As hospitals recognize the importance of patient-centered care and see the patient or his/her designee as a participant in a plan of care, we must also adapt our practice to show respect for the patient's preferences, values and needs.

At Mercy Medical Center, Rockville Centre, NY, staff searched for a way to empower our patients and families to notify the health care team when a noticeable change in condition occurs.

As part of our commitment to partnering with patients to provide quality and compassionate care to the whole person, we embarked on a program of communication and education to staff, patients and families so changes in a patient's condition could be reported to the health care team utilizing the existing Rapid Response program. We called this program "Condition A for Assistance."

Multidisciplinary Team

Mercy Medical Center's Rapid Response Team - comprised of critical care nurses, a physician assistant/nurse practitioner and a respiratory therapist - assess a patient's condition and determine with the bedside nurse the need for additional treatment.

Not only has the clinical value of the Rapid Response Team been proven with fewer transfers to ICU and reduced cardiac arrests, it has also changed the hospital culture. The emphasis is on shared learning, and the message of support is a critical component in challenging clinical situations.

"I am here to help - what can I do?" responds Daniel Murphy, MD, senior director of patient care operations/code committee chairman, to a Rapid Response Team call.

Family Involvement

It is this collaboration among professionals that promotes team care and positive outcomes for patient and families.

With the Condition A for Assistance program, Mercy Medical Center has taken this teamwork a step further by including the patient and family in alerting the health care team/rapid response team to a noticeable change in the patient's condition.

Keeping with the patient-centered/family-focused model, the patient or person who knows the patient best alerts the team to a condition change allowing for the delivery of collaborative patient-centered care.

At the time of admission the nurse sits down with the patient and family and explains how patients and families call a Condition A. The patient and family are instructed to call the bedside nurse immediately should any of the following occur:

• weakness in face, arms or legs
• chest pain, discomfort, or fast heart beat
• change in color of skin - pale or gray looking
• sudden sweating
• difficulty walking or speaking
• change in mental status - less awake than normal or agitated
• sudden loss of consciousness or a collapse
• bleeding
• seizure
• any noticeable change in the way the patient looks or feels.

If the health care team on the unit is not responsive to either the change in condition or to the specific concern of the patient/family, they are instructed to call a Condition A. Each bedside has a framed instructional card that outlines the symptoms, when to call a Condition A and how-to steps to place the call.

Program Roots

Condition A was piloted on 2 East and the staff enthusiastically embraced the idea and the opportunity to pilot one of the 2009 National Patient Safety Goals.

Since 2 East is primarily an oncology unit, the patients admitted there were usually cared for by one of their loved ones prior to admission. Often, these patients are repeat customers to the unit.

At the time of admission, the nurse sat down with the patient and family and explained the Condition A program and why the unit had started the initiative. A brochure was given to the family as a reference and the framed instructional guide was placed at every bedside.

The families who received the information on the Condition A program thought it was a supportive initiative, making them feel at ease to make a call if necessary. The staff said families appeared more relaxed knowing they were as involved in the care of their loved one as they could be - especially when they felt so helpless in other ways.

Patient satisfaction scores were indicators of the success of this initiative. We measured: attitude toward requests (mean score: 82), keeping the patient informed (mean score: 84), and safety (mean score: 93). After piloting this project for 3 months, the same indicators were measured again: attitude toward requests (mean score: 99), keeping the patient informed (mean score: 97), and safety (mean score: 99).

Teamwork at Its Best

Our patients and families, as well as our staff, are all seeing an improvement in communication and are pleased to know our customers' expectations are being met.

As a result of these findings, Mercy Medical Center expanded the Condition A program to every med/surg bedside. Both patient and family have the opportunity to partner with the health care team in providing quality care and participating in Condition A.

It is this partnering with the health care team, patients and their families that result in teamwork at its best. It relies on open communication, mutual respect and shared decision-making to achieve quality outcomes and provide safe patient care.

Margaret Glier is interim nurse manager of the ICU, and Kathleen McCaffrey is senior director of nursing, both at Mercy Medical Center, Rockville Centre, NY.