Author Archive
Friday, October 3rd, 2014
168
Instructor’s Guide – Step Up To Rounding
Overview:
This story is about falls which are three times more common in hospital and nursing home settings where they result in higher injury rates. But they can be reduced through a number of simple solutions, such as tweaking hourly rounds to make them more meaningful.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify unmet patient needs that contribute to risk for falls.
- Describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls.
- Develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model.
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.
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 was the importance of modifying the team’s current patient care practices?
A: The current patient care practices were not decreasing the amount of patient falls or the number of times that patients were using the call-light.
- What evidence-based practices for fall prevention were developed and put into place in this story?
A: They identified a few unmet patient needs that contributed to risk for falls and decided to focus on those issues while in the patient rooms.
- How did Taylor demonstrate effective leadership to ensure the commitment of her team to minimizing the risk of harm to patients?
A: She demonstrated leadership by allowing the staff to work through some of their concerns and issues without butting in to the conversation. She encouraged them to come-up with their own resolution and then supported their decision.
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: Most of the staff wanted to make the situation better for the patients and for themselves. Often times, people involved in a problem want to learn and grow from the situation. It was a good idea to reflect on what happened and potential options to take in the future. This should not be used as a punishment, but as a way to learn a different way of providing care to the patient.
- What steps can you take to ensure that you round with a purpose?
A: Tell the patient the 3Ws – Who I am, What I am Doing, Why I care. They would then emphasize the need to use the call light when they need to get up. Also, to help with any further issues the patient may have while the nurse is still in the room.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation for your colleagues describing unmet patient needs that contribute to risk for falls for your patients.
- Think of some patient-care practices you have observed that might lead to falls. Describe them. How might they be modified to better prevent falls in the future?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify unmet patient needs that contribute to risk for falls. |
Student struggles to identify unmet patient needs that contribute to risk for falls. |
Student can identify unmet patient needs that contribute to risk for falls, but needs further practice. |
Student can accurately identify unmet patient needs that contribute to risk for falls. |
| Describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls. |
Student struggles to describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls. |
Student can describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls, but needs further practice. |
Student can accurately describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls. |
| Develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model. |
Student struggles to develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model. |
Student can develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model, but needs further practice. |
Student can accurately develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model. |
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:
- Advocacy and Assertion
- Check-Backs
- Collaboration
- Cross Monitoring
- Feedback
- I PASS the BATON
- AskMe3
- Patient Rounding
- 3Ws – Who I am, What I am Doing, Why I care
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
167
Instructor’s Guide – Did You Remember to SBAR?
Overview:
This story is about SBAR, a TeamSTEPPS® tool that helps care providers through the use of a structured format for giving reports between clinical staff members that leads to increased efficiency and enhanced safety.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the words and meaning of the TeamSTEPPS SBAR tool.
- Describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.
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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: SBAR
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.
SBAR: SBAR provides a standardized framework for members of the healthcare team to communicate about a patient’s condition. SBAR is an easy-to-remember, concrete mechanism that is useful for framing any conversation, often a critical one requiring a clinician’s immediate attention and action. SBAR originated in the U.S. Navy submarine community to quickly provide critical information to the Captain. It provides members of the team with an easy and focused way to set expectations for what will be communicated and how. Standards of communication are essential for developing teamwork and fostering a culture of patient safety. SBAR provides a vehicle for individuals to speak up and express concern in a concise manner. In phrasing a conversation with another member of the team, consider the following:
- Situation: What is happening with the patient?
- Background: What is the clinical background?
- Assessment: What do I think the problem is?
- Recommendation: What would I recommend?
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
- How did Dr. Cowan’s approach to Henry improve teamwork, communication, and patient care in the hospital?
A: She took the time to sit down with him and explain the issue to him. She did not belittle him or make him feel dumb.
- What does this story illustrate about how effective team communication can impact patient care?
A: Henry seemed to need some help with one of his patients, but he did not communicate that clearly with the doctor. If we do not clearly communicate our needs then those around us cannot help us. This in turn impacts patient care because they are not receiving the best care possible.
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: Clear and concise information is important when providing information to other health care professionals. This can be done by using SBAR. It is a standardized framework used to communicate with other healthcare professionals.
- How could you employ SBAR to help you communicate with other team members?
A: SBAR should be used when communicating with other health care team members. One way is to offer an in-service on the use of SBAR. Once staff become more familiar with it they will become more comfortable using it.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation in which you teach other members of your team about SBAR and how to use it effectively.
- Think of another scenario in which you might use SBAR. Write a dialogue or act out your scenario, and demonstrate the effective use of SBAR.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the words and meaning of the TeamSTEPPS SBAR tool. |
Student struggles to identify the words and meaning of the TeamSTEPPS SBAR tool. |
Student can identify the words and meaning of the TeamSTEPPS SBAR tool, but needs further practice. |
Student can accurately identify the words and meaning of the TeamSTEPPS SBAR tool. |
| Describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate. |
Student struggles to describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate. |
Student can describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate, but needs further practice. |
Student can accurately describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate. |
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:
- Huddles
- STEP
- Cross-Monitoring
- Advocacy and Assertion
- Handoffs
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
166
Instructor’s Guide – Prioritizing Pressure Care
Overview:
Using a pressure prevention bundle can reduce the risk for pressure ulcers (PUs). Unfortunately, even though nurses understand its importance, it’s associated with low status work and they often don’t make it a priority, falsely assuming that LPNS are performing skin care/PU prevention.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention.
- Describe the responsibilities of each clinical staff role in the prevention of pressure ulcers.
- Explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk.
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.
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 identifying the training that all clinical staff have and need in pressure ulcer prevention?
A: It’s important that nurses can recognize early signs of skin break down and prevent it from happening. The safety of the patient needs to be the first priority.
- How did Thelma’s attitude in the story affect the care her patients received?
A: Thelma had her own priorities and duties she felt were more important than helping the LVN with her work. She did not address the fact that Lucy had asked for help turning the patients previously.
- How could this hospital better address pressure ulcer care and risk prevention to improve patient care?
A: Stress appears to be her major concern and potentially a reason the nurses did not help each other when turning patients. The hospital could try to implement a plan where the nursing staff rounded together to turn patients and assess for skin breakdown.
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: Thelma may have been suffering from burnout. Stress, fatigue, and burnout can happen to anyone. Every nurse to subject to burnout and they need to be aware of the signs so that patient safety remains the primary focus and not the stress of the nurse.
- What can you do to ensure you are up-to-date with evidence-based pressure ulcer prevention measures?
A: One way is to take continuing education modules that focus on pressure ulcer prevention. Another is to talk to the educator for that unit or the clinical nurse specialist to find out if there are new ways to prevent pressure ulcers.
Suggested Classroom Mastery Activities:These activities can be tailored for individuals or groups in a face to face or online setting.
- Imagine you are the manager of this team. Create a plan for addressing pressure ulcer prevention training and the implementation of that training. Be sure to define roles for LPNs and RNs.
- Create a brochure or presentation for families and patients about the risks for pressure ulcers and strategies to reduce risk.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention. |
Student struggles to explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention. |
Student can explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention, but needs further practice. |
Student can accurately explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention. |
| Describe the responsibilities of each clinical staff role in the prevention of pressure ulcers. |
Student struggles to describe the responsibilities of each clinical staff role in the prevention of pressure ulcers. |
Student can describe the responsibilities of each clinical staff role in the prevention of pressure ulcers, but needs further practice. |
Student can accurately describe the responsibilities of each clinical staff role in the prevention of pressure ulcers. |
| Explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk. |
Student struggles to explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk. |
Student can explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk, but needs further practice. |
Student can accurately explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk. |
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:
- Briefs
- Collaboration
- Cross Monitoring
- CUS
- I PASS the BATON
- Task Assistance
- 3Ws – Who I am, What I am Doing, and Why I Care
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
165
Instructor’s Guide – Walking Into Risk
Overview:
This story is about how most Venous Thromboembolisms (VTEs) in the ambulatory setting occurring within one month of discharge and are preventable, but oncologists’ adherence to VTE assessment/prophylaxis guidelines is suboptimal and a major barrier to implement VTE protocol.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the rationale for VTE risk assessment and prevention.
- Determine the barriers to conducting VTE assessment in the ambulatory setting.
- Create a team action plan to implement VTE risk assessment and prophylaxis.
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.
- 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.
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 VTE assessment and risk prevention?
A: It demonstrates the importance of complying with set standards related to VTE. It is just as important to follow the standards used to prevent harm to the patient as it is to comply with medication orders.
- What barriers kept the proper assessment from being conducted in the first place?
A: The doctor was in a hurry to get the medications ordered and did not find it urgent to complete a VTE assessment or risk prevention protocol.
- How did Dr. Levine and Donna’s inaction affect both Willie’s recovery and patient care experience?
A: Due to their inactivity the patient experienced a Venous Thromboembolisms. This should not have occurred in the first place and will potentially result in harm to the patient.
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: Protocols are in place for a reason and are supported by evidence based practice. This should not have occurred in the first place and it is preventable.
- What can you do to ensure that VTE risk assessment is conducted with all patients in your ambulatory care setting?
A: Each admission could have a check-off sheet on the front of the chart to ensure a VTE risk assessment has been conducted.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation that explains the rational for VTE risk assessment and prevention for the members of your team. Share your work with the class or a partner for discussion.
- Assess the barriers to conducting VTE risk assessments in a setting in which you have worked or visited. Think of some possible solutions for overcoming those barriers.
- Create a team action plan to implement VTE risk assessment and prophylaxis for the team in this story.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the rationale for VTE risk assessment and prevention. |
Student struggles to identify the rationale for VTE risk assessment and prevention. |
Student can identify the rationale for VTE risk assessment and prevention, but needs further practice. |
Student can accurately identify the rationale for VTE risk assessment and prevention. |
| Determine the barriers to conducting VTE assessment in the ambulatory setting. |
Student struggles to determine the barriers to conducting VTE assessment in the ambulatory setting. |
Student can determine the barriers to conducting VTE assessment in the ambulatory setting, but needs further practice. |
Student can accurately determine the barriers to conducting VTE assessment in the ambulatory setting. |
| Create a team action plan to implement VTE risk assessment and prophylaxis. |
Student struggles to create a team action plan to implement VTE risk assessment and prophylaxis. |
Student can create a team action plan to implement VTE risk assessment and prophylaxis, but needs further practice. |
Student can accurately create a team action plan to implement VTE risk assessment and prophylaxis. |
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:
- Feedback
- Briefs
- Bedside Handoffs
- Collaboration
- STEP
- Cross Monitoring
- I PASS the BATON
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
164
Instructor’s Guide – Who Knows Best?
Overview:
This story is about mutual support, especially when it comes to preventing VAP. A team-oriented approach to patient care requires that each team member’s expertise is respected, and differences of opinion about the direction of care are worked out in a supportive manner.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the core components of a VAP bundle.
- Describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application.
- Explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care.
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.
- 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.
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 components of a VAP bundle were addressed in this story?
A: Changing the ventilator circuit was addressed by Denise as a procedure that used to be performed, but may not be appropriate anymore.
- What does this story illustrate about the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application?
A: It’s important to demonstrate mutual support during information exchange, even team members do not agree on the plan of care.
A: All health care professionals are responsible for the care given to each patient, even if the doctor or another health care professional has not done the right thing in a previous situation.
- How do you feel Denise handled the disagreement with Dr. Martin? What else could she have done?
A: She handled the situation very well. She stayed focused on the task at hand and did not get distracted by the negative comments made by 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: It’s important to have mutual respect even when disagreements occur. The doctor did not agree with the suggestion made by Denise, but Denise continued to address the current issue. She was respectful and appropriate with the doctor.
- What can you do during daily rounds to make sure everyone agrees on patient goals regarding ventilator use?
A: Don’t hesitate to ask for clarification on an order if you are unsure. This may be to another nurse, the charge nurse, a doctor or the respiratory therapist.
A: If protocol is established then focus on the task at hand and try not to get distracted with negative comments or other issues.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Craft a poster or graphic to remind your colleagues of the core components of a VAP bundle.
- What steps can a team take to provide mutual support for team members in applying a VAP bundle? Create a protocol for providing mutual support for all team members and share with the class or a partner for discussion.
- Compose the dialogue that might have occurred where this story left off. How do you think Denise should address Dr. Hannah, considering Dr. Martin and the team are still in the room?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List the core components of a VAP bundle. |
Student struggles to list the core components of a VAP bundle. |
Student can list the core components of a VAP bundle, but needs further practice. |
Student can accurately list the core components of a VAP bundle. |
| Describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application. |
Student struggles to describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application. |
Student can describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application, but needs further practice. |
Student can accurately describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application. |
| Explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care. |
Student struggles to explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care. |
Student can explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care, but needs further practice. |
Student can accurately explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care. |
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:
- Advocacy and Assertion
- Briefs
- Collaboration
- Cross Monitoring
- Huddles
- Bedside Handoffs
- Check-backs
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
163
Instructor’s Guide – We Need 100% of You Now!
Overview:
This story is about how distractions can cause serious compromises in patient safety and need to be consciously controlled. Some teams have devised approaches to prevent distractions, similar to how the airline industry has created “sterile cockpits” that keep the team focused when it counts.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify potential distractions that occur during high-consequence patient care processes, such as surgery.
- Decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand.
- Describe and adopt guidelines that control distractions during the high-consequence time periods.
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.
- 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.
- 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 potential distractions could have disrupted the surgery in this story?
A: Mistakes or the potential for a mistake can easily be made, expecially when healthcare professionals are distracted. The potential distractions in this story include music, texting, and looking at one’s own personal phone.
- How did the team’s use of the “sterile cockpit” environment contribute to Steffan’s patient experience?
A: The patient experience was improved with the use of the “sterile cockpit”. Steffan felt more confident in the staff once they stopped what they were doing and focused on his upcoming surgery.
- How does the “sterile cockpit” environment” help control distractions during high-consequence time periods?
A: It stops all other activities and focuses on the patient and the procedure. This is one way to prevent errors in the surgical ward.
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: Patients want to be involved in their own care. They are interested in what the health care team is doing and they want to assist as much as they can.
- What can the team do to consciously manage distractions?
A: They should continue to use the “sterile cockpit” environment before any procedure. They need to continue to include the patient in the upcoming procedure and let them know what the plan of care is.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Brainstorm a list of potential distractions that could occur during high-consequence patient care processes like surgery. Describe ways to mitigate those distractions, and create a plan for maintaining a safe and patient-centered environment.
- Generate a chart to differentiate between periods of time that demand 100% of the caregiver team’s attention to the patient and procedure at hand, and the time periods that are appropriate for handling other matters like emails and data entry.
- Construct a protocol to control distractions during high-consequence time periods. Summarize your points in a poster or graphic to remind your team of the guidelines you’ve developed.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify potential distractions that occur during high-consequence patient care processes, such as surgery. |
Student struggles to identify potential distractions that occur during high-consequence patient care processes, such as surgery. |
Student can identify potential distractions that occur during high-consequence patient care processes, such as surgery, but needs further practice. |
Student can accurately identify potential distractions that occur during high-consequence patient care processes, such as surgery. |
| Decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand. |
Student struggles to decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand. |
Student can decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand, but needs further practice. |
Student can accurately decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand. |
| Describe and adopt guidelines that control distractions during the high-consequence time periods. |
Student struggles to describe and adopt guidelines that control distractions during the high-consequence time periods. |
Student can describe and adopt guidelines that control distractions during the high-consequence time periods, but needs further practice. |
Student can accurately describe and adopt guidelines that control distractions during the high-consequence time periods. |
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:
- Collaboration
- CUS
- Feedback
- I’M SAFE
- STEP
- Two-Challenge Rule
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
162
Instructor’s Guide – Aware of the Situation
Overview:
This story is about an elderly woman being cared for in a nursing home who is incontinent and catheterized despite new criteria for catheterization, because indwelling urinary catheters cause up to 80% of hospital-acquired infections, 30% of which are unnecessary.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the core features of a CAUTI Bundle.
- Identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit.
- Explain the importance of implementing evidence-based protocols to reduce CAUTI.
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.
Reflection Questions:
Students will answer re flection 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 core features of a CAUTI bundle were in place in this story?
A: The CAUTI bundle had just been implemented on this unit. This was a new policy for this unit.
- What attitudinal and work-load barriers were present in the story that prevented the implementation of the new protocol?
A: The staff were overworked and understaffed in this situation. This made implementation of the new protocol more difficult.
- What does this story illustrate about the importance of implementing evidence-based protocols to reduce CAUTI?
A: This story illustrates the importance of implementing evidence-based protocols because this is another example of a patient that developed a urinary tract infection when it could have been avoidable. This is another reason why established guidelines and protocols are important for nurses to follow. This way they are not reliant on their own personal judgement.
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: We have learned the importance of having a catheter checklist or protocol. Evidence based practice guidelines were newly implemented in this facility, and for good reason.
- What steps can you take to make CAUTI prevention part of your everyday practice?
A: Be proactive and remove the catheter as soon as medically possible. The patient should not suffer more because it is convenient for the staff.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a poster or graphic that reminds staff of the core features of a CAUTI bundle.
- Imagine how Donna could best address the issue with her staff. Compose the email that she was about to write, addressing the problems on the unit.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List the core features of a CAUTI Bundle. |
Student struggles to list the core features of a CAUTI Bundle. |
Student can list the core features of a CAUTI Bundle, but needs further practice. |
Student can accurately list the core features of a CAUTI Bundle. |
| Identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit. |
Student struggles to identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit. |
Student can identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit, but needs further practice. |
Student can accurately identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit. |
| Explain the importance of implementing evidence-based protocols to reduce CAUTI. |
Student struggles to explain the importance of implementing evidence-based protocols to reduce CAUTI. |
Student can explain the importance of implementing evidence-based protocols to reduce CAUTI, but needs further practice. |
Student can accurately explain the importance of implementing evidence-based protocols to reduce CAUTI. |
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:
- Advocacy and Assertion
- Collaboration
- Cross Monitoring
- SBAR
- Briefs
- Debriefs
- Huddles
- I’M SAFE
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
161
Instructor’s Guide – Dial I for Ignore
Overview:
This story is about the importance of hand washing. Failing to wash hands between each patient visit can result in CLABSIs. According to a recent CDC report, the majority of CLABSIs are now occurring outside of ICUs, especially in outpatient dialysis.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the essential best practices in a CLABSI bundle.
- Describe and apply evidence-based practices in hand hygiene.
- Explain the importance of providing patients with opportunities to ask questions about their care.
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.
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 essential best practices in a CLABSI bundle were followed in the story? Which weren’t?
A: Good hand is an important part of best practices and of reducing the risk of infection. It is very important that every member of the team complies by the best practices found in the CLABSI bundle.
- What does this story illustrate about the importance of applying evidence-based practices in hand hygiene?
A: It illustrates that all health care professionals need to comply with hand hygiene standards.
- What steps can the team take to ensure that they are consistently following best practices in hand hygiene?
A: It is important to keep the family members aware of the standards of care for their loved ones. It is empowering to the family members to keep them informed about medication or procedures their loved ones are receiving.
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 keeping the family aware of safe practices. The nephew wanted to say something about the phlebotomist not washing her hands, but he didn’t know if he should.
- What steps can I take to ensure patients have opportunities to ask questions about their care, and that I welcome those questions?
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.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- List the essential best practices in a CLABSI bundle and explain their importance.
- Create a poster or graphic that reminds all employees and family of the importance of following evidence-based practices for hand hygiene.
- Brainstorm ways you could engage patients and families in being an integral part of maintaining hand hygiene at all times.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List the essential best practices in a CLABSI bundle. |
Student struggles to list the essential best practices in a CLABSI bundle. |
Student can list the essential best practices in a CLABSI bundle, but needs further practice. |
Student can accurately list the essential best practices in a CLABSI bundle. |
| Describe and apply evidence-based practices in hand hygiene. |
Student struggles to describe and apply evidence-based practices in hand hygiene. |
Student can describe and apply evidence-based practices in hand hygiene, but needs further practice. |
Student can accurately describe and apply evidence-based practices in hand hygiene. |
| Explain the importance of providing patients with opportunities to ask questions about their care. |
Student struggles to explain the importance of providing patients with opportunities to ask questions about their care. |
Student can explain the importance of providing patients with opportunities to ask questions about their care, but needs further practice. |
Student can accurately explain the importance of providing patients with opportunities to ask questions about their care. |
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:
- Huddles
- Check-Backs
- Patient Rounding
- Two-Challenge Rule
- CUS
- Cross Monitoring
- 3Ws – Who I Am, What I am Doing, and Why I Care
- Task Assistance
- AskMe3
- “Speak Up”
- Advocacy and Assertion
- DESC Script
- I’M SAFE
- SBAR
- Briefs
- Call-Outs
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Friday, October 3rd, 2014
160
Instructor’s Guide – Admission of Failure
Overview:
This story is about preventable readmissions. They may result from incomplete treatment or poor care of the underlying problem, or may reflect poor coordination of services at the time of discharge. Every team member is responsible for the discharge process.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe evidence-based strategies that reduce preventable readmissions.
- Explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings.
- Generate a protocol to coordinate care between hospital and community settings.
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.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
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
- How did General Hospital fail to prevent Akiki’s relapse?
A: General Hospital did not provide the family with enough discharge information or physician follow-up to avoid a relapse.
- What evidence-based strategies to reduce preventable readmissions did Helen employ? Why were they important?
A: Helen found ways to engage the family in their discharge planning.
- What does this story illustrate about the importance of including families and patients in the discharge planning process?
A: This allows families to feel empowered and that they are a part of the discharge process. They are more likely to comply with discharge instructions if they understand the instructions and why they are so important.
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 engaging patients and families in the discharge planning process. Patient safety should be the priority for all health care providers
- What can a team do to empower patients to be actively involved in their discharge planning?
A: Explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during the transition from the hospital to community settings.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Brainstorm ways to engage patients in their discharge planning. Share them with a partner and create a presentation of your best/most creative ideas.
- Create a brochure to review with patients upon discharge that helps engage them in their discharge process.
- Develop a protocol for coordinating care between the hospital and community settings.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe evidence-based strategies that reduce preventable readmissions. |
Student struggles to describe evidence-based strategies that reduce preventable readmissions. |
Student can describe evidence-based strategies that reduce preventable readmissions, but needs further practice. |
Student can accurately describe evidence-based strategies that reduce preventable readmissions. |
| Explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings. |
Student struggles to explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings. |
Student can explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings, but needs further practice. |
Student can accurately explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings. |
| Generate a protocol to coordinate care between hospital and community settings. |
Student struggles to generate a protocol to coordinate care between hospital and community settings. |
Student can generate a protocol to coordinate care between hospital and community settings, but needs further practice. |
Student can accurately generate a protocol to coordinate care between hospital and community settings. |
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:
- Advocacy and Assertion
- Check-Backs
- Collaboration
- Handoff
- Cross Monitoring
- 3Ws – Who I Am, What I am Doing, and Why I Care
- I PASS the BATON
- SBAR
- AskMe3
- Bedside Handoffs
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
159
Instructor’s Guide – Brief to Set the Tone
Overview:
Team leaders must set the tone for service excellence. Without collective decision-making, targeted goal setting and clear roles and responsibilities, team performance suffers. This has a negative impact on patient satisfaction and safety.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the components of successful team briefing.
- Describe the importance of planning for contingencies related to staffing, resources, and equipment.
- Explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors.
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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Team Briefs
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 health care professionals.
Team Briefs: Similar to a pre-flight checklist used in aviation, during a brief the team leader should cover the items on the checklist. As in aviation, the briefings before flights provide the ideal forum for building a team dynamic that allows everyone to work together when carrying out routine tasks and when tackling unexpected problems. Briefs serve the following purposes:
- They clarify who will be leading the team so that others know to whom to look for guidance;
- They open lines of communication among team members, ensuring that everyone can contribute their unique knowledge base to the task, and thereby set the tone for the upcoming procedure. Protocols, responsibilities, and expected behaviors are discussed and reinforced so that possible misunderstandings are avoided;
- They prepare the team for the flow of the procedure, contingency plans, and the means for resolving any unusual circumstances; and,
- By delineating expectations, they reduce disruptive or unexpected behaviors.
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 components of successful team briefings are demonstrated in this story?
A: It is important the correct checks and communication are done no matter what situation is present. This situation could have turned into a negative conversation regarding the nursing staff, but instead it turned into an open dialogue.
- What do you feel Charlie did well in this story that helped build up his team?
A: He focused on the positive work and did not dwell on the complaints from the staff or nurses.
- What does this story illustrate about the importance of integrating safe practices into daily work practices by inviting team accountability and back-up behaviors?
A: The use of ‘check-backs’ allow for discussion and reflection to be made with each other. Although it may be subtle, the use of morning briefs is another way to improve communication and to invite other health care teams to be involved in the decision making process.
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: Appropriate communication, ‘check-backs’, and closed loop communication is important for team building and collaboration. The pharmacy team agreed it is better to have appropriate checks made instead of rushing forward with their work.
- What one thing can you do to set the tone for team-based care each day?
A: One way is to keep the morning meeting set on a positive tone. It is easy to get caught up with negative comments or issues, but a positive approach will set the tone for team-based care each morning.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a poster to remind your team members of the importance of team briefings.
- Write out a plan for this team’s morning briefings. What should they cover each day to be as successful and responsive to patient and staff needs as possible?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the components of successful team briefing. |
Student struggles to describe the components of successful team briefing. |
Student can describe the components of successful team briefing, but needs further practice. |
Student can accurately describe the components of successful team briefing. |
| Describe the importance of planning for contingencies related to staffing, resources, and equipment. |
Student struggles to describe the importance of planning for contingencies related to staffing, resources, and equipment. |
Student can describe the importance of planning for contingencies related to staffing, resources, and equipment, but needs further practice. |
Student can accurately describe the importance of planning for contingencies related to staffing, resources, and equipment. |
| Explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors. |
Student struggles to explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors. |
Student can explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors, but needs further practice. |
Student can accurately explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors. |
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:
- Briefs
- Feedback
- I’M SAFE
- AskMe3
- “Speak Up”
- 3Ws – Who I Am, What I am Doing, and Why I Care
- Cross Monitoring
- Task Assistance
- CUS
Posted in Pro ED Guides, Teacher Guides | No Comments »
