Archive for the ‘Student Guides’ Category
Friday, September 19th, 2014
124
Student’s Guide – No One Thing Killed Elias Smith
Overview:
This story is about how healthcare organizations are often ill-equipped to respond to the crisis following unexpected death or harm to a patient due to medical errors, and how an organization can establish an effective crisis management team to transparently respond to the family.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe and apply family-centered principles to respectfully disclose medical errors.
- Describe a crisis management response to medical errors that considers the caregivers.
- Explain how to convey medical error information to families in lay terms using transparency and empathy.
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.
Story Directions:
As you listen to and read the story, underline the things that you think the team members did well, and circle the things you think that could lead to errors. Also, think about the questions below as you listen.
Reflection Questions:
- Describe the actions of the CEO that you felt demonstrated his application of family-centered principles to respectfully disclose the medical errors in Elias’ case.
- What safety errors occurred in this story? How did the hospital system fail Elias?
- Why is empathy important in responding to the family? How was empathy used effectively in this story?
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Friday, September 19th, 2014
126
Student’s Guide – Almost Routine
Overview:
Central Line-Associated Blood Stream Infections (CLABSIs) cause up to 60,000 preventable deaths in the U.S. each year. This story highlights how deviation from evidence-based protocols and checklists can place the patient at risk for CLABSI, and how the CUS technique can help improve team member collaboration and patient safety.
Primary Learning Outcomes
After completing this lesson, you should be able to:
- Describe safe, evidence-based practices related to central line insertions
- Develop a checklist that includes proper protocols for a central line insertion scenario
- Understand and adopt critical language to ‘stop the line’ when deviation from protocols occurs, regardless of professional hierarchies.
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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: CUS
- Using the CUS technique provides another 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.
- First, state your Concern.
- Then state why you are Uncomfortable.
- If the conflict is not resolved, state that there is a Safety issue.
Story Directions:
As you listen to and read the story, think about what you think the team members did well, and the things you think that could lead to errors. Also, keep the questions below in mind as you listen.
Reflection Questions:
- What safety protocols that can help prevent the risk of CLABSI were violated in this scenario?
- QSEN requires you to discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences. Do you think Dr. Long’s deviations from EBP in this scenario were valid or invalid? Explain your reasoning.
- Thinking about the TeamSTEPPS best practice “CUS” described earlier, when and how could Carly have employed this technique to better advocate for her patient’s safety?
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Friday, September 19th, 2014
123
Student’s Guide – A Tale of Two Patients
Overview:
This is a story about how excellence in healthcare delivery requires attending to the needs, wants, feelings, insecurities, and anxieties of each and every patient and their families in addition to treating their medical problem.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain and adopt the 3Ws when interacting with patients and families.
- Describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families.
- Explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical.
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: 3 Ws & Bedside Handoffs
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.
- 3 Ws- Who I Am, What I am Doing, and Why I Care was originated by the Florida Hospital System as a simple, yet effective way to reliably greet, engage, and activate patients and families.
- Bedside Handoffs: Change of shift report occurring at the patient’s bedside with these essential components:
- A standardized nursing report handoff tool
- Bedside shift-to-shift report
- Inclusion of the patient and family in the discussion of plans and goals of care including introductions.
- Two-person medical record check
Story Directions:
As you listen to and read the story, underline the things that you think the team members did well, and circle the things you think that could lead to errors. Also, think about the questions below as you listen.
Reflection Questions:
- How did the use of the 3Ws improve Sheila’s experience?
- What effect did the staff conversations, actions, and norms have on Betty’s perception of their competence and her overall impression of the hospital?
- How did the use of bedside handoffs at Sheila’s hospital impact her experience?
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Friday, September 19th, 2014
122
Student’s Guide – The Rule of Six
Overview:
This story is about a patient being discharged following a readmission for pneumonia. A Care Transitions nurse uses patient coaching skills and motivational interviewing techniques with the patient to focus on important aspects of caring for himself at home to prevent readmission.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain the need for effectiveness of patient coaching in helping patients at risk of readmission.
- Distinguish the difference in aftercare patient coaching from traditional patient education.
- Describe patient coaching techniques suitable for use during patient discharge sessions.
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.
Story Directions:
As you listen to and read the story, underline the things that you think the team members did well, and circle the things you think that could lead to errors. Also, think about the questions below as you listen.
Reflection Questions:
- What can we learn from this story about the limits of teaching and the value of coaching?
- Describe the ways that Peggy worked with Mr. Falcone to overcome obstacles that might put him at higher risk for readmission?
- What coaching techniques did you learn from this story that you might be able to use in your role?
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Friday, September 19th, 2014
121
Student’s Guide – It’s Dangerous to Judge
Overview:
This story is about how persistent negative labeling can become ingrained in a culture, making it an acceptable norm. The end result can be poor quality or inappropriate, even unsafe care, misdiagnosis, and significant patient dissatisfaction, for which the patient may be blamed.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain why labeling behavior puts patient safety at risk
- Describe the importance of demonstrating equal regard for all patients regardless of socioeconomic, racial, or other factors.
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.
Story Directions:
As you listen to and read the story, underline the things that you think the team members did well, and circle the things you think that could lead to errors. Also, think about the questions below as you listen.
Reflection Questions:
- What are the risks to patient safety when we label and judge people?
- How does this story illustrate examples of patient-centered care?
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Thursday, September 18th, 2014
120
Student’s Guide – Doctor, I’m Concerned…
Overview:
This story is about what happens when a patient is allowed to leave a cardiac clinic without critical test results being examined and resolved because the protocols for allowing a patient to leave were either non-existent or not followed by the staff.
Primary Learning Outcomes
After completing this lesson, you should be able to:
- Demonstrate and apply critical language to advocate for patient safety.
- Demonstrate the ability to explain the “why” to patients related to safe practices and protocols.
- Describe the use of a team huddle for problem-solving related to all patient safety concerns.
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.
- 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: Team 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 health care professionals.
- A team huddle is an ad hoc meeting to discuss issues, realign resources, and modify the plan.
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:
- What critical language could Caroline have used with Dr. Feldman? With Harry?
- Describe how Caroline could have better explained the “why” to Harry in this story.
- How could a team huddle have prevented the problem in this story?
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Thursday, September 18th, 2014
119
Student’s Guide – Organizational Antibodies
Overview:
This story is about how one IT director learned through trial and error to gain the support of medical staff through carefully orchestrated EMR implementation planning, a must for any change initiative to succeed.
Primary Learning Outcomes
After completing this lesson, you should be able to:
- Describe the importance of creating understanding and buy-in related to change.
- Analyze and explain the risks and benefits of the change at the frontline.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Quality Improvement (QI): Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
- 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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Why is the use of EMR and other technologies important for quality patient care?
- Describe the actions in the story that helped create buy-in amongst the ED doctors. Why do you think they were so effective?
- What things could you do to promote understanding and buy-in related to change initiatives?
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Thursday, September 18th, 2014
118
Student’s Guide – The Perfect Storm
Overview:
This story is about how handoffs are the single most error-prone event in the patient continuum of care. Ineffective communication, coupled with distractions and an incomplete patient assessment, can often lead to a sentinel event.
Primary Learning Outcomes
After completing this lesson, you should be able to:
- Describe and demonstrate a structured patient handoff, including a verbal check back from the team member receiving the patient.
- Describe the importance of designing a team structure that ensures the team leader is not pulled away from coordinating care across the unit.
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.
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.
- A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicate, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked.
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:
- What do you feel was Juan’s biggest error in the story? What should he have done instead?
- How could the use of check-backs helped to avoid the problem in this story?
- How could Chelsea ensure that this problem never occurs in her unit again?
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Thursday, September 18th, 2014
117
Student’s Guide – Empowered to Challenge
Overview:
This story is about how retained foreign objects (RFOs) during surgery can result in significant harm due to infection and other complications, and speaking up is crucial when the instrument count is inaccurate. Protocols must be followed during surgical counts to ensure an RFO is not left behind that could be deadly to a patient.
Primary Learning Outcomes
After completing this lesson, you should be able to:
- Describe safe practices during all surgical procedures related to post-operative counts ensuring that no retained foreign objects remain.
- Recall and describe methods and strategies to ‘stop the line’ when surgical counts are questioned for accuracy.
- Describe and adopt team-based behaviors to successfully manage information conflict between team members.
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.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: 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 health care 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.
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:
- Describe safe practices during all surgical procedures related to post-operative counts ensuring that no retained foreign objects remain.
- What does this story illustrate about the importance of using Evidence-Based Practices, like the rules for accounting for all surgical instruments, at all times? Under what circumstances do you feel they can be ignored or altered?
- Describe how Juanita’s use of the CUS technique prevented a larger issue for Mrs. Gatlin. Why was this important?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, September 18th, 2014
116
Student’s Guide – Why Not?
Overview:
This story is about how patient choice can improve the patient experience by better meeting patients’ emotional needs. To do this, healthcare professionals must see exceptional care from the patient’s perspective and act as a navigator of the system of care.
Primary Learning Outcomes
After completing this lesson, you should be able to:
- Generate strategies and methods to meet the emotional needs of the patient.
- Examine patient and family policies and practices to ensure they provide choice and are patient-centered.
- Describe and adopt strategies to act as a system navigator for patients, not a system enforcer.
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.
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 were Charlie’s emotional needs met in this story?
- Who in this story acted as a system navigator for Charlie? Who acted as a system enforcer?
- What do you believe are the characteristics of someone who acts as a system navigator for patients?
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