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217 – Out of the Blue Instructor’s Guide

Monday, April 3rd, 2017

217

Instructor’s Guide – Out of the Blue


Overview:
This story highlights the importance of provider listening and questioning during patient assessments.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Integrate patient complaints within diagnostic processing.
  • Examine the seriousness of patient complaints until the patient feels they have adequately been addressed.
  • Modify treatment routines based on patient complaints, as required.

 

 

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: 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.
  • 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: Situation Monitoring

TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

 

  • Situation Monitoring is the process of continually scanning and assessing a situation to gain and maintain an understanding of what’s going on around you.
  • Situation Awareness is the state of “knowing what’s going on around you.”
  • A shared mental model results from each team member maintaining situation awareness and ensures that all team members are “on the same page.”

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. How could the health care team have improved their patient-centered care for Mr. Crane?
    A: The health care team could have improved patient care by listening to his complaints and integrating them into the diagnostic processing.
  2. How could the healthcare team improve their response and treatment of this patient?
    A: The healthcare team could have improved their response by examining the seriousness of Mr. Crane’s complaints until the patient feels they have adequately been addressed.
  3. What might have prevented Mr. Crane’s collapse?
    A: The treatment routine could have been modified as required based on Mr. Crane’s complaints both in the ED and during x-ray procedures.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  • What can we learn from this story?
    A: Patient complaints are an important part of initial and ongoing treatment processes.
  • Could this situation have been prevented? If so, how?
    A: One way the team may have prevented this situation was to address Mr. Crane’s complaints and adjust the treatment process accordingly.
  • What actions could have been taken to avoid patient harm in this situation?
    A: As soon as Mr. Crane stated that he was feeling dizzy during the x-ray procedure he could have been seated and monitored to prevent the fall.

 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Integrate patient complaints within diagnostic processing. Student ignores or underestimates the seriousness of patient complaints. Student notes patient complaint, but fails to modify treatment procedure to ensure patient safety. Student notes patient complaint, and modifies treatment procedure properly to ensure patient safety.
Examine seriousness of patient complaints until patient feels they have adequately been addressed. Student does not recognize the seriousness of patient complaints and fails to act accordingly. Student recognizes seriousness of and listens attentively to the complaint, but fails to repeat back their own understanding of the complaint with the patient for verification. Student recognizes seriousness of the complaint, addresses the complaint, and verifies with the patient that the complaint has been addressed.
Modify treatment routine based on patient complaints as required. Student makes no attempt to modify treatment routine based on patient complaint. Student verifies understanding of patient complaint, but fails to modify treatment. Student verifies understanding of patient complaint with patient and modifies treatment plan accordingly.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication, situation monitoring, situation awareness and mutual support. Some best practices to consider for improving team communication include:

  • STEP Process
  • Cross Monitoring
  • Advocacy
  • Active Listening

 

 

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216 – The Patient Traveled to Africa…What’s Next? Instructor’s Guide

Thursday, December 18th, 2014

216

Instructor’s Guide – The Patient Traveled to Africa…What’s Next?


Overview:
Healthcare facilities and especially Emergency Departments need to be prepared to implement administrative and precautionary procedures to treat potentially infected patients, but more importantly they need to protect their healthcare workers as well.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Describe proper procedures that would minimize staff exposure while identifying, informing, and isolating patients and family members during treatment for potentially highly contagious conditions.
  • Recognize the importance of following a plan that applies checklists and protocols established by the CDC and the healthcare facility during treatment of patients suspected of highly contagious conditions.
  • Explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process.

 

 

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.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Briefs, Handoff, and Check-Backs

TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

 

  • A brief is a short session prior to start to share the plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and likely contingencies.
  • A handoff is the transfer of information (along with authority and responsibility) during transitions in care across the continuum. It includes an opportunity to ask questions, clarify, and confirm.
  • A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked back.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. How could the safety, quality, and cost effectiveness of health care been improved through the active use of checklists and protocols?
    A: The health care team could have improved patient care by using checklists and protocols to manage the care of patients with suspected Ebola. In this scenario the staff were unsure of what to do and how to handle a potential Ebola case. The use of checklists and protocols could have avoided this type of situation.
  2. How could the healthcare team improve their response and treatment of this patient and family member?
    A: The healthcare team could have improved their response by using open communication and check-backs. Healthcare professions must be diligent to provide quality patient care no matter the situation.
  3. Was is it smart for the team to continue to treat the patient and family member as potentially highly contagious and keep them isolated in the way they did? Why or why not?
    A: The team needed a reason to continue to treat the patient and the family members as potentially highly contagious. The team appeared to be unprepared with specific protocol for such a situation. There was not consensus on how to treat a potentially contagious patient.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  • What can we learn from this story?
    A: Potential harm occurred to a patient because the nurse was trying to provide care for her patient, but did not use appropriate communication, ‘check-backs’, or closed loop communication. She could have avoided this scenario if she would have waited for the appropriate checks to be made instead of speaking negatively about the patient and avoiding the situation.
  • What are some things this team could have done to improve the way they communicated and to ‘stay on the same page’?
    A: One way for the team to improve communication would be to use a ‘debrief’ or a ‘huddle’ to allow the staff to learn about important patient issues or to allow them to ask questions. This is used as a way to improve communication and keep
    team members on the ‘same page’.
  • Did team members understand their roles and responsibilities? Why or why not?
    A: In this scenario team members did not understand their roles or responsibilities in a very way. By making team members more aware of their responsibilities they are more likely to take ownership of their own work.
  • What could this team have done to prepare for safe and effective hand-offs during staff changes, transitions between hospital units and to other care providers while keeping the patient and family informed throughout the process?
    A: It is important that safe and effective hand-offs encourage effective communication are done no matter what situation is present for the nurse. This may be even more critical during high workload periods due to the increased stress and chaos of the situation
    A: Another way to improve communication is to use the 3W’s and to include the patient in their own care. Patient-centered care means that health care professionals need to keep the patient informed of what they are doing, why they are doing it and that they care.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Provide students with CDC Guidelines/Protocols for Care of Potential Ebola Patients. Ask students to imagine that they are in charge of developing an updated plan for healthcare workers in a hospital setting, addresses CDC Guidelines/Protocols for care of potential Ebola patients. Ask students to breakout into 4 separate workgroups. Each group will develop a presentation and checklist for their designated precaution protocol step (Group 1-Identify, Group-2 Isolate, Group 3-Inform, and Group 4-Protection (PPE).
  • Ask groups to create a list of strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers, while keeping the patient and family informed throughout the process.

 

 




 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe proper procedures that would minimize staff exposure while identifying, informing, and isolating patients and family members during treatment for potentially highly contagious conditions. Student struggles to describe proper procedures that would minimize staff exposure while identifying, informing, and isolating patients and family members during treatment for potentially highly contagious conditions. Student can describe proper procedures that would minimize staff exposure while identifying, informing, and isolating patients and family members during treatment for potentially highly contagious conditions, but needs further practice. Student can accurately describe proper procedures that would minimize staff exposure while identifying, informing, and isolating patients and family members during treatment for potentially highly contagious conditions.
Recognize the importance of following a plan that applies checklists and protocols established by the CDC and the healthcare facility during treatment of patients suspected of highly contagious conditions. Student struggles to recognize the importance of following a plan that applies checklists and protocols established by the CDC and the healthcare facility during treatment of patients suspected of highly contagious conditions. Student can recognize the importance of following a plan that applies checklists and protocols established by the CDC and the healthcare facility during treatment of patients suspected of highly contagious conditions, but needs further practice. Student can accurately recognize the importance of following a plan that applies checklists and protocols established by the CDC and the healthcare facility during treatment of patients suspected of highly contagious conditions.
Explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers, while keeping the patient and family informed throughout the process. Student struggles to explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process. Student can explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process, but needs further practice. Student can accurately explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication, situation monitoring, situation awareness and mutual support. Some best practices to consider for improving team communication include:

  • 3 Ws – Who I Am, What I am Doing, and Why I Care
  • Briefs/Huddles/Debriefs
  • Check-Backs
  • STEP
  • SBAR
  • Handoffs
  • Collaboration
  • “Speak Up”

 

 

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215 – SBAR as Though Your Life Depended on It Instructor’s Guide

Thursday, December 18th, 2014

215

Instructor’s Guide – SBAR as Though Your Life Depended on It


Overview:
After receiving a report from a nurse who is vague and unspecific about the condition of his patient and what he wants done, a doctor takes the nurse aside and gives him some feedback and coaching about the form of the information that would be useful when the nurse is giving a report.  Having a structured format for giving reports between clinical staff members leads to increased efficiency and enhanced safety.  One such structured format is SBAR, which stands for Situation, Background, Assessment, and Recommendation.  The SBAR tool can be easily learned, readily applied, and will lead to more accurate, professional, and mistake-free communication.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Identify the words and meaning of the TeamSTEPPS© SBAR tool.
  • Demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.
  • Adopt SBAR as the standard tool for giving report from one staff member to another.

 

 

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: SBAR

TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

 

  • SBAR is a technique for communicating critical information that requires immediate attention and action concerning a patient’s condition.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. After listening to and/or reading the story, how can you improve your use of the TeamSTEPPS SBAR tool?
    A: One way is to implement an in-service to educate the nurses on the use of SBAR. Another way is to create a report sheet that reflects the outline of SBAR. It is important that staff are able to communicate in a easy to understand and still relays the necessary information. This form of communication is called SBAR.
  2. In what other situations would it be appropriate to use the TeamSTEPPS SBAR tool?
    A: Anytime health care professionals are transferring a patient or giving report about the care of the patient. The SBAR tool can be used anytime patient hand off is given to another healthcare professional.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: All team members need to be able to communicate appropriately to each other. This should be done out of mutual respect and not out of personal interest.
    A: In this situation Dr. Cowan did not make Henry feel bad about the report he gave, but spoke to him about the use of SBAR and then demonstrated the use of SBAR.
  2. How did the SBAR technique improve communication between the nurse and the physician?
    A: The SBAR technique improves communication because it is a succinct way to provide critical and relevant information regarding the patient.
  3. In what other situations could you effectively use the TeamSTEPPS SBAR tool?
    A: Any time you are communicating with other healthcare professionals, regarding patient care, it is appropriate to use SBAR. In this situation, SBAR would have been a more effective way to communicate this serious situation to the doctor

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Ask students to describe the possible consequences for both the patient and the hospital when situations like the one in this story occur. Why is it important for all team members to understand the consequences of their action or inaction for both patients, themselves, and the healthcare facility?
  • Ask the students to list four things that went well in the story and four things that could lead to errors.
  • Discuss possible barriers to using the TeamSTEPPS SBAR tool, and what to do to overcome them.

 

 




 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify the words and meaning of the TeamSTEPPS SBAR tool. Student struggles to identify the words and meaning of the TeamSTEPPS SBAR tool. Student can identify the words and meaning of the TeamSTEPPS SBAR tool, but needs further practice. Student can accurately identify the words and meaning of the TeamSTEPPS SBAR tool.
Demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate. Student struggles to demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate. Student can demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate, but needs further practice. Student can accurately demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.
Adopt SBAR as the standard tool for giving report from one staff member to another. Student struggles to adopt SBAR as the standard tool for giving report from one staff member to another. Student can adopt SBAR as the standard tool for giving report from one staff member to another, but needs further practice. Student can accurately adopt SBAR as the standard tool for giving report from one staff member to another.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication, situation monitoring, situation awareness and mutual support. Some best practices to consider for improving team communication include:

  • Brief
  • Huddle
  • Debrief
  • SBAR
  • Call-Out
  • Check-Back

 

 

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214 – Debrief or Perish…Ebola Risk Instructor’s Guide

Thursday, December 18th, 2014

214

Instructor’s Guide – Debrief or Perish…Ebola Risk


Overview:
An Emergency Department (ED) has a near miss (no patient harm; no staff harm) during an event in which a patient suspected of Ebola is admitted, and nurses notice a number of breaches of protocols recently issued by the CDC. Two weeks later another patient is brought in and the team has relaxed its vigilance. This time it’s for real, but the quick creep of deviance has begun to be normalized and staff are seriously exposed to harm. Teams often fail to learn as much as they can from critical incidents. By not taking adequate time to report, discuss, and examine near-misses and other errors in patient care, teams are destined to repeat the same mistakes. Team debriefs have proven to be an effective team learning and self-correction strategy.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Define key responsibilities of effective leaders.
  • List three strategies effective leaders can integrate into regular practice to promote team learning, error management, continuous improvement, and self-correction.
  • Describe the importance of sharing lessons learned from team 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.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Debrief

Team Strategies and Tools 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 debrief is an informal information exchange session designed to improve team performance and effectiveness through lessons learned and reinforcement of positive behaviors./li>

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. How could you solicit input from other team members to improve individual, as well as team performance?
    A: One was to solicit input is to learn more about what the staff are doing and to get staff involved in the change process. A debrief could be used to determine the resources staff are using and to learn more about ways to support the staff.
  2. What are some effective strategies you could use for communicating and resolving conflict?
    A: Some strategies that could be used would be the use of a “huddle” or “debrief”. This would allow staff to voice their concerns and to learn different ways of improving team performance.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: The importance of being prepared for emergencies or crisis to occur, but also the ability to adjust and adapt to those changes as needed. In this story we learned that errors had occurred in a previous situation, but the staff in the ER did not make improvements or changes to their work. Therefore, when a similar experience occurred again they were not prepared to make the necessary changes to improve patient care.
  2. What does this story illustrate about the importance of effective leadership skills? Do you think you could have emerged as a situational leader in the same situation?
    A: There is a need, in this situation, for a leader to emerge. It does not have to be someone assigned as a leader, but rather any staff member willing to make a change. This scenario describes how staff responded inappropriate to a potentially contagious patient and did not change their habits in order to protect
    themselves or to provide quality patient care.
  3. How can effective leaders make debriefs a consistent team practice for learning and improvement?
    A: Effective leaders use debriefs to keep the other team members informed of what is important and necessary. This can also be used as a time to clarify information and to let other team members express their concerns or to ask questions

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Ask students to describe key responsibilities of a designated or situational leaders.
  • Discuss three strategies that team leaders can use to facilitate team work.
  • Provide the students with the Debrief Checklist and ask them to write a debrief that covers Adama’s treatment plan results in the story.

 

 




 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Define key responsibilities of effective leaders. Student struggles to define key responsibilities of effective leaders. Student can define key responsibilities of effective leaders, but needs further practice. Student can accurately define key responsibilities of effective leaders.
List three strategies effective leaders can integrate into regular practice to promote team learning, error management, continuous improvement and self-correction. Student struggles to list three strategies effective leaders can integrate into regular practice to promote team learning, error management, continuous improvement, and self-correction. Student can list three strategies effective leaders can integrate into regular practice to promote team learning, error management, continuous improvement, and self-correction, but needs further practice. Student can accurately list three strategies effective leaders can integrate into regular practice to promote team learning, error management, continuous improvement, and self-correction.
Describe the importance of sharing lessons learned from team debriefs with other team members and across the organization. Student struggles to describe the importance of sharing lessons learned from team debriefs with other team members and across the organization. Student can describe the importance of sharing lessons learned from team debriefs with other team members and across the organization, but needs further practice. Student can accurately describe the importance of sharing lessons learned from team debriefs with other team members and across the organization.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • Brief
  • Huddle
  • Debrief

 

 

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213 – To Monitor or To Observe…That Is the Question Instructor’s Guide

Thursday, December 18th, 2014

213

Instructor’s Guide – To Monitor or To Observe…That Is the Question


Overview:
This story highlights how when a team deviates from infection control policies and procedures, the staff, hospital, and community can be at risk for spreading infectious disease without knowing it. Hospitals are responsible for maintaining up to date infection control procedures that are consistent with the Centers for Disease Control and Prevention’s Infection Prevention and Control Recommendations while treating patients with known or suspected Ebola Virus Disease. The overall safe care of patients being investigated for Ebola must be overseen by an onsite manager. Strict adherence to Personal Protective Equipment (PPE) donning/doffing procedures must be supervised by a trained observer in order to prevent risk of self-contamination. This includes observing staff while they provide supportive care to the patient whether it is through a glass wall or by video monitoring system.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Explain safe practices related to donning/doffing PPE while caring for a person under investigation for Ebola Virus Disease.
  • Apply checklists and protocols during implementation of PPE precautions for suspected Ebola risk.
  • Adopt critical language to ‘stop the line’ when deviation from protocols occurs regardless of professional hierarchies.

 

 

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: Two-Challenge Rule

TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) 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 empowers all team members to “stop the line” if they sense or discover an essential safety breach. 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. When an initial assertive statement is ignored:
    • It is your responsibility to assertively voice concern at least two times to ensure that it has been heard.
    • The team member being challenged must acknowledge that concern has been heard.
    • If the safety issue still hasn’t been addressed:
      • Take a stronger course of action.
      • Utilize supervisor or chain of command.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. After reading the story, discuss the basic principles for safe and effective PPE use and the need for a trained observer to oversee each healthcare worker as they don and doff PPE. How frequently do you think you need to train the steps to donning/doffing PPE in order to maintain proficiency and confidence?
    A: Proficiency and confidence may not be the same for every health care professional. This is why it is important to have a trained observer oversee the donning and doffing process. At some hospitals this training is done on a yearly basis, but it may need to be done semi-annually or quarterly if the need arises.
  2. Why is the trained observer required to monitor and document donning and doffing procedures?
    A: This is necessary due to the serious nature and high risk of contracting Ebola. A trained observer is not a requirement when donning or doffing PPE equipment in many other scenarios. However, a trained observer is needed in this situation due to the serious risk this disease poses to the health care provider.
  3. Did the healthcare team provide adequate mutual support to its team members? Why or why not?
    A: It is unknown in this scenario if mutual support was given to the team members. However, it is known that this nurse was not placed with another preceptor even though she was still new to the facility.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: We learned the importance or appropriate donning and doffing of PPE equipment.
  2. What could the team in this story do to reduce the risk of self-contamination while treating a person under investigation for Ebola in their unit?
    A: One way would be to inform the monitor of the importance of having a trained observer present anytime a health care provider entered or exited the patient’s room.
  3. What one or two things could you do to ensure safety protocols related to donning and doffing PPE are regularly followed?
    A: One way to ensure safety is to have a trained observer present when donning and doffing PPE equipment. Another way is to provide regular in-service times when staff can practice donning and doffing PPE equipment in a non-stressful environment.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Ask students to identify risk factors that might affect their proficiency and comfort levels with performing duties while wearing PPE.
  • Provide students an opportunity to review and discuss the CDC Guidance on PPE To Be Used by Healthcare Workers During Management of Patients with Ebola Virus Disease in US hospitals, including Procedures for Putting On (Donning) and Removing (Doffing).
  • Ask students to demonstrate the Two-Challenge Rule strategy.

 

 




 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain the safe practices related to donning/doffing PPE while caring for a person under investigation for Ebola Virus Disease. Student struggles to explain the safe practices related to donning/doffing PPE while caring for a person under investigation for Ebola Virus Disease. Student can explain safe practices related to donning/doffing PPE while caring for a person under investigation for Ebola Virus Disease, but needs further practice. Student can accurately explain the safe practices related to donning/doffing PPE while caring for a person under investigation for Ebola Virus Disease.
Apply checklists and protocols during implementation of PPE precautions for suspected Ebola risk. Student struggles to apply checklists and protocols during implementation of PPE precautions for suspected Ebola risk. Student can apply checklists and protocols during implementation of PPE precautions for suspected Ebola risk, but needs further practice. Student can accurately apply checklists and protocols during implementation of PPE precautions for suspected Ebola risk.
Adopt critical language to ‘stop the line’ when deviation from protocols occurs regardless of professional hierarchies. Student struggles to adopt critical language to ‘stop the line’ when deviation from protocols occurs regardless of professional hierarchies. Student can adopt critical language to ‘stop the line’ when deviation from protocols occurs regardless of professional hierarchies, but needs further practice. Student can accurately adopt critical language to ‘stop the line’ when deviation from protocols occurs regardless of professional hierarchies.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • STEP
  • SBAR
  • Collaboration
  • I’M SAFE
  • Task Assistance
  • Feedback
  • Two-Challenge Rule
  • CUS

 

 

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212 – Can You Hear Me…Ebola Risk Instructor’s Guide

Thursday, December 18th, 2014

212

Instructor’s Guide – Can You Hear Me…Ebola Risk


Overview:
This story highlights how inefficient assessment and engagement with the patient and their issues can lead to extraordinary consequences for the patient and the staff. One missed step in the assessment process can possibly lead to deadly viral contamination for healthcare providers. Implementation of standard precautions, such as determining risk for Ebola, should be everyone’s concern, including implementing procedures that inform or train staff returning from vacation or other types of leave of absences, when critical training is missed.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Explain the importance of analyzing a patient’s condition by conducting a thorough assessment including making eye contact and reading body language.
  • Demonstrate a structured patient handoff including a verbal check-back from the team member receiving the patient.
  • Design a team structure that ensures the team leader is not pulled away from coordinating care across the unit.

 

 

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: Briefs, Handoff, and Check-Backs

TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.

 

  • A brief is a short session prior to start to share the plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, and anticipate outcomes and likely contingencies.
  • A handoff is the transfer of information (along with authority and responsibility) during transitions in care across the continuum. It includes an opportunity to ask questions, clarify, and confirm.
  • A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked back.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. After reading the story, discuss strategies for identifying and managing overlaps in team member roles and the things they’re accountable for. How could the Nurse Leader/Manager/Administrator better prepare Nurse Hansen to return to his duties after vacation and missing critical training?
    A: One way is to given Nurse Hansen a quick in service regarding the necessary information he may have missed while out on vacation. Another is to have him read the notes from the last meeting to ensure he is aware of any changes.
  2. How could the health care team improve their response and treatment of this patient? Did they follow precaution protocols accurately? Why or why not?
    A: This patient should have been asked about any recent travel to ensure a variety of contagious disease are not spread within the ER. Although Nurse Hansen did not follow the appropriate protocol the other health care team members did. This will help to reduce the risk of spreading contagious disease to other health
    care team members or patients.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: All team member need to accountable for their actions and decisions. In this story, Nurse Hansen put himself, along with everyone in the ER, at risk of exposure to Ebola.
  2. What could this team do to improve the way they coordinate care across teams especially when workload increases?
    A: One way is to meet with the people involved in the error and to emphasize the need to learn and grow from the situation. It is then a good idea to reflect on what happened and potential options to take in the future. This should not be used as a punishment, but as a way to learn a different way of providing care to the patient
  3. What one thing can you do to ensure you provide a thorough report and safe handoff for every patient?
    A: A thorough report and safe patient handoff is important in providing safe patient care. This can be done by implementing SBAR any time a patient leaves the floor and during change of shift report. Another way is to use briefs, huddles, or debriefs to ensure all health care team members are aware of the patient’s
    condition and the plan of care.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Write a one page summary of the impact this story might have on the ED. Include how you might react if in a similar situation. Students are provided an opportunity to examine the CDC Ebola guidelines.
  • Students are designated into breakout groups and each group is give a healthcare role to discuss within their group (such as, group 1 discusses impact of the story as it concerns Nurse Hansen/intake team, group 2 discusses impact as it concerns treatment team, group 3 discusses impact on healthcare sanitation team, etc.) Each group is responsible for writing down 5 errors they recognize. The groups are asked to share and discuss perspectives and concerns.
  • Students are asked to describe a structured hand-off procedure that would provide improved communication during transitions in care for this patient.
  • Students are asked to describe a team structure that would allow the leader/manager to focus on primary duties and not get involved in lower priority tasks.

 

 




 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain the importance of analyzing a patient’s condition by conducting a thorough assessment including making eye contact and reading body language. Student struggles to explain the importance of analyzing a patient’s condition by conducting a thorough assessment including making eye contact and reading body language. Student can explain the importance of analyzing a patient’s condition by conducting a thorough assessment including making eye contact and reading body language, but needs further practice. Student can accurately explain the importance of analyzing a patient’s condition by conducting a thorough assessment including making eye contact and reading body language.
Demonstrate a structured patient handoff including a verbal check-back from the team member receiving the patient. Student struggles to demonstrate a structured patient handoff including a verbal check-back from the team member receiving the patient. Student can demonstrate a structured patient handoff including a verbal check-back from the team member receiving the patient, but needs further practice. Student can accurately demonstrate a structured patient handoff including a verbal check-back from the team member receiving the patient.
Design a team structure that ensures the team leader is not pulled away from coordinating care across the unit. Student struggles to design a team structure that ensures the team leader is not pulled away from coordinating care across the unit. Student can design a team structure that ensures the team leader is not pulled away from coordinating care across the unit, but needs further practice. Student can accurately design a team structure that ensures the team leader is not pulled away from coordinating care across the unit.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • 3 Ws- Who I Am, What I am Doing, and Why I Care
  • Briefs/Huddles/Debriefs
  • Check-Backs
  • STEP
  • SBAR
  • Handoffs
  • Collaboration
  • “Speak Up”

 

 

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211 – Yes, I’ve Been to Africa Recently Instructor’s Guide

Monday, December 1st, 2014

211

Instructor’s Guide – Yes, I’ve Been to Africa Recently


Overview:
Treating patients with possible deadly viral infections with respect and dignity while keeping them and their family members fully informed and as comfortable as possible during the observation and treatment processes can be difficult and challenging when staff are not prepared.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Describe and adopt communication and decision-making strategies that involve patient and family members as full team members during treatment for potentially highly contagious conditions.
  • Design and evaluate a plan to follow evidence-based practices during treatment for potentially highly contagious conditions, which includes keeping the patient and family as comfortable as possible.
  • Explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. In what ways was patient-centered care compromised in this story? What do you feel should have been handled differently and why?
    A: Patient-centered care was compromised when the nurse did not foster open communication when providing care to the patient and her husband. Mutual respect is an important part of team work and that was not demonstrated in this story. This situation could be been handled differently by treating the patient with respect and not jumping to conclusions regarding the patient’s diagnosis.
  2. What does this story illustrate about the consequences of not fully understanding or planning for the implementation of evidence-based practices in a highly contagious scenario?
    A: The consequences related to this scenario are potentially devastating for the patient. The patient has been sent a bill the insurance will not cover and it is due to the care the hospital gave. This patient will most likely not return to this hospital and she may not be able to pay her hospital bill. This is an unnecessary burden for the patient.
  3. After examining the CDC’s guidelines and protocols for potential Ebola patients, what do you feel the hospital could have done to better address Hannah and Eric’s needs, while not compromising staff safety?
    A: They hospital staff could have created an environment of mutual respect and shared decision making. Hannah and Eric could have been involved in the
    decision making process regarding their plan of care.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: All team members need to be able to hold each other accountable for their behavior. This should be done out of mutual respect and not out of personal interest. Hannah and Eric may come to believe they were treated improperly due to the lack of preparation by the hospital staff.
  2. What can we do to prepare for safe and effective hand-offs during staff changes, transitions between hospital units and to other care providers while keeping the patient and family informed throughout the process?
    A: Safe and effective hand-offs are important in keeping patients and staff safe. SBAR is one way to establish a safe and effective hand-off. This will help to aid in transitions between hospital units and to other care providers.
  3. What can we do as a team to ensure patient and family members are included as part of the team and that their basic comfort needs are addressed during treatment for potentially highly contagious conditions?
    A: Good teamwork behaviors need to start with the health care team. Mutual respect and shared-decision making needs to be established with the nurse and doctor first. This is especially important when health care team members are concerned about contracting a contagious disease from a patient. The nurse and doctor could have set the best standard for others to follow.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • After examining the CDC’s guidelines and protocols for the care of potential Ebola patients, rewrite this story following what you feel are the procedures the hospital’s staff should have followed to adhere to evidence-based practices for highly contagious conditions and patient-centered care. Compare your suggestions with those of classmates and discuss and evaluation your choices.
  • Create a presentation or brochure that describes the CDC’s guidelines and protocols for the care of potential Ebola patients, and how they could be applied in an Emergency Department. Compare your presentation with those of your classmates, and discuss and evaluate the choices you’ve made.
  • Describe better hand-off procedures that could have been used in this story to keep the Hannah and Eric informed throughout the process. Think of their transitions between units, to other care providers, and throughout the duration of their stay.
  • Write a review of this hospital stay from Hannah’s perspective.

 

 




 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe and adopt communication and decision-making strategies that involve patient and family members as full team members during treatment for potentially highly contagious conditions. Student struggles to describe and adopt communication and decision-making strategies that involve patient and family members as full team members during treatment for potentially highly contagious conditions. Student can describe and adopt communication and decision-making strategies that involve patient and family members as full team members during treatment for potentially highly contagious conditions, but needs further practice. Student can accurately describe and adopt communication and decision-making strategies that involve patient and family members as full team members during treatment for potentially highly contagious conditions.
Design and evaluate a plan to follow evidence-based practices during treatment for potentially highly contagious conditions, which includes keeping the patient and family as comfortable as possible. Student struggles to design and evaluate a plan to follow evidence-based practices during treatment for potentially highly contagious conditions, which includes keeping the patient and family as comfortable as possible. Student can design and evaluate a plan to follow evidence-based practices during treatment for potentially highly contagious conditions, which includes keeping the patient and family as comfortable as possible, but needs further practice. Student can accurately design and evaluate a plan to follow evidence-based practices during treatment for potentially highly contagious conditions, which includes keeping the patient and family as comfortable as possible.
Explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process.   Student struggles to explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process. Student can explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process, but needs further practice. Student can accurately explain strategies and methods to ensure safe and timely hand-offs during staff transitions, between hospital units and to other care providers while keeping the patient and family informed throughout the process.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • 3 Ws- Who I Am, What I am Doing, and Why I Care
  • Briefs/Debriefs
  • AskMe3
  • STEP
  • Handoffs
  • Collaboration
  • “Speak Up”

 

 

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210 – I’m Alright, Really Instructor’s Guide

Friday, October 10th, 2014

210

Instructor’s Guide – I’m Alright, Really


Overview:
It is difficult to be objective about the well-being and fitness to work both about ourselves and our co-workers. The TeamSTEPPS I’M SAFE tool is meant to be a helpful checklist for assessing different dimensions of our own and others ability to deliver safe patient care.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Summarize elements of the TeamSTEPPS “I’M SAFE” resilience self-assessment tool.
  • Evaluate team members’ fitness for duty by identifying cues of stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD.
  • Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with crippling stress, burnout, and/or more severe psychological 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.
  • 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: 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.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. How did Amanda’s situation awareness help avoid a possible medical error?
    A: Amanda used insight and situational awareness to help avoid the placement of bilateral tourniquets on a patient before it was necessary.
  2. How can we improve our ability to recognize and manage stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD among team members using the TeamSTEPPS I’M SAFE tool?
    A: It means being aware of our own situation, but also that of our co-workers. It is not enough to just follow orders, but we must be aware of subtle changes in those around us.
  3. How can we develop the mutual support necessary to address, and if necessary, confront compromised performance on the part of a team member?
    A: One way to develop mutual support is to address the current situation or problem. Amanda did not ask the doctor a series of questions, but she addressed his current state. This should be done in a respectful manner to each person involved.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: It is important to be aware of subtle changes that may occur with our co-workers. It can be awkward at times, but it is important to address these changes. One way to address this issue is to use the I’M SAFE tool.
  2. How can you self-evaluate using the “I’M SAFE” tool, and why is this an important skill?
    A: It is often hard to slow down during high workload periods, but it is necessary for patient safety. It is import to use the I’M SAFE tool if a change is observed in a co-worker or even yourself.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Create a presentation for colleagues on the usefulness of the TeamSTEPPS STEP tool. Describe how it could be used.
  • Think of another scenario for using the STEP tool. Describe the scenario and write a story using the STEP tool effectively.
  • Brainstorm ways to practice the STEP tool on a regular basis. Share your ideas with the class and come up with a list of the best ways to practice using the tool.

 

 




 

Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Summarize elements of TeamSTEPPS “I’M SAFE” resilience self-assessment tool.  Student struggles to summarize elements of the TeamSTEPPS “I’M SAFE” resilience self-assessment tool. Student can summarize elements of the TeamSTEPPS “I’M SAFE” resilience self-assessment tool, but needs further practice. Student can accurately summarize elements of the TeamSTEPPS “I’M SAFE” resilience self-assessment tool.
Evaluate team members’ fitness for duty by identifying cues of stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD. Student struggles to evaluate team members’ fitness for duty by identifying cues of stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD. Student can evaluate team members’ fitness for duty by identifying cues of stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD, but needs further practice. Student can accurately evaluate team members’ fitness for duty by identifying cues of stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD.
Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with crippling stress, burnout, and/or more severe psychological problems.   Student struggles to adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with crippling stress, burnout, and/or more severe psychological problems. Student can adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with crippling stress, burnout, and/or more severe psychological problems, but needs further practice. Student can accurately adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with crippling stress, burnout, and/or more severe psychological problems.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • I’M SAFE

 

 

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209 – First Baby STEP Instructor’s Guide

Friday, October 10th, 2014

209

Instructor’s Guide – First Baby STEP


Overview:
This story is about the loss of situation awareness as the root cause of many serious medical errors and sentinel events. A team’s ability to maintain situation awareness depends on having good tools to use, and using those tools consistently and skillfully.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Summarize the elements of the TeamSTEPPS STEP situation awareness tool.
  • Describe how situation awareness can be maintained by consistent use of the STEP tool.
  • Plan how to consistently use and practice applying the STEP tool on the unit.

 

 

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: 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?

 

  
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. How does the STEP tool improve patient safety?
    A: TEAM STEPPS improves patient safety because good communication allows every team member to be aware of what is happening with the patient. The patient remains the focus of the team.
  2. Describe how and why the STEP tool was effective in this story.
    A: This team works in a very busy unit and by using the STEP tool they are proving safe patient care. The use of the STEP tool allows for all team members to be aware of what is occurring and how to support the team and the patient.
  3. How can the TeamSTEPPS STEP tool help us maintain situation awareness at all times and in all circumstances?
    A: TeamSTEPPS provides a framework for good communication. It is a way of verbalizing what is happening and to establish common goals.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: We have learned the appropriate use of good communication, teamSTEPPS, and closed loop communication. It may seem awkward in the beginning, but the more this type of communication is practiced the easier it is to use.
  2. How can I use the STEP tool to help maintain situation awareness?
    A: Situation awareness can be maintained by using check backs and open communication. This may be more critical during high workload periods due to the increased stress and chaos of a situation.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Create a presentation for colleagues on the usefulness of the TeamSTEPPS STEP tool. Describe how it could be used.
  • Think of another scenario for using the STEP tool. Describe the scenario and write a story using the STEP tool effectively.
  • Brainstorm ways to practice the STEP tool on a regular basis. Share your ideas with the class and come up with a list of the best ways to practice using the tool.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Summarize the elements of TeamSTEPPS STEP situation awareness tool.  Student struggles to summarize the elements of the TeamSTEPPS STEP situation awareness tool. Student can summarize the elements of the TeamSTEPPS STEP situation awareness tool, but needs further practice. Student can accurately summarize the elements of the TeamSTEPPS STEP situation awareness tool.
Describe how situation awareness can be maintained by consistent use of the STEP tool. Student struggles to describe how situation awareness can be maintained by consistent use of the STEP tool. Student can describe how situation awareness can be maintained by consistent use of the STEP tool, but needs further practice. Student can accurately describe how situation awareness can be maintained by consistent use of the STEP tool.
Plan how to consistently use and practice applying the STEP tool on the unit.   Student struggles to plan how to consistently use and practice applying the STEP tool on the unit. Student can plan how to consistently use and practice applying the STEP tool on the unit, but needs further practice. Student can accurately plan how to consistently use and practice applying the STEP tool on the unit.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • STEP

 

 

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208 – Check Back for a Good Outcome Instructor’s Guide

Friday, October 10th, 2014

208

Instructor’s Guide – Check Back for a Good Outcome


Overview:
This story is about how using check backs to ensure communication exchanges between the sender and the receiver can impact the accuracy of patient safety-critical information.

 


Primary Learning Outcomes

After completing this lesson, the student will be able to:

  • Summarize the elements of the TeamSTEPPS Check Back communication tool.
  • Describe how check backs close the communication loop and create more accuracy when exchanging critical information with other team members.
  • Adopt check backs as a tool to effectively exchange critical information with other team members, patients, and their families.

 

 

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: Check-Backs

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

 

Check-Backs: 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.

 

Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers

  1. What are check-backs and how can they improve team communication, patient safety, and patient care?
    A: Check-backs improve team communication, patient safety, and patient care by allowing team members to be aware of what is happening with the patient. It enables the team to use closed-loop communication as a way to enhance patient care.
  2. How did the lack of check-backs impact patient safety and care in this story?
    A: This team works in a very busy unit and by not using check-backs they impeded safe patient care. Each person in the scenario was working to care for the patient, but they were not able to work together.
  3. What do team members need to be able to do in order to effectively close the communication loop when exchanging critical information with other team members?
    A: The use of ‘check-backs’ allows for discussion and reflection to be made with each patient. Although it may be subtle, the use of ‘check-backs’ is another safe guard and allows for more thorough patient care.

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers

  1. What can we learn from this story?
    A: Potential harm occurred to the patient because the nurses and doctor were trying to provide care for the patient, but they did not use appropriate communication, ‘check-backs’, or closed loop communication. The health care team could have avoided this scenario if they would have had appropriate checks in place.
  2. How can I ensure that I close the communication loop with other team members when the instructions, procedures, or medications being given are of a critical nature?
    A: It is often hard to slow down during high workload periods, but it necessary for patient safety. It is important the correct checks and communication are done no matter what situation is present for the nurse. This may be even more critical during high workload periods due to the increased stress and chaos of the situation.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Imagine that this team used check-backs regularly. Rewrite this dialogue using appropriate check-backs.
  • Create a presentation that teaches your colleagues about the importance of check-backs and how they can improve safety and communication.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Summarize the elements of the TeamSTEPPS Check Back communication tool.  Student struggles to summarize the elements of the TeamSTEPPS Check Back communication tool. Student can summarize the elements of the TeamSTEPPS Check Back communication tool, but needs further practice. Student can accurately summarize the elements of TeamSTEPPS Check Back communication tool.
Describe how check backs close the communication loop and create more accuracy when exchanging critical information with other team members. Student struggles to describe how check backs close the communication loop and create more accuracy when exchanging critical information with other team members. Student can describe how check backs close the communication loop and create more accuracy when exchanging critical information with other team members, but needs further practice. Student can accurately describe how check backs close the communication loop and create more accuracy when exchanging critical information with other team members.
Adopt check backs as a tool to effectively exchange critical information with other team members, patients and their families.  Student struggles to adopt check backs as a tool to effectively exchange critical information with other team members, patients, and their families. Student can adopt check backs as a tool to effectively exchange critical information with other team members, patients, and their families, but needs further practice. Student can accurately adopt check backs as a tool to effectively exchange critical information with other team members, patients, and their families.

 

 

Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


Story-Specific Best Practices and Proven Tools:

In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:

  • STEP

 

 

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