Author Archive
Friday, October 3rd, 2014
158
Instructor’s Guide – The Tiger Gets New Stripes
Overview:
This story is about the deviation from safety protocols. It is a leading cause of patient harm. Executive leaders must hold all providers and staff accountable for safe practices and protocols. Coaching for engagement is a strategy for gaining buy-in and behavior change.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain the consequences of not consistently following safety protocols or practices.
- Describe the importance of applying consistent consequences across all disciplines for not following safe practices.
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
- Why is it important that all team members consistently follow safety protocols and practices?
A: If all team members are consistently following safety protocols and practices it will help to reduce patient harm. They are put into place for a specific reason and are used for patient safety.
- Why was it imperative for Mr. Porter to establish the same standard for Dr. Barnes as he expected from the rest of the staff?
A: It will create consistency within each team. Also, every team member should be held to the same standards.
- If you were on this surgical team, what could you have done to help ensure that safety protocols were consistently practiced?
A: A check-off sheet could be created and used with each surgery. Also, the surgery team could inform the surgeon that safety protocols are to be used on every patient for every surgery. The surgical staff have the power to “speak up” and confront the surgeon. His surgeries are not an exception to the rule.
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 therapeutic communication allows for open dialogue and continued communication. The surgeon was not put down for his previous work, but he was informed of the standards used in this facility.
- What one thing could you do to ensure all members are consistently following safety protocols?
A: One way is to allow every team member to communicate openly with each other. Welcome communication and dialogue with the CEO, doctors and medical staff regarding any issues with patient safety.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write a dialogue in which a member of the surgical prep team confronts Dr. Barnes and explains the necessity and importance of the hospital’s safety protocols.
- Create a poster reminding colleagues of the importance of following safety protocols.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Explain the consequences of not consistently following safety protocols or practices. |
Student struggles to explain the consequences of not consistently following safety protocols or practices. |
Student can explain the consequences of not consistently following safety protocols or practices, but needs further practice |
Student can accurately explain the consequences of not consistently following safety protocols or practices. |
| Describe the importance of applying consistent consequences across all disciplines for not following safe practices. |
Student struggles to describe the importance of applying consistent consequences across all disciplines for not following safe practices. |
Student can describe the importance of applying consistent consequences across all disciplines for not following safe practices, but needs further practice. |
Student can accurately describe the importance of applying consistent consequences across all disciplines for not following safe practices. |
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
- CUS
- DESC Script
- Collaboration
- STEP
- Cross Monitoring
- “Speak Up”
- Two-Challenge Rule
- I’M SAFE
- 4 Step Process
- PEARLA
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
157
Instructor’s Guide – Improving Medication Safety
Overview:
This story is about how labor nurses are at risk for professional liability when titration results in uterine tachysystole aren’t recognized in a timely manner, and how effective nurse-doctor communication is crucial to provide an outstanding patient experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin.
- Describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin.
- Explain and adopt IHI elective induction and augmentation bundles.
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 are the responsibilities of team members in reducing patient harm associated with the use of oxytocin?
A: Team members need to be able to safely monitor the baby and the mother when administering oxytocin.
- How were those responsibilities fulfilled and neglected in this story?
A: The nurse did monitor the mother and baby, however she did not agree with the doctor’s order to increase the medication. She could have used ‘CUS’ to let the doctor know her concerns with the order to increase the oxytocin.
- What could be done to better empower Francine to speak up and intervene when she sees an unsafe situation involving oxytocin?
A: A check-back dialogue could be developed between the nursing staff and the physicians to facilitate better communication and empower the nurses.
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 could hear what was happening in the delivery room, but could not fully understand what was happening with the baby.
A: There did not appear to be a good check-back dialogue as the delivery nurse had not communicated fully with the doctor. She also did not inform the patient about what she was doing.
- What can I do to ensure that I speak up and intervene if an unsafe situation involving oxytocin may be occurring?
A: A better check-back dialogue could have been initiated. It appeared as if the nurse knew better, but she did not communicating that information back to the doctor.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Research the IHI elective induction and augmentation bundles. Create a presentation for your colleagues on why these bundles are important to ensure patient safety, and how they should be implemented and adopted.
- Describe what might have happened if Francine had not intervened when she did. What dangers were there to the patient and baby?
- Research Francine’s liability in this situation. Write a brief on the liability of nurses when titration results in uterine tachysystole aren’t recognized in a timely manner.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin. |
Student struggles to describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin. |
Student can describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin, but needs further practice. |
Student can accurately describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin. |
| Describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin. |
Student struggles to describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin. |
Student can describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin, but needs further practice. |
Student can accurately describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin. |
| Explain and adopt IHI elective induction and augmentation bundles. |
Student struggles to explain and adopt IHI elective induction and augmentation bundles. |
Student can explain and adopt IHI elective induction and augmentation bundles, but needs further practice. |
Student can accurately explain and adopt IHI elective induction and augmentation bundles. |
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:
- STEP
- Task Assistance
- Two-Challenge Rule
- AskMe3
- SBAR
- Advocacy and Assertion
- Cross Monitoring
- “Speak Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
156
Instructor’s Guide – Everyone is a Monitor
Overview:
This story is about the impacts of adverse drug events (ADEs). Proper communication protocols between physicians and nursing home staff are essential to prevent patient ADEs.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety.
- Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
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 evidence-based practices for medication safety were not followed in this story?
A: There was a lack of closed loop communication between the physician and the nurse. The nurse assumed the doctor knew the regularly prescribed medications for the patient, but did not communicate that information to the doctor.
- What are some ways this team could ensure better medication safety for their patients?
A: The use of ‘check-backs’ allow for discussion and reflection to be made with each patient. The nurse in this situation could have used ‘check-backs’ or closed loop communication when giving report to the doctor and receiving medication orders.
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: There was a lack of closed loop communication between the physician and the nurse. The nurse assumed the doctor was aware of the patients medication and her lack of shared decision-making and closed-loop communication had a negative impact on patient safety
- What can I do to ensure I monitor situations to ensure medication safety?
A: One way is to ensure that medication reconciliation is completed on each patient. Another way is to create a checklist to be completed each time a patient receives a new medication. This should include the patient’s current medications and any allergies.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a checklist for this team to use to ensure medication safety for all of their patients.
- Identify the primary challenges to medication safety in this story, and describe how they could be overcome.
- Create a presentation to remind staff to follow evidence-based practices to improve medication safety and prevent ADEs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety. |
Student struggles to describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety. |
Student can describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety, but needs further practice. |
Student can accurately describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety. |
| Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. |
Student struggles to identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. |
Student can identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking, but needs further practice. |
Student can accurately identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. |
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
- Cross Monitoring
- STEP
- SBAR
- “Speak Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
155
Instructor’s Guide – No Shortcuts to Risk Reduction
Overview:
This story is about surgical site infections (SSIs). According to the CDC, SSIs are the second most common healthcare-acquired infection. Following evidence-based perioperative practices such as using precautions to prevent contamination of sterile equipment can prevent the risk of SSI.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List evidence-based perioperative practices that prevent SSIs.
- Demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices.
- Describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist.
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.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: CUS
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.
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.
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 evidence-based perioperative practices were ignored in this story? Why are they important to follow?
A: The practices that were ignored in this story are related to surgical asepsis. Surgical equipment should stay in the sterile packaging until it is opened in the surgical suite.
- What barriers did Celeste face in addressing the breaks in evidence-based practice that she witnessed? What does this say about the norms of the unit?
A: She was concerned about speaking up because she is new to this unit. The surgical nurses had been preparing surgical equipment in this way for an extended amount of time. Due to the fact this was not a new occurrence may make it even more difficult to discuss.
- How could the use of the CUS Technique have helped Celeste address her concerns?
A: First, she would need to state her concern regarding the sterile equipment being opened in the storage unit. Then she would need to stay why she was uncomfortable. Then if the conflict were not resolved, she would need to state their was a patient safety issue related to the equipment.
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 although the staff knew the right thing to do they had become accustomed to doing it a different way. It is not always wrong to change how things are done, but they still must comply with safety standards. In this case the staff were no longer complying by the necessary perioperative practices.
- What steps can the team take to ensure we feel able to intervene if another team member takes a safety-compromising shortcut?
A: One way is to encourage open communication and regular dialogue regarding patient care and safety.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write a dialogue in which Celeste utilizes the CUS Technique to address the breach of evidence-based practice that she has witnessed. How do you think the others might react, and what might she need to do to ensure patient safety?
- Make a poster to remind team members about the importance of following evidence-based perioperative practices that prevent SSIs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List evidence-based perioperative practices that prevent SSI. |
Student struggles to list evidence-based perioperative practices that prevent SSIs. |
Student can list evidence-based perioperative practices that prevent SSIs, but needs further practice and instruction. |
Student can accurately list evidence-based perioperative practices that prevent SSIs. |
| Demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
Student struggles to demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
Student can demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices, but needs further practice and instruction. |
Student can accurately demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
| Describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
Student struggles to describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
Student can describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist, but needs further practice and instruction. |
Student can accurately describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
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
- STEP
- Call-Out
- AskMe3
- Cross Monitoring
- SBAR
- “Speak Up”
- Task Assistance
- Huddles
- 4 Step Process
- Two-Challenge Rule
- DESC Script
- PEARLA
- CUS
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
154
Instructor’s Guide – Patients are People Too
Overview:
This story illustrates how knowing about being patient-centered, and actually doing it, are two different things, and that staff must be intentional and self-aware about engaging the patient.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the core components of patient-centered behavior.
- Describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members.
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.
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 important elements of patient-centered care did Tiana and Javier miss in this story?
A: The patient should be the source of control and full partner in the care team
A: The tasks should not prevent active listening
A: Explaining the rationale for each step and speaking to NOT around the patient involves them in the care process
- Why is it important to view events from the patient’s perspective when evaluating the efficacy of patient-centered care?
A: Safe and quality care requires that the patient be actively involved in the plan of care
A: Understanding that hospital sounds and otherwise simple cryptic comments can be fear inducing if not thoroughly explained and put into context
A: Being actively present and engaging is key to effective communication
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: Verbalizes that the patients experience is important does not demonstrate an understanding of patient centered care.
A: Following protocols and procedures does not demonstrate that the patient is the focus of the care
A: Enhancing the patient experience requires a patient centered approach
- How can we as a team make sure our patient-centered principles translate consistently into patient-centered behaviors?
A: Mentors should demonstrate consistent patient centered competency
A: Patient centered understanding cannot be evaluated via testing or verbalizing alone, but must be demonstrated over time
A: Holding one another accountable and have a culture of transparent communication is key to be a highly effective team
- How can I make sure I use good patient-centered behavior in every interaction with my patients?
A: Assess verbal and non-verbal queues with each interaction to better under that patients preferences, values and needs.
A: Find dedicated time to be present.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write Mrs. Tillman’s review of her care on her patient survey. What do you think she would say about her experience with her nurses?
- Make a quick-reference chart or checklist that reminds nurses and other medical professionals to think about patient-centered care as they work through their normal procedures.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the core components of patient-centered behavior. |
Student struggles to identify the core components of patient-centered behavior. |
Student can identify the core components of patient-centered behavior, but needs further instruction. |
Student can accurately identify the core components of patient-centered behavior. |
| Describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members. |
Student struggles to describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members. |
Student can describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members, but needs further instruction. |
Student can accurately describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family 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:
- Collaboration
- Feedback
- 3Ws – Who I am, What I am Doing, Why I Care
- DESC Script
- I’M SAFE
- STEP
- Bedside Handoffs
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
153
Instructor’s Guide – No One Sits Until Everyone Sits
Overview:
This story is about mutual support and task assistance, and how offering assistance to other team members when your workload permits promotes safety, mutual trust, efficiency, productivity, and service excellence.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of adopting task sharing norms across team members to effectively manage workload.
- Identify high threat practices or protocols requiring increased shared vigilance.
- Generate team norms for engaging non-supportive team members to provide consistent mutual support.
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.
- 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: Task Assistance
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.
Task Assistance is guided by situation monitoring because situation awareness allows team members to effectively identify the need for assistance by others on the team. To a certain degree, some of us have been conditioned to avoid asking for help because of the fear of suggesting lack of knowledge or confidence. Many people refuse to seek assistance when overwhelmed by tasks. In support of patient safety, however, task assistance is expected. One of the most important concepts to remember with regard to Task Assistance is that assistance should be actively given and offered whenever there is a concern for patient safety related to workload. Task assistance may involve asking for assistance when overwhelmed or unsure; helping team members to perform their tasks, shifting workload by redistributing tasks to other team members, delaying/rerouting work so the overburdened member can recover, and/or filling in for overburdened team members when necessary.
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 task assistance across the unit and hospital?
A: It is important that nurses can recognize when they have limitations. The safety of the patient needs to be the first priority
- What high threat practices and protocols were occurring in this story?
A: Individual preferences and negative behaviors had caused a decline in safe patient care on this unit. The negative progression had continued until a potentially deadly occurrence happened on the floor.
- What team norms did Jane establish for engaging non-supportive team members to provide consistent mutual support across the unit? Why was this important?
A: Jane established a supportive environment where all team members supported each other. Even to the point of saying no one sits until everyone can sit down.
A: This is important because it builds a sense of support for all of the team members, but also keeps the patient the focus of care.
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 psychological safety is important for health care team members. 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 individual behaviors are often permitted that do not enhance team mutual support and may be placing patients at risk?
A: Individual behaviors such as trying to do work alone or having poor communication puts patients at risk and does not support a team environment.
- What one thing can you do to promote mutual support and encourage task assistance across the team?
A: By promoting task assistance is one way to promote mutual support. Another way to promote mutual support is to continue to keep an open dialogue with staff members. This can be done by allowing the staff to express their feelings and to state when they are overwhelmed with their assignment.
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 describes the practice of task assistance, its importance, and the benefits for the unit and its patients.
- Brainstorm a list of high threat practices and protocols that require shared vigilance, and describe how the use of task assistance could address each.
- Write a script for the conversation you imagine Jane had with one of the less compliant members of her team. Illustrate how you think she won them over, or how she handled letting them go.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of adopting task sharing norms across team members to effectively manage workload. |
Student struggles to describe the importance of adopting task sharing norms across team members to effectively manage workload. |
Student can describe the importance of adopting task sharing norms across team members to effectively manage workload, but needs further practice. |
Student can accurately describe the importance of adopting task sharing norms across team members to effectively manage workload. |
| Identify high threat practices or protocols requiring increased shared vigilance. |
Student struggles to identify high threat practices or protocols requiring increased shared vigilance. |
Student can identify high threat practices or protocols requiring increased shared vigilance, but needs further practice. |
Student can accurately identify high threat practices or protocols requiring increased shared vigilance. |
| Generate team norms for engaging non-supportive team members to provide consistent mutual support. |
Student struggles to generate team norms for engaging non-supportive team members to provide consistent mutual support. |
Student can generate team norms for engaging non-supportive team members to provide consistent mutual support, but needs further practice. |
Student can accurately generate team norms for engaging non-supportive team members to provide consistent mutual support. |
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:
- Task Assistance
- Collaboration
- Cross Monitoring
- Feedback
- Huddles
- I’M SAFE
- STEP
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
152
Instructor’s Guide – Let’s Huddle Up Here
Overview:
This story illustrates the importance of the TeamSTEPPS® “huddle” tool to keep everyone on the same page and allow for brief problem-solving before continuing the treatment plan as a patient’s condition changes.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the types of situations where huddles could be advantageous in coordinating patient care.
- Explain how and when huddles should be conducted.
- Describe how to adopt huddles as a normal problem-solving event for improved patient care.
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: Huddles
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.
Huddles: A huddle is a tool for reinforcing the plans already in place for the treatment of patients and for assessing the need to change plans. It can also help develop a shared understanding between team members of the plan of care and provides team leaders with the opportunity to informally monitor patient and unit-level situations. Huddles are particularly useful because information and patient status change over time, requiring ongoing monitoring and updating of the team. It may just be a matter of a sudden increase in the activity level of an individual or the team needing to reevaluate workload status. Workload distribution may have to be adjusted as a result. Information updates within the team should occur as often as necessary, and can take the form of a huddle at the status board or can occur between individual team members whenever new information needs to be shared.
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 would a huddle have been useful in this story?
A: It would have given the rest of the team more information regarding the conversation Jan had with Sarah’s mother.
- How could the use of huddles help a team better coordinate patient care?
A: Huddle allows each team member to know and understand what is expected regarding care to be provided for a patient. It also allows team members to know if there is a new situation they previously didn’t know.
- What were the barriers to using huddles in this story? How could they have been overcome?
A: One barrier was the increased deterioration of the patient. Jan believed that because the patient continued to have an increased need for medical attention that took away the opportunity of using a huddle.
A: This could have been overcome by implementing a team huddle. This could have been done by contacting the social worker or charge nurse in order to initiate a team huddle.
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: Jan had specific information regarding Sarah’s wishes however she was unable to get that information to the rest of the medical team.
- What barriers might you face in using the concept of huddling? How can you overcome those barriers?
A: Some barriers include feeling unsure of one’s own decisions or doubting the seriousness of a situation. You can overcome these barriers by focusing on the patient as the priority. If patient care is the focus then the focus is no longer on our insecurities or pride, but on the patient receiving quality care.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Make a list of all of the players in this story. Explain how a huddle would have helped them all be on the same page about Sarah’s care.
- Create a poster reminding your team of the importance of huddles and their benefits.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the types of situations where huddles could be advantageous in coordinating patient care. |
Student struggles to identify the types of situations where huddles could be advantageous in coordinating patient care. |
Student can identify the types of situations where huddles could be advantageous in coordinating patient care, but needs further practice. |
Student can accurately identify the types of situations where huddles could be advantageous in coordinating patient care. |
| Explain how and when huddles should be conducted. |
Student struggles to explain how and when huddles should be conducted. |
Student can explain how and when huddles should be conducted, but needs further practice. |
Student can accurately explain how and when huddles should be conducted. |
| Describe how to adopt huddles as a normal problem-solving event for improved patient care. |
Student struggles to describe how to adopt huddles as a normal problem-solving event for improved patient care. |
Student can describe how to adopt huddles as a normal problem-solving event for improved patient care, but needs further practice. |
Student can accurately describe how to adopt huddles as a normal problem-solving event for improved patient care. |
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:
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Friday, October 3rd, 2014
151
Instructor’s Guide – CUS-sing for Safety’s Sake
Overview:
This story is about CUS, a TeamSTEPPS® tool that helps care providers find the right words to express their concerns when they become aware of something they think will compromise patient safety.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety.
- Generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety.
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.
- 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: CUS Technique
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.
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.
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
- Why was the use of CUS so important in this story? What might have happened if it had not been employed?
A: It is highly likely that Marylou would have administered the incorrect amount of medication if she would not have used the CUS technique. She was looking out for the safety of the patient in this situation.
- Why is it important to express your concerns, regardless of hierarchy?
A: It is important because every patient deserves to receive the best care possible and thought would not have happened if this situation were handled differently. Hierarchy should not play a role in the care provided to the patient.
- What barriers did Marylou have to overcome in order to successfully use the CUS strategy?
A: She had to overcome her own feels and past experiences related to dealing with this pharmacist in the past. Although it is an uncomfortable conversation she knew it was the right 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: Patient safety needs to be the first priority. It is not safe to try to administer a partial dose of an adult medication to a pediatric patient. It would not have been safe for Marylou to administer the medication as it was delivered to her. She was assertive and kept her patient the focus of the conversation.
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 CUS to your team members as a way to confront differences of opinion regarding patient safety.
- Think of other scenarios where the use of CUS is appropriate.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
Student struggles to describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
Student can describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety, but needs further instruction. |
Student can accurately describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
| Generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
Student struggles to generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
Student can generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety, but needs further practice. |
Student can accurately generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
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:
- Check-backs
- Advocacy and Assertion
- CUS
- Handoff
- STEP
- Two-Challenge Rule
- Cross Monitoring
- 3Ws – Who I Am, What I am Doing, and Why I Care
- “Speak Up”
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Friday, October 3rd, 2014
210
Student’s Guide – I’m Alright, Really
Overview:
It is difficult to be objective about the well-being and fitness to work both about ourselves and our co-workers. The TeamSTEPPS I’M SAFE tool is meant to be a helpful checklist for assessing different dimensions of our own and others ability to deliver safe patient care.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize elements of the TeamSTEPPS “I’M SAFE” resilience self-assessment tool.
- Evaluate team members’ fitness for duty by identifying cues of stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD.
- Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with crippling stress, burnout, and/or more severe psychological problems.
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.
- 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: I’M SAFE
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.
I’M SAFE: Be aware of your own condition to ensure that you are fit and ready to fulfill your duties is essential to delivering safe, quality care. “I’M SAFE” is a simple checklist that should be used daily (or more frequently) to determine both your co-workers’ and your own ability to perform safely.
I’M SAFE stands for:
- Illness: Am I feeling so bad that I cannot perform my duties?
- Medication: Is the medication I am taking affecting my ability to maintain situation awareness and perform my duties?
- Stress: Is there something that is detracting from my ability to focus and perform my duties?
- Alcohol/Drugs: Is my use of alcohol or illicit drugs affecting me so that I cannot focus on the performance of my duties?
- Fatigue: Team members should alert the team regarding their state of fatigue (e.g., watch me a little closer today, I only had three hours of sleep last night).
- Eating and Elimination: Not taking care of our eating and elimination needs affects our ability to concentrate and stresses us physiologically.
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:
- How did Amanda’s situation awareness help avoid a possible medical error?
- How can we improve our ability to recognize and manage stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD among team members using the TeamSTEPPS I’M SAFE tool?
- How can we develop the mutual support necessary to address, and if necessary, confront compromised performance on the part of a team member?
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Friday, October 3rd, 2014
209
Student’s Guide – First Baby STEP
Overview:
This story is about the loss of situation awareness as the root cause of many serious medical errors and sentinel events. A team’s ability to maintain situation awareness depends on having good tools to use, and using those tools consistently and skillfully.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize the elements of the TeamSTEPPS STEP situation awareness tool.
- Describe how situation awareness can be maintained by consistent use of the STEP tool.
- Plan how to consistently use and practice applying the STEP tool on the unit.
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.
- 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: STEP
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.
STEP: How do you acquire a trained eye as you “monitor the situation” on your unit? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment. The STEP process involves ongoing monitoring of the:
- Status of the patient,
- Team members,
- Environment, and
- Progress toward the goal.
In a healthcare setting, the most obvious element of the situation requiring constant monitoring is your patient’s status. Even minor changes in the patient’s vital signs may require dramatic changes in the team’s actions and the urgency of its response. You should also be aware of team members’ status, including fatigue and stress level, workload, and skill level. You should be aware of the environment, including triage acuity, and equipment. And finally, you should assess your progress towards goals by asking the following key questions: What is the status of the team’s patient(s)? Has the team established goals? Has the team accomplished their task/actions? Is the plan still appropriate?
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:
- How does the STEP tool improve patient safety?
- Describe how and why the STEP tool was effective in this story.
- How can the TeamSTEPPS STEP tool help us maintain situation awareness at all times and in all circumstances?
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