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NOD and Wave: Improving communication and hand hygiene in the Emergency Department

Toronto, November 22, 2016

By Kaitlyn Patterson

Dr. Steve Lin washes his hands and RN Jodi Den Bok shows her new badge to patient Manohar Lai Verma
Dr. Steve Lin washes his hands in the Emergency Department, where RN Jodi Den Bok shows her new badge to patient Manohar Lai Verma. NOD and Wave is a new ED initiative to encourage staff to practice good hand hygiene and introduce themselves and their roles to patient. (Photos by Yuri Markarov)

Visiting the Emergency Department can be a scary experience, especially if patients don’t know the name or role of the health-care professional treating them.

Focus surveys conducted in the ED with patients and staff at St. Michael’s Hospital found that being able to identify staff and their roles is highly important to patients. To address this, an ID badge pilot project with an education component called NOD and Wave is underway in the ED.

When staff meet with a patient, they now introduce themselves with NOD: name, occupation and duty, a concept adapted from Thunder Bay Regional Hospital. For example, “My name is John. I’m a nurse and I will be taking your blood pressure.”

“Wave” is an original component that was added to the project at St. Michael’s to remind staff to wash their hands before interacting with a patient.

“It can be confusing for patients because we all wear the same uniform and often have crossover in our roles,” said Lee Barratt, a clinical nurse educator in the ED. “NOD and Wave reminds us to identify ourselves to patients, explain what we will be doing and to practice hand hygiene.”

New colour-coded ID badges with larger occupation titles, larger names and smaller photos are being used to identify staff. The colours on the badges match posters in the ED, which provide patient-friendly descriptions of the project and the role of each occupation. For instance, if a staff member is wearing a badge with a light blue stripe, it means he or she is either a resident doctor or medical student. Patients can read one of the posters to gain a better understanding of what the health professional’s role involves and with whom he or she typically works.

“Our goal for this project is to minimize patient confusion,” said Anthea Tseng, a quality improvement analyst. “We’ve emphasized the provider’s name and role on the badge and selected a handful of colours to identify the different groups of providers who work in the ED.”

Other departments such as the Diabetes Clinic and Breast Centre have also administered surveys to patients to determine if the project should be extended beyond the ED.

“So far, we’ve received all positive feedback regarding the ID badge project and the NOD and Wave component,” said Tseng. “It gives patients comfort knowing that the staff is focused on improving open communication and hand hygiene within the hospital.”

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.