Archive for the ‘Student Guides’ Category
Thursday, October 2nd, 2014
186
Student’s Guide – When Concerned, It’s Time to Huddle
Overview:
This story is about a patient who 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. If only the caregivers had taken the time to huddle.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify the types of situations where huddles could be used to advantage in coordinating patient care.
- Explain how and when huddles should be conducted.
- 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:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 requiring the need 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.
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:
- Where in this story could the care team have used huddling to better coordinate care?
- What barriers to using the concept of huddling occurred in this story, and how could they be overcome?
- How do huddles promote more patient-centered, safe care from all staff?
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Thursday, October 2nd, 2014
185
Student’s Guide – When in Doubt, Use the 2-Challenge Rule
Overview:
This story is about when safety protocols in any area are not being followed and patient safety is at risk. It is the responsibility of all team members to speak up and challenge the direction the patient’s care is taking to ‘stop the line’ if their concerns can’t be quickly resolved.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- State the Two-Challenge Rule from TeamSTEPPS.
- Demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk.
- Adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned.
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: 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 does this story illustrate the importance of using the Two Challenge rule to ‘stop the line’ for patient safety?
- When is it appropriate to deviate from evidence-based practice, as Dr. Charles requested in this story?
- Why is it important to speak up and advocate for patient safety, regardless of hierarchy?
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Thursday, October 2nd, 2014
184
Student’s Guide – Step Up to Safety
Overview:
This story illustrates how adherence to protocols, closed loop communication, documentation, and building time for improved decision making are important strategies to safely manage spikes in workload.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the potential effects workload ‘spikes’ have on patient safety.
- Describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory.
- Generate and adopt strategies to eliminate workarounds especially during high workload periods.
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.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: 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:
- What safety protocols did Mary ignore? What barriers did she feel kept her from following those protocols?
- How could the use of the STEP process improved the chaos in the emergency department in this story?
- Why is it more difficult to follow established safety protocols during high workload periods?
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Thursday, October 2nd, 2014
183
Student’s Guide – I’M SAFE When I Reach Out
Overview:
This story focuses on care for the caregiver, sometimes referred to as resilience. The stress of caring for patients can lead to chronic fatigue, burnout, and unprofessional behaviors. All team members have a responsibility to recognize and respond when team members become overwhelmed.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Summarize the elements of the resilience self-assessment tool, I’M SAFE.
- Describe the importance of evaluating team members’ fitness for duty by identifying cues of stress, fatigue, and burnout.
- Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with severe stress.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 would the “I’M SAFE” protocol have helped in this story?
- What does this story illustrate about the importance of recognizing and managing stress, fatigue, and burnout among a team?
- What do you feel June did well in this story? What could she do better?
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Thursday, October 2nd, 2014
182
Student’s Guide – Trust Your Instincts: Cross Monitor!
Overview:
This story addresses the issue of cross monitoring as it relates to error prevention. A work environment that encourages staff to openly share concerns related to the safety of the patients is necessary for optimal patient care and experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of applying reporting principles without fear of retribution or punishment.
- Explain the necessity of integrating reporting daily as a feedback mechanism and safety improvement system.
- Describe the importance of creating a just culture to improve front line reporting.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 should Allison have done when she discovered Sarah’s injuries?
- What issues regarding the staff’s attitude towards reporting need to be addressed in this nursing home?
- How could better cross-monitoring have helped improve patient safety and CNA willingness to report in this nursing home?
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Thursday, October 2nd, 2014
181
Student’s Guide – Advocate for Patient Safety
Overview:
This story addresses the importance of effective and consistent forms of team communication. Staff should feel empowered to speak up, assert, and advocate on behalf of the patient and the team regardless of perceived organizational hierarchies.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy.
- Analyze the conditions for calling team huddles in emergent situations to improve problem solving.
- Explain and adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family.
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: 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:
- How could Beth have been more assertive in her advocacy for Tracy?
- Describe the importance of advocacy using examples from this story and from your own experiences.
- What does this story illustrate about the importance of including the family and patient in decision-making for emergent situations?
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Thursday, October 2nd, 2014
180
Student’s Guide – Cross Monitor for Patient Safety
Overview:
This story is about how cross monitoring helps maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it allows team member to self-correct their actions and provides a safety net or error-prevention mechanism for the team.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Compare written orders in the context of the entire patient care plan to ensure accuracy.
- Explain and adopt strategies to limit distractions, interruptions, and multitasking during critical care activities.
- Describe the importance of applying cross monitoring skills across the team regardless of position, status, or hierarchy to create trust and prevent errors.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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:
- Why is it important to compare written orders in the context of the entire patient care plan?
- How can we limit distractions, interruptions, and multi-tasking during critical care activities?
- What does this story illustrate about the importance of cross-monitoring?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
179
Student’s Guide – A Fatal Interruption
Overview:
This story is about minimizing distractions during medication administration to prevent adverse drug events. Rigorously following patient identification protocols using the “5 Rights” is crucial to ensure the right patient receives the right medication dose at the right time.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Examine the impact of interruptions on patient safety protocol.
- Evaluate the impact of personal stress on individual performance.
- Design strategies to avoid errors due to interruptions in workflow.
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.
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 could Dianne have done to avoid the critical error she made?
- How could this team better manage interruptions during medication administration?
- What protocols should be in place across the team to ensure that errors like this do not occur?
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Thursday, October 2nd, 2014
178
Student’s Guide – If Only…
Overview:
This story is about the lack of preparedness of teams to handle out-of-the-ordinary emergent events, and the dire consequences for patients of the failure of teamwork within and across hospital units.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Demonstrate understanding of preparedness for infrequent emergent events, including equipment, materials, and training.
- Explain how to modify processes as necessary for ensuring that the right equipment, materials, and properly trained staff are available for infrequently occurring, but life-threatening emergent events.
- Describe the importance of adopting proactive strategies to defeat complacency regarding infrequent, but life-threatening emergent events.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
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 does this story illustrate about the importance of being prepared for emergent events?
- How could this team have been better prepared for this emergent event?
- What proactive strategies could be put in place in this hospital to avoid a repeat of an incident like the one in this story?
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Thursday, October 2nd, 2014
177
Student’s Guide – The Burden of VTE
Overview:
This story is about when healthcare team members are acutely overburdened at work, the potential for error rises and patient safety is put at risk, especially for Venous Thromboembolism (VTE). Most hospitalized patients have at least one risk factor for VTE, however, appropriate prophylaxis is applied only 39.5% of the time.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe the consequences for patient safety when team members are overwhelmed.
- Identify tools (e.g., task assistance) to support team members who are acutely overburdened and enable them to carry out patient safety tasks, such as VTE prevention.
- Explain and adopt a plan to monitor compliance with evidence-based VTE prophylaxis policies.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: 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 healthcare professionals.
Task Assistance: 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.
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 was Kathi’s intervention on Deloris’ behalf so critical in this case?
- What does this story illustrate about the importance of developing a culture of teamwork that includes task assistance?
- How did this team successfully monitor compliance with evidence-based VTE prophylaxis policies? What could they improve?
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