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194 – When There’s a Conflict, DESC It! Instructor’s Guide

Friday, October 10th, 2014

194

Instructor’s Guide – When There’s a Conflict, DESC It!


Overview:
This story is about dealing with difficult interpersonal conflicts that can often become personal if not properly managed. Using the DESC tool, even difficult situations that have the potential to become inflamed can be appropriately managed in a manner that is respectful, yet still assertive.

 


Primary Learning Outcomes

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

  • Identify and describe early elective C-section delivery (EED) scheduling protocol.
  • Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
  • Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.

 

 

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: DESC Script

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.

 

DESC Script: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.

 

DESC is a mnemonic:

D = Describe the specific situation;

E = Express your concerns about the action;

S = Suggest other alternatives; and,

C = Consequences should be stated. Ultimately, consensus should be reached.

 

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

  1. What changes in practices and protocols were causing concern in this story? Why were they important for patient safety?
    A: The change in practice was related to delivering babies that were less than 40 weeks gestation. The change in practice and protocol were put into place in order to improve patient outcomes. Babies that are delivered closer to their due date do better than those who are delivered early.
  2. What barriers did Dr. Dorsey perceive in following the new protocol?
    A: He felt that patient satisfaction scores would go down because patients would not be able to make their own C-section date. He stated that patient satisfaction was just as important as patient safety.
  3. How can we use DESC to reduce conflict related to changes in practices and protocols?
    A: DESC can be used to reduce conflict because the focus is on the patient and reaching positive outcomes. It is not about achieving personal goals.

Discussion Questions:

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

  1. What can we learn from this story?
    A: Being proactive and confronting the doctor was necessary in this situation. Patient safety was the primary concern and the nurse emphasized this information. It may be hard to confront a doctor or another nurse, but there may be times when it is necessary.
  2. What can I do to practice using DESC?
    A: One way to practice DESC is to think of a scenario and practice working through DESC with another co-worker. They can objectively hear your approach and give you pointers or corrections, if needed. It may also help to write down the necessary information. This will help you to stay focused and on track during the potentially uncomfortable conversation.

 

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

  • Create a presentation or brochure describing early elective C-section delivery and its possible consequences.
  • Think of another scenario where an EED is scheduled. Write a dialogue that uses a DESC script to express your concerns about non-compliance with EED scheduling protocol.
  • Develop a presentation that teaches the DESC Script tool to your colleagues as a way to avoid medical errors and lapses in safety. Use an EED situation as an example in your presentation.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify and describe early elective C-section delivery (EED) scheduling protocol.   Student struggles to identify and describe early elective C-section delivery (EED) scheduling protocol. Student can identify and describe early elective C-section delivery (EED) scheduling protocol, but needs further practice. Student can accurately identify and describe early elective C-section delivery (EED) scheduling protocol.
Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol. Student struggles to explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol. Student can explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol, but needs further practice. Student can accurately explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.      Student struggles to develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes. Student can develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes, but needs further practice. Student can accurately develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.

 

 

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:

  • Advocacy and Assertion
  • Cross Monitoring
  • Collaboration
  • DESC Script
  • Feedback
  • PEARLA

 

 

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

193 – Safety Depends on Feedback Instructor’s Guide

Friday, October 10th, 2014

193

Instructor’s Guide – Safety Depends on Feedback


Overview:
This story is about how patient safety is everyone’s responsibility, and how all staff members are accountable for giving fellow team members feedback when their practices diverge from accepted safety norms and practices that have been adopted by the unit or the hospital.

 


Primary Learning Outcomes

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

  • Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
  • Identify how situation awareness can help you identify problems that undermine patient safety.
  • Use Feedback as a tool to challenge team members and advocate for patients.

 

 

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: Feedback

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.

 

Feedback: Another type of mutual support is feedback. Feedback is information provided for the purpose of improving team performance. The ability to communicate self-improvement information in a useful way is an important skill in the team improvement process. Feedback can be given by any team member at any time. It is not limited to management roles or formal evaluation mechanisms. Rules of effective feedback include the following:

  1. Timely—Feedback is most effective when the behavior being discussed is still fresh in the mind of the receiver;
  2. Respectful—The feedback should not be personal, and it should not be about personality. It should be about behavior;
  3. Specific—The feedback should relate to a specific situation or task;
  4. Directed—Goals should be set for improvement;
  5. Considerate—Be considerate of team members’ feelings when delivering feedback, and remember to praise good performance.

 

 

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

  1. How was the feedback tool utilized in this story?
    A: In this situation Bridget was direct, timely, respectful, and specific. She focused on the patient and patient safety and not on herself and her own feelings.
  2. Why is it so important to always abide by evidence-based practices regarding patient safety?
    A: Evidence based practice is the standard of care each patient should be receiving.
    A: There should never be a time when Evidence-Based Practices should be ignored or altered.
  3. How did you feel about Dr. Walter’s reaction to Bridget’s questions?
    A: Bridget was appropriate when she spoke to Dr. Walters regarding his lack of hand hygiene. She provided necessary feedback to the doctor and ensured that patient safety was the top priority. Dr. Walters received this information and agreed with Bridget. He treated her with respect and agreed that hand hygiene should be more of a priority.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The importance of providing feedback to other health care professionals. It would have been very easy for Bridget to wait a few weeks or more before saying anything to the doctor, but she did not. Patient safety should be the priority for all health care providers. It may be hard to receive feedback at times, but it is important to remember it is for the safety of the patient.
  2. How can I use Feedback to advocate for patient safety?
    A: Feedback can be difficult to use if you are new to a hospital or clinic. However, it is important to advocate for the patient. Many times it is difficult to bring up a difficult subject, but by using the feedback tool it is possible. By being timely, respectful, specific, direct and considerate you are able to focus on the needs of the patient. The priority of the healthcare team should focus on the patient and not on feeling hurt or offended by the feedback.

 

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

  • Create a presentation to teach others about the concept of “Feedback”. Create your own situation in which to demonstrate the concept.
  • Describe another situation where situation awareness could help improve patient safety. Write a dialogue or act out a scene where feedback is employed to help improve the patient’s experience and safety.
  • Imagine if Dr. Walters had a different reaction. Write out a dialogue in which Dr. Walters responds to Bridget’s criticism defensively, and think of a response that could respectfully drive her point home.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions. Student struggles to recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions. Student can recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions, but needs further practice. Student can accurately recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
Identify how situation awareness can help you identify problems that undermine patient safety.  Student struggles to identify how situation awareness can help you identify problems that undermine patient safety. Student can identify how situation awareness can help you identify problems that undermine patient safety, but needs further practice. Student can accurately identify how situation awareness can help you identify problems that undermine patient safety.
Use Feedback as a tool to challenge team members and advocate for patients.    Student struggles to use Feedback as a tool to challenge team members and advocate for patients. Student can use Feedback as a tool to challenge team members and advocate for patients, but needs further practice. Student can accurately use Feedback as a tool to challenge team members and advocate for patients.

 

 

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:

  • Advocacy and Assertion
  • Cross Monitoring
  • Check-Backs
  • STEP
  • SBAR
  • “Speak Up”

 

 

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

191 – Cross Monitor to Address Adverse Drug Events Instructor’s Guide

Friday, October 10th, 2014

191

Instructor’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, the student 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.

 

 

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

  1. What evidence-based practices were violated in this story? Were the violations warranted?
    A: The violation noted in this scenario is related to an adverse drug event. This patient had been prescribed a sulfonamide and warfarin at the same time. This in turn created an adverse drug even.
  2. What assumptions about patient safety did the nurses in this story make? Why were they detrimental?
    A: The nurse assumed the doctor new about the Coumadin and wanted to continue with the antibiotic. Her assumptions were detrimental because the patient had an adverse drug reaction and that in turn affected the patient.
  3. How could cross monitoring help this unit provide better patient care and safety?
    A: Cross monitoring would have alerted the doctor to the potential adverse drug event. It would have also given the nurse a chance to discuss her concerns with the doctor.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The nurse could have discussed this potential adverse drug event with the doctor. It is also important to note that nurses are responsible for the side effects of medications that are given to the patient. The doctor may have prescribed the medication, but the nurse is responsible for monitoring the effects of the medications and to anticipate potential problems that may occur.
  2. What can I do to ensure that I monitor situations to ensure medication safety?
    A: The nurse must be proactive and advocate for the patient first. The doctor may not change the medication order, but the nurse needs to advocate for the patient. Also, if the medication regime was not altered then the nurse should be monitoring for potential adverse side effects.

 

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

  • What challenges exist when trying to ensure medication safety? Make a list of the challenges and their possible solutions.
  • Develop a step-by-step protocol for improving medication safety, which includes the empowerment of patients.
  • Create a presentation that could help teach a team about cross monitoring and other evidence based communication tools to help ensure patient safety during medication administration.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe challenges in ensuring medication safety. Student struggles to describe challenges in ensuring medication safety. Student can describe challenges in ensuring medication safety, but needs further practice. Student can accurately describe challenges in ensuring medication safety.
Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. Student struggles to identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. Student can identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking, but needs further practice. Student can accurately 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.  Student struggles to explain the importance of using evidence-based communication measures to improve medication safety in a unit. Student can explain the importance of using evidence-based communication measures to improve medication safety in a unit, but needs further practice. Student can accurately explain the importance of using evidence-based communication measures to improve medication safety in a 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:

  • Advocacy and Assertion
  • Cross Monitoring
  • Check-Backs
  • STEP
  • SBAR
  • “Speak Up”

 

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

190 – Safety Practices Depend on Advocacy and Assertion Instructor’s Guide

Friday, October 10th, 2014

190

Instructor’s Guide – Advocate for a Smooth Delivery


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, the student 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.

 

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

  1. What evidence-based practices were violated in this story? Were the violations warranted?
    A: The violations noted in this story are related to evidence based practice and maintaining a sterile field.
    A: The violations in this story do not appear to be an intentional violation, but rather a change in practice. However, the current practice is not acceptable and breaches the standards of care.
  2. What barriers to patient advocacy did Celeste face?
    A: She was new to the role and did not know how much she could say. She also did not know enough about the culture of the operating room. She did not know if this was an intentional violation of sterility or something that had been in practice for a long time.
  3. How might she have overcome them to better advocate for the patient in this story?
    A: Celeste needs to remember that patient care is the priority. It may be difficult at times to speak up in a new situation, but the safety of the patient needs to be more important than feeling uncomfortable about the situation.

Discussion Questions:

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

  1. What can we learn from this story?
    A: All team members need to be able to hold each other accountable for their behavior. This should be done out of mutual respect and not out of personal interest.
    A: There may be times when small changes over time are not best for the patient. The nurses did not intend to cause harm to the patient, but because they contaminated the sterile field, patient care was compromised.
  2. What steps can you take to ensure you feel able to assert yourself and advocate for the patient if another team member takes a safety-compromising shortcut?
    A: Good teamwork needs to be demonstrated by everyone on the team. Mutual respect and shared-decision making needs to be established by the senior leadership. However, if this is not the case, then everyone needs to be able to speak up and advocate for the patient.

 

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

  • What are some of the barriers we experience when we attempt to advocate for a patient or assert a concern when we see shortcuts being taken? Develop a list of barriers and possible solutions for overcoming them.
  • Think of an assertive statement that Celeste could have used in this story. Share your statement with the class and work to decide which statements would be most effective.
  • Develop a protocol that could be used by a team when a team member takes a shortcut. Include an assertive statement and steps to maintain the team’s progress and the team member’s dignity without compromising patient safety.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS. Student struggles to identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS. Student can identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS, but needs further practice. Student can accurately 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.   Student struggles to explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety. Student can explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety, but needs further practice. Student can accurately 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.  Student struggles to describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken. Student can describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken, but needs further practice. Student can accurately describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.

 

 

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:

  • Advocacy and Assertion
  • Cross Monitoring
  • CUS
  • Two-Challenge Rule

 

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

189 – Your Patients and Family See What You Can’t See Instructor’s Guide

Friday, October 10th, 2014

189

Instructor’s Guide – Your Patients and Family See What You Can’t See


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:

  • 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.

 

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

  1. How does this story illustrate the importance of cross monitoring?
    A: Cross-monitoring is one way to check the accuracy of another nurse. This should be done every time a “high alter” medication is given. It includes not only checking the doctor’s order, but also ensuring it is the correct dosage.
    A: In this situation it was important to check the medication and the appropriate dose. Without further cross monitoring, the patient would have received the wrong dosage.
  2. If Beverly had dismissed Cynthia’s concerns as she was about to do, what might have happened?
    A: The patient would have received the wrong dose of a very lethal drug.
  3. 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?
    A: The patient and family members should feel encouraged to be a part of the team. They often have knowledge and experience the healthcare member may benefit from knowing.

Discussion Questions:

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

  1. What can we learn from this story?
    A: That no one double checked the dosage or strength of the medication. It is not enough to only check the doctor’s order, but the dosage as well.
    A: The patient would have received an extremely high and potentially lethal dose of the medication.
  2. How can we make sure our cross-monitoring of important procedures or medication administrations are not compromised by multitasking or staff changes?
    A: Each of us must keep the patient the priority of our care. It is easy to get distracted by conversations or other patient activities, but medication administration should not be compromised.
    A: This is a great example to keep in mind when patients or family members want to know more about medication or procedures their loved ones are receiving. They often have very valuable information, but it should not compromise patient care.

 

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

  • Design a cross monitoring checklist for this team to use for high-risk medication administration, like chemotherapy.
  • Develop a protocol for involving families and patients in high-risk medication administrations, like chemotherapy.
  • Imagine that Cynthia was not there to intervene for Inez. What might have happened? Write the incident report, with what you believe might be the consequences to Inez, the nurses, and the hospital.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Examine team practices to promote cross-monitoring of high risk procedures including medication administration. Student struggles to examine team practices to promote cross-monitoring of high risk procedures including medication administration. Student can examine team practices to promote cross-monitoring of high risk procedures including medication administration, but needs further practice. Student can accurately 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. Student struggles to generate policies and practices to limit distractions and multitasking during critical care practices. Student can generate policies and practices to limit distractions and multitasking during critical care practices, but needs further practice. Student can accurately 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.   Student struggles to 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. Student can 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, but needs further practice. Student can accurately 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.

 

 
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:

  • Advocacy and Assertion
  • Call Out
  • Check Backs
  • Collaboration
  • Cross Monitoring
  • Feedback
  • STEP
  • “Speak Up”
  • CUS
  • Debriefs
  • Handoffs
  • Huddles
  • Two-Challenge Rule
  • AskMe3

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

188 – Advocate for a Smooth Delivery Instructor’s Guide

Friday, October 10th, 2014

188

Instructor’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, the student 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.

 

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

  1. Describe Dr. Burdy’s deviation from Evidence-Based Practices in this story. Do you believe her deviation was warranted? Why or why not?
    A: Care based on evidence based practice ensures patient safety. There are often several reasons why evidence based practice should be used. It is based on facts and research and not a healthcare professionals opinion or convenience.
    A: In this situation the family did not want a different OBGYN, however because their doctor was going on vacation they agreed with her decision to deliver the baby early.
  2. 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?
    A: Beverly could have suggested they ask about options aside from having their baby delivered early. Many times patients don’t feel comfortable standing up to a doctor or disagreeing with their decision.
  3. How is this story a non-example of patient-centered care?
    A: This example does not reflect patient-centered care because the baby was delivered according to the doctor’s schedule and not the schedule that should have been used. There was not a medical reason to deliver the baby early, except that it was convenient for the doctor.

Discussion Questions:

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

  1. What can we learn from this story?
    A: That potential harm occurred because evidence based practice was not followed. The family did not seem to have an advocate or someone they could speak to about the decision to deliver their baby early.
  2. What one thing can you do to ensure that elective deliveries less than 39 weeks are reduced?
    A: One way is to provide the obgyn’s with research and evidence that supports elective deliveries over 39 weeks gestational age.

 

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

  • Create a brochure for expecting parents on the risks inherent with elective deliveries at 39 weeks or less.
  • Recall the portion of the story when Beverly recognizes Dr. Burdy’s comment about delivering the baby at 37 weeks carries significant risks. Rewrite this portion of the story with Beverly using assertive statements to advocate for the patients.
  • Pretend you are investigating this incident on the hospital’s behalf after the fact. Write a report that details what went wrong, who was at fault, how the situation should have been handled, and the consequences (as well as potential consequences) of the actions.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
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. Student struggles 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. Student can 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, but needs further practice. Student can accurately 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.  Student struggles to develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication. Student can develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication, but needs further practice. Student can accurately 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.  Student struggles to explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family. Student can explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family, but needs further practice. Student can accurately explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family.

 

 
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:

  • Advocacy and Assertion
  • Cross Monitoring
  • Feedback
  • CUS
  • Debriefs
  • Handoffs
  • Huddles
  • Two-Challenge Rule
  • AskMe3

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

187 – Those Who Don’t Debrief are Destined… Instructor’s Guide

Thursday, October 9th, 2014

187

Instructor’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.

 

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

  1. How does this story illustrate the importance of debriefing?
    A: Debriefs are used to share information and improve the effectiveness of teamwork. In this case, a debrief could have focused on the understanding of ACLS protocol and Code standards. It could have also been used as a time to answer questions related to the care provided in a code and to improve a potential code in the future.
  2. What can be done to consistently engage the family as a potential source of key patient information?
    A: In this situation the patient was not able to provide a medical history. Therefore, the family may be able to provide lifesaving information and aid in the treatment of the patient.
  3. Why is it important to speak up and advocate for patient safety, regardless of hierarchy, in emergent situations?
    A: The patient needs to be the priority and not the concern of hierarchy. This is when cross monitoring or feedback would be an effective way to advocate for the patient. The rank of the doctor or the nurse should not be as much of a concern as the need to provide the best care for the patient possible.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The resource the family can be during an emergency situation is vital to patient care. Also, it is apparent that debriefs need to be a regular part of team building and learning new lessons. It is not appropriate to continue to practice in the same manner
  2. How can you help make debriefs a consistent team practice for learning and improvement?
    A: One way is to establish a debrief session after every code. This is one way to address current issues or potential needs. It may take a few tries before it becomes routine, but as the team continues this practice it will become routine.

 

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

  • Write or act out the dialogue for the debrief that should have happened after Mr. Pearson’s close call.
  • Create a checklist for collecting information from family members in emergent situations.
  • Design a protocol for conducting debriefs after a critical incident, including ground rules for how team members should deliver and respond to criticism.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement and self-correction. Student struggles to explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction. Student can explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction, but needs further practice. Student can accurately 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.  Student struggles to 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. Student can 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, but needs further practice. Student can accurately 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. Student struggles to adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization. Student can adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization, but needs further practice. Student can accurately adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization.

 

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


Story-Specific Best Practices and Proven Tools:

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

  • Call Out
  • Check Backs
  • Task Assistance
  • Cross Monitoring
  • Debriefs
  • Feedback
  • STEP
  • 3Ws – Who I am, What I am Doing, and Why I Care

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

186 – When Concerned, It’s Time to Huddle Instructor’s Guide

Thursday, October 9th, 2014

186

Instructor’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, the student 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.

 

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

  1. Where in this story could the care team have used huddling to better coordinate care?
    A: By using a huddle, Caroline could have told Dr. Feldman that Harry was intending on leaving and the lab results were not back. She could have updated the team on his desire to leave and the seriousness of the situation. She could have told Harry the seriousness of his situation and the potential adverse effects if he were to leave the office
  2. What barriers to using the concept of huddling occurred in this story, and how could they be overcome?
    A: Caroline needed to remember that as an educator she is responsible to inform Harry of the seriousness of his situation. He may be feeling fine, but his heart was at increased risk of a heart attack.
  3. How do huddles promote more patient-centered, safe care from all staff?
    A: It allows every team member to be aware of the current situation. It also allows builds team work and collaboration between team members. It is important to provide each patient with accurate and precise information. The nurse should not provide information to scare the patient, but to provide them with the information in order to make an educated decision.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The patient has the right to leave or sign out against medical advice (AMA), however the nurse is responsible to provide the patient with accurate information. The patient can then make a sound decision based on knowing the information.
  2. How can your team use huddling to better coordinate patient care?
    A: A team huddle is a way of getting all team members on the same page and aware of a particular situation. A team huddle would have informed the cardiologist and nurses of the current situation. Although this may have turned out differently, every situation should be treated in a serious manner. A team huddle would have allowed the team to hear Caroline’s concerns and provide her with support or feedback.

 

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

  • Develop a list of situations where huddles could be used to help coordinate patient care. Share your list with a partner or the class for discussion.
  • Write or act out a dialogue for a scenario in which a huddle would be appropriate.
  • Create a poster or graphic that reminds colleagues of the importance of huddles and their benefits for patient safety and care.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify the types of situations where huddles could be used to advantage in coordinating patient care. Student struggles to identify the types of situations where huddles could be used to advantage in coordinating patient care. Student can identify the types of situations where huddles could be used to advantage in coordinating patient care, but needs further practice. Student can accurately identify the types of situations where huddles could be used to advantage in coordinating patient care.
Explain how and when huddles should be conducted. Student struggles to explain how and when huddles should be conducted. Student can explain how and when huddles should be conducted, but needs further practice. Student can accurately explain how and when huddles should be conducted.
Adopt huddles as a normal problem-solving event for improved patient care. Student struggles to adopt huddles as a normal problem-solving event for improved patient care. Student can adopt huddles as a normal problem-solving event for improved patient care, but needs further practice. Student can accurately adopt huddles as a normal problem-solving event for improved patient care.

 

 
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:

  • Huddles
  • Advocacy and Assertion
  • 3Ws – Who I am, What I am Doing, and Why I Care

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

185 – When in Doubt, Use the 2-Challenge Rule Instructor’s Guide

Thursday, October 9th, 2014

185

Instructor’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.

 

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

  1. How does this story illustrate the importance of using the Two Challenge rule to ‘stop the line’ for patient safety?
    A: The two challenge rule was necessary in this situation and kept the patient from harm. Safe practices include counting the sponges and equipment once the surgery is complete. This post operative step is necessary before suturing the patient and sending them to the recovery room.
  2. When is it appropriate to deviate from evidence-based practice, as Dr. Charles requested in this story?
    A: There should never be a time when Evidence-Based Practices should be ignored or altered.
  3. Why is it important to speak up and advocate for patient safety, regardless of hierarchy?
    A: Juanita was appropriate when she spoke to the surgeon regarding the missing sponge. She provided the necessary information to the surgeon and ensured that Patient Safety was the top priority.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The importance of advocating for the patient, even when it is uncomfortable. Also, doing an accurate count of all instruments and sponges is a requirement. The surgeon did not believe he was wrong; however patient safety should be the priority for all health care providers.
  2. Why is there conflict when challenging other team members related to patient safety?
    A: Information conflict can be difficult to discuss, but by using the CUS technique it is possible. In this situation the surgeon did not believe he had made a mistake, however the nurse was correct in pointing out the error to the surgeon.

 

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

  • Think of a scenario in which you might need to use the Two-Challenge Rule. Describe your scenario and how you might apply the rule.
  • Rewrite the end of this story assuming that Juanita did not insist on x-raying the patient. What might the consequences have been for the team, Dr. Charles, the patient, and the hospital?

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
State the Two-Challenge Rule from TeamSTEPPS. Student struggles to state the Two-Challenge Rule from TeamSTEPPS. Student can state the Two-Challenge Rule from TeamSTEPPS, but needs further practice. Student can accurately state the Two-Challenge Rule from TeamSTEPPS.
Demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk. Student struggles to demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk. Student can demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk, but needs further practice. Student can accurately 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. Student struggles to adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned. Student can adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned, but needs further practice. Student can accurately adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned.

 

 
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:

  • Two-Challenge Rules
  • Advocacy and Assertion
  • CUS
  • 3Ws – Who I am, What I am Doing and Why I Care
  • PEARLA

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

184 – Step Up to Safety Instructor’s Guide

Thursday, October 9th, 2014

184

Instructor’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?

 

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

  1. What safety protocols did Mary ignore? What barriers did she feel kept her from following those protocols?
    A: Mary was not initially putting her patients in danger, but her lack of shared decision-making and closed-loop communication had a negative impact on patient safety. She did not want to wait for pharmacy to clear the medication and put it in the pyxis.
  2. How could the use of the STEP process improved the chaos in the emergency department in this story?
    A: High workload periods make it difficult to think clearly and accurately. Health care professionals must be diligent to provide quality safe patient care no matter how busy their assignment may be. The fatigue and stress level were very high on the unit during this scenario.
  3. Why is it more difficult to follow established safety protocols during high workload periods?
    A: Harm occurred to a patient because the nurse was trying to provide care for her patient, but did not use appropriate communication, ‘check-backs’, or closed loop communication. She could have avoided this scenario if she would have waited for the appropriate checks to be made instead of rushing forward with her work.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The use of ‘check-backs’ allow for discussion and reflection to be made with each patient. Although it may be subtle, the use of ‘check-backs’ is another check and allows for more thorough patient care. Rushing to get things done does not always end in a good result for the patient.
  2. What one thing can you do to ensure patient safety during high workload periods?
    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. 

  • Create a presentation for staff that teaches them about the STEP process and how it can be applied to improve patient safety and care.
  • Work with a partner to develop a list of errors that are caused by workload spikes, and brainstorm ways to reduce those errors using best practices for closed loop communication, managing interrupts, and limiting over-reliance on memory. Compare your ideas with the class for discussion.
  • Make a checklist that helps staff eliminate workarounds during high workload periods.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe the potential effects workload ‘spikes’ have on patient safety.  Student struggles to describe the potential effects workload ‘spikes’ have on patient safety. Student can describe the potential effects workload ‘spikes’ have on patient safety, but needs further practice. Student can accurately 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.  Student struggles to describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory. Student can describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory, but needs further practice. Student can accurately 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.  Student struggles to generate and adopt strategies to eliminate workarounds especially during high workload periods. Student can generate and adopt strategies to eliminate workarounds especially during high workload periods, but needs further practice. Student can accurately generate and adopt strategies to eliminate workarounds especially during high workload periods.

 

 
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:

  • Huddles
  • Check-Backs
  • Debriefs
  • Cross Monitoring
  • SBAR
  • Call Out
  • Handoff
  • Task Assistance
  • Speak Up
  • 3Ws – Who I am, What I am Doing, and Why I Care
  • STEP

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