Archive for the ‘Pro ED Guides’ Category
Thursday, October 2nd, 2014
191
Student’s Guide – Cross Monitor to Address Adverse Drug Events
Overview:
This story addresses the issue of cross monitoring as it relates to adverse drug events (ADEs). Proper communication protocols between physicians and nursing staff are essential to prevent patient ADEs.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe challenges in ensuring medication safety.
- Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
- Explain the importance of using evidence-based communication measures to improve medication safety in a unit.
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: Cross Monitoring
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Cross Monitoring: Cross monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What evidence-based practices were violated in this story? Were the violations warranted?
- What assumptions about patient safety did the nurses in this story make? Why were they detrimental?
- How could cross monitoring help this unit provide better patient care and safety?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
190
Student’s Guide – Safety Practices Depend on Advocacy and Assertion
Overview:
This story is about when we witness team members depart from evidence-based safety practices designed to minimize risk, and how we can best intervene when it’s often difficult or uncomfortable to speak up assertively to confront unsafe practices.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS.
- Explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.
- Describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Advocacy and Assertion
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Advocacy and Assertion: Advocacy and assertion interventions are invoked when a team member’s viewpoint does not coincide with that of a decision maker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to employ advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person’s view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What evidence-based practices were violated in this story? Were the violations warranted?
- What barriers to patient advocacy did Celeste face?
- How might she have overcome them to better advocate for the patient in this story?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
189
Student’s Guide – Your Patients and Family See What You Can’t See
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 family members are witnesses to their care and can provide cross monitoring to prevent errors from occurring.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Examine team practices to promote cross-monitoring of high risk procedures including medication administration.
- Generate policies and practices to limit distractions and multitasking during critical care practices.
- Design a process 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:
- 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: Cross Monitoring
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Cross Monitoring: Cross Monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How does this story illustrate the importance of cross monitoring?
- If Beverly had dismissed Cynthia’s concerns as she was about to do, what might have happened?
- 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?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
188
Student’s Guide – Advocate for a Smooth Delivery
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:
- Explain and apply the TeamSTEPPS strategy of advocacy for the patient and express concerns assertively when there is a scheduled early elective delivery with no apparent medical necessity.
- Develop 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 with deliveries less than 39 weeks without medical indication to the patient and their family.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Advocacy and Assertion
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Advocacy and Assertion: Advocacy and assertion interventions are invoked when a team member’s viewpoint does not coincide with that of a decision maker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to employ advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person’s view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Describe Dr. Burdy’s deviation from Evidence-Based Practices in this story. Do you believe her deviation warranted? Why or why not?
- What could Beverly have done or said to better advocate for the patients and their newborn? How could the TeamSTEPPS tool of Advocacy and Assertion have helped her?
- How is this story a non-example of patient-centered care?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
187
Student’s Guide – Those Who Don’t Debrief are Destined…
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, the student will be able to:
- Explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.
- Describe the importance of integrating family members as an important source of patient information and medical history, especially if the patient is incapacitated or impaired.
- Adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization.
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: Debriefs
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 debriefing?
- What can be done to consistently engage the family as a potential source of key patient information?
- Why is it important to speak up and advocate for patient safety, regardless of hierarchy, in emergent situations?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
186
Student’s Guide – When Concerned, It’s Time to Huddle
Overview:
This story is about a patient who is allowed to leave a cardiac clinic without critical test results being examined and resolved because the protocols for allowing a patient to leave were either non-existent or not followed by the staff. If only the caregivers had taken the time to huddle.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify the types of situations where huddles could be used to advantage in coordinating patient care.
- Explain how and when huddles should be conducted.
- Adopt huddles as a normal problem-solving event for improved patient care.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Huddles
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Huddles: A huddle is a tool for reinforcing the plans already in place for the treatment of patients and for assessing the need to change plans. It can also help develop a shared understanding between team members of the plan of care and provides team leaders with the opportunity to informally monitor patient and unit-level situations. Huddles are particularly useful because information and patient status change over time, requiring ongoing monitoring and updating of the team. It may just be a matter of a sudden increase in the activity level of an individual or the team requiring the need to reevaluate workload status. Workload distribution may have to be adjusted as a result. Information updates within the team should occur as often as necessary, and can take the form of a huddle at the status board or can occur between individual team members whenever new information needs to be shared.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Where in this story could the care team have used huddling to better coordinate care?
- What barriers to using the concept of huddling occurred in this story, and how could they be overcome?
- How do huddles promote more patient-centered, safe care from all staff?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
185
Student’s Guide – When in Doubt, Use the 2-Challenge Rule
Overview:
This story is about when safety protocols in any area are not being followed and patient safety is at risk. It is the responsibility of all team members to speak up and challenge the direction the patient’s care is taking to ‘stop the line’ if their concerns can’t be quickly resolved.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- State the Two-Challenge Rule from TeamSTEPPS.
- Demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk.
- Adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Two Challenge Rule
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Two Challenge Rule: It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How does this story illustrate the importance of using the Two Challenge rule to ‘stop the line’ for patient safety?
- When is it appropriate to deviate from evidence-based practice, as Dr. Charles requested in this story?
- Why is it important to speak up and advocate for patient safety, regardless of hierarchy?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
184
Student’s Guide – Step Up to Safety
Overview:
This story illustrates how adherence to protocols, closed loop communication, documentation, and building time for improved decision making are important strategies to safely manage spikes in workload.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the potential effects workload ‘spikes’ have on patient safety.
- Describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory.
- Generate and adopt strategies to eliminate workarounds especially during high workload periods.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: STEP
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
STEP: How do you acquire a trained eye as you “monitor the situation” on your unit? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment.
The STEP process involves ongoing monitoring of the:
- Status of the patient
- Team members,
- Environment, and
- Progress toward the goal.
In a healthcare setting, the most obvious element of the situation requiring constant monitoring is your patient’s status. Even minor changes in the patient’s vital signs may require dramatic changes in the team’s actions and the urgency of its response. You should also be aware of team members’ status, including fatigue and stress level, workload, and skill level. You should be aware of the environment, including triage acuity, and equipment. And finally, you should assess your progress towards goals by asking the following key questions: What is the status of the team’s patient(s)? Has the team established goals? Has the team accomplished their task/actions? Is the plan still appropriate?
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What safety protocols did Mary ignore? What barriers did she feel kept her from following those protocols?
- How could the use of the STEP process improved the chaos in the emergency department in this story?
- Why is it more difficult to follow established safety protocols during high workload periods?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
183
Student’s Guide – I’M SAFE When I Reach Out
Overview:
This story focuses on care for the caregiver, sometimes referred to as resilience. The stress of caring for patients can lead to chronic fatigue, burnout, and unprofessional behaviors. All team members have a responsibility to recognize and respond when team members become overwhelmed.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Summarize the elements of the resilience self-assessment tool, I’M SAFE.
- Describe the importance of evaluating team members’ fitness for duty by identifying cues of stress, fatigue, and burnout.
- Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with severe stress.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: I’M SAFE
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
I’M SAFE: Be aware of your own condition to ensure that you are fit and ready to fulfill your duties is essential to delivering safe, quality care. “I’M SAFE” is a simple checklist that should be used daily (or more frequently) to determine both your co-workers’ and your own ability to perform safely.
I’M SAFE stands for:
- Illness: Am I feeling so bad that I cannot perform my duties?
- Medication: Is the medication I am taking affecting my ability to maintain situation awareness and perform my duties?
- Stress: Is there something that is detracting from my ability to focus and perform my duties?
- Alcohol/Drugs: Is my use of alcohol or illicit drugs affecting me so that I cannot focus on the performance of my duties?
- Fatigue: Team members should alert the team regarding their state of fatigue (e.g., watch me a little closer today, I only had three hours of sleep last night).
- Eating and Elimination: Not taking care of our eating and elimination needs affects our ability to concentrate and stresses us physiologically.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How would the “I’M SAFE” protocol have helped in this story?
- What does this story illustrate about the importance of recognizing and managing stress, fatigue, and burnout among a team?
- What do you feel June did well in this story? What could she do better?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
182
Student’s Guide – Trust Your Instincts: Cross Monitor!
Overview:
This story addresses the issue of cross monitoring as it relates to error prevention. A work environment that encourages staff to openly share concerns related to the safety of the patients is necessary for optimal patient care and experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of applying reporting principles without fear of retribution or punishment.
- Explain the necessity of integrating reporting daily as a feedback mechanism and safety improvement system.
- Describe the importance of creating a just culture to improve front line reporting.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Cross Monitoring
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Cross Monitoring: Cross Monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What should Allison have done when she discovered Sarah’s injuries?
- What issues regarding the staff’s attitude towards reporting need to be addressed in this nursing home?
- How could better cross-monitoring have helped improve patient safety and CNA willingness to report in this nursing home?
Posted in Pro ED Guides, Student Guides | No Comments »
