Dr Nicola Clayton1,2,3, Mrs Kelly Lewis1, Ms Katina Skylas1, Ms Rhiannon Hunt1, Dr Mark Kol1
1Concord Hospital, Sydney, Australia, 2School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia, 3Faculty of Health Sciences, University of Sydney, Sydney, Australia
Background: The inability to communicate during mechanical ventilation (MV) is one of the most stressful events during hospitalisation with communication impaired patients at greater risk for medical error and poorer outcomes. Personal smart devices including Apps are increasingly utilised in healthcare, however advances in applying technology in Australian ICUs specifically for communication is lacking.
Aim: To evaluate the feasibility and effectiveness of a touch-screen tablet and purpose-built communication App to facilitate communication in the MV patient.
Methods: All patients admitted to Concord Hospital ICU receiving MV, and staff treating MV patients, were considered for inclusion. Communication effectiveness, anxiety and distress during MV was evaluated, pre and post implementation of the touch-screen tablet.
Results: 20 staff (5-medical, 11-nursing, 4-allied-health) and 16 patients participated in the pre-intervention survey. 100% staff believe good communication improves patient care, however 90% reported communication with MV patients as challenging. Staff describe using communication strategies with MV patients, although 80% report limited success. 86% patients expressed communication was difficult to very difficult during MV. Most common communication difficulties were: conveying feelings (100%), obtaining information about care (94%), feeling involved in care (94%), reduced satisfaction of being understood (94%) and conveying physical needs (86%). Preliminary post-intervention data indicates mixed success for both staff and patients with commercially available communication Apps, possibly partly due to low staff-patient knowledge and training.
Conclusion: Touch-screen tablets are potentially a feasible method to promote communication in the MV patient. The purpose-built communication App will be built, trialled with comprehensive staff-patient training and evaluated.
Dr Nicola Clayton is a Clinical Specialist Speech Pathologist in ICU and the Burns Unit at Concord Hospital in Sydney. She is internationally recognised for her expertise, research and education in the field of dysphagia and critical care.