April 12, 2012

Student’s project helps give voice to ventilator patients

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Vanderbilt University School of Medicine student Sarah Tiggelaar works with patient Marcella Johnson using a communication tool Tiggelaar created to better communicate with patients on ventilators. (photo by Susan Urmy)

Student’s project helps give voice to ventilator patients

Fourth-year Vanderbilt University School of Medicine student Sarah Tiggelaar has an ear for patients’ needs, even when they cannot speak.

When a patient expressed intense frustration about periods of time when she became unable to communicate because a ventilator made her unable to speak, Tiggelaar found the inspiration for her elective quality improvement project.

“It was during the third year of my Surgery rotation. I helped take care of a patient who was on and off the ventilator several times, but in between she said she couldn’t even tell nurses she had an itch, or tell doctors where her pain was. She was the one who suggested a communication board for ICU patients, and I took the idea and went from there,” Tiggelaar said.

Nothing like that was in place in Vanderbilt Medical or Surgical Intensive Care Units, although speech pathology experts were sometimes consulted. So Tiggelaar worked to create a large, laminated card that fits patients with different communication needs and is widely available.

Many patients on ventilators are awake, but temporarily unable to speak because of the breathing tube in their airway. For 24-year-old Marcella Johnson, the card was a great help because she didn’t have the dexterity to text on her phone. She remained on a ventilator for several days after a surgery. Her mother, Sharon, says the communication board became invaluable.

“I could see her frustration, but the card helped so much. She could just point to one thing if she was itching or thirsty, and use the letters to spell other things out for me,” Sharon Johnson said.

Tiggelaar worked with mentors Wes Ely, M.D., MPH, professor of Medicine, and Christopher Hughes, M.D., assistant professor of Anesthesiology Critical Care Medicine, and their teams.

She also received funding from the Vanderbilt Institute for Clinical and Translational Research (VICTR) to produce more than 300 of the double-sided, laminated cards and to perform surveys to determine how well they work.

The cards are already in use in the MICU and SICU with requests to expand usage to the Cardiovascular and Neuro ICUs, the trauma and burn units, and other step-down units as well.

In her design Tiggelaar included a number of tools so patients can point to a simple word or illustration to indicate their needs, or use the letter board to spell it out. The cards are printed in English as well as Spanish.

Tiggelaar said her hope is through her quality improvement project she can show that the communication cards not only help patients feel more in control of their care and reduce frustration, but will also improve outcomes.

“Outcomes are often linked with good communication. If patients can express their needs, we ensure the best possible care and help them get better faster,” Tiggelaar said.