Communication Problems and Patient Injury

According to The Joint Commission, communication problems and patient injury go hand in hand. Legal nurse consultants, risk managers, attorneys and healthcare administrators are all aware of the risks to patient safety from communication errors.

In today’s multicultural society, sources of misunderstanding and communication problems can result in multiple opportunities for errors resulting in harm to patients. Communication barriers between patients and nurses, and nurses and other healthcare workers can result in inappropriate orders, incorrect interventions or failure to take action.

Absence of communication also sets up a climate for errors to occur. Lack of communication may convey lack of interest, concern, leadership, or knowledge. Communication is the glue that holds a team together. Here are some real life examples of communication problems and patient injury.

Examples of Communication Problems and Patient Injury

• The nursing department has difficulty communicating to the pharmacists that in the middle of a cardiac arrest, the nurses on the unit are too busy to run to the pharmacy to retrieve a drug needed to resuscitate a patient. There is a delay in retrieving a critical drug.
• A female nurse who comes from a culture of subservient women may be reluctant to question a male doctor who writes an incorrect order.
• The housekeepers do not speak English, and the nurses are unable to communicate the need for a bed to be washed quickly in order to receive a critically ill patient.
• The nurses do not report that one of their beds has been vacated, because if the Admitting Department learns this, a new patient will be put in the bed. This will cause more work for the nurses. The patient waiting for that bed is in an overcrowded emergency department and not getting sufficient attention.
• The nursing department has no standardized data elements that should be conveyed in a change of shift report.
• The emergency department nurse forgets to tell the critical care unit nurse at the time of transfer that the patient has already received Heparin. A nurse inadvertently gives a second dose as soon as the patient arrives in the ICU.
• A nurse with limited English skills misinterprets a patient’s explanation of symptoms.
• A stoic nurse who minimizes the patient’s pain can delay reporting an ominous development of chest pain.
• There is no mechanism for an employee to make a suggestion to correct a safety problem, and no recognition for such ideas.
• An abusive physician is permitted to publicly chastise nurses because he brings a large volume of patients into the hospital.

Communication Problems and Patient Injury Case
Consider the miscommunication associated with this case.

The patient underwent a liver biopsy to diagnose hemochromatosis. He took aspirin daily. The plaintiff claimed the patient should have been instructed to suspend the aspiring for sever days prior to the biopsy to reduce the risk of bleeding. During the biopsy, the defendant radiologist made four passes and took multiple tissue samples. A major blood vessel was damaged, leading to a bleed that was not timely recognized. The patient died after developing hemorrhage, congestive heart failure, acute respiratory distress syndrome and progressive renal failure. The case was settled for $1 million. Estate of Anonymous Seventy-four Year-Old man v Anonymous Hematologist and Anonymous Radiologist, Massachusetts, settled in 2014.

Nursing Responsibilities for Communication

As you assist attorneys with medical or nursing malpractice cases, consider these responsibilities.
The nurse is responsible for:

• Identifying and reporting concerning changes in the patient’s condition.
• Repeating back telephone and verbal orders to confirm that they have been properly heard.
• Asking individuals to repeat back understanding of what has been said, for example, during patient education.
• Acting as part of a multidisciplinary team to encourage collaboration and mutual respect for the contributions of each discipline.
• Providing patient education including how to take medications and recognizing side effects
• Advocating for a patient.
• Working with the healthcare team to address patient care priorities.

Nurse Manager responsibilities for Communication

Nurse managers have deeper responsibilities for communication including

• Ensuring that a translator service is available for use in the care of patients.
• Encouraging staff to speak up when they do not understand what another person is saying.
• Encouraging staff from different shifts to work together to resolve issues that affect the smooth functioning of the nursing unit.
• Assisting staff to recognize that communication skills decrease during stress and fatigue, and that extra caution needs to be employed during those vulnerable times.

LNC Responsibilities for Communication

Your responsibilities as a legal nurse consultant may include

• Assisting the attorney to understand the unique aspects of communication within a healthcare facility or team.
• Helping the attorney prepare for a deposition of a healthcare provider by developing questions that relate to communication.
• Suggesting names of communication-related policies/organization charts/procedures to be obtained during discovery.
• Suggesting the attorney determine if the nursing unit of a hospital or nursing home had a communication or log book which contained clinical information that may relate to the issues in the case.



• Suggesting that the attorney locate former employees who may have information about the communication climate of the specific nursing unit involved in the incident.

LNCs have critical roles in helping attorneys understand communication problems and patient injury.

Pat Iyer is president of the Pat Iyer Group and the author of How to Analyze Medical Records, a new in 2016 guide for legal nurse consultants. Get it here.