Quality of care and resource use among mechanically ventilated patients before and after an intervention to assist nurse-nonvocal patient communication.

OBJECTIVES: Implement and test unit-wide patient-nurse assisted communication strategies (SPEACS). BACKGROUND: SPEACS improved nurse-patient communication outcomes; effects on patient care quality and resource use are unknown. METHODS: Prospective, randomized stepped-wedge pragmatic trial of 1440 adults ventilated ≥2 days and awake for at least one shift in 6 ICUs at 2 teaching hospitals 2009-2011 with blinded retrospective medical record abstraction. MAIN RESULTS: 323/383 (84%) nurses completed training; their communication knowledge (p < .001) and satisfaction and comfort (p < .001) increased. ICU days with physical restraint use (p = .44), heavy sedation (p = .73), pain score documentation (p = .97), presence of ICU-acquired pressure ulcers (p = .78), coma-free days (p = .76), ventilator-free days (p = .83), ICU length of stay (p = .77), hospital length of stay (p = .22), and median costs (p = .07) did not change. CONCLUSIONS: SPEACS improved ICU nurses' knowledge, satisfaction and comfort in communicating with nonvocal MV patients but did not impact patient care quality or resource use.

Listening to the voiceless patient: case reports in assisted communication in the intensive care unit.

Communication problems experienced by nonspeaking, critically ill patients in the Intensive Care Unit (ICU) have serious implications for the physical and psychological well-being of patients and the quality of their care. These problems are most profound for those with prolonged critical illnesses who are at the highest risk of dying. Recently, speech language pathologist (SLP) services have been used to provide augmentative and alternative communication (AAC) assistance to this vulnerable group of patients, their caregivers, and medical staff. Here we present three clinical cases that illustrate the application of AAC strategies across different levels of illness severity and communication impairment for nonspeaking patients in the ICU. Both high-tech communication devices with voice output and low-tech options were used for each patient according to their motor and cognitive abilities. To accommodate fluctuations in patient status and communication needs, multiple AAC strategies were integrated into the communication repertoire and tailored for each case. Medical personnel involved in these cases attributed enhanced communication efficiency, improved ventilator weaning trials, and increased patient engagement to the AAC techniques. This approach has the potential to improve symptom communication and to ease suffering for seriously ill ICU patients with speech limitations.

SPEACS-2: intensive care unit "communication rounds" with speech language pathology.

Intensive care unit (ICU) nurses occupy an essential role in facilitating patient communication and preventing the detrimental effects experienced by critically ill patients who are unable to speak, yet most are not equipped with the tools or training to enable communication most effectively with patients who are unable to speak. The goal of the Study of Patient-Nurse Effectiveness with Assisted Communication Strategies (SPEACS-2) is to explore the impact of an innovative, Web-based instructional package for ICU nurses with pocket reference guides, an instructional manual, and the provision of "low-tech" augmentative and alternative communication materials on nursing care quality and patient clinical outcomes. We hypothesize that this intervention will 1) improve nurses' skills in assessing and communicating with ICU patients who are unable to speak and 2) increase the collaboration between nursing and speech-language pathology in addressing complex patient communication needs in the ICU.