Outcomes of ‘#SPAconf2012’ Workshop on Communication in Hospital for adults with developmental disability

Outcomes from #SPAconf2012 Speech Pathology Australia National Conference, Hobart, 24-27 June 2012.

Workshop: AAC in Hospital for Adults with Developmental Disability and Complex Communication Needs [Hemsley, B., Balandin, S., & Worrall, L.]

Attended by 30 Speech Pathologists – majority working in hospital settings and with adults, some SLPs in schools, community health, and adult disability services.

After hearing the findings of recent research outlining the experiences of adults with complex communication needs in hospital, speech pathologists discussed how we can make a difference – what needs to happen or to be implemented that goes beyond ‘provision of communication aids’ and a focus on ‘tools’ for communication. Participants were encouraged to ‘think online’ and ‘think tech’ and also to consider not only the patient but the provider and the health setting, and the wider environment for communication as being important. The items discussed were written down and are arranged here according to common categories across the four participant groups. Of note is the common strategy suggested of addressing broader hospital quality assurance procedures (measuring communication access), creating an ‘alert system’ and increasing strength of procedures at admission and assessment, considering management guidelines for staff similar to the dysphagia management guidelines, and providing universal communication supports on the hospital ward.

Awareness of Patient’s Communication Method/Needs in Hospital Policy and Procedures: Promoting Communication Access

  • Hospitals might adopt SCOPE’s communication access symbol
  • Include ‘communication access’ in EQUIP (Australian Council on Healthcare Standards) achs@achs.org.au
  • Key stakeholders are given the patient experience (to change attitudes) like the ‘CEO sleepout’ campaign and action re CEO and community awareness of homelessness
  • Adapting/Adopting the US Joint Commission ‘Roadmap for Hospitals’ of the US
  • The Joint Commission: Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care: A Roadmap for Hospitals. Oakbrook Terrace, IL: The Joint Commission, 2010.

Alert system for ‘complex communication needs’

  • Card, armband, alert system etc with client (Universal)
  • Same process as “hearing/allergy” alert for patients with complex communication needs (e.g., on chart, on patient band)
  • Visual alert for above the patient’s bed to alert that they have communication difficulties, with picture of the device / tool
  • Alert re communication impairment or AAC needs on electronic record – carry over between admissions and departments, wards etc.
Admission Information / Assessment
  • Communication screen similar to dysphagia screens in use by nurses
  • Initial assessment needs identification of key communication partner/resource.
  • Guidelines for communication management (? Similar to dysphagia management in hospitals?)
  • Patient-controlled e-health record: SLP to encourage clients to have one.
  • Community based care plans – request at admission
  • Advocating for clients with limited communication
  • Easy English rights/responsibilities
  • Engage with legal units in hospitals on this issue (esp re communication in consent, information)
  • Medicolegal focus – does patient have capacity with or without the communication aid, to give consent?
  • Include patient communication needs in nursing initial assessment
  • Routine part of nursing handover
  • Carer education, nursing education re here and now, during the admission of a patient with complex needs, coaching and modelling
  • Patient education ‘don’t leave your voice at home’
  • SLPs to ensure patients complete the patient feedback form
  • ALL of the above linked to a broader awareness and advocacy (i.e., beyond SLP)

At school – preparing for hospital

  • Collaboration between parents/carers with school staff prior to hospitalisation
  • educating peers to provide peer support
  • Community professionals being paid and supported to have links and provide info to hospital based services about the client’s communication
  • Interagency acceptance of communication supports and sharing information
  • Increased focus on communication for all patients
  • Teaching generalization skills to child in the classroom – have nurses come to the classroom.
  • Teach the child to use the system when they go to GP or school nurse/sick bay.
  • Focusing on communication needs in the school program.

Communication aids / communication supports in hospital

  • Universal communication supports on all wards – e.g., ?iPADs
  • Pictorial supports (generic universally available)
  • Communication passports for all clients – key info re communication
  • Organisation ‘Quality Assurance’ re care for clients in all settings à link to funding
  • Lines of communication with community SLP and hospital SLP
  • Developing resources
  • Staff training – senior management? Mentors? Specialists, esp re terminology.
  • make sure they have a personal communication dictionary for them, maybe with a specific tab for hospital ? can we put this on the web somehow so nurses can access it? Can we link it to e-health?
  • Hygiene – infection control – use of laminated low tech, aid placed in ziplock plastic bag/dry pack; touch screens work with covers? Gloves; pre-shower, establish communication with low tech waterproof or non-verbal unaided strategies in wet areas.
  • Communication aid – labelled with Bradma/ID sticker. Policy re who replaces/fixes it?
  • Need to be listed as a valuable to be covered by hospital insurance
  • Standard basic ward low tech kit (see several resources on the Patient Provider Communication Website, US).

I would like to thank all participants in the #ASHA2011 and #SPAconf2012 workshop discussions – each workshop contributed important insights and builds upon the strategies suggested by participants in each of the research projects undertaken to date. This information will be used to guide implementation research and the movement of findings into policy and practice to improve communication in hospital for adults with developmental disabilities and little or no speech.

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