akeller@synensysglobal.com

Author Archive

139 – Nature to Nurture Instructor’s Guide

Friday, September 26th, 2014

139

Instructor’s Guide – Nature to Nurture

Overview:
This story is about bullying and hazing practices often associated with a healthcare worker’s indoctrination. These practices cause both unnecessary stress and premature abandonment of the field, and often compromise both the satisfaction and safety of patients.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care.
Describe the importance of adopting “no bullying, no hazing” policies and protocols.
Clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

What does this story illustrate about the importance of shared on-boarding practices?
A: Cheryl was not put in a position to succeed. This not only put her in danger, but also the other patients.
Explain how Karen and Alice failed to create a climate of respect and professionalism in this story.
A: Kyrie and Alice spoke negatively about having a new nurse in their department and that attitude was made known to Cheryl. She was not oriented to the unit or welcomed to the department.
How did Kyrie and Alice, and the procedures in place at the hospital, fail to minimize the risk of harm to patients in this story? What should have been done instead?
A: Alice should have learned more about Susie’s clinical skills, strengths and weaknesses. Alice is responsible for the care that Susie provides to each of the patients and needs to know the scope of Alice’s training.

A: Alice should have been oriented to the unit and her surroundings. She should have then been placed with a nurse that would demonstrate the proper way to do things on that unit. She should have been given more simple tasks in the beginning and then guided through the more complicated tasks.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: That bullying and hazing can come in different forms and does not always look the same. Alice might not think she is being a bully, but she needs to know her behavior is not acceptable.
What one thing can you do to ensure all team members are treated with respect, regardless of rank, position, or role?
A: One way is to “talk up” a colleague. Kyrie could have discussed how nice it is to have a new member to their team. Cheryl may be able to contribute in ways Kyrie and Alice did not realize.
Have you witnessed or been a victim of hazing or bullying from other colleagues, classmates, or staff members? How did it make you feel?
A: It becomes a negative environment when nurses speak negatively about each other. Lateral violence, bullying, and hazing are all too common in the healthcare field. One way to stop this is to use open communication and learn to collaborate with all healthcare team members.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Continue this story from Cheryl’s perspective. How do you think Kyrie and Alice’s actions in this story might affect her future in the profession?
Create a presentation to educate others on the effects of bullying and hazing in the medical profession. Use the Professional Conduct Survey to learn more about issues in the medical workplace, and do other research on your own.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
Evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care.	Student struggles to evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care.	Student can evaluate and explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care, but needs further practice.	Student can evaluate and accurately explain on-boarding practices that ensure proper supervision for safe, competent, and quality patient care.
Describe the importance of adopting “no bullying, no hazing” policies and protocols.	Student struggles to describe the importance of adopting “no bullying, no hazing” policies and protocols.	Student can describe the importance of adopting “no bullying, no hazing” policies and protocols, but needs further practice.	Student can accurately describe the importance of adopting “no bullying, no hazing” policies and protocols.
*Clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members.*	Student struggles to clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members.	Student can clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members, but needs further practice and instruction.	Student can accurately clarify the responsibility of each team member in creating a climate of respect and professionalism for new team members.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

DESC Script
Collaboration
Cross Monitoring
I’M SAFE
STEP
Task Assistance
CUS
“Speak Up”
4 Step Process
PEARLA

Posted in Pro ED Guides, Teacher Guides | No Comments »

138 – The Pressure’s On Instructor’s Guide

Friday, September 26th, 2014

138

Instructor’s Guide – The Pressure’s On

Overview:
Pressure ulcers are common in patients with spinal cord injuries due to lack of mobility. Evidence-based protocols for pressure ulcer prevention must be developed, trained, and followed across teams to prevent patient harm. Effective handoffs are essential to ensure continuity of care.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Describe the role of the nurse in pressure ulcer surveillance and skin assessment.
Recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs.
Explain how to apply evidence-based measures to prevent the development of pressure ulcers.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

What is the role of the nurse in pressure ulcer surveillance and skin assessment?
A: It is the nurse’s responsibility to assess for ulcers and skin breakdown every shift, or more often if needed.
What did this team do well in documenting and communicating their efforts to prevent Trevon’s pressure ulcers? What could they improve?
A: They did a good job of documenting and communicating their efforts, however the LVN was not notified of the potential issue for skin breakdown and she did not understand the abbreviated letters written on the front of the chart.
What can we do to ensure that a pressure ulcer prevention plan is consistently documented, practiced and communicated, including the ‘why’ for patients and families?
A: There may be a need to place pressure ulcer prevention plans in the front of every patients chart. It is not acceptable for patients to develop a pressure ulcer once they are in the hospital and insurance companies will no longer pay for the care of that pressure ulcer if one were to develop.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: The importance of vigilant skin assessments is vital to safe patient care. With good assessments and turning procedures skin breakdown is preventable.
What can we do to ensure that all members of the healthcare team receive timely, clear communication about pressure ulcer prevention plans tailored to patient needs?
A: The charge nurse is a good person to start the communication about pressure ulcer prevention. It is also effective to have a “super user” or a champion who will lead the healthcare team in communicating the pressure ulcer prevention plans for each patient.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Create a poster that reminds team members of the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoff.
Research the consequences of pressure ulcers, and share your findings with the class.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Describe the role of the nurse in pressure ulcer surveillance and skin assessment.*	Student struggles describe the role of the nurse in pressure ulcer surveillance and skin assessment.	Student can describe the role of the nurse in pressure ulcer surveillance and skin assessment, but needs further instruction and practice.	Student can accurately describe the role of the nurse in pressure ulcer surveillance and skin assessment.
*Recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs.*	Student struggles to recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs.	Student can recognize and explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs, but needs more practice.	Student can recognize and accurately explain the importance of documenting and communicating steps to prevent pressure ulcers, especially during handoffs.
*Explain how to apply evidence-based measures to prevent the development of pressure ulcers.*	Student struggles to explain how to apply evidence-based measures to prevent the development of pressure ulcers.	Student can explain how to apply evidence-based measures to prevent the development of pressure ulcers, but needs more practice.	Student can accurately explain how to apply evidence-based measures to prevent the development of pressure ulcers.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

Briefs
Check-Backs
Debriefs
Collaboration
Handoff
Cross Monitoring
Huddles
I PASS the BATON
SBAR
Task Assistance
Patient Rounding
Bedside Handoffs

Posted in Pro ED Guides, Teacher Guides | No Comments »

137 – Vigilance is Never In Vain Instructor’s Guide

Friday, September 26th, 2014

137

Instructor’s Guide – Vigilance is Never In Vain

Overview:
This story highlights the importance of Venous Thrombosis Embolism (VTE) prevention protocols. Signs and symptoms of VTE are frequently silent and can lead to fatal pulmonary embolism. All team members are responsible for VTE.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis.
Describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change (e.g. moving into post-operative phase).
Develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS Best Practice: Two Challenge Rule

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

Two Challenge Rule

It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.

Why is it important to ensure that patient order sets include a plan for VTE prophylaxis?
A: This is one way to ensure the patient does not get a DVT after surgery. The order sets are put into place for a reason and they reflect Evidence Based Practice.
How could Sally have applied the Two-Challenge Rule when she discovered Dr. Hamdi’s orders?
A: She could have called the doctor right away and asked if he would like to implement the VTE protocol. If the doctor does not agree then the nurse can suggest they implement the VTE protocol.
What does this story illustrate about the importance of fostering and maintaining open communication, mutual respect, and shared decision-making among the team, regardless of roles or hierarchy?
A: The nurse did not call the doctor because she was nervous about how he would respond. The hospitalist also did not want to contact Dr Hamdi because she did not think he would respond well. Therefore, because the nurse was nervous about speak to the doctor then the patient did not receive the appropriate medication.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: The patient needs to be the priority for the nurse and not the concern over what the doctor will say. The patient should have received different medication and the nurse knew that, but she did not feel comfortable calling the doctor.
What could you do to ensure daily review of VTE risk factors for all patients?
A: All surgical patients should be provided with VTE standards of care. A daily check could be made by the change nurse to ensure this is done.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Create a presentation explaining VTE risk, and the precautions that can help prevent fatal errors. Share your work with your classmates.
Create a VTE prophylaxis protocol/checklist that members of this unit could follow when re-assessing patients.
Write a dialogue between Sally and Dr. Hamdi where Sally employs the Two-Challenge Rule to advocate for Dina.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis.*	Student struggles to explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis.	Student can explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis, but needs improvement.	Student can accurately explain the importance of ensuring that patient order sets include a plan for VTE prophylaxis.
*Describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change (e.g. moving into post-operative phase).*	Student struggles to describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change.	Student can describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change, but needs improvement.	Student can accurately describe the necessity of re-assessing patients for VTE risk when their conditions or circumstances change.
*Develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team.*	Student struggles to develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team.	Student is able to develop a plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team, but needs improvement.	Student is able to develop an accurate and complete plan to communicate patient goals including VTE prophylaxis to all members of the multidisciplinary team.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

Advocacy and Assertion
Check Backs
Bedside Handoffs
Collaboration
Cross Monitoring
STEP
Handoff
I PASS the BATON
Two-Challenge Rule
Debriefs
SBAR
AskMe3
CUS
Feedback
Patient Rounding
Huddles
Task Assistance

Posted in Pro ED Guides, Teacher Guides | No Comments »

135 – If It Was Your Mom Instructor’s Guide

Thursday, September 25th, 2014

135

Instructor’s Guide – If It Was Your Mom

Overview:
This story is about the impacts of medication errors. Distractions and interruptions can cause human error that may not be caught by other team members. Patients and/or family members are witnesses to their care and can provide cross-monitoring to prevent errors from occurring.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Examine and describe team practices to promote cross-monitoring of high risk procedures including medication administration.
Summarize policies and practices that can limit distractions and multi-tasking during critical care practices.
Describe processes for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS Best Practice: Cross-Monitoring

Cross Monitoring – Cross Monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.

Why is cross-monitoring an important practice? How was it illustrated in this story?
A: Cross-monitoring is one way to check the accuracy of another nurse. This should be done every time a “high alter” medication is given. It includes not only checking the doctor’s order, but also ensuring it is the correct dosage.
How can we make sure our cross-monitoring of important procedures or medication administrations is not compromised by multitasking or staff changes?
A: One way is to ensure staff are not interrupted when administering medication. At some hospitals this is done by wearing a vest that indicates medications are about to be administered and that all side conversations must be stopped.
How can we include the patients and families as members of the clinical care team and ensure that they have the opportunity to ask questions and express concerns before important procedures or medication administrations?
A: The patient and family members should feel encouraged to be a part of the team. They often have knowledge and experience the healthcare member may benefit from knowing.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: That no one double checked the dosage or strength of the medication. It is not enough to only check the doctors order, but the dosage as well.
What might have happened if Lucy had not advocated for her patient, or if Cynthia had not been there to advocate for her mother?
A: The patient would have received an extremely high and potentially lethal dose of the medication.
What if Inez was your mom? How does that change your perspective on the story?
A: Each of us want the best care to be given to our parents. This is a great example to keep in mind when patients or family members want to know more about medication or procedures their loved ones are receiving.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Read “The Human Factor: The critical importance of effective teamwork and communication in providing safe care” and create a presentation on the importance of cross monitoring and other preventative actions that can help increase patient safety during high risk procedures.
Work with a partner to generate a list of policies and practices that can limit distractions and multi-tasking during critical care procedures. Create a poster of your top ten reminders for limiting distractions and focusing on patient safety.
Create a checklist to assist medical staff in working with patients and their families in critical care situations. What can they do on a regular basis to include patients and families as full partners in their care?

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Examine and describe team practices to promote cross-monitoring of high risk procedures including medication administration.*	Student struggles to examine and describe team practices to promote cross-monitoring of high risk procedures including medication administration.	Student can examine and describe some team practices to promote cross-monitoring of high risk procedures including medication administration, but needs further practice.	Student can examine and describe team practices to promote cross-monitoring of high risk procedures including medication administration.
*Summarize policies and practices that can limit distractions and multitasking during critical care practices.*	Student struggles to summarize policies and practices that can limit distractions and multitasking during critical care practices.	Student can summarize some policies and practices that can limit distractions and multitasking during critical care practices, but needs further practice.	Student can accurately summarize policies and practices that can limit distractions and multitasking during critical care practices.
*Describe processes for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns.*	Student struggles to describe processes for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns.	Student can describe some processes for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns, but needs further practice.	Student can describe processes for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

Call Out
Advocacy and Assertion
Check Backs
Bedside Handoffs
Collaboration
“Speak Up”
Cross Monitoring
STEP
CUS
AskMe3
Handoff
3Ws – Who I am, What I am Doing, Why I Care
Two-Challenge Rule
Handoff

Posted in Pro ED Guides, Teacher Guides | No Comments »

134 – In Whose Time? Instructor’s Guide

Thursday, September 25th, 2014

134

Instructor’s Guide – In Whose Time?

Overview:
This story is about an expectant mother and the timing of a scheduled C-section delivery. The physician’s schedule, not the gestation age of the fetus, becomes the primary scheduling concern. Reducing or eliminating early elective deliveries has been shown to be safer for newborns.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Describe evidence-based safety protocols across the team to reduce planned deliveries less than 39 weeks without medical indication.
Adopt and apply an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication.
Explain the increased risks to the newborn to the patient and their family with deliveries less than 39 weeks without medical indication.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS Best Practice: CUS

The CUS technique provides a framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue, but also the magnitude of the issue.

CUS Technique:

First, state your Concern.
Then state why you are Uncomfortable.
If the conflict is not resolved, state that there is a Safety issue.

Explain why it is important to follow evidence-based practices to ensure patient safety, regardless of inconveniences it might cause.
A: Care based on evidence based practice ensures patient safety. There are often several reasons why evidence based practice should be used. It is based on facts and research and not a healthcare professionals opinion or convenience.
How might Beverly’s use of the CUS technique prevented the issues in this story? Why do you think she didn’t speak up?
A: Beverly didn’t want to say anything because she wanted her OBGYN to deliver here baby and not another doctor. Many times patients don’t feel comfortable standing up to a doctor or disagreeing with their decision.
How is this story a non-example of patient-centered care? What would you change to make it an example of patient-centered care?
A: This example is not patient-centered care because the baby was delivered according to the doctor’s schedule and not the schedule that should have been used. There was not a medical reason to deliver the baby early, except that it was convenient for the doctor.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: That potential harm occurred because evidence based practice was not followed.
What is one thing you could do to ensure that elective deliveries less than 39 weeks are decreased in your workplace?
A: One way is to provide the obgyn’s with research and evidence that supports elective deliveries over 39 weeks gestational age.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Write an addendum to this story where Beverly intercedes to advocate for Rachel and Andy using the CUS technique. Decide whether she confronts Dr. Burdy in the room or out, and the possible reaction of the doctor.
Research other possible consequences of an early C-section (that is not medically necessary). Create a presentation with your findings.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Describe evidence-based safety protocols across the team to reduce planned deliveries less than 39 weeks without medical indication.*	Student struggles to describe evidence-based safety protocols across the team to reduce planned deliveries less than 39 weeks without medical indication.	Student can describe some evidence-based safety protocols across the team to reduce planned deliveries less than 39 weeks without medical indication, but needs further instruction.	Student can accurately describe evidence-based safety protocols across the team to reduce planned deliveries less than 39 weeks without medical indication.
*Adopt and apply an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication.*	Student struggles to adopt and apply an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication.	Student can adopt and apply an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication, but needs further instruction or practice.	Student can adopt and apply an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication.
*Explain the increased risks to the newborn to the patient and their family with deliveries less than 39 weeks without medical indication.*	Student struggles to explain the increased risks to the newborn to the patient and their family with deliveries less than 39 weeks without medical indication.	Student can explain some of the increased risks to the newborn to the patient and their family with deliveries less than 39 weeks without medical indication, but needs further instruction and practice.	Student can accurately explain the increased risks to the newborn to the patient and their family with deliveries less than 39 weeks without medical indication.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

Advocacy and Assertion
Collaboration
Cross Monitoring
Debriefs
Two Challenge Rule
AskMe3
Feedback
CUS
Handoff
Huddles
SBAR

Posted in Pro ED Guides, Teacher Guides | No Comments »

133 – They Come and Go Instructor’s Guide

Thursday, September 25th, 2014

133

Instructor’s Guide – They Come and Go

Overview:
This story is about the patient experience as seen through the eyes of the patient. Patients view their care as competent, yet disjointed, especially at shift changes. Bedside handoffs are one technique to make the transitions of care both satisfying and safer for the patient.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Evaluate and explain team opportunities to consistently involve patients and family members during transitions of care, especially at shift changes.
Describe the importance of integrating bedside handoffs into daily practice to promote safer care and improve patient experience.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS Best Practice: Bedside Handoffs

Bedside Handoffs – Change of shift report occurring at the patient’s bedside with these essential components:

A standardized nursing report handoff tool.
Bedside shift-to-shift report.
Inclusion of the patient and family in the discussion of plans and goals of care, including introductions.
Two-person medical record check.

How did the team’s inability to consistently involve Daryl and Ed during transitions of care affect their experiences?
A: Both Daryl and Ed had a negative attitude regarding their care after the first two days on the floor. They did not feel involved in their own care once they had been there for a few shift changes.
What does this story illustrate about the importance of bedside handoffs?
A: Not only is bedside handoff important, but it is also important to let the patient know that bedside handoff will be occurring in the near future. It works well when the patient is informed prior to the shift change.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: That patient feels more in control of their own care when they are informed of the regular activities on the floor and what to expect. Although the care of the patient may not change, the patient feels more in control of the situation.
What is one thing you can do to make sure the patient is confident and comfortable with the transition to the next care provider?
A: One way is to inform them when change of shift will be occurring and who their next nurse will be. Another way is to create more communication between the day shift and night shift nurses so that the patient feels they are the center of care.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Using the criteria provided for bedside handoffs, create a dialogue that should have happened during a bedside handoff between Madeline and the night nurse.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Evaluate and explain team opportunities to consistently involve patients and family members during transitions of care, especially at shift changes.*	Student struggles to evaluate and explain team opportunities to consistently involve patients and family members during transitions of care, especially at shift changes.	Student can evaluate and explain some team opportunities to consistently involve patients and family members during transitions of care, especially at shift changes, but needs further practice.	Student can accurately evaluate and explain team opportunities to consistently involve patients and family members during transitions of care, especially at shift changes.
*Describe the importance of integrating bedside handoffs into daily practice to promote safer care and improve patient experience.*	Student struggles to describe the importance of integrating bedside handoffs into daily practice to promote safer care and improve patient experience.	Student can describe some of the importance of integrating bedside handoffs into daily practice to promote safer care and improve patient experience, but needs further practice.	Student can accurately describe the importance of integrating bedside handoffs into daily practice to promote safer care and improve patient experience.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

Briefs
Collaboration
Cross Monitoring
Feedback
Handoff
Huddles
I PASS the BATON
SBAR
3Ws – Who I am, What I am Doing, and Why I Care
Bedside Handoffs
Check-Backs

Posted in Pro ED Guides, Teacher Guides | No Comments »

132 – Debrief or Perish Instructor’s Guide

Thursday, September 25th, 2014

132

Instructor’s Guide – Debrief or Perish

Overview:
This story is about the importance of team debriefs. Teams often fail to learn as much as they can from critical incidents by not taking adequate time to report, discuss, and examine errors in patient care. Teams are destined to repeat the same mistakes if they fail to debrief.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Describe the importance of integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.
Explain the importance of integrating family members as a critical source of patient information and medical history, especially if the patient is incapacitated or impaired.
Generate and summarize strategies for recording and sharing lessons learns from debriefs with other team members and across the organization.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Quality Improvement (QI): Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS Best Practice:

Debriefs: To conduct a debrief:

Facilitate the discussion as a leader by asking questions related to team performance. What did we do well?
Recap the situation, background, and key events that occurred.
As a team, assess how the following played a role in the performance of the team:

Team Leadership
Situation Awareness
Mutual Support
Communication

Then summarize lessons learned and set goals for improvement.
This checklist can be used by the team during a debriefing to ensure that all information is discussed.

How does this story illustrate the importance of integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction?
A: Debriefs are evidence based tools used to improved the effectiveness of teamwork. Clearly, the collective understanding of ACLS protocol was lossed in the hierarchy of the Code Team. In a debrief, questions related to the order of care in these events could be questioned and discussed, therefore there opportunity for collective learning and accountability could have been achieved.
Why is it important to actively seek out family members to participate as a full partner in a patient’s care?
A: In circumstances where the patient is unable to provide a comprehensive history, it is essential to identify other sources of information that can provide lifesaving guidance on the patient’s needed treatment strategy.
What are some ways this team could record and share lessons learned from debriefs with other team members and across the organization, considering their time constraints?
A: Summarizing “lessons learned” and developing action steps related to gaps in knowledge or process are opportunities to share what each debrief illuminates. Each unit should have a designee that owns the debrief process and communicates findings in a meaningful way.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: Time will always be a challenge, particularly in high throughput healthcare environments like the Emergency Department. Establishing policy that requires debriefs before the end of shift, would set the expectation that the process be honored. This will require a well-communicated institutional commitment to clinical excellence that emphasized the benefits of such debriefs. Again, lessons learned should be shared to maximize the positive influence of the process.
What can we do to consistently engage the family as a potential source of key patient information?
A: Often times checklists are the best mechanism to systematize processes. As part of the admission, transfer or rapid response team mechanism, consideration of family as a resource should be included.
How can we make debriefs a constant team practice for learning and improvement?
A: Inbedding debriefs in the orientation process, or any time a new skill or learning exercise is deployed would teach the effectiveness and establish debriefs as part of the culture of the unit or institution.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Using the debriefing steps above, conduct a debrief of the errors in this story. Explain how your debrief might have prevented some of the errors that occurred, and/or would help prevent future errors.
Work with a partner to develop a list of ways to share information obtained in debriefs across the team and organization. Share your list with the class for further discussion.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Describe the importance of integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.*	Student struggles to describe the importance of integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.	Student can describe some of the importance of integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction, but needs more practice.	Student can accurately describe the importance of integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.
*Generate and summarize strategies for recording and sharing lessons learned from debriefs with other team members and across the organization.*	Student struggles to generate and summarize strategies for recording and sharing lessons learned from debriefs with other team members and across the organization	Student can generate and summarize some strategies for recording and sharing lessons learned from debriefs with other team members and across the organization, but needs further practice.	Student can accurately generate and summarize strategies for recording and sharing lessons learned from debriefs with other team members and across the organization
*Explain the importance of integrating family members as a critical source of patient information and medical history, especially if the patient is incapacitated or impaired.*	Student struggles to explain the importance of integrating family members as a critical source of patient information and medical history, especially if the patient is incapacitated or impaired.	Student can explain some of the importance of integrating family members as a critical source of patient information and medical history, especially if the patient is incapacitated or impaired, but needs further practice.	Student can accurately explain the importance of integrating family members as a critical source of patient information and medical history, especially if the patient is incapacitated or impaired.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication (Details and definitions can be found in the Best Practices section of the website). Some best practices to consider for improving team communication include:

Call Out
Check-Backs
Cross Monitoring
Debriefs
Feedback
Task Assistance
STEP
3Ws – Who I am, What I am Doing, and Why I Care

Posted in Pro ED Guides, Teacher Guides | No Comments »

131 – Between the Cracks Instructor’s Guide

Thursday, September 25th, 2014

131

Instructor’s Guide – Between the Cracks

Overview:
This story demonstrates the importance of improving team communication, developing effective cues, re-engineering processes, and promoting coordination between units to reduce Emergency Department length of stay (LOS) to improve patient safety, efficiency, and satisfaction.

Primary Learning Outcomes

After completing this lesson, the student will be able to:

Identify and describe strategies and methods to improve team monitoring of patient flow status related to discharge or admitting.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Quality Improvement (QI): Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.

Reflection Questions:

Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

Who do you believe is most at fault for the breakdown in Mrs. Harris’ care in the story? Explain your reasoning.
A: Each unit has its own established processes of care. In any unit there should be clear delineation of “ownership” of various tasks, including the monitoring and communication of admission and transfer status. Although a unit coordinator may assume responsibility for order entry, Ginny, as Mrs. Harris’ nurse is ultimately responsible to advocate for her needs and communicate on her behalf.
What strategies and methods for monitoring patient flow could this team use to achieve better quality patient care?
A: Emergency departments are very busy units, requiring systems that support enhanced communication. It sounds, from the story, that attempts at providing “communication boards” are in place. The challenge is to maximize their utilization. The opportunities include: establish an “on stage” area for patient care rooms. Ginny’s team member Linda was clearly available to assist with Mrs. Harris’ transfer as she had 15 minutes for chatting. Additionally, there should be someone responsible for monitoring updates to the board, and communicating these updates to the nurses impacted by changes. Potentially this role could be fulfilled by the Charge Nurse. In her role as Charge, she could better assess everyone’s work load and encourage team support when the balance of responsibilities is skewed.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

What can we learn from this story?
A: Technology is helpful but not fullproof and requires intentional use. Establishing monitoring processes and communication expectations cannot be assumed.
What will the events of this story likely do to Estelle’s perception of the hospital? Why is this an important consideration for all members of the medical team?
A: Estelle’s perception of the hospital will be negatively impacted by the lack of teamwork. Clearly, the way healthcare professional work together and communicate in the care environment can either support a patient centered focus or reflect a self importance message.

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting.

Read through the story again and make a flow chart that shows everyone who was involved (or supposed to be involved) in Mrs. Harris’ transfer to her new room. How do you think this system could be improved? Where is the breakdown most likely to occur? Discuss your chart and solutions with the class.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Identify and describe strategies and methods to improve team monitoring of patient flow status related to discharge or admitting.*	Student struggles to identify and describe strategies and methods to improve team monitoring of patient flow status related to discharge or admitting.	Student can identify and describe some strategies and methods to improve team monitoring of patient flow status related to discharge or admitting.	Student can accurately identify and describe strategies and methods to improve team monitoring of patient flow status related to discharge or admitting.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

Story-Specific Best Practices and Proven Tools:

Call-Out
Check Backs
Collaboration
Cross Monitoring
Handoff
SBAR
STEP
Patient Rounding
“Speak Up”

Posted in Pro ED Guides, Teacher Guides | No Comments »

135 – If It Was Your Mom Student’s Guide

Thursday, September 25th, 2014

135

Student’s Guide – If It Was Your Mom

Primary Learning Outcomes

After completing this lesson, you will be able to:

Examine and describe team practices to promote cross-monitoring of high risk procedures including medication administration.
Summarize policies and practices that can limit distractions and multi-tasking during critical care practices.
Describe processes for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Cross-Monitoring

Story Directions:

As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.

Reflection Questions:

Why is cross-monitoring an important practice? How was it illustrated in this story?
How can we make sure our cross-monitoring of important procedures or medication administrations is not compromised by multitasking or staff changes?
How can we include the patients and families as members of the clinical care team and ensure that they have the opportunity to ask questions and express concerns before important procedures or medication administrations?

Posted in Pro ED Guides, Student Guides | No Comments »

134 – In Whose Time? Student’s Guide

Thursday, September 25th, 2014

134

Student’s Guide – In Whose Time?

Primary Learning Outcomes

After completing this lesson, you will be able to:

Describe evidence-based safety protocols across the team to reduce planned deliveries less than 39 weeks without medical indication.
Adopt and apply an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication.
Explain the increased risks to the newborn to the patient and their family with deliveries less than 39 weeks without medical indication.

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: CUS

The CUS technique provides a framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue, but also the magnitude of the issue.

CUS Technique:

First, state your Concern.
Then state why you are Uncomfortable.
If the conflict is not resolved, state that there is a Safety issue.

Story Directions:

As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.

Reflection Questions:

Explain why it is important to follow evidence-based practices to ensure patient safety, regardless of inconveniences it might cause.
How might Beverly’s use of the CUS technique prevented the issues in this story? Why do you think she didn’t speak up?
How is this story a non-example of patient-centered care? What would you change to make it an example of patient-centered care?

Posted in Pro ED Guides, Student Guides | No Comments »

Author Archive

139 – Nature to Nurture Instructor’s Guide

Instructor’s Guide – Nature to Nurture

138 – The Pressure’s On Instructor’s Guide

Instructor’s Guide – The Pressure’s On

137 – Vigilance is Never In Vain Instructor’s Guide

Instructor’s Guide – Vigilance is Never In Vain

135 – If It Was Your Mom Instructor’s Guide

Instructor’s Guide – If It Was Your Mom

134 – In Whose Time? Instructor’s Guide

Instructor’s Guide – In Whose Time?

133 – They Come and Go Instructor’s Guide

Instructor’s Guide – They Come and Go

132 – Debrief or Perish Instructor’s Guide

Instructor’s Guide – Debrief or Perish

131 – Between the Cracks Instructor’s Guide

Instructor’s Guide – Between the Cracks

135 – If It Was Your Mom Student’s Guide

Student’s Guide – If It Was Your Mom

134 – In Whose Time? Student’s Guide

Student’s Guide – In Whose Time?

My StoryCare

Story Resources

Program Support