HCAHPS #1 – Patient Preferences

Posted: Thu, Feb 5, 2015 08:10

So let’s look a question number one of the HCAHPS Transition of Care domain: The hospital staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left the hospital. How do you do that? One way is to use a personal care plan checklist.

Consider This:

First, you want to learn what a patient and his/her family value (take into account cultural components, past hospital experiences, and healthcare literacy). Keep demographics, ethnicity, religion, and socioeconomic status in mind when you plan a patient’s future care. How’s their decision-making ability?

Second, assess their health and medical needs. For example, who’s going to help them with activities of daily living (bathing, dressing, meal prep, etc.)? Who’ll assist with wound care and ongoing medical supervision, if necessary? Who will deliver medication, rent or buy equipment (such as a walker), purchase supplies like home O2, syringes, bandages, and compression stockings? Do they need a special diet, or foods? Preferences or restrictions?

Third is communication - it’s a big factor today. Do they have easy access to the telephone, internet, and email?

Fourth, transportation. Can they get to follow-up appointments or therapy sessions?

Fifth is patient and caregiver communication education. Who should the patient contact if questions or problems arise? I like the idea of giving each patient a card that includes:

• a number they can call
• signs and symptoms to watch out for
• a list of their medications and how to safely administer them
• Safe and effective methods to manage pain. It’s a big issue when you’re on your own!
• How to perform self-care
• In some cases, those awkward, delicate, important end-of-life services (such as hospice) to help the patient understand his/her options

These are all things that the patient is taking into account. Maybe these are things they don’t have enough experience to know they should be considering. In either case, they are good for you to know. Patients expect to discuss their values and priorities with their doctors and nurses, but they rarely initiate these conversations - which is why we need to initiate these conversations.

The Take Away:

How skilled or prepared are you in starting values/priorities conversations? Can you say something like this? “Now that I’ve taken your medical history, would you like to spend some time talking about things that are on your mind? For example, what’s your biggest concern about this hospital stay? What would you like to know from me, Mr. Smith?”

How do you gather personal information? Some things (religion, ethnicity) can be worked into the conversation. Others things, such as medical literacy, decision-making, and the influence of social norms can be deduced during your interpersonal conversation, giving you insight into to their abilities and family dynamics.

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