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173 – Transferring Blame Instructor’s Guide

Thursday, October 9th, 2014

173

Instructor’s Guide – Transferring Blame


Overview:
This story is about implementing a follow-up plan when patients are transferred across hospital units or discharged to ensure that their care history is documented and passed on. It also highlights the importance of listening to what patients tell you about their care.

 


Primary Learning Outcomes

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

  • Describe the process for information follow-up when patients are transferred into or out of the unit.
  • Examine how information and communication gaps can contribute to preventable readmissions.
  • Create a plan for involving the patient as a team member by actively soliciting and validating information from them about their prior medications and care.

 

 

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.

 

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 information and communication gaps occurred among the medical staff in this story?
    A: There were several issues that occurred in this story. Angela did not have the medical records from the previous infusion center and she did not call the doctor to get an order for an antiemetic, even though the patient asked for it. This situation may have been avoided if Angela would have looked at the previous chemo administration record and called the doctor for an antiemetic order.
  2. What steps could this unit have taken to ensure that team members had access to all necessary information about patients when they transfer into the unit, and that they know who to talk to when information is missing?
    A: One way this can be done is by having all medical records sent to the office prior to the patient being seen. Another way would be to hold off on the medication administration until the medical records are received. The patient should have been the focus of the scenario and not the nurse and doctor blaming other people for the lack of information.
  3. What does this story illustrate about the importance of actively soliciting and validating information from patients about their prior medications and care?
    A: There was a great deal of unspoken communication during this scenario due to the fact that nurse did not have all of the information. This situation may have been avoided if there were standards in place prior to chemo administration.

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: Harm occurred to a patient because the nurse was trying to provide care for her patient, but did not use appropriate 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.
  2. What can you do to ensure that you seek patient input about their medications and care?
    A: The nurse did not follow through with the information that had been provided by the patient. If everyone were responsible for their own behavior this situation may have turned out differently. It is important for the nurse and other health care professionals to communicate clearly with the patient regarding their care.

 

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

  • Create a flowchart for what you believe should happen when a patient is transferred to the unit in this story. Who should have what information, when, and why?
  • Develop a presentation or brochure for patients about the importance of sharing their prior medications and care with their new healthcare providers, especially when being transferred from one unit to another.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe the process for information follow-up when patients are transferred into or out of the unit.  Student struggles to describe the process for information follow-up when patients are transferred into or out of the unit. Student can describe the process for information follow-up when patients are transferred into or out of the unit, but needs further practice. Student can accurately describe the process for information follow-up when patients are transferred into or out of the unit.
Examine how information and communication gaps can contribute to preventable readmissions.  Student struggles to examine how information and communication gaps can contribute to preventable readmissions. Student can examine how information and communication gaps can contribute to preventable readmissions, but needs further practice. Student can accurately examine how information and communication gaps can contribute to preventable readmissions.
Create a plan for involving the patient as a team member by actively soliciting and validating information from them about their prior medications and care.  Student struggles to create a plan for involving the patient as a team member by actively soliciting and validating information from them about their prior medications and care. Student can create a plan for involving the patient as a team member by actively soliciting and validating information from them about their prior medications and care, but needs further practice. Student can accurately create a plan for involving the patient as a team member by actively soliciting and validating information from them about their prior medications and 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:

  • Check-Backs
  • Collaboration
  • Cross Monitoring
  • Handoff
  • I PASS the BATON
  • 3Ws – Who I am, What I am Doing, and Why I Care
  • AskMe3
  • “Speak Up”

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

172 – Checklists – Check! Instructor’s Guide

Thursday, October 9th, 2014

172

Instructor’s Guide – Checklists – Check!


Overview:
This story is about how all staff members are accountable for following safe practices. When team members diverge, others need to be able to call them on it in a respectful, non-threatening way, without being made to feel uncomfortable.

 


Primary Learning Outcomes

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

  • Explain how speaking up in the context of potential error can make improvement in patient safety.
  • Describe communication tools that can help team members draw attention to potential safety breaches.
  • Design methods for practicing the use of evidence-based communication tools that call out errors and hold staff members accountable for their actions.

 

 

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. How did Kimberly and Vilma’s advocacy and assertion for their patient improve patient safety?
    A: They could have agreed with the surgeon and continued on with their work, but they decided to be assertive and to double check the surgical site and x-rays.
  2. What does this story illustrate about the importance of all team members’ roles?
    A: Every team member is responsible for the care of the patient. Each team member in this scenario kept the patient the focus of care and not their own feelings or opinions.
  3. What tools were employed in this story to help build a culture of patient advocacy among this team?
    A: The tools of advocacy and assertion were employed in this story. In this case the surgeon would have completed the surgery on the wrong site, if the staff had not been assertive and stood up for the patient.

Discussion Questions:

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

  1. What can we learn from this story?
    A: We learned that by being a patient advocate and by being assertive positive patient outcomes are the result.
  2. What steps can I take to ensure that I am comfortable speaking up when I have potential safety concerns?
    A: Everyone must be responsible for their own behavior and actions while in the OR. The team did a good job of showing respect to the doctor while still be assertive. Advocating for the patient should be the first priority any time a team member is feeling uncomfortable about speaking up to another health care team member.

 

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

  • Rewrite the ending of this story, assuming that Vilma and Kimberly did not continue to question Dr. Esser. What consequences could have resulted from their inaction? Think about the consequences for Mr. Fenton, the doctors, nurses, hospital, and anyone else who might be impacted by the error.
  • Create a presentation describing communication tools that can help team members draw attention to potential safety breaches.

 


Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain how speaking up in the context of potential error can make improvement in patient safety.  Student struggles to explain how speaking up in the context of potential error can make improvement in patient safety. Student can explain how speaking up in the context of potential error can make improvement in patient safety, but needs further practice. Student can accurately explain how speaking up in the context of potential error can make improvement in patient safety.
Describe communication tools that can help team members draw attention to potential safety breaches.  Student struggles to describe communication tools that can help team members draw attention to potential safety breaches. Student can describe communication tools that can help team members draw attention to potential safety breaches, but needs further practice. Student can accurately describe communication tools that can help team members draw attention to potential safety breaches.
Design methods for practicing the use of evidence-based communication tools that call out errors and hold staff members accountable for their actions.   Student struggles to design methods for practicing the use of evidence-based communication tools that call out errors and hold staff members accountable for their actions. Student can design methods for practicing the use of evidence-based communication tools that call out errors and hold staff members accountable for their actions, but needs further practice. Student can accurately design methods for practicing the use of evidence-based communication tools that call out errors and hold staff members accountable for their actions.

 
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
  • Briefs
  • Cross Monitoring
  • CUS
  • DESC Script
  • Two-Challenge Rule
  • 3W’s – Who I am, What I am Doing, and Why I Care
  • AskMe3
  • “Speak Up”

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

171- A Question of Timing Instructor’s Guide

Thursday, October 9th, 2014

171

Instructor’s Guide – A Question of Timing


Overview:
This story is about the failure to give antibiotic prophylaxis on time, which can contribute to Surgical Site Infections (SSIs) and can be averted with a pre-op briefing.

 


Primary Learning Outcomes

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

  • Demonstrate awareness of how timely antibiotic prophylaxis can reduce SSIs.
  • Explain the importance of adopting a plan to create antibiotic standing orders based on local consensus guidelines.
  • Describe how briefings can support teams and avoid preventable errors and complications.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Briefs

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

 

Briefs: Briefs serve the following purposes:

  • They clarify who will be leading the team so that others know to whom to look for guidance.
  • They open lines of communication among team members, ensuring that everyone can contribute their unique knowledge base to the task, and thereby set the tone for the upcoming procedure. Protocols, responsibilities, and expected behaviors are discussed and reinforced so that possible misunderstandings are avoided.
  • They prepare the team for the flow of the procedure, contingency plans, and the means for resolving any unusual circumstances.
  • By delineating expectations, they reduce disruptive or unexpected behaviors.

 

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

  1. How did the lack of a plan for antibiotic standing orders detract from patient care and safety in this story?
    A: There was not a set plan for antibiotic standing orders and therefore they were not given in a time that was beneficial for the patient.
  2. What steps can be taken to educate the OR team about the rationale for timely antibiotic prophylaxis?
    A: The OR can be educated on the importance of timely antibiotic prophylaxis and how it prevents the risk of infection for the patient. The OR team could also start implementing briefs in order to deliver this information to every team member.
  3. How could engaging in pre-op briefings with the surgical team stop scenarios like the one in this story from happening?
    A: A pre-op briefing would not be done until all of the team members were present, including the surgeon. If the antibiotics were given at this time it would guarantee the antibiotics were given at the appropriate time.

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 briefs directly before surgery. It is also important that everyone is aware of the small time window allowed for prophylactic antibiotics.
  2. What steps can you take to ensure that every patient who requires antibiotic prophylaxis prior to surgery receives it on time, every time?
    A: One way is to have the antibiotic available in the OR, but to wait to give it until the surgeon is in the room and ready to make his incision.

 

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

  • Research and describe the evidence-based best practices for approaching perioperative antibiotic prophylaxis. Develop a presentation to share with the class.
  • Create a list of guidelines for antibiotic standing orders that could be applied in the hospital in this story.
  • Write out or act out a dialogue of the brief that could have happened in this story.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Demonstrate awareness of how timely antibiotic prophylaxis can reduce SSIs.  Student struggles to demonstrate awareness of how timely antibiotic prophylaxis can reduce SSIs. Student can demonstrate awareness of how timely antibiotic prophylaxis can reduce SSIs, but needs further practice. Student can accurately demonstrate awareness of how timely antibiotic prophylaxis can reduce SSIs.
Explain the importance of adopting a plan to create antibiotic standing orders based on local consensus guidelines.  Student struggles to explain the importance of adopting a plan to create antibiotic standing orders based on local consensus guidelines. Student can explain the importance of adopting a plan to create antibiotic standing orders based on local consensus guidelines, but needs further practice. Student can accurately explain the importance of adopting a plan to create antibiotic standing orders based on local consensus guidelines.
Describe how briefings can support teams and avoid preventable errors and complications.  Student struggles to describe how briefings can support teams and avoid preventable errors and complications. Student can describe how briefings can support teams and avoid preventable errors and complications, but needs further practice. Student can accurately describe how briefings can support teams and avoid preventable errors and complications.

 
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
  • Briefs
  • Collaboration
  • CUS
  • Feedback
  • Huddles
  • 3Ws – Who I am, What I am Doing, and Why I Care
  • Task Assistance
  • Two-Challenge Rule
  • AskMe3

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

169 – Are You Challenging Me? Instructor’s Guide

Friday, October 3rd, 2014

169

Instructor’s Guide – Are You Challenging Me?”


Overview:
This story is about what happens when team members express their concerns about the safety and well-being of a patient twice, and if the concern is not alleviated, it is their responsibility to escalate the conflict to someone who has authority to resolve the situation.

 


Primary Learning Outcomes

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

  • Define the TeamSTEPPS® “Two-Challenge” Rule
  • Explain the importance of each team member advocating for their patients and using the Two-Challenge Rule to guide their expression of concerns.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Two-Challenge Rule

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

  • What does this story illustrate about the importance of the Two-Challenge Rule?
  • Why was it so important that Sheila remained vigilant in her advocacy for Tiffany with Dr. Peters?
  • How can you give the message to other team members that you welcome challenges and will take them in the spirit of collaborating on what’s best for patients?

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.

  • What can we learn from this story?
  • What situations or circumstances would call for the use of the Two-Challenge Rule?

 

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

  • Develop a presentation or brochure to teach your colleagues about the Two-Challenge Rule and encourage them to use it and be open to its use by others.
  • Craft a scenario in which a nurse might need to use the Two-Challenge Rule. Write or act out your dialogue.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Define the TeamSTEPPS® “Two-Challenge” Rule Student struggles to  define the TeamSTEPPS® “Two-Challenge” Rule Student can define the TeamSTEPPS® “Two-Challenge” Rule, but needs further practice. Student can accurately define the TeamSTEPPS® “Two-Challenge” Rule
Explain the importance of each team member advocating for their patients and using the Two-Challenge Rule to guide their expression of concerns.  Student struggles to  explain the importance of each team member advocating for their patients and using the Two-Challenge Rule to guide their expression of concerns. Student can explain the importance of each team member advocating for their patients and using the Two-Challenge Rule to guide their expression of concerns, but needs further practice. Student can accurately explain the importance of each team member advocating for their patients and using the Two-Challenge Rule to guide their expression of 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:

  • Two-Challenge Rule
  • Advocacy and Assertion

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

168 – Step Up To Rounding Instructor’s Guide

Friday, October 3rd, 2014

168

Instructor’s Guide – Step Up To Rounding


Overview:
This story is about falls which are three times more common in hospital and nursing home settings where they result in higher injury rates. But they can be reduced through a number of simple solutions, such as tweaking hourly rounds to make them more meaningful.

 


Primary Learning Outcomes

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

  • Identify unmet patient needs that contribute to risk for falls.
  • Describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls.
  • Develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.

 

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 was the importance of modifying the team’s current patient care practices?
    A: The current patient care practices were not decreasing the amount of patient falls or the number of times that patients were using the call-light.
  2. What evidence-based practices for fall prevention were developed and put into place in this story?
    A: They identified a few unmet patient needs that contributed to risk for falls and decided to focus on those issues while in the patient rooms.
  3. How did Taylor demonstrate effective leadership to ensure the commitment of her team to minimizing the risk of harm to patients?
    A: She demonstrated leadership by allowing the staff to work through some of their concerns and issues without butting in to the conversation. She encouraged them to come-up with their own resolution and then supported their 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: Most of the staff wanted to make the situation better for the patients and for themselves. Often times, people involved in a problem want to learn and grow from the situation. It was 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.
  2. What steps can you take to ensure that you round with a purpose?
    A: Tell the patient the 3Ws – Who I am, What I am Doing, Why I care. They would then emphasize the need to use the call light when they need to get up. Also, to help with any further issues the patient may have while the nurse is still in the room.

 

 
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 your colleagues describing unmet patient needs that contribute to risk for falls for your patients.
  • Think of some patient-care practices you have observed that might lead to falls. Describe them. How might they be modified to better prevent falls in the future?

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify unmet patient needs that contribute to risk for falls.  Student struggles to identify unmet patient needs that contribute to risk for falls. Student can identify unmet patient needs that contribute to risk for falls, but needs further practice. Student can accurately identify unmet patient needs that contribute to risk for falls.
Describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls.  Student struggles to describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls. Student can describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls, but needs further practice. Student can accurately describe the importance of modifying current patient care practices to anticipate patient needs and reduce the likelihood of falls.
Develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model.  Student struggles to develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model. Student can develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model, but needs further practice. Student can accurately develop and adopt an evidence-based plan to reduce patient risk from falls that builds on the unit’s care delivery model.
   

 
 
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
  • Check-Backs
  • Collaboration
  • Cross Monitoring
  • Feedback
  • I PASS the BATON
  • AskMe3
  • Patient Rounding
  • 3Ws – Who I am, What I am Doing, Why I care

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

167 – Did You Remember to SBAR? Instructor’s Guide

Friday, October 3rd, 2014

167

Instructor’s Guide – Did You Remember to SBAR?


Overview:
This story is about SBAR, a TeamSTEPPS® tool that helps care providers through the use of a structured format for giving reports between clinical staff members that leads to increased efficiency and enhanced safety.

 


Primary Learning Outcomes

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

  • Identify the words and meaning of the TeamSTEPPS SBAR tool.
  • Describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: SBAR

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

SBAR: SBAR provides a standardized framework for members of the healthcare team to communicate about a patient’s condition. SBAR is an easy-to-remember, concrete mechanism that is useful for framing any conversation, often a critical one requiring a clinician’s immediate attention and action. SBAR originated in the U.S. Navy submarine community to quickly provide critical information to the Captain. It provides members of the team with an easy and focused way to set expectations for what will be communicated and how. Standards of communication are essential for developing teamwork and fostering a culture of patient safety. SBAR provides a vehicle for individuals to speak up and express concern in a concise manner. In phrasing a conversation with another member of the team, consider the following:

  • Situation: What is happening with the patient?
  • Background: What is the clinical background?
  • Assessment: What do I think the problem is?
  • Recommendation: What would I recommend?

 

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

  1. How did Dr. Cowan’s approach to Henry improve teamwork, communication, and patient care in the hospital?
    A: She took the time to sit down with him and explain the issue to him. She did not belittle him or make him feel dumb.
  2. What does this story illustrate about how effective team communication can impact patient care?
    A: Henry seemed to need some help with one of his patients, but he did not communicate that clearly with the doctor. If we do not clearly communicate our needs then those around us cannot help us. This in turn impacts patient care because they are not receiving the best care 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: Clear and concise information is important when providing information to other health care professionals. This can be done by using SBAR. It is a standardized framework used to communicate with other healthcare professionals.
  2. How could you employ SBAR to help you communicate with other team members?
    A: SBAR should be used when communicating with other health care team members. One way is to offer an in-service on the use of SBAR. Once staff become more familiar with it they will become more comfortable using it.

 

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

  • Create a presentation in which you teach other members of your team about SBAR and how to use it effectively.
  • Think of another scenario in which you might use SBAR. Write a dialogue or act out your scenario, and demonstrate the effective use of SBAR.



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify the words and meaning of the TeamSTEPPS SBAR tool.  Student struggles to identify the words and meaning of the TeamSTEPPS SBAR tool. Student can identify the words and meaning of the TeamSTEPPS SBAR tool, but needs further practice. Student can accurately identify the words and meaning of the TeamSTEPPS SBAR tool.
Describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.  Student struggles to describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate. Student can describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate, but needs further practice. Student can accurately describe and demonstrate the effective use of SBAR in situations where a report and recommendations for action are appropriate.

 
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
  • STEP
  • Cross-Monitoring
  • Advocacy and Assertion
  • Handoffs

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166 – Prioritizing Pressure Care Instructor’s Guide

Friday, October 3rd, 2014

166

Instructor’s Guide – Prioritizing Pressure Care


Overview:
Using a pressure prevention bundle can reduce the risk for pressure ulcers (PUs). Unfortunately, even though nurses understand its importance, it’s associated with low status work and they often don’t make it a priority, falsely assuming that LPNS are performing skin care/PU prevention.

 


Primary Learning Outcomes

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

  • Explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention.
  • Describe the responsibilities of each clinical staff role in the prevention of pressure ulcers.
  • Explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.

 

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 does this story illustrate about the importance of identifying the training that all clinical staff have and need in pressure ulcer prevention?
    A: It’s important that nurses can recognize early signs of skin break down and prevent it from happening. The safety of the patient needs to be the first priority.
  2. How did Thelma’s attitude in the story affect the care her patients received?
    A: Thelma had her own priorities and duties she felt were more important than helping the LVN with her work. She did not address the fact that Lucy had asked for help turning the patients previously.
  3. How could this hospital better address pressure ulcer care and risk prevention to improve patient care?
    A: Stress appears to be her major concern and potentially a reason the nurses did not help each other when turning patients. The hospital could try to implement a plan where the nursing staff rounded together to turn patients and assess for skin breakdown.

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: Thelma may have been suffering from burnout. Stress, fatigue, and burnout can happen to anyone. Every nurse to subject to burnout and they need to be aware of the signs so that patient safety remains the primary focus and not the stress of the nurse.
  2. What can you do to ensure you are up-to-date with evidence-based pressure ulcer prevention measures?
    A: One way is to take continuing education modules that focus on pressure ulcer prevention. Another is to talk to the educator for that unit or the clinical nurse specialist to find out if there are new ways to prevent pressure ulcers.

 

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

  • Imagine you are the manager of this team. Create a plan for addressing pressure ulcer prevention training and the implementation of that training. Be sure to define roles for LPNs and RNs.
  • Create a brochure or presentation for families and patients about the risks for pressure ulcers and strategies to reduce risk.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention.  Student struggles to explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention. Student can explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention, but needs further practice. Student can accurately explain the importance of identifying the training that all clinical staff need in pressure ulcer prevention.
Describe the responsibilities of each clinical staff role in the prevention of pressure ulcers.  Student struggles to describe the responsibilities of each clinical staff role in the prevention of pressure ulcers. Student can describe the responsibilities of each clinical staff role in the prevention of pressure ulcers, but needs further practice. Student can accurately describe the responsibilities of each clinical staff role in the prevention of pressure ulcers.
Explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk.  Student struggles to explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk. Student can explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk, but needs further practice. Student can accurately explain and adopt a plan for educating patients and their families about the risks for pressure ulcers and strategies to reduce risk.

 

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:

  • Briefs
  • Collaboration
  • Cross Monitoring
  • CUS
  • I PASS the BATON
  • Task Assistance
  • 3Ws – Who I am, What I am Doing, and Why I Care

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

165 – Walking Into Risk Instructor’s Guide

Friday, October 3rd, 2014

165

Instructor’s Guide – Walking Into Risk


Overview:
This story is about how most Venous Thromboembolisms (VTEs) in the ambulatory setting occurring within one month of discharge and are preventable, but oncologists’ adherence to VTE assessment/prophylaxis guidelines is suboptimal and a major barrier to implement VTE protocol.

 


Primary Learning Outcomes

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

  • Identify the rationale for VTE risk assessment and prevention.
  • Determine the barriers to conducting VTE assessment in the ambulatory setting.
  • Create a team action plan to implement VTE risk assessment and prophylaxis.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

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 does this story illustrate about the importance of VTE assessment and risk prevention?
    A: It demonstrates the importance of complying with set standards related to VTE. It is just as important to follow the standards used to prevent harm to the patient as it is to comply with medication orders.
  2. What barriers kept the proper assessment from being conducted in the first place?
    A: The doctor was in a hurry to get the medications ordered and did not find it urgent to complete a VTE assessment or risk prevention protocol.
  3. How did Dr. Levine and Donna’s inaction affect both Willie’s recovery and patient care experience?
    A: Due to their inactivity the patient experienced a Venous Thromboembolisms. This should not have occurred in the first place and will potentially result in harm to the patient.

Discussion Questions:

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

  1. What can we learn from this story?
    A: Protocols are in place for a reason and are supported by evidence based practice. This should not have occurred in the first place and it is preventable.
  2. What can you do to ensure that VTE risk assessment is conducted with all patients in your ambulatory care setting?
    A: Each admission could have a check-off sheet on the front of the chart to ensure a VTE risk assessment has been conducted.

 

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

  • Create a presentation that explains the rational for VTE risk assessment and prevention for the members of your team. Share your work with the class or a partner for discussion.
  • Assess the barriers to conducting VTE risk assessments in a setting in which you have worked or visited. Think of some possible solutions for overcoming those barriers.
  • Create a team action plan to implement VTE risk assessment and prophylaxis for the team in this story.

 

 


Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify the rationale for VTE risk assessment and prevention.  Student struggles to identify the rationale for VTE risk assessment and prevention. Student can identify the rationale for VTE risk assessment and prevention, but needs further practice. Student can accurately identify the rationale for VTE risk assessment and prevention.
Determine the barriers to conducting VTE assessment in the ambulatory setting.  Student struggles to determine the barriers to conducting VTE assessment in the ambulatory setting. Student can determine the barriers to conducting VTE assessment in the ambulatory setting, but needs further practice. Student can accurately determine the barriers to conducting VTE assessment in the ambulatory setting.
Create a team action plan to implement VTE risk assessment and prophylaxis.  Student struggles to create a team action plan to implement VTE risk assessment and prophylaxis. Student can create a team action plan to implement VTE risk assessment and prophylaxis, but needs further practice. Student can accurately create a team action plan to implement VTE risk assessment and prophylaxis.

 

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:

  • Feedback
  • Briefs
  • Bedside Handoffs
  • Collaboration
  • STEP
  • Cross Monitoring
  • I PASS the BATON

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

164 – Who Knows Best? Instructor’s Guide

Friday, October 3rd, 2014

164

Instructor’s Guide – Who Knows Best?


Overview:
This story is about mutual support, especially when it comes to preventing VAP. A team-oriented approach to patient care requires that each team member’s expertise is respected, and differences of opinion about the direction of care are worked out in a supportive manner.

 


Primary Learning Outcomes

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

  • List the core components of a VAP bundle.
  • Describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application.
  • Explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

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 components of a VAP bundle were addressed in this story?
    A: Changing the ventilator circuit was addressed by Denise as a procedure that used to be performed, but may not be appropriate anymore.
  2. What does this story illustrate about the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application?
    A: It’s important to demonstrate mutual support during information exchange, even team members do not agree on the plan of care.
    A: All health care professionals are responsible for the care given to each patient, even if the doctor or another health care professional has not done the right thing in a previous situation.
  3. How do you feel Denise handled the disagreement with Dr. Martin? What else could she have done?
    A: She handled the situation very well. She stayed focused on the task at hand and did not get distracted by the negative comments made by 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: It’s important to have mutual respect even when disagreements occur. The doctor did not agree with the suggestion made by Denise, but Denise continued to address the current issue. She was respectful and appropriate with the doctor.
  2. What can you do during daily rounds to make sure everyone agrees on patient goals regarding ventilator use?
    A: Don’t hesitate to ask for clarification on an order if you are unsure. This may be to another nurse, the charge nurse, a doctor or the respiratory therapist.
    A: If protocol is established then focus on the task at hand and try not to get distracted with negative comments or other issues.

 

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

  • Craft a poster or graphic to remind your colleagues of the core components of a VAP bundle.
  • What steps can a team take to provide mutual support for team members in applying a VAP bundle? Create a protocol for providing mutual support for all team members and share with the class or a partner for discussion.
  • Compose the dialogue that might have occurred where this story left off. How do you think Denise should address Dr. Hannah, considering Dr. Martin and the team are still in the room?

 

 


Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
List the core components of a VAP bundle.  Student struggles to list the core components of a VAP bundle. Student can list the core components of a VAP bundle, but needs further practice. Student can accurately list the core components of a VAP bundle.
Describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application.  Student struggles to describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application. Student can describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application, but needs further practice. Student can accurately describe the importance of demonstrating mutual support during information exchange among team members about the VAP bundle’s application.
Explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care.  Student struggles to explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care. Student can explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered care, but needs further practice. Student can accurately explain how adopting daily rounds as the time to agree on patient goals and support VAP prevention can improve patient-centered 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:

  • Advocacy and Assertion
  • Briefs
  • Collaboration
  • Cross Monitoring
  • Huddles
  • Bedside Handoffs
  • Check-backs
  • Patient Rounding

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

163 – We Need 100% of You Now! Instructor’s Guide

Friday, October 3rd, 2014

163

Instructor’s Guide – We Need 100% of You Now!


Overview:
This story is about how distractions can cause serious compromises in patient safety and need to be consciously controlled. Some teams have devised approaches to prevent distractions, similar to how the airline industry has created “sterile cockpits” that keep the team focused when it counts.

 


Primary Learning Outcomes

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

  • Identify potential distractions that occur during high-consequence patient care processes, such as surgery.
  • Decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand.
  • Describe and adopt guidelines that control distractions during the high-consequence time periods.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

 

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 potential distractions could have disrupted the surgery in this story?
    A: Mistakes or the potential for a mistake can easily be made, expecially when healthcare professionals are distracted. The potential distractions in this story include music, texting, and looking at one’s own personal phone.
  2. How did the team’s use of the “sterile cockpit” environment contribute to Steffan’s patient experience?
    A: The patient experience was improved with the use of the “sterile cockpit”. Steffan felt more confident in the staff once they stopped what they were doing and focused on his upcoming surgery.
  3. How does the “sterile cockpit” environment” help control distractions during high-consequence time periods?
    A: It stops all other activities and focuses on the patient and the procedure. This is one way to prevent errors in the surgical ward.

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: Patients want to be involved in their own care. They are interested in what the health care team is doing and they want to assist as much as they can.
  2. What can the team do to consciously manage distractions?
    A: They should continue to use the “sterile cockpit” environment before any procedure. They need to continue to include the patient in the upcoming procedure and let them know what the plan of care is.

 

 
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 potential distractions that could occur during high-consequence patient care processes like surgery. Describe ways to mitigate those distractions, and create a plan for maintaining a safe and patient-centered environment.
  • Generate a chart to differentiate between periods of time that demand 100% of the caregiver team’s attention to the patient and procedure at hand, and the time periods that are appropriate for handling other matters like emails and data entry.
  • Construct a protocol to control distractions during high-consequence time periods. Summarize your points in a poster or graphic to remind your team of the guidelines you’ve developed.

 

  


Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify potential distractions that occur during high-consequence patient care processes, such as surgery.  Student struggles to identify potential distractions that occur during high-consequence patient care processes, such as surgery. Student can identify potential distractions that occur during high-consequence patient care processes, such as surgery, but needs further practice. Student can accurately identify potential distractions that occur during high-consequence patient care processes, such as surgery.
Decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand.  Student struggles to decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand. Student can decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand, but needs further practice. Student can accurately decide what periods of time demand 100% of the caregiver team’s attention to the patient and procedure at hand.
Describe and adopt guidelines that control distractions during the high-consequence time periods.   Student struggles to describe and adopt guidelines that control distractions during the high-consequence time periods. Student can describe and adopt guidelines that control distractions during the high-consequence time periods, but needs further practice. Student can accurately describe and adopt guidelines that control distractions during the high-consequence time 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:

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

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

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