Archive for the ‘Student Guides’ Category
Thursday, October 2nd, 2014
176
Student’s Guide – Word of Mouth
Overview:
This story is about including patients’ families as members of the healthcare team. Evidence suggests that when they are contributing to the care of their loved ones, risk for VAP will be reduced and VAP rates will decrease. Plus, they will be more satisfied with their care.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain how the patient’s family and caregivers need to be involved in discussions about the care of their loved ones.
- Generate strategies for including the patient’s family and caregivers in briefings and trainings about how to care for their loved ones.
- Describe and adopt strategies that, wherever possible, allow family members to be involved in providing care for their loved ones.
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:
- What does this story illustrate about the importance of involving the patient’s family and caregivers in discussions and care of their loved ones?
- How did Jimmy’s explanation of VAP
- How did Penelope’s reaction to Gladys’ mistake create a positive patient care experience instead of a negative one?
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Thursday, October 2nd, 2014
175
Student’s Guide – No One is Exempt
Overview:
This story is about how there is often an implicit assumption that Patient Satisfaction is predominantly a function of nursing, whereas these problems may be caused by everyone but nursing. One of the best ways to get to the source of poor ratings is to listen to your patients’ stories.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify how every staff member who interacts with patients has an impact on and is responsible for patient satisfaction.
- Explain the importance of integrating patient-centered behavior such as appropriate body language and 3Ws into orientation, training, and performance expectations for all clinical and administrative staff who interact with patients.
- Describe how to plan for patient interviews as a regular part of executive data-gathering.
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.
- 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.
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 all staff members being focused on patient care and satisfaction?
- How would the use of the 3Ws have alleviated some of the patient complaints in this story?
- Why is it important that upper management examine patient experiences first hand, as well as monitoring data?
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Thursday, October 2nd, 2014
174
Student’s Guide – It’s Not That Obvious
Overview:
This story is about how when team members don’t communicate effectively with each other and patients about their actions, patient input is sidelined, patients lack sufficient information to make informed choices about their care, and safety can be compromised.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe how establishing shared goals between staff and patients can contribute to patient safety.
- Describe and apply standardized verbal and written communications in emergent obstetric situations as part of a perinatal bundle.
- Explain and adopt a safety climate/perinatal bundle to detect, prevent, and mitigate 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.
- 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.
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 always focusing on patient safety and care?
- How did Dr. Walters’ lack of teamwork impact Pamela’s experience at the hospital?
- What elements of a perinatal bundle were in place in this story? What elements were absent or poorly executed?
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Thursday, October 2nd, 2014
173
Student’s Guide – Transferring Blame
Overview:
This story is about implementing a follow-up plan when patients are transferred across hospital units or discharged to ensure that their care history is documented and passed on. It also highlights the importance of listening to what patients tell you about their care.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the process for information follow-up when patients are transferred into or out of the unit.
- Examine how information and communication gaps can contribute to preventable readmissions.
- Create a plan for involving the patient as a team member by actively soliciting and validating information from them about their prior medications and 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.
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 information and communication gaps occurred among the medical staff in this story?
- What steps could this unit have taken to ensure that team members had access to all necessary information about patients when they transfer into the unit, and that they know who to talk to when information is missing?
- What does this story illustrate about the importance of actively soliciting and validating information from patients about their prior medications and care?
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Thursday, October 2nd, 2014
172
Student’s Guide – Checklists – Check!
Overview:
This story is about how all staff members are accountable for following safe practices. When team members diverge, others need to be able to call them on it in a respectful, non-threatening way, without being made to feel uncomfortable.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain how speaking up in the context of potential error can make improvement in patient safety.
- Describe communication tools that can help team members draw attention to potential safety breaches.
- Design methods for practicing the use of evidence-based communication tools that call out errors and hold staff members accountable for their actions.
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:
- How did Kimberly and Vilma’s advocacy and assertion for their patient improve patient safety?
- What does this story illustrate about the importance of all team members’ roles?
- What tools were employed in this story to help build a culture of patient advocacy among this team?
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Thursday, October 2nd, 2014
171
Student’s Guide – A Question of Timing
Overview:
This story is about the failure to give antibiotic prophylaxis on time, which can contribute to Surgical Site Infections (SSIs) and can be averted with a pre-op briefing.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Demonstrate awareness of how timely antibiotic prophylaxis can reduce SSIs.
- Explain the importance of adopting a plan to create antibiotic standing orders based on local consensus guidelines.
- Describe how briefings can support teams and avoid preventable errors and complications.
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.
- 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: Briefs
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Briefs: Briefs serve the following purposes:
- They clarify who will be leading the team so that others know to whom to look for guidance.
- They open lines of communication among team members, ensuring that everyone can contribute their unique knowledge base to the task, and thereby set the tone for the upcoming procedure. Protocols, responsibilities, and expected behaviors are discussed and reinforced so that possible misunderstandings are avoided.
- They prepare the team for the flow of the procedure, contingency plans, and the means for resolving any unusual circumstances.
- By delineating expectations, they reduce disruptive or unexpected behaviors.
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 the lack of a plan for antibiotic standing orders detract from patient care and safety in this story?
- What steps can be taken to educate the OR team about the rationale for timely antibiotic prophylaxis?
- How could engaging in pre-op briefings with the surgical team stop scenarios like the one in this story from happening?
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Thursday, October 2nd, 2014
169
Student’s Guide – Are You Challenging Me?
Overview:
This story is about what happens when team members express their concerns about the safety and well-being of a patient twice, and if the concern is not alleviated, it is their responsibility to escalate the conflict to someone who has authority to resolve the situation.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Define the TeamSTEPPS® “Two-Challenge” Rule
- Explain the importance of each team member advocating for their patients and using the Two-Challenge Rule to guide their expression of concerns.
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: 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 health care 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:
- What does this story illustrate about the importance of the Two-Challenge Rule?
- Why was it so important that Sheila remained vigilant in her advocacy for Tiffany with Dr. Peters?
- How can you give the message to other team members that you welcome challenges and will take them in the spirit of collaborating on what’s best for patients?
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Thursday, October 2nd, 2014
168
Student’s Guide – Step Up To Rounding
Overview:
This story is about falls which are three times more common in hospital and nursing home settings where they result in higher injury rates. But they can be reduced through a number of simple solutions, such as tweaking hourly rounds to make them more meaningful.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify unmet patient needs that contribute to risk for falls.
- Describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls.
- Develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 was the importance of modifying the team’s current patient care practices?
- What evidence-based practices for fall prevention were developed and put into place in this story?
- How did Taylor demonstrate effective leadership to ensure the commitment of her team to minimizing the risk of harm to patients?
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Thursday, October 2nd, 2014
167
Student’s Guide – Did You Remember to SBAR?
Overview:
This story is about SBAR, a TeamSTEPPS® tool that helps care providers through the use of a structured format for giving reports between clinical staff members that leads to increased efficiency and enhanced safety.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify the words and meaning of the TeamSTEPPS SBAR tool.
- Describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: SBAR
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
SBAR: SBAR provides a standardized framework for members of the healthcare team to communicate about a patient’s condition. SBAR is an easy-to-remember, concrete mechanism that is useful for framing any conversation, often a critical one requiring a clinician’s immediate attention and action. SBAR originated in the U.S. Navy submarine community to quickly provide critical information to the Captain. It provides members of the team with an easy and focused way to set expectations for what will be communicated and how. Standards of communication are essential for developing teamwork and fostering a culture of patient safety. SBAR provides a vehicle for individuals to speak up and express concern in a concise manner. In phrasing a conversation with another member of the team, consider the following:
- Situation: What is happening with the patient?
- Background: What is the clinical background?
- Assessment: What do I think the problem is?
- Recommendation: What would I recommend?
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 Dr. Cowan’s approach to Henry improve teamwork, communication and patient care in the hospital?
- What does this story illustrate about how effective team communication can impact patient care?
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Thursday, October 2nd, 2014
166
Student’s Guide – Prioritizing Pressure Care
Overview:
Using a pressure prevention bundle can reduce the risk for pressure ulcers (PUs). Unfortunately, even though nurses understand its importance, it’s associated with low status work and they often don’t make it a priority, falsely assuming that LPNS are performing skin care/PU prevention.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention.
- Describe the responsibilities of each clinical staff role in the prevention of pressure ulcers.
- Explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
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 identifying the training that all clinical staff have and need in pressure ulcer prevention?
- How did Thelma’s attitude in the story effect the care her patients received?
- How could this hospital better address pressure ulcer care and risk prevention to improve patient care?
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