Interprofessional communication in emergencies during a pandemic

‘The right message, at the right time from the right person can save lives’, (Eldridge et al., 2020, p. 50). In some situations, communication can be the difference between life and death (Eldridge et al., 2020; Olvera et al., 2020; Rodrigues et al., 2020). Healthcare emergencies are just one of those types of situations that rely heavily on good communication to protect everyone involved (Olvera et al., 2020; Rodrigues et al., 2020). Since the pandemic onset in March of 2020, emergency situations are that significantly more common (Rodrigues et al., 2020). Each healthcare provider contributes their own expertise and unique perspective while responding to these emergency situations to aid in achieving a positive outcome. However, when one provider does not communicate their role to the highest ability, there is room for hazardous errors (Eldridge et al., 2020; Rodrigues et al., 2020). Consider the consequences if a team member fails to communicate a diagnosis of coronavirus disease 2019 (COVID-19) before an intubation procedure. Failure to communicate that will result in the aerosolising procedure spreading the highly infectious virus to all the people in the room if not properly protected (Panda et al., 2021). Communication is the responsibility of all healthcare providers when working together to achieve a common goal (Rodrigues et al., 2020). The purpose of this professional issues paper is to clearly identify the effect communication has in emergency situations in the context of a pandemic. In order to improve the understanding of the role that communication plays in nursing care, this professional issues paper will examine the barriers to communication in a pandemic setting, its role in safety for staff and patients, and the need for clear communication in emergencies. Furthermore, recommendations for nursing practice will be discussed to promote safe work environments for staff, resulting in safe patient outcomes will be discussed. As The pandemic presented new challenges for providers both physically and mentally (Rodrigues et al., 2020). Particularly, a strain on interdisciplinary communication has resulted in poorer quality care (Rodrigues et al., 2020). High staff turnover, heavy workload and lack of experience, factors already known to interfere with interdisciplinary communication, have been exacerbated during the pandemic (Eldridge et al., 2020; Rodrigues et al., 2020). To reduce the hindrance that these barriers hold, good communication and teamwork among providers is required in order to safely disclosing assessments, interventions and working towards common goals (Rodrigues et al., 2020). Acknowledging the value of good communication improves interprofessional relationships, and ultimately patient outcomes through this pandemic (Rodrigues et al., 2020). Therefore, effective interprofessional communication must thoroughly be emphasised by all providers and leadership in the practice environments. Communication is not just about getting a message across; it is also making sure the message is correctly received (Rodrigues et al., 2020). Listening has become a vital skill during the fluid and evolving pandemic circumstances as providers need to hear new information that influences their clinical decision-making (Rodrigues et al., 2020). Misinterpretation of crucial information has become increasingly common during high-pressure situations and can result in negative outcomes for the patient and providers involved (Eldridge et al., 2020). Multidisciplinary training sessions developed to familiarise all providers with what is expected during emergencies can contribute to safer patient outcomes (Obenrader et al., 2019). In an environment striving to provide the highest quality care, safety is everyone’s concern (Obenrader et al., 2019). Safety of patients and staff is directly influenced by communication (Eldridge et al., 2020; Obenrader et al., 2019; Panda et al., 2021). Environments with good communication practices achieve reduced errors, have higher staff and patient satisfaction, and maintain patient safety (Obenrader et al., 2019). Tools, such as checklists and algorithms, may facilitate communication that promotes safety (Panda et al., 2021). Additionally, these tools are being updated to accommodate the challenges that are posed by the highly contagious COVID-19 (Panda et al., 2021). The use of these protective and preventative instruments should be thoroughly enforced by leadership using effective communication strategies (Eldridge et al., 2020; Panda et al., 2021). Furthermore, healthcare workers should keep themselves up to date with the latest changes to the tools and other safety measures to protect themselves and their patients (Panda et al., 2021). This includes the latest update on the pest practice concerning personal protective equipment (PPE) and aerosolising procedures (Panda et al., 2021). By doing so, not only are they protecting themselves, but they can also disseminate the valuable information to their colleagues to allow all providers to protect themselves. If providers fail to do so, they risk contracting the virus, compromising the safety of other staff and patients (Panda et al., 2021). Communicating to colleagues when a breech in PPE is identified is also important in preventing spread and is an opportunity to educate the provider on correct use (Panda et al., 2021). Frequent training to familiarise staff with effective communication techniques during a pandemic is strongly encouraged (Olvera et al., 2020; Panda et al., 2021). As providers become more comfortable with the strategies, the ability to apply those strategies in emergency scenarios will also become easier. In emergency situations, the entire interdisciplinary team should be involved with all aspects of the patient’s scenario. Many people enter the environment with the intention of providing assistance where possible. In emergencies, good communication is essential to support positive teamwork (Obenrader et al., 2019). However, during the crucial period that patient information is rapidly being shared with new team members, there is the opportunity for miscommunications or overlooking imperative facts about the case (Olvera et al., 2020). To prevent this from occurring, standardised checklists have been proven to reduce negative outcomes for the patient and care team involved (Olvera et al., 2020; Panda et al., 2021). Assigning team members to tasks can ensure clear role definition, an essential step to ensure all the items on the checklist are complete. A team member should also be responsible for ensuring that all providers are made aware of critical details of the case, such as allergies, infectious disease status and contributing factors related to the emergency (Panda et al., 2021). The individual responsible for conveying that information will vary based on department; however, it needs to be clear who that person is in each case to ensure no details get missed (Panda et al., 2021). As patient advocates, the primary nurse should be familiar with the details of the patient’s situation and be able to communicate that information to the interdisciplinary team (Obenrader et al., 2019). Similar to time outs, direct, closed-loop communication should be used in these acute situations to disclose imperatives (Eldridge et al., 2020). By doing so, incidental exposures to COVID-19 can be minimised (Panda et al., 2021). In nursing undergraduate programmes, communication is emphasised heavily, but like everything, it takes practice (Obenrader et al., 2019; Olvera et al., 2020; Rodrigues et al., 2020). Nurses are key advocates for promoting safe care, and communication is a huge part of that. To establish good communication, all team members must be agreeable to the strategies (Obenrader et al., 2019; Olvera et al., 2020). To maintain it, effective techniques must be built into policy and reinforced through leadership (Obenrader et al., 2019). Nurses make a substantial contribution to unit and hospital wide culture (Obenrader et al., 2019). By using this influential role, nurses need to advocate for incorporating safety checks into emergencies with topics that are applicable to the types of situations that occur on the particular unit. During times of crisis, clear messages must be delivered in order to be well received (Eldridge et al., 2020). Additionally, each discipline should be able to identify the team leader to ensure effective messaging (Eldridge et al., 2020). To further develop these communication skills, mock drills and simulations have been shown to improve the interaction among the interdisciplinary team (Olvera et al., 2020). Closed-loop communication is one of many strategies that can be practised during these simulations to achieve effective communication during emergencies in a pandemic (Obenrader et al., 2019). In clinical practice, using closed-loop communication makes individuals accountable for tasks to minimise opportunities for skipped steps. Furthermore, debriefing after the simulations allows for each discipline to address the strengths and concerns from their perspective, including physicians, nurses, anaesthesia and respiratory therapists (Olvera et al., 2020). Incorporating these disciplines in the planning and active process of these simulations lead to common goals being achieved when those emergency situations arise during clinical practice (Olvera et al., 2020). When developing the policies to prepare for those aforementioned emergencies, they too need to be clear (Eldridge et al., 2020). Any type of message needs to be, ‘timely, regular, accurate, credible, consistent, appropriate, and relevant’, (Eldridge et al., 2020, p. 50). Leaders should attempt to recruit all the disciplines involved with the unit to help incorporate their perspectives and goals to prepare for critical situations (Olvera et al., 2020). Rodrigues et al. (2020) pointed out that, ‘the use of communication in the interprofessional team contributes to dynamic, engaging relationships, with effective and high-quality results’. By taking these steps, safety measures can be put into place to protect patients and colleagues through policy development. Once these policies are implemented, education regarding the changes and the rationale for change should be provided to all parties affected (Panda et al., 2021). Nursing leaders should be involved with the implementation phase as they directly impact the profession (Panda et al., 2021). Appointing a nurse to be a resource to their colleagues regarding the policies and communication strategies can also be a supportive measure to promote safe care. Mock-ups or drills should also be made available to all staff to allow for skill development and ease of transition (Olvera et al., 2020; Panda et al., 2021). Communication is essential during times of uncertainty, like emergencies during a pandemic (Eldridge et al., 2020). Nurses have a direct role to play in facilitating interdisciplinary communication to reduce the ambiguities of emergency situations and increase patient safety. Challenges to communication are exacerbated during trying times, but there is the opportunity to make progress. Although it cannot be done overnight, the blueprints for change and improvement are here and can be used to develop good communication strategies among providers and ultimately result in safer care for staff and patients. We would like to thank Dr. Lorna de Witt for her guidance and input through the composition of this paper. No funding was received for this article. The Author has no conflicts of interest to disclose.

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