Effective communications between doctors and nurses has always been a high priority in the medical field, especially in an arena such as a hospital, health clinic or hospice. Communicating effectively between the nurses and the doctors is especially important in a hospice setting due to the fact that the patient is usually suffering the most; both with the physical and the emotional pain and suffering that is being experienced as the patient nears death.
One recent study determined that "doctors and nurses have different but complementary roles in what, when and how treatment choices are negotiated with patients" (Mccullough, Mckinlay, Barthow, Moss, Wise, 2010, p. 482) and the treatment choices when facing death are decisions that should not be taken lightly, either by the involved nurses or the doctors. The decisions taking place in the hospice setting will often determine how much pain and suffering the patient will endure before the final breath is drawn. It is likely, therefore, that the doctor and the nurse needs to be on the same page as to how the patient will be treated, and one method for achieving that same page status is through effective communications.
Another study sought to determine what barriers were present in a setting where the patient was suffering a life-ending disease; what the study found was that hospice providers oftentimes encountered site-readiness barriers such as "ill-defined hierarchy, poor communication, disagreements between care providers, and responsibility overload" (Lau, Masin-Peters, Berdes, Ong, 2010, p. 306). Many of these problems could be overcome or alleviated with improved communications between the nurses and doctors (not forgetting the patients need for effective communications as well).
The concern over ineffective communications is that the patient does not receive the necessary care to ease the pain and suffering that oftentimes afflicts those patients in hospice care. Providing effective pain management treatments in a hospice setting is a quality issue because the vast majority of the time the patients, and the patient's loved ones, do not wish to endure the suffering associated with the dying process. This process is often measured by how effective are the pain treatments. Most hospice settings aim to maintain a safe environment, while efficiently managing pain treatments through use of timely doses of pain medicines as prescribed by the doctor. Because the pain is an ongoing concern, the communications by the doctor to the nurses concerning the timeliness of the pain administrations is critical to effective management. Since the doctor oftentimes is not present in the hospice, the communications can sometimes be delayed or bogged down.
One method used in many hospice settings for measuring effective communications between the doctors and nurses is to document each and every communication. This can be accomplished both on the doctor's end of the communication as well as on the nursing side of the equation. This method of documentation can also be used for patient communications as well, especially in regards to what the patient desires as life nears an end. These wishes are often designated by advance care directives. A 2009 Australian study however determined that "the facilities surveyed reported that advance care directives are the exception rather than the rule" (Bezzina, 2009, p. 379). Ensuring that patient directives are known and adhered to is both the doctor's and the nurses' responsibilities.
Using a system to document communications could easily include the advance care directives and would ensure that the patient, doctor and nurse(s) are all on the same wave length regarding medical treatments.
The same study showed that part of the reason for lack of communications between the involved parties was that not all the facilities had processes in place for regular reviews or 24-hour access to the documentation for caregivers. Documenting communications is all well and good if such documentation leads to more effective communications. However, if facilities are only documenting to be documenting, it seems like a somewhat wasted effort is being made. This can be especially true when quality of life issues are taking place.
One unique method for documenting communications regarding quality of life is now taking place in CIS-based patient registrations. A quality of life (QofL) questionnaire has been incorporated into the system that allows the patient to provide the medical provider with information regarding perceived quality of life. A 2005 study determined that QofL issues are rarely documented in routine healthcare (David, Ahmed, Salek, Finlay, 2005, p. 998) although, according to the study, quality of life assessments are not only beneficial to the patient, but assist the medical staff in making decisions as well. Another study found that QofL data makes it possible to track and determine a patient's progress during treatment, and transferring the data between the different medical personnel (hospice, primary care, nurses, etc.) aids in incorporating the information in an effective manner, and improves the continuity of care by the various providers (Fritz, Stander, Breil, Riek, Dugas, 2011, p. 28).
The Fritz et al. study sought to incorporate the QofL data into the patient's CIS registration via a handheld Ipad; in their study, the patient filled out the questionnaire using an Ipad that would automatically link the questionnaire to the patient's other registration forms.
Other experts have taken the same approach as Fritz et al. with correspondingly good results as well. Two other studies found that planning and evaluating effective treatments using the QofL questionnaire adds an additional parameter and value to the clinical practice (Doward, Gnanasakthy, Baker, 2010, (Basch, 2010)). Clinics and hospitals seem to be quickly discovering the added benefits of not only the QofL questionnaire, but other information that can be shared via an online network as well. There are a number of systems that are being used that helps doctors, nurses and patients track treatments and healthcare options. Three online systems currently being used include the EPICare Electronic Medical Record (EMR), the IDX/Last Word Electronic Medical Record and the Care360.
The EPICare Electronic Medical Record (EMR) is a system which creates and maintains a record for each patient that can be shared between doctors in different offices as well as at hospitals and clinics. The EMR takes a "one-patient, one-record" (EPIC, 2011) approach that seems to be catching on with a large number of medical facilities including; hospitals, doctor's offices, emergency and ambulatory care personnel. The problem is that many hospices have not yet become part of the loop in using EMR's on shareable media. According to the EPIC website, the EPICare provides the capability to integrate stand-alone Personal Health Records (PHR) through online accessibility to any interested individual designated by the patient.
This capability could certainly include accessibility for hospice doctors and nurses. EPIC also provides the patient with controlled access to their medical records and "provides convenient self-service functions that reduce costs and increase satisfaction" (EPIC, 2011). Even though EPIC seems to be on the cutting edge of technology, if it is used correctly the system can also provide end results and treatment options that are good for the patient as well as the medical professional(s) working with the patient, including doctors and nurses.
Another system that offers many of the same capabilities as the EPICare system is the IDC/Last Word Electronic Medical Record System. Within the last year, a large medical group comprised of more than 450 cost centers chose the IDX/Last Word system because they believed that Last Word's capabilities included "providing the essential resources necessary for sustaining a single, accessible medical record that adds both value and safety for the provider and the patient (Byrnes, Braden, James, Broadus, Owen, 2011, p. 808). IDX/Last Word and EPIC are very similar in capabilities but EPIC seems to do away with all but a tiny bit of the paperwork that is normally required by the act of creating a record. Last Word, however, still has some problem areas concerning paperwork that needs to be addressed.
Experts agree that the Last Word system takes an inordinate amount of time, effort and coordination to implement when compared to other software systems such as the EPICare. Byrnes et al. found that "careful attention to the process of implementation, in particular the interface between the clinical practice and the technical installation is essential to the success of this costly enterprise" (Byrnes et al., 2011, p. 808).
Both the EPICare and Last Word systems concentrate on maintaining one record for each patient with input from a wide variety of doctors, nurses and the patients themselves. When compared the two systems, it seems as if Last Word has improvements to make regarding the auxiliaries that enhance the EPICare system.
Last, but certainly not least, is the Care360 software product. The Care360 website describes the software as "simple, flexible and reliable" (Care360, 2011). This is a system that has a focus that is geared towards physician and medical personnel use rather than patient use. The Care360 system allows for online ordering and receiving lab tests, hospice and clinical messaging systems, comprehensive medical management services, and a very comprehensive clinical encounter documentation component that can…