Archive for the ‘Student Guides’ Category
Thursday, October 2nd, 2014
165
Student’s Guide – Walking Into Risk
Overview:
This story is about how most Venous Thromboembolisms (VTEs) in the ambulatory setting occurring within one month of discharge and are preventable, but oncologists’ adherence to VTE assessment/prophylaxis guidelines is suboptimal and a major barrier to implement VTE protocol.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the rationale for VTE risk assessment and prevention.
- Determine the barriers to conducting VTE assessment in the ambulatory setting.
- Create a team action plan to implement VTE risk assessment and prophylaxis.
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.
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 VTE assessment and risk prevention?
- What barriers kept the proper assessment from being conducted in the first place?
- How did Dr. Levine and Donna’s inaction affect both Willie’s recovery and patient care experience?
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Thursday, October 2nd, 2014
164
Student’s Guide – Who Knows Best?
Overview:
This story is about mutual support, especially when it comes to preventing VAP. A team-oriented approach to patient care requires that each team member’s expertise is respected, and differences of opinion about the direction of care are worked out in a supportive manner.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- List the core components of a VAP bundle.
- Describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application.
- Explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered 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.
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 components of a VAP bundle were addressed in this story?
- What does this story illustrate about the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application?
- How do you feel Denise handled the disagreement with Dr. Martin? What else could she have done?
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Thursday, October 2nd, 2014
163
Student’s Guide – We Need 100% of You Now!
Overview:
This story is about how distractions can cause serious compromises in patient safety and need to be consciously controlled. Some teams have devised approaches to prevent distractions, similar to how the airline industry has created “sterile cockpits” that keep the team focused when it counts.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify potential distractions that occur during high-consequence patient care processes, such as surgery.
- Decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand.
- Describe and adopt guidelines that control distractions during the high-consequence time periods.
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.
- 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, 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 potential distractions could have disrupted the surgery in this story?
- How did the team’s use of the “sterile cockpit” environment contribute to Steffan’s patient experience?
- How does the “sterile cockpit” environment” help control distractions during high-consequence time periods?
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Thursday, October 2nd, 2014
162
Student’s Guide – Aware of the Situation
Overview:
This story is about an elderly woman being cared for in a nursing home who is incontinent and catheterized despite new criteria for catheterization, because indwelling urinary catheters cause up to 80% of hospital-acquired infections, 30% of which are unnecessary.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the core features of a CAUTI Bundle.
- Identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit.
- Explain the importance of implementing evidence-based protocols to reduce CAUTI.
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 core features of a CAUTI bundle were in place in this story?
- What attitudinal and work-load barriers were present in the story that prevented the implementation of the new protocol?
- What does this story illustrate about the importance of implementing evidence-based protocols to reduce CAUTI?
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Thursday, October 2nd, 2014
161
Student’s Guide – Dial I for Ignore
Overview:
This story is about the importance of hand washing. Failing to wash hands between each patient visit can result in CLABSIs. According to a recent CDC report, the majority of CLABSIs are now occurring outside of ICUs, especially in outpatient dialysis.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the essential best practices in a CLABSI bundle.
- Describe and apply evidence-based practices in hand hygiene.
- Explain the importance of providing patients with opportunities to ask questions about their 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.
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 essential best practices in a CLABSI bundle were followed in the story? Which weren’t?
- What does this story illustrate about the importance of applying evidence-based practices in hand hygiene?
- What steps can the team take to ensure that they are consistently following best practices in hand hygiene?
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Thursday, October 2nd, 2014
160
Student’s Guide – Admission of Failure
Overview:
This story is about preventable readmissions. They may result from incomplete treatment or poor care of the underlying problem, or may reflect poor coordination of services at the time of discharge. Every team member is responsible for the discharge process.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe evidence-based strategies that reduce preventable readmissions.
- Explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings.
- Generate a protocol to coordinate care between hospital and community settings.
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.
- 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:
- How did General Hospital fail to prevent Akiki’s relapse?
- What evidence-based strategies to reduce preventable readmissions did Helen employ? Why were they important?
- What does this story illustrate about the importance of including families and patients in the discharge planning process?
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Thursday, October 2nd, 2014
159
Student’s Guide – Brief to Set the Tone
Overview:
Team leaders must set the tone for service excellence. Without collective decision-making, targeted goal setting and clear roles and responsibilities, team performance suffers. This has a negative impact on patient satisfaction and safety.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe the components of successful team briefing.
- Describe the importance of planning for contingencies related to staffing, resources, and equipment.
- Explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors.
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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Team 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 health care professionals.
Team Briefs: Similar to a pre-flight checklist used in aviation, during a brief the team leader should cover the items on the checklist. As in aviation, the briefings before flights provide the ideal forum for building a team dynamic that allows everyone to work together when carrying out routine tasks and when tackling unexpected problems. 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; and,
- 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:
- What components of successful team briefings are demonstrated in this story?
- What do you feel Charlie did well in this story that helped build up his team?
- What does this story illustrate about the importance of integrating safe practices into daily work practices by inviting team accountability and back-up behaviors?
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Thursday, October 2nd, 2014
158
Student’s Guide – The Tiger Gets New Stripes
Overview:
This story is about the deviation from safety protocols. It is a leading cause of patient harm. Executive leaders must hold all providers and staff accountable for safe practices and protocols. Coaching for engagement is a strategy for gaining buy-in and behavior change.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain the consequences of not consistently following safety protocols or practices.
- Describe the importance of applying consistent consequences across all disciplines for not following safe practices.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 that all team members consistently follow safety protocols and practices?
- Why was it imperative for Mr. Porter to establish the same standard for Dr. Barnes as he expected from the rest of the staff?
- If you were on this surgical team, what could you have done to help ensure that safety protocols were consistently practiced?
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Thursday, October 2nd, 2014
157
Student’s Guide – Improving Medication Safety
Overview:
This story is about how labor nurses are at risk for professional liability when titration results in uterine tachysystole aren’t recognized in a timely manner, and how effective nurse-doctor communication is crucial to provide an outstanding patient experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin.
- Describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin.
- Explain and adopt IHI elective induction and augmentation bundles.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 are the responsibilities of team members in reducing patient harm associated with the use of oxytocin?
- How were those responsibilities fulfilled and neglected in this story?
- What could be done to better empower Francine to speak up and intervene when she sees and unsafe situation involving oxytocin?
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Thursday, October 2nd, 2014
156
Student’s Guide – Everyone is a Monitor
Overview:
This story is about the impacts of adverse drug events (ADEs). Proper communication protocols between physicians and nursing home staff are essential to prevent patient ADEs.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety.
- Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 for medication safety were not followed in this story?
- What are some ways this team could ensure better medication safety for their patients?
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