Archive for the ‘Pro ED Guides’ Category
Thursday, October 2nd, 2014
171
Student’s Guide – A Question of Timing
Overview:
This story is about the failure to give antibiotic prophylaxis on time, which can contribute to Surgical Site Infections (SSIs) and can be averted with a pre-op briefing.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Demonstrate awareness of how timely antibiotic prophylaxis can reduce SSIs.
- Explain the importance of adopting a plan to create antibiotic standing orders based on local consensus guidelines.
- Describe how briefings can support teams and avoid preventable errors and complications.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Briefs
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Briefs: Briefs serve the following purposes:
- They clarify who will be leading the team so that others know to whom to look for guidance.
- They open lines of communication among team members, ensuring that everyone can contribute their unique knowledge base to the task, and thereby set the tone for the upcoming procedure. Protocols, responsibilities, and expected behaviors are discussed and reinforced so that possible misunderstandings are avoided.
- They prepare the team for the flow of the procedure, contingency plans, and the means for resolving any unusual circumstances.
- By delineating expectations, they reduce disruptive or unexpected behaviors.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How did the lack of a plan for antibiotic standing orders detract from patient care and safety in this story?
- What steps can be taken to educate the OR team about the rationale for timely antibiotic prophylaxis?
- How could engaging in pre-op briefings with the surgical team stop scenarios like the one in this story from happening?
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Thursday, October 2nd, 2014
169
Student’s Guide – Are You Challenging Me?
Overview:
This story is about what happens when team members express their concerns about the safety and well-being of a patient twice, and if the concern is not alleviated, it is their responsibility to escalate the conflict to someone who has authority to resolve the situation.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Define the TeamSTEPPS® “Two-Challenge” Rule
- Explain the importance of each team member advocating for their patients and using the Two-Challenge Rule to guide their expression of concerns.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Two-Challenge Rule
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
Two-Challenge Rule: It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What does this story illustrate about the importance of the Two-Challenge Rule?
- Why was it so important that Sheila remained vigilant in her advocacy for Tiffany with Dr. Peters?
- How can you give the message to other team members that you welcome challenges and will take them in the spirit of collaborating on what’s best for patients?
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Thursday, October 2nd, 2014
168
Student’s Guide – Step Up To Rounding
Overview:
This story is about falls which are three times more common in hospital and nursing home settings where they result in higher injury rates. But they can be reduced through a number of simple solutions, such as tweaking hourly rounds to make them more meaningful.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify unmet patient needs that contribute to risk for falls.
- Describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls.
- Develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What was the importance of modifying the team’s current patient care practices?
- What evidence-based practices for fall prevention were developed and put into place in this story?
- How did Taylor demonstrate effective leadership to ensure the commitment of her team to minimizing the risk of harm to patients?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
167
Student’s Guide – Did You Remember to SBAR?
Overview:
This story is about SBAR, a TeamSTEPPS® tool that helps care providers through the use of a structured format for giving reports between clinical staff members that leads to increased efficiency and enhanced safety.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify the words and meaning of the TeamSTEPPS SBAR tool.
- Describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: SBAR
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
SBAR: SBAR provides a standardized framework for members of the healthcare team to communicate about a patient’s condition. SBAR is an easy-to-remember, concrete mechanism that is useful for framing any conversation, often a critical one requiring a clinician’s immediate attention and action. SBAR originated in the U.S. Navy submarine community to quickly provide critical information to the Captain. It provides members of the team with an easy and focused way to set expectations for what will be communicated and how. Standards of communication are essential for developing teamwork and fostering a culture of patient safety. SBAR provides a vehicle for individuals to speak up and express concern in a concise manner. In phrasing a conversation with another member of the team, consider the following:
- Situation: What is happening with the patient?
- Background: What is the clinical background?
- Assessment: What do I think the problem is?
- Recommendation: What would I recommend?
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How did Dr. Cowan’s approach to Henry improve teamwork, communication and patient care in the hospital?
- What does this story illustrate about how effective team communication can impact patient care?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
166
Student’s Guide – Prioritizing Pressure Care
Overview:
Using a pressure prevention bundle can reduce the risk for pressure ulcers (PUs). Unfortunately, even though nurses understand its importance, it’s associated with low status work and they often don’t make it a priority, falsely assuming that LPNS are performing skin care/PU prevention.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention.
- Describe the responsibilities of each clinical staff role in the prevention of pressure ulcers.
- Explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What does this story illustrate about the importance of identifying the training that all clinical staff have and need in pressure ulcer prevention?
- How did Thelma’s attitude in the story effect the care her patients received?
- How could this hospital better address pressure ulcer care and risk prevention to improve patient care?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
165
Student’s Guide – Walking Into Risk
Overview:
This story is about how most Venous Thromboembolisms (VTEs) in the ambulatory setting occurring within one month of discharge and are preventable, but oncologists’ adherence to VTE assessment/prophylaxis guidelines is suboptimal and a major barrier to implement VTE protocol.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the rationale for VTE risk assessment and prevention.
- Determine the barriers to conducting VTE assessment in the ambulatory setting.
- Create a team action plan to implement VTE risk assessment and prophylaxis.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What does this story illustrate about the importance of VTE assessment and risk prevention?
- What barriers kept the proper assessment from being conducted in the first place?
- How did Dr. Levine and Donna’s inaction affect both Willie’s recovery and patient care experience?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
164
Student’s Guide – Who Knows Best?
Overview:
This story is about mutual support, especially when it comes to preventing VAP. A team-oriented approach to patient care requires that each team member’s expertise is respected, and differences of opinion about the direction of care are worked out in a supportive manner.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- List the core components of a VAP bundle.
- Describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application.
- Explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What components of a VAP bundle were addressed in this story?
- What does this story illustrate about the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application?
- How do you feel Denise handled the disagreement with Dr. Martin? What else could she have done?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
163
Student’s Guide – We Need 100% of You Now!
Overview:
This story is about how distractions can cause serious compromises in patient safety and need to be consciously controlled. Some teams have devised approaches to prevent distractions, similar to how the airline industry has created “sterile cockpits” that keep the team focused when it counts.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify potential distractions that occur during high-consequence patient care processes, such as surgery.
- Decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand.
- Describe and adopt guidelines that control distractions during the high-consequence time periods.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What potential distractions could have disrupted the surgery in this story?
- How did the team’s use of the “sterile cockpit” environment contribute to Steffan’s patient experience?
- How does the “sterile cockpit” environment” help control distractions during high-consequence time periods?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
162
Student’s Guide – Aware of the Situation
Overview:
This story is about an elderly woman being cared for in a nursing home who is incontinent and catheterized despite new criteria for catheterization, because indwelling urinary catheters cause up to 80% of hospital-acquired infections, 30% of which are unnecessary.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the core features of a CAUTI Bundle.
- Identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit.
- Explain the importance of implementing evidence-based protocols to reduce CAUTI.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What core features of a CAUTI bundle were in place in this story?
- What attitudinal and work-load barriers were present in the story that prevented the implementation of the new protocol?
- What does this story illustrate about the importance of implementing evidence-based protocols to reduce CAUTI?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
161
Student’s Guide – Dial I for Ignore
Overview:
This story is about the importance of hand washing. Failing to wash hands between each patient visit can result in CLABSIs. According to a recent CDC report, the majority of CLABSIs are now occurring outside of ICUs, especially in outpatient dialysis.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the essential best practices in a CLABSI bundle.
- Describe and apply evidence-based practices in hand hygiene.
- Explain the importance of providing patients with opportunities to ask questions about their care.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What essential best practices in a CLABSI bundle were followed in the story? Which weren’t?
- What does this story illustrate about the importance of applying evidence-based practices in hand hygiene?
- What steps can the team take to ensure that they are consistently following best practices in hand hygiene?
Posted in Pro ED Guides, Student Guides | No Comments »
