Problems Unique to In-hospital Prescribing
At our hospital, we have been providing medicines at the pharmacy counter inside the hospital since it opened in 1980, for the purpose of ensuring convenience and economy for patients, exercising control of drug administration status and side effects, and providing appropriate support. According to our results from FY2015, more than 98% of our outpatients had received in-hospital prescriptions and an average of 173 prescriptions a day had been filled.
However, against the backdrop of the aging of patients and the increasing number of difficult drug names, problems that occur at the pharmacy counter, such as "the patients cannot hear when called," "the pharmacists are required to constantly repeat explanations," and "it is hard to communicate", had become more serious with each passing year. We wanted to absolutely avoid increasing patients' wait times and prescribing medicines without the patients fully understanding due to difficulties in interactions with the pharmacists. The buildup of such small frustrations and worries can negatively impact the trusting relationships that have been built up with patients over previous years. While I was keeping an eye out for solutions to these issues, I happened to see a program on TV in which Comuoon was being introduced. At the same time, I heard about Comuoon from our head nurse and I thought instinctively, "this could be the solution to those problems." We immediately decided to introduce a total of three Comuoon units to our pharmacy counter, outpatient care, and hospital wards.
Aiming for More Sophisticated Environmental Improvement
When we conducted verification of the sound volume of the pharmacists' voices after Comuoon was introduced, it was found that they certainly no longer had to explain in a "loud voice". Also, in the verification, about half of the 86 patients stated that "their hearing had improved", and more than 90% of patients answered that "they could not hear other people's conversations at the pharmacy counter." However, we decided to tackle other challenges while consulting with Mr. Nakaishi in order to utilize Comuoon more effectively and to ensure that the patients could benefit from the changes.
The pharmacy counter of our hospital is located in the corner of the outpatient waiting room on the first floor. We wanted to improve accuracy of hearing while protecting patients' privacy, even in a place where many people come and go. We set the following two goals: "Increase the hearing improvement effects" and "Protect the patients' privacy." While reviewing the sound volume of the speaker's voice and the position of the microphone, we decided to try out installation of a "partition board." A "partition board" reverberates the sound generated via Comuoon and makes it easy to transmit the sound to patients. At the same time, it prevents sound leakage, which would otherwise allow other people to overhear your conversation. We prepared three types of "partition board" (1. Acrylic board, 2. Attached a sound-absorbing panel directly onto the acrylic board, 3. Created a gap of 1 cm between the acrylic board and the sound-absorbing panel), and verified the environment of each counter. As a result, we found out that "3. the "partition board" that has a gap," was best at capturing the sound and the sound was least likely to be overheard by other people. After we installed the "3. partition board" and improved the environment by having the next patient's waiting position indicated with a colored tape, we immediately received feedback from patients to the effect that "words are easier to understand" and "I can hear clearly, now". As the pharmacists also said that "questions are repeated less often", "there are fewer complaints" and "messages can be conveyed at normal sound volume", significant stress reduction results were obtained.
These series of initiatives, which achieved the two goals of "Improvement in hearing" and "Privacy protection", were presented at an academic meeting together with Mr. Nakaishi, as "Verifying the usefulness of the Table-top communication support system 'Comuoon' at the pharmacy counter".
Further Cultivation of Two-way Communication
The improved environment of the pharmacy counter centered on Comuoon has generated positive feedback such as "I understand the explanations of the medicines better," "I'm grateful that my privacy is being protected," and "I had given up because of hearing difficulties, but I'm relieved now." We will continue to further improve pharmacists' awareness as to how they can convey the drug names that are difficult to hear and make efforts to enhance patient satisfaction. At the same time, I think Comuoon can be further utilized in outpatient care and hospital wards.
Our hospital plays an important role as a regional-based medical institution, including serving as a designated cancer care hospital, acute hospital, and regional comprehensive care hospital. In our medical practice, there are situations that make us nervous, such as explaining serious illness conditions, surgical procedures and treatment plans. The basic premise of the so-called "informed consent," whereby treatment is administered after the doctor provides sufficient explanation to the patient about the details of treatment and medicines and obtains his/her consent, is that the doctor communicates information accurately to the patient. However, in reality, many patients and families are often in a state of shock after hearing the explanation, and their thoughts may be elsewhere. The doctor may speak loudly with a grim expression due to tension, despite his or her intention. In such a situation, the role played by Comuoon, which resolves patients' "hearing" problems and enables calm conversations in a normal tone of voice, is very significant.
In our outpatient care and hospital wards, we interact with patients in various situations, including during treatment, rehabilitation, and night rounds of the hospital wards. For example, a patient with lung disease often can speak only in a small voice due to significantly reduced lung capacity. Comuoon is very effective not only for "hearing" problems but also for the doctors to correctly catch the patients' weak voices. By reducing communication barriers between medical professionals and patients and achieving two-way communication, Comuoon is a high-function tool that truly represents "universal hearing design."
Support - What Only a "Person" Can Do
Thanks to Comuoon, I have an unforgettable recollection. One elderly patient always came to our hospital with his wife as it was necessary for her to repeat the information into the patient's ear because he had hearing difficulties due to old age. Unfortunately, the patient eventually passed away but I received a letter from his wife at a later date. It contained words of gratitude and joy for the fact that the patient was able to converse directly with me via Comuoon. As I read those words, the scene came back to my mind, reminding me of the time when the patient and I were both smiling and holding a conversation without his wife having to relay what I was saying. It was a very beautiful moment. Comuoon helped me realize how good it feels to enjoy mutual understanding through natural conversation and sharing our hearts.
Whilst Comuoon is effectively only hardware (device, equipment), what you can get from it is warm experiences, such as conversations and mutual understanding. There is an old adage for doctors: "Treat the sick, not his sickness. Comuoon has great value in providing support for experiencing the true joy that can be obtained only through a conversation between doctor and patient; that is, person-to-person, and for building relationships of trust. By utilizing Comuoon, you can focus on what only a "person" can do, and that is a wonderful thing.
Power to Create Innovation
Mr. Nakaishi is an engaging person with a great sense of humor, who has a dream and is always thinking of ways to help people in need. I think his innovative idea of "the surroundings make efforts" toward addressing "hearing difficulties" was born out of his flexible creativity and strong sense of commitment in always thinking about " what he can do".
This is off-topic but the British recording company EMI developed and sold the world's first CT scanner, now a well-known device for diagnostic imaging. The record label Apple Records, to which the Beatles belonged, was a subsidiary of EMI, and their record-breaking sales are said to have made possible procurement of the research and development funding for development of the CT scanner. When I was young, CT scanners were known as "EMI scanners," and they were hailed in the industry as a "great legacy left by the Beatles." Mr. Nakaishi told me that he began his research on speakers, which was the starting point for Comuoon, while he was working for EMI. It's curious that Comuoon, which creates innovation in "hearing," was born out of the same "EMI" connection as the CT scanner which significantly transformed medical diagnostic technology.
We will make sure to follow up on how the "universal hearing design" that Comuoon brings evolves, going forward through the proactive practice of our hospital.