Archive for the ‘Student Guides’ Category
Thursday, October 2nd, 2014
197
Student’s Guide – Toxic Handoff
Overview:
This story is about how a poor patient handoff can result in crucial information about the patient’s condition not being communicated, resulting in incomplete or inappropriate care decisions that can seriously endanger the patient’s safety.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Summarize the benefits for patient safety of having a structured handoff process.
- Identify tools to support an effective handoff (e.g., checklist).
- Develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients.
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: 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 healthcare professionals.
Handoffs: When a team member is temporarily or permanently relieved of duty, there is a risk that necessary information about the patient might not be communicated. The handoff strategy is designed to enhance information exchange at critical times such as transitions in care. More important, it maintains continuity of care despite changing caregivers and patients. Handoffs include the transfer of knowledge and information about the degree of uncertainty (or certainty about diagnoses, etc.), response to treatment, recent changes in condition and circumstances, and the plan (including contingencies). In addition, both authority and responsibility are transferred. Lack of clarity about who is responsible for care and for decision-making has often been a major contributor to medical error (as identified in root cause analyses of sentinel events and poor outcomes).
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:
- Which parts of the handoff process were most challenging for this team?
- How could a structured handoff process have improved patient safety in this story?
- How could the hospital improve its handoff process to better address patient safety?
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Thursday, October 2nd, 2014
196
Student’s Guide – Close the Loop
Overview:
This story is about patient discharge as a crucial activity to ensure their safety. It’s not enough for caregivers to simply communicate instructions—we must ensure that the patient and their family fully understand every detail using the check-back process.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
- Describe how check backs close the communication loop when exchanging information with patients and their families.
- Adopt check backs as a tool to effectively exchange information with patients and their families.
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: Check-Backs
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.
Check-Back: 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 communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked back.
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:
- Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
- Describe how check backs could have helped to close the communication loop with this family.
- What do team members need to be able to do in order to effectively close the communication loop when exchanging information with patients about their care?
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Thursday, October 2nd, 2014
195
Student’s Guide – Question Everything!
Overview:
This story is about a patient who is prescribed an inappropriate and dangerous dose of a drug, and how no one from the nurse carrying out the order to the pharmacist filling the order challenged the dosage that could have resulted in patient harm.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe how situation monitoring supports team functioning.
- Identify tools that enable team members to assertively voice concerns over patient care.
- Apply the Two-Challenge rule in situations where there are conflicting perspectives on patient 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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Two Challenge Rule
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Two Challenge Rule: It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.
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 could the two-challenge rule have helped improve patient safety in this story?
- What barriers were present in this story that prevented Alice from questioning Dr. Racinelli’s orders?
- What skills do team members in this story need to develop to enable them to effectively advocate for patients?
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Thursday, October 2nd, 2014
194
Student’s Guide – When There’s a Conflict, DESC It!
Overview:
This story is about dealing with difficult interpersonal conflicts that can often become personal if not properly managed. Using the DESC tool, even difficult situations that have the potential to become inflamed can be appropriately managed in a manner that is respectful, yet still assertive.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify and describe early elective C-section delivery (EED) scheduling protocol.
- Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
- Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.
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: DESC Script
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.
DESC Script: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.
DESC is a mnemonic:
D = Describe the specific situation;
E = Express your concerns about the action;
S = Suggest other alternatives; and,
C = Consequences should be stated. Ultimately, consensus should be reached.
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 changes in practices and protocols were causing concern in this story? Why were they important for patient safety?
- What barriers did Dr. Dorsey perceive in following the new protocol?
- How can we use DESC to reduce conflict related to changes in practices and protocols?
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Thursday, October 2nd, 2014
193
Student’s Guide – Safety Depends on Feedback
Overview:
This story is about how patient safety is everyone’s responsibility, and how all staff members are accountable for giving fellow team members feedback when their practices diverge from accepted safety norms and practices that have been adopted by the unit or the hospital.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
- Identify how situation awareness can help you identify problems that undermine patient safety.
- Use Feedback as a tool to challenge team members and advocate for patients.
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: Feedback
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.
Feedback: Another type of mutual support is feedback. Feedback is information provided for the purpose of improving team performance. The ability to communicate self-improvement information in a useful way is an important skill in the team improvement process. Feedback can be given by any team member at any time. It is not limited to management roles or formal evaluation mechanisms. Rules of effective feedback include the following:
- Timely—Feedback is most effective when the behavior being discussed is still fresh in the mind of the receiver;
- Respectful—The feedback should not be personal, and it should not be about personality. It should be about behavior;
- Specific—The feedback should relate to a specific situation or task;
- Directed—Goals should be set for improvement;
- Considerate—Be considerate of team members’ feelings when delivering feedback, and remember to praise good performance.
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 was the feedback tool utilized in this story?
- Why is it so important to always abide by evidence-based practices regarding patient safety?
- How did you feel about Dr. Walter’s reaction to Bridget’s questions?
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Thursday, October 2nd, 2014
191
Student’s Guide – Cross Monitor to Address Adverse Drug Events
Overview:
This story addresses the issue of cross monitoring as it relates to adverse drug events (ADEs). Proper communication protocols between physicians and nursing staff are essential to prevent patient ADEs.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe challenges in ensuring medication safety.
- Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
- Explain the importance of using evidence-based communication measures to improve medication safety in a 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: Cross Monitoring
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.
Cross Monitoring: Cross monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
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 evidence-based practices were violated in this story? Were the violations warranted?
- What assumptions about patient safety did the nurses in this story make? Why were they detrimental?
- How could cross monitoring help this unit provide better patient care and safety?
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Thursday, October 2nd, 2014
190
Student’s Guide – Safety Practices Depend on Advocacy and Assertion
Overview:
This story is about when we witness team members depart from evidence-based safety practices designed to minimize risk, and how we can best intervene when it’s often difficult or uncomfortable to speak up assertively to confront unsafe practices.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS.
- Explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.
- Describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.
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: Advocacy and Assertion
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.
Advocacy and Assertion: Advocacy and assertion interventions are invoked when a team member’s viewpoint does not coincide with that of a decision maker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to employ advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person’s view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.
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 evidence-based practices were violated in this story? Were the violations warranted?
- What barriers to patient advocacy did Celeste face?
- How might she have overcome them to better advocate for the patient in this story?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
189
Student’s Guide – Your Patients and Family See What You Can’t See
Overview:
This story is about the impacts of medication errors. Distractions and interruptions can cause human error that may not be caught by other team members. Patients and family members are witnesses to their care and can provide cross monitoring to prevent errors from occurring.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Examine team practices to promote cross-monitoring of high risk procedures including medication administration.
- Generate policies and practices to limit distractions and multitasking during critical care practices.
- Design a process for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- 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: Cross Monitoring
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.
Cross Monitoring: Cross Monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
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 this story illustrate the importance of cross monitoring?
- If Beverly had dismissed Cynthia’s concerns as she was about to do, what might have happened?
- How can we include the patients and families as members of the clinical care team and ensure that they have the opportunity to ask questions and express concerns before important procedures or medication administrations?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
188
Student’s Guide – Advocate for a Smooth Delivery
Overview:
This story is about an expectant mother and the timing of a scheduled C-section delivery. The physician’s schedule, not the gestation age of the fetus, becomes the primary scheduling concern. Reducing or eliminating early elective deliveries has been shown to be safer for newborns.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain and apply the TeamSTEPPS strategy of advocacy for the patient and express concerns assertively when there is a scheduled early elective delivery with no apparent medical necessity.
- Develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication.
- Explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family.
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: Advocacy and Assertion
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.
Advocacy and Assertion: Advocacy and assertion interventions are invoked when a team member’s viewpoint does not coincide with that of a decision maker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to employ advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person’s view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.
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 Dr. Burdy’s deviation from Evidence-Based Practices in this story. Do you believe her deviation warranted? Why or why not?
- What could Beverly have done or said to better advocate for the patients and their newborn? How could the TeamSTEPPS tool of Advocacy and Assertion have helped her?
- How is this story a non-example of patient-centered care?
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Thursday, October 2nd, 2014
187
Student’s Guide – Those Who Don’t Debrief are Destined…
Overview:
This story is about the importance of team debriefs. Teams often fail to learn as much as they can from critical incidents by not taking adequate time to report, discuss and examine errors in patient care. Teams are destined to repeat the same mistakes if they fail to debrief.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.
- Describe the importance of integrating family members as an important source of patient information and medical history, especially if the patient is incapacitated or impaired.
- Adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization.
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: Debriefs
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.
Debriefs – To conduct a debrief:
- Facilitate the discussion as a leader by asking questions related to team performance. What did we do well?
- Recap the situation, background, and key events that occurred.
- As a team, assess how the following played a role in the performance of the team:
- Team Leadership
- Situation Awareness
- Mutual Support
- Communication
- Then summarize lessons learned and set goals for improvement.
- This checklist can be used by the team during a debriefing to ensure that all information is discussed.
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 this story illustrate the importance of debriefing?
- What can be done to consistently engage the family as a potential source of key patient information?
- Why is it important to speak up and advocate for patient safety, regardless of hierarchy, in emergent situations?
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