The Pharmaceutical Journal Vol 267 No 7168 p460
6 October 2001

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There’s more to interprofessional communication than sticky notes!

By Sally-Anne Francis, Bryony Dean and Chris Rees

Communication is an essential basis for the provision of quality health care. By 2002, to qualify as a health care professional and be able to practise in the National Health Service (NHS), each individual must demonstrate competence in communication with patients. Much recent research has focused on the different communication patterns between health care professionals and patients in a range of settings, but what about communication among health care professionals in the hospital setting?

The new performance standards framework for preregistration trainees emphasises the importance of effective communication, both with patients and other members of the health care team. For example, performance standard B1 requires the trainee to demonstrate “communication skills that promote the provision of a quality service”. Although this is an appropriate expectation of newly registered pharmacists, what about those of us already registered and practising in the NHS? We believe that the quality of communication between health care professionals can, and should be, improved.

In our experience, a common way for hospital pharmacists to communicate with medical staff is to leave sticky notes on in-patients’ drug charts. This is often perceived as a convenient and efficient method to draw the attention of medical staff who may be “on the move”, however, it has severe limitations. First, there is no acknowledgement for the pharmacist that a message has been seen or acted upon. Secondly, it limits opportunity for discussion thereby preventing health care professionals learning from each others’ perspectives. Thirdly, it can be dangerous: at least one patient’s death could have been prevented if a Post-It note that was subsequently lost had not been used as the main method of communication. The panel conducting the inquiry into this patient’s death reported that the “use of Post-It notes for the amendment of therapy is inherently unsafe”. An alternative approach is to write in a patient’s medical notes. This provides a more permanent record of communication and is an important forum for documenting pharmaceutical advice. However, again, it does not encourage discussion, and can delay the transmission of important information.

Two-way communication is important for two reasons. First, there is direct acknowledgement that the information has been shared and, secondly, it allows a more effective transfer of information. Most pharmacists would agree that only when they have a clear understanding of a patient’s medical problems and clinical priorities can they best contribute to patient care. However, these are almost impossible to establish when working in professional isolation. Although much essential information about the patient is recorded in the medical notes, communication that takes place during ward rounds, including discussions about choice of treatment, is not routinely documented. Therefore, a patient’s medical notes are unlikely to provide all the information needed to contribute to patient care.

The importance of two-way communication in health care has been investigated in previous studies. For example, a small observation study of doctors and nurses demonstrated their preference for synchronous communication (when two individuals participate in a conversation at the same time) compared to asynchronous communication (when the exchange does not require both to be active participants at the same time).1 The authors suggested that the benefits of synchronous communication included dealing with tasks as they arose as well as immediate acknowledgement that a message had been received. Furthermore, because clinical problems are often poorly defined, two-way conversations were used to achieve clarification.

Many technological solutions have been suggested for the development of communication methods between health care professionals. However, to improve communication between pharmacists and other health care professionals currently, guidance may be gained from models of postgraduate study and clinical practice.

Consultant led placements for pharmacists studying for the postgraduate MSc in clinical pharmacy at the School of Pharmacy, University of London, provided an opportunity for the pharmacist to be a full-time member of the clinical team. The pharmacist was present at team discussions regarding patient care, and at the point of prescribing. Case studies were presented by the pharmacists and discussed in the presence of team members. These created opportunities for successful interprofessional communication, with the added benefit of interprofessional learning, by emphasising the different perspectives and contributions made to patient care by the different team members. In practice, models of clinical pharmacy services where pharmacists are present and contribute during ward rounds, or are ward-based and have increased opportunity for discussion with the medical team, have been implemented.

Innovations have included the introduction of communication books/boards as a permanent focal point for messages by any team member. Although this is an improvement on the sticky note approach, attention should be paid to reducing the limitations of such schemes: the need for all staff to visit a central place, and the lack of opportunity for feedback about when messages are likely to be read or acted upon.¹

Even with limited resources, communication among health professionals can be improved. Preferences for different systems of communication on different wards and with different clinical teams should be explicitly established. The appropriateness of different methods of communication depending upon the urgency and importance of the message should be considered (Figure 1).

Teamwork between professionals is one element of the quality framework in the NHS. Establishing the best methods for communication should be a priority for clinical teams. It has been suggested that there may be some way to go before health professionals are routinely working together, not simply alongside one another.² We suggest that improving our communication strategies may be one way to more effective interprofessional working.

Sally-Anne Francis is a lecturer at School of Pharmacy, University of London
Bryony Dean is principal pharmacist clinical services at the Hammersmith Hospitals NHS Trust
Chris Rees is specialist registrar at the Royal National Orthopaedic Hospital, Stanmore