Archive for the ‘Pro ED Guides’ Category
Friday, October 3rd, 2014
162
Instructor’s Guide – Aware of the Situation
Overview:
This story is about an elderly woman being cared for in a nursing home who is incontinent and catheterized despite new criteria for catheterization, because indwelling urinary catheters cause up to 80% of hospital-acquired infections, 30% of which are unnecessary.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the core features of a CAUTI Bundle.
- Identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit.
- Explain the importance of implementing evidence-based protocols to reduce CAUTI.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
Reflection Questions:
Students will answer re flection 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
- What core features of a CAUTI bundle were in place in this story?
A: The CAUTI bundle had just been implemented on this unit. This was a new policy for this unit.
- What attitudinal and work-load barriers were present in the story that prevented the implementation of the new protocol?
A: The staff were overworked and understaffed in this situation. This made implementation of the new protocol more difficult.
- What does this story illustrate about the importance of implementing evidence-based protocols to reduce CAUTI?
A: This story illustrates the importance of implementing evidence-based protocols because this is another example of a patient that developed a urinary tract infection when it could have been avoidable. This is another reason why established guidelines and protocols are important for nurses to follow. This way they are not reliant on their own personal judgement.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: We have learned the importance of having a catheter checklist or protocol. Evidence based practice guidelines were newly implemented in this facility, and for good reason.
- What steps can you take to make CAUTI prevention part of your everyday practice?
A: Be proactive and remove the catheter as soon as medically possible. The patient should not suffer more because it is convenient for the staff.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a poster or graphic that reminds staff of the core features of a CAUTI bundle.
- Imagine how Donna could best address the issue with her staff. Compose the email that she was about to write, addressing the problems on the unit.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List the core features of a CAUTI Bundle. |
Student struggles to list the core features of a CAUTI Bundle. |
Student can list the core features of a CAUTI Bundle, but needs further practice. |
Student can accurately list the core features of a CAUTI Bundle. |
| Identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit. |
Student struggles to identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit. |
Student can identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit, but needs further practice. |
Student can accurately identify attitudinal and work-load barriers to integrating new protocols such as CAUTI bundles to a unit. |
| Explain the importance of implementing evidence-based protocols to reduce CAUTI. |
Student struggles to explain the importance of implementing evidence-based protocols to reduce CAUTI. |
Student can explain the importance of implementing evidence-based protocols to reduce CAUTI, but needs further practice. |
Student can accurately explain the importance of implementing evidence-based protocols to reduce CAUTI. |
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
- Collaboration
- Cross Monitoring
- SBAR
- Briefs
- Debriefs
- Huddles
- I’M SAFE
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
161
Instructor’s Guide – Dial I for Ignore
Overview:
This story is about the importance of hand washing. Failing to wash hands between each patient visit can result in CLABSIs. According to a recent CDC report, the majority of CLABSIs are now occurring outside of ICUs, especially in outpatient dialysis.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List the essential best practices in a CLABSI bundle.
- Describe and apply evidence-based practices in hand hygiene.
- Explain the importance of providing patients with opportunities to ask questions about their care.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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
- What essential best practices in a CLABSI bundle were followed in the story? Which weren’t?
A: Good hand is an important part of best practices and of reducing the risk of infection. It is very important that every member of the team complies by the best practices found in the CLABSI bundle.
- What does this story illustrate about the importance of applying evidence-based practices in hand hygiene?
A: It illustrates that all health care professionals need to comply with hand hygiene standards.
- What steps can the team take to ensure that they are consistently following best practices in hand hygiene?
A: It is important to keep the family members aware of the standards of care for their loved ones. It is empowering to the family members to keep them informed about medication or procedures their loved ones are receiving.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The importance of keeping the family aware of safe practices. The nephew wanted to say something about the phlebotomist not washing her hands, but he didn’t know if he should.
- What steps can I take to ensure patients have opportunities to ask questions about their care, and that I welcome those questions?
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.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- List the essential best practices in a CLABSI bundle and explain their importance.
- Create a poster or graphic that reminds all employees and family of the importance of following evidence-based practices for hand hygiene.
- Brainstorm ways you could engage patients and families in being an integral part of maintaining hand hygiene at all times.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List the essential best practices in a CLABSI bundle. |
Student struggles to list the essential best practices in a CLABSI bundle. |
Student can list the essential best practices in a CLABSI bundle, but needs further practice. |
Student can accurately list the essential best practices in a CLABSI bundle. |
| Describe and apply evidence-based practices in hand hygiene. |
Student struggles to describe and apply evidence-based practices in hand hygiene. |
Student can describe and apply evidence-based practices in hand hygiene, but needs further practice. |
Student can accurately describe and apply evidence-based practices in hand hygiene. |
| Explain the importance of providing patients with opportunities to ask questions about their care. |
Student struggles to explain the importance of providing patients with opportunities to ask questions about their care. |
Student can explain the importance of providing patients with opportunities to ask questions about their care, but needs further practice. |
Student can accurately explain the importance of providing patients with opportunities to ask questions about their 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
- Check-Backs
- Patient Rounding
- Two-Challenge Rule
- CUS
- Cross Monitoring
- 3Ws – Who I Am, What I am Doing, and Why I Care
- Task Assistance
- AskMe3
- “Speak Up”
- Advocacy and Assertion
- DESC Script
- I’M SAFE
- SBAR
- Briefs
- Call-Outs
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
160
Instructor’s Guide – Admission of Failure
Overview:
This story is about preventable readmissions. They may result from incomplete treatment or poor care of the underlying problem, or may reflect poor coordination of services at the time of discharge. Every team member is responsible for the discharge process.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe evidence-based strategies that reduce preventable readmissions.
- Explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings.
- Generate a protocol to coordinate care between hospital and community settings.
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.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
Reflection Questions:
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
- How did General Hospital fail to prevent Akiki’s relapse?
A: General Hospital did not provide the family with enough discharge information or physician follow-up to avoid a relapse.
- What evidence-based strategies to reduce preventable readmissions did Helen employ? Why were they important?
A: Helen found ways to engage the family in their discharge planning.
- What does this story illustrate about the importance of including families and patients in the discharge planning process?
A: This allows families to feel empowered and that they are a part of the discharge process. They are more likely to comply with discharge instructions if they understand the instructions and why they are so important.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The importance of engaging patients and families in the discharge planning process. Patient safety should be the priority for all health care providers
- What can a team do to empower patients to be actively involved in their discharge planning?
A: Explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during the transition from the hospital to community settings.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Brainstorm ways to engage patients in their discharge planning. Share them with a partner and create a presentation of your best/most creative ideas.
- Create a brochure to review with patients upon discharge that helps engage them in their discharge process.
- Develop a protocol for coordinating care between the hospital and community settings.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe evidence-based strategies that reduce preventable readmissions. |
Student struggles to describe evidence-based strategies that reduce preventable readmissions. |
Student can describe evidence-based strategies that reduce preventable readmissions, but needs further practice. |
Student can accurately describe evidence-based strategies that reduce preventable readmissions. |
| Explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings. |
Student struggles to explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings. |
Student can explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings, but needs further practice. |
Student can accurately explain the importance of arranging for all patients to be encouraged to ask questions about their discharge plans during transitions from hospital to community settings. |
| Generate a protocol to coordinate care between hospital and community settings. |
Student struggles to generate a protocol to coordinate care between hospital and community settings. |
Student can generate a protocol to coordinate care between hospital and community settings, but needs further practice. |
Student can accurately generate a protocol to coordinate care between hospital and community settings. |
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
- Handoff
- Cross Monitoring
- 3Ws – Who I Am, What I am Doing, and Why I Care
- I PASS the BATON
- SBAR
- AskMe3
- Bedside Handoffs
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
159
Instructor’s Guide – Brief to Set the Tone
Overview:
Team leaders must set the tone for service excellence. Without collective decision-making, targeted goal setting and clear roles and responsibilities, team performance suffers. This has a negative impact on patient satisfaction and safety.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the components of successful team briefing.
- Describe the importance of planning for contingencies related to staffing, resources, and equipment.
- Explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors.
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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Team 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 health care professionals.
Team Briefs: Similar to a pre-flight checklist used in aviation, during a brief the team leader should cover the items on the checklist. As in aviation, the briefings before flights provide the ideal forum for building a team dynamic that allows everyone to work together when carrying out routine tasks and when tackling unexpected problems. 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; and,
- 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
- What components of successful team briefings are demonstrated in this story?
A: It is important the correct checks and communication are done no matter what situation is present. This situation could have turned into a negative conversation regarding the nursing staff, but instead it turned into an open dialogue.
- What do you feel Charlie did well in this story that helped build up his team?
A: He focused on the positive work and did not dwell on the complaints from the staff or nurses.
- What does this story illustrate about the importance of integrating safe practices into daily work practices by inviting team accountability and back-up behaviors?
A: The use of ‘check-backs’ allow for discussion and reflection to be made with each other. Although it may be subtle, the use of morning briefs is another way to improve communication and to invite other health care teams to be involved in the decision making process.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Appropriate communication, ‘check-backs’, and closed loop communication is important for team building and collaboration. The pharmacy team agreed it is better to have appropriate checks made instead of rushing forward with their work.
- What one thing can you do to set the tone for team-based care each day?
A: One way is to keep the morning meeting set on a positive tone. It is easy to get caught up with negative comments or issues, but a positive approach will set the tone for team-based care each morning.
Suggested Classroom Mastery Activities: These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a poster to remind your team members of the importance of team briefings.
- Write out a plan for this team’s morning briefings. What should they cover each day to be as successful and responsive to patient and staff needs as possible?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the components of successful team briefing. |
Student struggles to describe the components of successful team briefing. |
Student can describe the components of successful team briefing, but needs further practice. |
Student can accurately describe the components of successful team briefing. |
| Describe the importance of planning for contingencies related to staffing, resources, and equipment. |
Student struggles to describe the importance of planning for contingencies related to staffing, resources, and equipment. |
Student can describe the importance of planning for contingencies related to staffing, resources, and equipment, but needs further practice. |
Student can accurately describe the importance of planning for contingencies related to staffing, resources, and equipment. |
| Explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors. |
Student struggles to explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors. |
Student can explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors, but needs further practice. |
Student can accurately explain how to integrate safe practices into daily work practices by inviting team accountability and back-up behaviors. |
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
- Feedback
- I’M SAFE
- AskMe3
- “Speak Up”
- 3Ws – Who I Am, What I am Doing, and Why I Care
- Cross Monitoring
- Task Assistance
- CUS
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
158
Instructor’s Guide – The Tiger Gets New Stripes
Overview:
This story is about the deviation from safety protocols. It is a leading cause of patient harm. Executive leaders must hold all providers and staff accountable for safe practices and protocols. Coaching for engagement is a strategy for gaining buy-in and behavior change.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain the consequences of not consistently following safety protocols or practices.
- Describe the importance of applying consistent consequences across all disciplines for not following safe practices.
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
- Why is it important that all team members consistently follow safety protocols and practices?
A: If all team members are consistently following safety protocols and practices it will help to reduce patient harm. They are put into place for a specific reason and are used for patient safety.
- Why was it imperative for Mr. Porter to establish the same standard for Dr. Barnes as he expected from the rest of the staff?
A: It will create consistency within each team. Also, every team member should be held to the same standards.
- If you were on this surgical team, what could you have done to help ensure that safety protocols were consistently practiced?
A: A check-off sheet could be created and used with each surgery. Also, the surgery team could inform the surgeon that safety protocols are to be used on every patient for every surgery. The surgical staff have the power to “speak up” and confront the surgeon. His surgeries are not an exception to the rule.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That therapeutic communication allows for open dialogue and continued communication. The surgeon was not put down for his previous work, but he was informed of the standards used in this facility.
- What one thing could you do to ensure all members are consistently following safety protocols?
A: One way is to allow every team member to communicate openly with each other. Welcome communication and dialogue with the CEO, doctors and medical staff regarding any issues with patient safety.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write a dialogue in which a member of the surgical prep team confronts Dr. Barnes and explains the necessity and importance of the hospital’s safety protocols.
- Create a poster reminding colleagues of the importance of following safety protocols.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Explain the consequences of not consistently following safety protocols or practices. |
Student struggles to explain the consequences of not consistently following safety protocols or practices. |
Student can explain the consequences of not consistently following safety protocols or practices, but needs further practice |
Student can accurately explain the consequences of not consistently following safety protocols or practices. |
| Describe the importance of applying consistent consequences across all disciplines for not following safe practices. |
Student struggles to describe the importance of applying consistent consequences across all disciplines for not following safe practices. |
Student can describe the importance of applying consistent consequences across all disciplines for not following safe practices, but needs further practice. |
Student can accurately describe the importance of applying consistent consequences across all disciplines for not following safe practices. |
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
- CUS
- DESC Script
- Collaboration
- STEP
- Cross Monitoring
- “Speak Up”
- Two-Challenge Rule
- I’M SAFE
- 4 Step Process
- PEARLA
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
157
Instructor’s Guide – Improving Medication Safety
Overview:
This story is about how labor nurses are at risk for professional liability when titration results in uterine tachysystole aren’t recognized in a timely manner, and how effective nurse-doctor communication is crucial to provide an outstanding patient experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin.
- Describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin.
- Explain and adopt IHI elective induction and augmentation bundles.
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
- What are the responsibilities of team members in reducing patient harm associated with the use of oxytocin?
A: Team members need to be able to safely monitor the baby and the mother when administering oxytocin.
- How were those responsibilities fulfilled and neglected in this story?
A: The nurse did monitor the mother and baby, however she did not agree with the doctor’s order to increase the medication. She could have used ‘CUS’ to let the doctor know her concerns with the order to increase the oxytocin.
- What could be done to better empower Francine to speak up and intervene when she sees an unsafe situation involving oxytocin?
A: A check-back dialogue could be developed between the nursing staff and the physicians to facilitate better communication and empower the nurses.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The patient could hear what was happening in the delivery room, but could not fully understand what was happening with the baby.
A: There did not appear to be a good check-back dialogue as the delivery nurse had not communicated fully with the doctor. She also did not inform the patient about what she was doing.
- What can I do to ensure that I speak up and intervene if an unsafe situation involving oxytocin may be occurring?
A: A better check-back dialogue could have been initiated. It appeared as if the nurse knew better, but she did not communicating that information back to the doctor.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Research the IHI elective induction and augmentation bundles. Create a presentation for your colleagues on why these bundles are important to ensure patient safety, and how they should be implemented and adopted.
- Describe what might have happened if Francine had not intervened when she did. What dangers were there to the patient and baby?
- Research Francine’s liability in this situation. Write a brief on the liability of nurses when titration results in uterine tachysystole aren’t recognized in a timely manner.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin. |
Student struggles to describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin. |
Student can describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin, but needs further practice. |
Student can accurately describe the roles and responsibilities of team members in reducing patient harm associated with the use of oxytocin. |
| Describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin. |
Student struggles to describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin. |
Student can describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin, but needs further practice. |
Student can accurately describe evidence-based strategies to enable team members to speak up and intervene in an unsafe situation involving oxytocin. |
| Explain and adopt IHI elective induction and augmentation bundles. |
Student struggles to explain and adopt IHI elective induction and augmentation bundles. |
Student can explain and adopt IHI elective induction and augmentation bundles, but needs further practice. |
Student can accurately explain and adopt IHI elective induction and augmentation bundles. |
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:
- STEP
- Task Assistance
- Two-Challenge Rule
- AskMe3
- SBAR
- Advocacy and Assertion
- Cross Monitoring
- “Speak Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
156
Instructor’s Guide – Everyone is a Monitor
Overview:
This story is about the impacts of adverse drug events (ADEs). Proper communication protocols between physicians and nursing home staff are essential to prevent patient ADEs.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety.
- Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
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
- What evidence-based practices for medication safety were not followed in this story?
A: There was a lack of closed loop communication between the physician and the nurse. The nurse assumed the doctor knew the regularly prescribed medications for the patient, but did not communicate that information to the doctor.
- What are some ways this team could ensure better medication safety for their patients?
A: The use of ‘check-backs’ allow for discussion and reflection to be made with each patient. The nurse in this situation could have used ‘check-backs’ or closed loop communication when giving report to the doctor and receiving medication orders.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: There was a lack of closed loop communication between the physician and the nurse. The nurse assumed the doctor was aware of the patients medication and her lack of shared decision-making and closed-loop communication had a negative impact on patient safety
- What can I do to ensure I monitor situations to ensure medication safety?
A: One way is to ensure that medication reconciliation is completed on each patient. Another way is to create a checklist to be completed each time a patient receives a new medication. This should include the patient’s current medications and any allergies.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a checklist for this team to use to ensure medication safety for all of their patients.
- Identify the primary challenges to medication safety in this story, and describe how they could be overcome.
- Create a presentation to remind staff to follow evidence-based practices to improve medication safety and prevent ADEs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety. |
Student struggles to describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety. |
Student can describe evidence-based practices to improve medication safety, and the challenges in ensuring medication safety, but needs further practice. |
Student can accurately describe evidence-based practices to improve medication safety, and the 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. |
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
- Cross Monitoring
- STEP
- SBAR
- “Speak Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
155
Instructor’s Guide – No Shortcuts to Risk Reduction
Overview:
This story is about surgical site infections (SSIs). According to the CDC, SSIs are the second most common healthcare-acquired infection. Following evidence-based perioperative practices such as using precautions to prevent contamination of sterile equipment can prevent the risk of SSI.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- List evidence-based perioperative practices that prevent SSIs.
- Demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices.
- Describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: CUS
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.
CUS: The CUS technique provides a framework for conflict resolution, advocacy, and mutual support. Signal words, such as “danger,” “warning,” and “caution” are common in the medical arena. They catch the reader’s attention. “CUS” and several other signal phrases have a similar effect in verbal communication. When they are spoken, all team members will understand clearly not only the issue, but also the magnitude of the issue.
CUS Technique:
- First, state your Concern.
- Then state why you are Uncomfortable.
- If the conflict is not resolved, state that there is a Safety issue.
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
- What evidence-based perioperative practices were ignored in this story? Why are they important to follow?
A: The practices that were ignored in this story are related to surgical asepsis. Surgical equipment should stay in the sterile packaging until it is opened in the surgical suite.
- What barriers did Celeste face in addressing the breaks in evidence-based practice that she witnessed? What does this say about the norms of the unit?
A: She was concerned about speaking up because she is new to this unit. The surgical nurses had been preparing surgical equipment in this way for an extended amount of time. Due to the fact this was not a new occurrence may make it even more difficult to discuss.
- How could the use of the CUS Technique have helped Celeste address her concerns?
A: First, she would need to state her concern regarding the sterile equipment being opened in the storage unit. Then she would need to stay why she was uncomfortable. Then if the conflict were not resolved, she would need to state their was a patient safety issue related to the equipment.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That although the staff knew the right thing to do they had become accustomed to doing it a different way. It is not always wrong to change how things are done, but they still must comply with safety standards. In this case the staff were no longer complying by the necessary perioperative practices.
- What steps can the team take to ensure we feel able to intervene if another team member takes a safety-compromising shortcut?
A: One way is to encourage open communication and regular dialogue regarding patient care and safety.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write a dialogue in which Celeste utilizes the CUS Technique to address the breach of evidence-based practice that she has witnessed. How do you think the others might react, and what might she need to do to ensure patient safety?
- Make a poster to remind team members about the importance of following evidence-based perioperative practices that prevent SSIs.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| List evidence-based perioperative practices that prevent SSI. |
Student struggles to list evidence-based perioperative practices that prevent SSIs. |
Student can list evidence-based perioperative practices that prevent SSIs, but needs further practice and instruction. |
Student can accurately list evidence-based perioperative practices that prevent SSIs. |
| Demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
Student struggles to demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
Student can demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices, but needs further practice and instruction. |
Student can accurately demonstrate awareness of techniques to resolve conflict when team members take shortcuts in perioperative practices. |
| Describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
Student struggles to describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
Student can describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist, but needs further practice and instruction. |
Student can accurately describe a strategy to improve SSI preventative practices, such as implementation of the WHO SSI checklist. |
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
- STEP
- Call-Out
- AskMe3
- Cross Monitoring
- SBAR
- “Speak Up”
- Task Assistance
- Huddles
- 4 Step Process
- Two-Challenge Rule
- DESC Script
- PEARLA
- CUS
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
154
Instructor’s Guide – Patients are People Too
Overview:
This story illustrates how knowing about being patient-centered, and actually doing it, are two different things, and that staff must be intentional and self-aware about engaging the patient.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the core components of patient-centered behavior.
- Describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
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
- What important elements of patient-centered care did Tiana and Javier miss in this story?
A: The patient should be the source of control and full partner in the care team
A: The tasks should not prevent active listening
A: Explaining the rationale for each step and speaking to NOT around the patient involves them in the care process
- Why is it important to view events from the patient’s perspective when evaluating the efficacy of patient-centered care?
A: Safe and quality care requires that the patient be actively involved in the plan of care
A: Understanding that hospital sounds and otherwise simple cryptic comments can be fear inducing if not thoroughly explained and put into context
A: Being actively present and engaging is key to effective communication
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: Verbalizes that the patients experience is important does not demonstrate an understanding of patient centered care.
A: Following protocols and procedures does not demonstrate that the patient is the focus of the care
A: Enhancing the patient experience requires a patient centered approach
- How can we as a team make sure our patient-centered principles translate consistently into patient-centered behaviors?
A: Mentors should demonstrate consistent patient centered competency
A: Patient centered understanding cannot be evaluated via testing or verbalizing alone, but must be demonstrated over time
A: Holding one another accountable and have a culture of transparent communication is key to be a highly effective team
- How can I make sure I use good patient-centered behavior in every interaction with my patients?
A: Assess verbal and non-verbal queues with each interaction to better under that patients preferences, values and needs.
A: Find dedicated time to be present.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write Mrs. Tillman’s review of her care on her patient survey. What do you think she would say about her experience with her nurses?
- Make a quick-reference chart or checklist that reminds nurses and other medical professionals to think about patient-centered care as they work through their normal procedures.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the core components of patient-centered behavior. |
Student struggles to identify the core components of patient-centered behavior. |
Student can identify the core components of patient-centered behavior, but needs further instruction. |
Student can accurately identify the core components of patient-centered behavior. |
| Describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members. |
Student struggles to describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members. |
Student can describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members, but needs further instruction. |
Student can accurately describe the importance of planning for all care providers to demonstrate patient-centered behaviors in all interactions with patients and family members. |
Additional Story-Specific Resources:
For additional information on improving team communication, please consult the following articles and resources in Further Reading:
Story-Specific Best Practices and Proven Tools:
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
- Feedback
- 3Ws – Who I am, What I am Doing, Why I Care
- DESC Script
- I’M SAFE
- STEP
- Bedside Handoffs
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
153
Instructor’s Guide – No One Sits Until Everyone Sits
Overview:
This story is about mutual support and task assistance, and how offering assistance to other team members when your workload permits promotes safety, mutual trust, efficiency, productivity, and service excellence.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of adopting task sharing norms across team members to effectively manage workload.
- Identify high threat practices or protocols requiring increased shared vigilance.
- Generate team norms for engaging non-supportive team members to provide consistent mutual support.
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.
- 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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Task Assistance
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among health care professionals.
Task Assistance is guided by situation monitoring because situation awareness allows team members to effectively identify the need for assistance by others on the team. To a certain degree, some of us have been conditioned to avoid asking for help because of the fear of suggesting lack of knowledge or confidence. Many people refuse to seek assistance when overwhelmed by tasks. In support of patient safety, however, task assistance is expected. One of the most important concepts to remember with regard to Task Assistance is that assistance should be actively given and offered whenever there is a concern for patient safety related to workload. Task assistance may involve asking for assistance when overwhelmed or unsure; helping team members to perform their tasks, shifting workload by redistributing tasks to other team members, delaying/rerouting work so the overburdened member can recover, and/or filling in for overburdened team members when necessary.
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
- What does this story illustrate about the importance of task assistance across the unit and hospital?
A: It is important that nurses can recognize when they have limitations. The safety of the patient needs to be the first priority
- What high threat practices and protocols were occurring in this story?
A: Individual preferences and negative behaviors had caused a decline in safe patient care on this unit. The negative progression had continued until a potentially deadly occurrence happened on the floor.
- What team norms did Jane establish for engaging non-supportive team members to provide consistent mutual support across the unit? Why was this important?
A: Jane established a supportive environment where all team members supported each other. Even to the point of saying no one sits until everyone can sit down.
A: This is important because it builds a sense of support for all of the team members, but also keeps the patient the focus of care.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That psychological safety is important for health care team members. 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.
- What individual behaviors are often permitted that do not enhance team mutual support and may be placing patients at risk?
A: Individual behaviors such as trying to do work alone or having poor communication puts patients at risk and does not support a team environment.
- What one thing can you do to promote mutual support and encourage task assistance across the team?
A: By promoting task assistance is one way to promote mutual support. Another way to promote mutual support is to continue to keep an open dialogue with staff members. This can be done by allowing the staff to express their feelings and to state when they are overwhelmed with their assignment.
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 describes the practice of task assistance, its importance, and the benefits for the unit and its patients.
- Brainstorm a list of high threat practices and protocols that require shared vigilance, and describe how the use of task assistance could address each.
- Write a script for the conversation you imagine Jane had with one of the less compliant members of her team. Illustrate how you think she won them over, or how she handled letting them go.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of adopting task sharing norms across team members to effectively manage workload. |
Student struggles to describe the importance of adopting task sharing norms across team members to effectively manage workload. |
Student can describe the importance of adopting task sharing norms across team members to effectively manage workload, but needs further practice. |
Student can accurately describe the importance of adopting task sharing norms across team members to effectively manage workload. |
| Identify high threat practices or protocols requiring increased shared vigilance. |
Student struggles to identify high threat practices or protocols requiring increased shared vigilance. |
Student can identify high threat practices or protocols requiring increased shared vigilance, but needs further practice. |
Student can accurately identify high threat practices or protocols requiring increased shared vigilance. |
| Generate team norms for engaging non-supportive team members to provide consistent mutual support. |
Student struggles to generate team norms for engaging non-supportive team members to provide consistent mutual support. |
Student can generate team norms for engaging non-supportive team members to provide consistent mutual support, but needs further practice. |
Student can accurately generate team norms for engaging non-supportive team members to provide consistent mutual support. |
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:
- Task Assistance
- Collaboration
- Cross Monitoring
- Feedback
- Huddles
- I’M SAFE
- STEP
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
