Archive for the ‘Student Guides’ Category
Thursday, September 25th, 2014
135
Student’s Guide – If It Was Your Mom
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/or family members are witnesses to their care and can provide cross-monitoring to prevent errors from occurring.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Examine and describe team practices to promote cross-monitoring of high risk procedures including medication administration.
- Summarize policies and practices that can limit distractions and multi-tasking during critical care practices.
- Describe processes 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:
- 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.
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 health care 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 cross-monitoring an important practice? How was it illustrated in this story?
- How can we make sure our cross-monitoring of important procedures or medication administrations is not compromised by multitasking or staff changes?
- 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?
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Thursday, September 25th, 2014
134
Student’s Guide – In Whose Time?
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:
- Describe evidence-based safety protocols across the team to reduce planned deliveries less than 39 weeks without medical indication.
- Adopt and apply 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 to the patient and their family with deliveries less than 39 weeks without medical indication.
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.
- 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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: CUS
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals
- The CUS technique provides a framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue, but also the magnitude of the issue.
- First, state your Concern.
- Then state why you are Uncomfortable.
- If the conflict is not resolved, state that there is a Safety issue.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Explain why it is important to follow evidence-based practices to ensure patient safety, regardless of inconveniences it might cause.
- How might Beverly’s use of the CUS technique prevented the issues in this story? Why do you think she didn’t speak up?
- How is this story a non-example of patient-centered care? What would you change to make it an example of patient-centered care?
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Thursday, September 25th, 2014
133
Student’s Guide – They Come and Go
Overview:
This story is about the patient experience as seen through the eyes of the patient. Patients view their care as competent, yet disjointed, especially at shift changes. Bedside handoffs are one technique to make the transitions of care both satisfying and safer for the patient.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Evaluate and explain team opportunities to consistently involve patients and family members during transitions of care, especially at shift changes.
- Describe the importance of integrating bedside handoffs into daily practice to promote safer care and improve patient experience.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Bedside Handoffs
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
Bedside Handoffs – Change of shift report occurring at the patient’s bedside with these essential components:
- A standardized nursing report handoff tool.
- Bedside shift-to-shift report.
- Inclusion of the patient and family in the discussion of plans and goals of care, including introductions.
- Two-person medical record check.
Story Directions:
As you listen to and read the story, 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 team’s inability to consistently involve Daryl and Ed during transitions of care affect their experiences?
- What does this story illustrate about the importance of bedside handoffs?
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Thursday, September 25th, 2014
132
Student’s Guide – Debrief or Perish
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, you will be able to:
- Describe the importance of integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.
- Explain the importance of integrating family members as a critical source of patient information and medical history, especially if the patient is incapacitated or impaired.
- Generate and summarize strategies for recording and sharing lessons learns from debriefs with other team members and across the organization.
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.
- 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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice:
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 integrating team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction?
- Why is it important to actively seek out family members to participate as a full partner in a patient’s care?
- What are some ways this team could record and share lessons learned from debriefs with other team members and across the organization, considering their time constraints?
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Thursday, September 25th, 2014
131
Student’s Guide – Between the Cracks
Overview:
This story demonstrates the importance of improving team communication, developing effective cues, re-engineering processes, and promoting coordination between units to reduce Emergency Department length of stay (LOS) to improve patient safety, efficiency, and satisfaction.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify and describe strategies and methods to improve team monitoring of patient flow status related to discharge or admitting.
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.
- 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 the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Who do you believe is most at fault for the breakdown in Mrs. Harris’ care in the story? Explain your reasoning.
- What strategies and methods for monitoring patient flow could this team use to achieve better quality patient care?
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Thursday, September 25th, 2014
130
Student’s Guide – Sound the Alarm
Overview:
This story is about how staff response to safety alarms and patient call lights is essential to ensure patient safety. Preventing patient harm due to falls requires effective strategies and protocols in addition to team vigilance.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain the factors that affect team response to bed alarms or call signals.
- Describe team strategies to reduce patient falls through improved response to alarms or call signals.
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 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 some reasons that no one responded to Cecil’s alarm? Explain those in the story, as well as others you might infer from the story and your experience.
- Describe strategies that the team on this floor might be able to use to reduce patient falls and improve their response to alarms and call signals. Identify your top three priorities for improvement based on what you learned in the story.
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Thursday, September 25th, 2014
129
Student’s Guide – The Floor’s Open
Overview:
This story is about the importance of patience, flexibility, adaptability, and prior planning during the ‘learning curve’ to manage the changes related to team processes, workflows, and practices when any new technology or information system is introduced.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Analyze the impact of new technology on established team processes, practices, and workflows.
- Describe team strategies to balance workload and prioritize the use of technology or automation against established safe care practices.
- Explain the importance of demonstrating civility among team members to manage conflict, build trust, and establish open channels of team communication.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Quality Improvement (QI): Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: PEARLA
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.
- PEARLA is a technique used for connecting strongly with someone in order to establish their trust when delivering suggestions for correcting unprofessional or disruptive behavior. The letters stand for:
- P (Presence) – Look and see if you are fully present for the discussion or if you are distracted by other concerns or are overly emotional about the situation.
- E (Empathy) – Use empathic listening skills to actively express your understanding.
- A (Acknowledge) – Acknowledge the importance to them and to everyone concerned of finding a solution to the problem.
- R (Reflect/Reframe) – The goal is to reflect back what may be important to the person who is making the statement and provide an alternative way to view the situation that captures what matters most to that person.
- L (Listen Openly) – Listening openly requires that you listen to the facts, listen to the emotions, notice the body language, and listen for the meaning behind words.
- A (Ask Clarifying Questions) – Ask open-ended questions to more fully understand the situation from the other’s point of view.
Story Directions:
As you listen to and read the story, think about what you think the team members did well, and the things you think that could lead to errors. Also, keep the questions below in mind as you listen.
Reflection Questions:
- What safety protocols that can help prevent the risk of CLABSI were violated in this scenario?
- QSEN requires you to discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences. Do you think Dr. Long’s deviations from EBP in this scenario were valid or invalid? Explain your reasoning.
- Thinking about the TeamSTEPPS best practice “CUS” described earlier, when and how could Carly have employed this technique to better advocate for her patient’s safety?
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Thursday, September 25th, 2014
128
Student’s Guide – Welcome to the Team
Overview:
This story is about how bullying, hazing, and lateral violence are frequently part of a healthcare professional’s indoctrination. These practices cause both unnecessary stress and premature abandonment of the field, and often compromise both the satisfaction and safety of patients.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain and evaluate on-boarding practices to ensure proper supervision for safe, competent, and quality patient care.
- Describe the importance of adopting “no bullying, no hazing” policies and protocols.
- Clarify and explain the responsibility of team members in creating a climate of respect and professionalism for new team members.
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.
Story Directions:
As you listen to and read the story, think about the things that 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 shared on-boarding practices?
- Explain how Karen and Alice failed to create a climate of respect and professionalism in this story.
- How did Karen and Alice, and the procedures in place at the hospital, fail to minimize the risk of harm to Susie and Trey in this story? What should have been done instead?
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Thursday, September 25th, 2014
127
Student’s Guide – Caution for CAUTI
Overview:
This story describes the importance of following best practice protocols, such as the IHI bundle, to prevent urinary catheter associated infections. Use of a daily checklist ensures appropriate practices and guidelines are followed to decrease potential for infection.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe and apply safe guidelines for placement, care, and removal of urinary tract catheters.
- Generate strategies to ensure urinary tract catheter safe practices are strictly followed.
- Explain and adopt methods for challenging team members when safety protocols are not followed for any reason.
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 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 commonly accepted safe guidelines for the placement, care, and removal of urinary tract catheters. How were these Evidence-Based Practices not utilized in this story?
- What strategies could be used in this hospital to ensure that preventable CAUTIs do not continue to occur?
- How does this story demonstrate the importance of teamwork and communication that is focused on patient safety?
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Thursday, September 25th, 2014
125
Student’s Guide – These Things Happen
Overview:
This story is about how human error is common during ‘workload spikes’ due to monitoring failures, multitasking, distractions, deviations, or interruptions. Cross monitoring and team ‘backup behaviors’ are essential safety practices for managing such workload threats.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe safe practices and processes related to accurate lab specimen labeling.
- Identify and explain potential risks associated with mislabeled lab specimens including high workload periods.
- Describe team-based strategies and systems to ensure accurate labeling of lab specimens.
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: 3 Ws & Bedside Handoffs
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
- 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.
Story Directions:
As you listen to and read the story, think about the things that the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Describe safe practices and processes related to accurate lab specimen labeling that you have previously encountered.
- What safety errors occurred in this story? Describe each and their causes.
- How could the use of check-backs helped to avert the errors in this story?
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