complaints data?
Define who the cognitively impaired patients are and how you may communicate with them or the family/significant other(s).
This standard receives a revised and a new EP as part of the patient-centered communication initiative. RC.02.01.01 deals with the medical record, ensuring that the record contains the correct name, address, date of birth, legal status, and other key points of information.
EP 1 has been altered to include additional requirements for patient communication. The EP now requires that the patient’s preferred language for discussing healthcare is included in the medical record.
Additionally, the hospital must, if the patient is a minor, is incapacitated, or has a designated advocate, ensure the needs of the person or persons who will be the representative or advocate for the patient are also documented in the medical record.
EP 28 is new with the advent of this program. This EP requires that the medical record note the patient’s race and ethnicity.
Don’t forget to look at how your demographics data are being collected. As always, make sure you are following your own policies for how and when these data are to be gathered. Dig down into staff understanding of data collection processes as well—don’t be afraid to talk with them about what they understand about the policy.
Go back into the medical records to make sure all the necessary information is being documented appropriately.
Finally, if you don’t have a policy or process in place for gathering language requirement information and race/ethnicity data, it’s time to create a system to do so.
This standard, which requires hospitals to respect, protect, and promote patient rights, has had two additional EPs created for patient-centered communication. They are:
• EP 28: This EP requires hospitals to allow someone (a family member, friend, or advocate of some kind) to be with the patient for emotional support during the course of his or her hospital stay. This is required unless that person’s presence infringes on the rights or safety of others, or is contrary to the treatment and well-being of the patient. This person need not be the advocate or decision-maker for the patient, however.
This is a good time to look at the hospital’s rules for visitation. Does the existing policy prohibit the patient’s chosen support person from visiting? Is the hospital able to accommodate this person’s presence during key time frames (e.g., patient education, discharge planning, and other areas where the patient may want a second set of ears)? Does the staff understand the patient’s right to have this person present?
• EP 29 states that hospitals cannot discriminate based on any of the following criteria:
- Physical or mental disability
- Socioeconomic status
- Sexual orientation
- Gender identity or expression
Review your organization’s mission and vision statements; patient rights documents; complaint and satisfaction data—both staff and patient; policies addressing nondiscrimination; and processes for complaint resolution.
This standard requires the hospital to respect the rights of patients to receive information in an understandable format. Under RI.01.01.03, EP 2 has been revised to require hospitals to provide language and interpreting services. This may include employed translators, outside services, or bi- or multilingual staff, provided they have appropriate training.
The service can be in-person, although this is not required—telephone or video links are also appropriate. The hospital should look at its population and that population’s unique needs to determine how to provide these services.
EP 3 has also been updated to address the needs of patients with vision, speech, hearing, or cognitive impairments. These must be addressed in a way specific to the patient’s needs.
Much of The Joint Commission’s advice on this standard falls in line with other patient-centered communication standards: Do the staff understand existing policies? Do existing policies comply with the new requirements? Is the hospital clear on how to address specific communication needs in terms of language, hearing, or sight?
Here, however, you want to make sure that interpreters are a part of the care team—they must understand the patient’s needs in order to communicate better with that patient. Also, are interpreters being used as often as needed? Do you have the right amount of translators to meet your facility’s given population?
If your facility has an audiology department or speech pathology department, ask yourself how that department is being used as a resource. There is a wealth of opportunity for collaboration with this department to meet patient communication needs.
Tips and examples
An excellent resource document titled Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals will be helpful for organizations to refine their processes, policies, procedures, and education of staff members and physicians.
This guideline for implementation of the standards has some great checklists that you can use to self-assess your organization’s needs. This helpful resource can be found online at www.jointcommission.org/NR/rdonlyres/87C00B33-FCD0-4D37-A4EB-21791FB3969C/0/ARoadmapforHospitalsfinalversion727.pdf.
A personal anecdote on how you would orient the hearing or visually impaired patient to fire alarms: The fire alarm system usually has an audio and visual component. It is a good idea to include this education on admission to your unit.
Another means of orienting the visually impaired patient is by using the clock method. For example, the bathroom is at 12:00, the door to your room is at 9:00, etc. You can also use the clock method for orientation to the food on a patient’s tray. Water is at 2:00, meat is at 7:00, potatoes at 10:00, and vegetables at 5:00.
It can be challenging to communicate with the cognitively impaired patient, such as a patient with expressive aphasia, who is unable to verbally communicate to you his or her level of pain. One strategy is to use a pain chart and have the patient point to where his or her pain level is on the chart.
When you have a hearing-impaired patient, how have you provided for all staff to know when the call bell rings at the central nursing station that they must go to the patient’s room? Some hospitals will place a note on the central call bell station: “Go to room hearing impairment.”