Speak It, Write It, Repeat It

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Verbal communication is the sending and receiving of information between two or more people using speech. The goal of communication is to convey information from one person to another. There are many barriers to communication including foreign language, distractions, lack of attention or interest, and differences in perception and viewpoint, just to name a few! These barriers multiply without the benefit of face-to-face communication.

The telephone is the quickest and most convenient when contacting patients and their families. Most of us carry our phones with us wherever we go and are multi-tasking as we take phone calls. The listener's distractions and barriers can make it difficult to listen and process information. The message you intend to send may not be the message that is received. It is important to get feedback from the listener to verify the message has been clearly understood.

Our outpatient/inpatient pediatric Cardiology service sees a diverse population of pediatric cardiology patients. Some of these patients receive sedated echocardiograms; others we prepare for the cardiac catheterization lab or the operating room. These patients are given NPO instructions either in person or via telephone the day before their scheduled appointment.

We were experiencing a higher than expected volume of patients that were arriving without having adhered to the NPO instructions that were given by telephone resulting in many procedures being cancelled or delayed. The nurses in the unit decided to start a "Speak It, Write It, Repeat It" guideline for giving the telephone NPO instructions.

During the pre-admission phone call the parent is asked if it is a convenient time to receive and write down the NPO instructions for the procedure their child is scheduled for. Many parents are driving or at work when we call to give the pre-instructions. This question requires the parent to stop what they are doing and devote their attention to the information. If the parent is not able to interrupt what they are doing to write down the instructions, arrangements are made to contact the parent or patient at a later time.

The NPO instructions are age specific and patient specific. The NPO time is longer for a patient receiving formula vs breast milk. Some of our families add food and supplements to the milk which makes it a solid food, so culturally we have to be aware of the differences in our multi-cultural patient population. A translator is used to help ensure understanding and compliance.

The cardiac unit RN calls each patient and gives the patient specific NPO instructions including the rationale for an empty stomach for general anesthesia or sedation. The instructions are spoken by the RN and it is requested the parent write the instructions down as the instructions are being given over the phone. Once the instructions have been completely conveyed to the parent, the parent is asked to read back the written instructions to the RN. Any discrepancies will be immediately rectified and any questions answered.

When the patient arrives in the unit for their procedure, the RN asks the parent when the last time was the patient had food, milk and or breast milk, and clear liquids. We have not had to cancel or delay any surgical cases, cardiac catheterizations or sedations since the implementation of "Speak It, Write It, Repeat It". Our patient's NPO compliance is now at 100%!!

The Barriers to communication can occur at any point in a conversation. Barriers can lead to confusion or distortion of the message with wasted time and money the result. Clear concise messages with feedback from the listener can save time, save resources, and increase staff and patient satisfaction.

Speak It, Write It, Repeat It

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