1. Sticky Notes: More Than a Reminder to Buy Milk and Eggs Brigitte Vola, BSN, RN, CRRN, PN II University of Alabama at Birmingham Hospital Sticky Notes  Sticky Notes are used as a means of informal communication between Health Care Providers (HCP) to facilitate the delivery of patient care.  Once posted, these notes may be viewed by anyone who has access to the Electronic Medical Record (EMR).  Anyone may delete a Sticky Note, regardless of whether they generated the note or not.  Although not included in the printed EMR, Sticky Notes become a part of the permanent EMR if not deleted.  Notes that remain a part of the EMR will be viewable in subsequent encounters (cross encounters).  Nurse will create a "New Sticky Note" (found in toolbar at top of patient's chart page in IMPACT) with the non-critical patient information to be communicated to the primary team.  Sticky Note Entry box will appear. Nurse can free text a message. When the note gets saved, it automatically saves the date, time, and author.  The "View Sticky Note" area in the toolbar will no longer be dithered (grayed out). It should be immediately obvious that patient has a sticky note attached to their chart.  To View a Sticky Note, click the “View Sticky Note” Icon in the Patient’s Chart  Sticky Notes can also be viewed from the Patient List.  From the Patient List, the HCP can right click on the Sticky Note Icon and choose Add/View Sticky Note. Process  The Rehabilitation Unit-Based Congress (Rehab UBC) formed a team to address communication.  The team created and distributed a survey to nurses, physicians, and inpatient rehab faculty at a large academic medical center.  The survey addressed 10 “yes/no” communication-related questions with open-ended comments available.  The Rehab UBC evaluated the survey results, confirming communication was an issue. The team discussed options to improve communication including: communication binders, a dedicated email account, and building a documentation section into IMPACT.  Discussions with informatics confirmed a documentation section already existed in IMPACT called “Sticky Notes”. Introduction Despite the fact that inpatient rehabilitation necessitates a multidisciplinary approach, there was a definite lack of communication between night shift nurses and the primary medical team. Night shift nurses would ask day shift nurses to ask the primary medical team a question such as: where should that ordered cream go because the order only read “Apply to affected area” or could blood sugars be checked only once or twice a day (or discontinued altogether) for the non-diabetic patient whose blood sugars haven’t run high or low in over a week. When the night shift nurse came back to work days later, the orders hadn’t been clarified or changed and when questioned, day shift had been too busy and forgot to ask the doctor. The purpose of this project was to improve communication of non-critical patient information between the night shift nurses and the primary medical team. Results  The Rehab UBC developed guidelines, created a PowerPoint, and educated all rehab nurses, physicians and NPs on the use of Sticky Notes to improve communication of non-critical patient information.  The Physician/NP checks for Sticky Notes daily. The Physician/NP acts, if appropriate, on the question asked by the nurse.  After acting on the order, the Physician/NP deletes the Sticky Note.  The "View Sticky Note" area will again be dithered.  If there is a reason why the Physician/NP does not want to act on the order at that time, he/she writes a quick note directly on the current Sticky Note acknowledging that the Sticky Note was viewed.  Once the Physician/NP saves his/her message on the Sticky Note, it will automatically save his/her name, time, and date.  A follow-up survey was sent after 3 months of using Sticky Notes. 100% of responding nurses and physicians felt communication improved. Implications for Practice A simple tool has improved communication between night shift nurses and the primary medical team. By improving communication, the nurses and physicians also expressed greater satisfaction in the care provided to the patients. When communication between healthcare providers is improved, the patient care is improved. The same tool is available across the hospital. Other nursing units could develop guidelines for use in their areas to improve the communication between night shift nurses and the medical team. Where do you want that cream to go?