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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

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.
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

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.
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
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”

Posted in Pro ED Guides, Teacher Guides | No Comments »

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

Thursday, December 18th, 2014

212

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

Primary Learning Outcomes

After completing this lesson, you 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

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.

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 read.

Reflection Questions:

Think about 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?
How could the health care team improve their response and treatment of this patient? Did they follow precaution protocols accurately? Why or why not?

Posted in Pro ED Guides, Student Guides | No Comments »

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

Monday, December 1st, 2014

211

Student’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, you 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:

In what ways was patient-centered care compromised in this story? What do you feel should have been handled differently and why?
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?
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?

Posted in Pro ED Guides, Student Guides | No Comments »

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

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.

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.
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.
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

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.
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.
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:

CDC Guidelines/Protocols for Care of Potential Ebola Patients

Story-Specific Best Practices and Proven Tools:

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

Posted in Pro ED Guides, Teacher Guides | No Comments »

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.

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.
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.
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

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.
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:

TeamSTEPPS Essentials

Story-Specific Best Practices and Proven Tools:

I’M SAFE

Posted in Pro ED Guides, Teacher Guides | No Comments »

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

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?

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.
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.
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

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.
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:

TeamSTEPPS Essentials

Story-Specific Best Practices and Proven Tools:

STEP

Posted in Pro ED Guides, Teacher Guides | No Comments »

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

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.

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.
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.
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

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.
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:

TeamSTEPPS Essentials

Story-Specific Best Practices and Proven Tools:

STEP

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207 – Let’s STEP Back Instructor’s Guide

Friday, October 10th, 2014

207

Instructor’s Guide – Let’s STEP Back

Overview:
This story is about how training for situation awareness can prevent many serious medical errors and sentinel events. A team’s ability to maintain situation awareness depends on having good tools to use, and practicing the use of those tools.

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

Status of the patient,
Team members,
Environment, and
Progress toward the goal.

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.
Why is it important that this team is practicing the STEP tool?
A: This team works in a very busy unit and by practicing the STEP tool they are preparing for safe patient care. It is good to practice the STEP tool because the team is more likely to use it in a real case situation if they also practice it in a simulation type setting.
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

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.
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 the 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:

TeamSTEPPS Essentials

Story-Specific Best Practices and Proven Tools:

STEP

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206 – That One Little Thing Instructor’s Guide

Friday, October 10th, 2014

206

Instructor’s Guide – That One Little Thing

Overview:
Each contact with a patient in a healthcare facility creates an opportunity to satisfy or dissatisfy that patient as a consumer. If careful attention is not paid, small incidents can color the overall perception of care.

Primary Learning Outcomes

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

Describe the process patients go through when they sit down to fill out a survey of patient satisfaction.
Generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients.
Adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increase patient satisfaction.

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.

What does this story illustrate about the importance of providing a consistent level of patient-centered care throughout the hospital?
A: It only takes one bad experience or encounter to impact the overall patient experience and organizational perception.
Describe the examples of excellent patient-centered care and poor patient-centered care in this story?
A: The smiling, personable transporter was a positive, along with menu selections and provision of a warm blanket as an unexpected comfort measure.

A: Clearly, leaving him in the cold basement – unattended for 25 minutes was inconsistent with the overall experience.
How can you use information from patient surveys to improve care?
A: Look for common themes to determine how to change processes or systems of care.

A: Identify opportunities to improving communication.

A: Identify opportunities to repeat positive behaviors.

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: One bad experience can minimize dozens of positive patient encounters.

A: Our goal must be to have everyone striving for consistent excellence and patient centered care.

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

Think of an experience you or a loved one had in a hospital or clinic. How would you rate your stay or visit? What situations or experiences would cause you to lower your rating?
Research the reasons that patients rate hospitals poorly. Create a presentation that teaches your colleagues about the importance of providing a high level of patient centered care.
Develop a plan for using patient surveys to evaluate policies and procedures in your workplace.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Describe the process patients go through when they sit down to fill out a survey of patient satisfaction.*	Student struggles to describe the process patients go through when they sit down to fill out a survey of patient satisfaction.	Student can describe the process patients go through when they sit down to fill out a survey of patient satisfaction, but needs further practice.	Student can accurately describe the process patients go through when they sit down to fill out a survey of patient satisfaction.
*Generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients.*	Student struggles to generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients.	Student can generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients, but needs further practice.	Student can accurately generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients.
Adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction.	Student struggles to adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction.	Student can adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction, but needs further practice.	Student can accurately adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increased patient satisfaction.

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:

3Ws – Who I Am, What Am I Doing, and Why I Care
Bedside Handoffs
Patient Rounding
Check-Backs
Speak Up
AskMe3

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205 – The Sound Resounds Instructor’s Guide

Friday, October 10th, 2014

205

Instructor’s Guide – The Sound Resounds

Overview:
This story is about a very important part of the patient experience – a clean, orderly, and quiet environment. Staff members can become desensitized to noises over time that disturb and annoy patients.

Primary Learning Outcomes

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

Explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience.
Be able to define noise and list possible sources of noise affecting patients.
Create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.

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.

What does this story illustrate about the importance of viewing all hospital decisions through patients’ eyes?
A: Clearly, the first impression is important, however, not a priority over patient’s getting adequate for recovery
What can we do to ensure that noise is controlled and has a minimal impact on the well-being and satisfaction of patients?
A: Nurses should advocate for patient’s rest by keeping unnecessary conversation and confusion in the halls to a minimum.

A: Identify systems of care – environmental services, etc – that could adjust their services to accommodate a peaceful environment for the patients.
What can you do to eliminate unnecessary sources of noise?
A: Most unnecessary noise in the hospital setting falls into 2 categories:
-Human generated
-Technology generated

A: Communicating with staff and visitors and express that noise is disruptive to patients and their recovery and should be minimized

A: Advocate for patients and intervene when appropriate

A: Be sure all technology is kept “updated” and “serviced” to minimize unnecessary technology related noises.

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: When making care decisions, it is vital to see through the patient’s eyes.

A: Providing patients and opportunity to share their concerns and perspective is vital to patient centered care.
Why is it important to be sensitive to patient frustrations and irritations?
A: Sensitivity is core to a patient centered approach. Although we cannot resolve every frustration or irritation, demonstrating compassion and interest is key to improving the quality of care we provide.

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

Brainstorm a list of hospital noises that could have a negative effect on patients and their satisfaction with their hospital experience. Share your list with a partner and design solutions for the unnecessary noise.
Conduct a noise audit at a local hospital. Walk around and listen to the noises that might disturb patients. Share your findings with the class.
Create a graphic or poster to remind colleagues about the importance of reducing unnecessary noise to increase patient satisfaction.

Measuring Student Mastery:

Learning Outcome	Level 1	Level 2	Level 3
*Explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience.*	Student struggles to explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience.	Student can explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience, but needs further practice.	Student can accurately explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience.
*Be able to define noise and list possible sources of noise affecting patients.*	Student struggles to define noise and list possible sources of noise affecting patients.	Student is able to define noise and list possible sources of noise affecting patients, but needs further practice.	Student is able to accurately define noise and list possible sources of noise affecting patients.
*Create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.*	Student struggles to create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.	Student can create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members, but needs further practice.	Student can accurately create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.

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:

3Ws – Who I Am, What Am I Doing, and Why I Care
Collaboration

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Archive for the ‘Pro ED Guides’ Category

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

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

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

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

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

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

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

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

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

Instructor’s Guide – I’m Alright, Really

209 – First Baby STEP Instructor’s Guide

Instructor’s Guide – First Baby STEP

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

Instructor’s Guide – Check Back for a Good Outcome

207 – Let’s STEP Back Instructor’s Guide

Instructor’s Guide – Let’s STEP Back

206 – That One Little Thing Instructor’s Guide

Instructor’s Guide – That One Little Thing

205 – The Sound Resounds Instructor’s Guide

Instructor’s Guide – The Sound Resounds

My StoryCare

Story Resources

Program Support