Archive for the ‘Pro ED Guides’ Category
Friday, October 3rd, 2014
152
Instructor’s Guide – Let’s Huddle Up Here
Overview:
This story illustrates the importance of the TeamSTEPPS® “huddle” tool to keep everyone on the same page and allow for brief problem-solving before continuing the treatment plan as a patient’s condition changes.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the types of situations where huddles could be advantageous in coordinating patient care.
- Explain how and when huddles should be conducted.
- Describe how to adopt huddles as a normal problem-solving event for improved patient care.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS Best Practice: Huddles
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Huddles: A huddle is a tool for reinforcing the plans already in place for the treatment of patients and for assessing the need to change plans. It can also help develop a shared understanding between team members of the plan of care and provides team leaders with the opportunity to informally monitor patient and unit-level situations. Huddles are particularly useful because information and patient status change over time, requiring ongoing monitoring and updating of the team. It may just be a matter of a sudden increase in the activity level of an individual or the team needing to reevaluate workload status. Workload distribution may have to be adjusted as a result. Information updates within the team should occur as often as necessary, and can take the form of a huddle at the status board or can occur between individual team members whenever new information needs to be shared.
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- How would a huddle have been useful in this story?
A: It would have given the rest of the team more information regarding the conversation Jan had with Sarah’s mother.
- How could the use of huddles help a team better coordinate patient care?
A: Huddle allows each team member to know and understand what is expected regarding care to be provided for a patient. It also allows team members to know if there is a new situation they previously didn’t know.
- What were the barriers to using huddles in this story? How could they have been overcome?
A: One barrier was the increased deterioration of the patient. Jan believed that because the patient continued to have an increased need for medical attention that took away the opportunity of using a huddle.
A: This could have been overcome by implementing a team huddle. This could have been done by contacting the social worker or charge nurse in order to initiate a team huddle.
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: Jan had specific information regarding Sarah’s wishes however she was unable to get that information to the rest of the medical team.
- What barriers might you face in using the concept of huddling? How can you overcome those barriers?
A: Some barriers include feeling unsure of one’s own decisions or doubting the seriousness of a situation. You can overcome these barriers by focusing on the patient as the priority. If patient care is the focus then the focus is no longer on our insecurities or pride, but on the patient receiving quality care.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Make a list of all of the players in this story. Explain how a huddle would have helped them all be on the same page about Sarah’s care.
- Create a poster reminding your team of the importance of huddles and their benefits.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the types of situations where huddles could be advantageous in coordinating patient care. |
Student struggles to identify the types of situations where huddles could be advantageous in coordinating patient care. |
Student can identify the types of situations where huddles could be advantageous in coordinating patient care, but needs further practice. |
Student can accurately identify the types of situations where huddles could be advantageous in coordinating patient care. |
| Explain how and when huddles should be conducted. |
Student struggles to explain how and when huddles should be conducted. |
Student can explain how and when huddles should be conducted, but needs further practice. |
Student can accurately explain how and when huddles should be conducted. |
| Describe how to adopt huddles as a normal problem-solving event for improved patient care. |
Student struggles to describe how to adopt huddles as a normal problem-solving event for improved patient care. |
Student can describe how to adopt huddles as a normal problem-solving event for improved patient care, but needs further practice. |
Student can accurately describe how to adopt huddles as a normal problem-solving event for improved patient care. |
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:
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
151
Instructor’s Guide – CUS-sing for Safety’s Sake
Overview:
This story is about CUS, a TeamSTEPPS® tool that helps care providers find the right words to express their concerns when they become aware of something they think will compromise patient safety.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety.
- Generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety.
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: CUS Technique
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.
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
- Why was the use of CUS so important in this story? What might have happened if it had not been employed?
A: It is highly likely that Marylou would have administered the incorrect amount of medication if she would not have used the CUS technique. She was looking out for the safety of the patient in this situation.
- Why is it important to express your concerns, regardless of hierarchy?
A: It is important because every patient deserves to receive the best care possible and thought would not have happened if this situation were handled differently. Hierarchy should not play a role in the care provided to the patient.
- What barriers did Marylou have to overcome in order to successfully use the CUS strategy?
A: She had to overcome her own feels and past experiences related to dealing with this pharmacist in the past. Although it is an uncomfortable conversation she knew it was the right 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
- What can we learn from this story?
A: Patient safety needs to be the first priority. It is not safe to try to administer a partial dose of an adult medication to a pediatric patient. It would not have been safe for Marylou to administer the medication as it was delivered to her. She was assertive and kept her patient the focus of the conversation.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation explaining CUS to your team members as a way to confront differences of opinion regarding patient safety.
- Think of other scenarios where the use of CUS is appropriate.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
Student struggles to describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
Student can describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety, but needs further instruction. |
Student can accurately describe situations where the TeamSTEPPS® CUS tool would be appropriate to use to advocate for patient safety. |
| Generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
Student struggles to generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
Student can generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety, but needs further practice. |
Student can accurately generate a plan for and practice using the TeamSTEPPS® CUS tool among providers and staff where there are unexpressed concerns about patient safety. |
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
- Advocacy and Assertion
- CUS
- Handoff
- STEP
- Two-Challenge Rule
- Cross Monitoring
- 3Ws – Who I Am, What I am Doing, and Why I Care
- “Speak Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 3rd, 2014
210
Student’s Guide – I’m Alright, Really
Overview:
It is difficult to be objective about the well-being and fitness to work both about ourselves and our co-workers. The TeamSTEPPS I’M SAFE tool is meant to be a helpful checklist for assessing different dimensions of our own and others ability to deliver safe patient care.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize elements of the TeamSTEPPS “I’M SAFE” resilience self-assessment tool.
- Evaluate team members’ fitness for duty by identifying cues of stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD.
- Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with crippling stress, burnout, and/or more severe psychological problems.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: I’M SAFE
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
I’M SAFE: Be aware of your own condition to ensure that you are fit and ready to fulfill your duties is essential to delivering safe, quality care. “I’M SAFE” is a simple checklist that should be used daily (or more frequently) to determine both your co-workers’ and your own ability to perform safely.
I’M SAFE stands for:
- Illness: Am I feeling so bad that I cannot perform my duties?
- Medication: Is the medication I am taking affecting my ability to maintain situation awareness and perform my duties?
- Stress: Is there something that is detracting from my ability to focus and perform my duties?
- Alcohol/Drugs: Is my use of alcohol or illicit drugs affecting me so that I cannot focus on the performance of my duties?
- Fatigue: Team members should alert the team regarding their state of fatigue (e.g., watch me a little closer today, I only had three hours of sleep last night).
- Eating and Elimination: Not taking care of our eating and elimination needs affects our ability to concentrate and stresses us physiologically.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How did Amanda’s situation awareness help avoid a possible medical error?
- How can we improve our ability to recognize and manage stress, fatigue, burnout, and the possibility of more serious psychological problems such as PTSD among team members using the TeamSTEPPS I’M SAFE tool?
- How can we develop the mutual support necessary to address, and if necessary, confront compromised performance on the part of a team member?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, October 3rd, 2014
209
Student’s Guide – First Baby STEP
Overview:
This story is about the loss of situation awareness as the root cause of many serious medical errors and sentinel events. A team’s ability to maintain situation awareness depends on having good tools to use, and using those tools consistently and skillfully.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize the elements of the TeamSTEPPS STEP situation awareness tool.
- Describe how situation awareness can be maintained by consistent use of the STEP tool.
- Plan how to consistently use and practice applying the STEP tool on the unit.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: STEP
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
STEP: How do you acquire a trained eye as you “monitor the situation” on your unit? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment. The STEP process involves ongoing monitoring of the:
- Status of the patient,
- Team members,
- Environment, and
- Progress toward the goal.
In a healthcare setting, the most obvious element of the situation requiring constant monitoring is your patient’s status. Even minor changes in the patient’s vital signs may require dramatic changes in the team’s actions and the urgency of its response. You should also be aware of team members’ status, including fatigue and stress level, workload, and skill level. You should be aware of the environment, including triage acuity, and equipment. And finally, you should assess your progress towards goals by asking the following key questions: What is the status of the team’s patient(s)? Has the team established goals? Has the team accomplished their task/actions? Is the plan still appropriate?
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How does the STEP tool improve patient safety?
- Describe how and why the STEP tool was effective in this story.
- How can the TeamSTEPPS STEP tool help us maintain situation awareness at all times and in all circumstances?
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Friday, October 3rd, 2014
208
Student’s Guide – Check Back for a Good Outcome
Overview:
This story is about how using check backs to ensure communication exchanges between the sender and the receiver can impact the accuracy of patient safety-critical information.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Summarize the elements of the TeamSTEPPS Check Back communication tool.
- Describe how check backs close the communication loop and create more accuracy when exchanging critical information with other team members.
- Adopt check backs as a tool to effectively exchange critical information with other team members, patients, and their families.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Check-Backs
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.
Check-Backs: A check-back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order, which must be checked.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What are check-backs and how can they improve team communication, patient safety, and patient care?
- How did the lack of check-backs impact patient safety and care in this story?
- What do team members need to be able to do in order to effectively close the communication loop when exchanging critical information with other team members?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, October 3rd, 2014
207
Student’s Guide – Let’s STEP Back
Overview:
This story is about how training for situation awareness can prevent many serious medical errors and sentinel events. A team’s ability to maintain situation awareness depends on having good tools to use, and practicing the use of those tools.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize the elements of the TeamSTEPPS STEP situation awareness tool.
- Describe how situation awareness can be maintained by consistent use of the STEP tool.
- Plan how to consistently use and practice applying the STEP tool on the unit.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: STEP
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
STEP: How do you acquire a trained eye as you “monitor the situation” on your unit? The STEP process is a mnemonic tool that can help you monitor the situation and the overall environment. The STEP process involves ongoing monitoring of the:
- Status of the patient,
- Team members,
- Environment, and
- Progress toward the goal.
In a healthcare setting, the most obvious element of the situation requiring constant monitoring is your patient’s status. Even minor changes in the patient’s vital signs may require dramatic changes in the team’s actions and the urgency of its response. You should also be aware of team members’ status, including fatigue and stress level, workload, and skill level. You should be aware of the environment, including triage acuity, and equipment. And finally, you should assess your progress towards goals by asking the following key questions: What is the status of the team’s patient(s)? Has the team established goals? Has the team accomplished their task/actions? Is the plan still appropriate?
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How does the STEP tool improve patient safety?
- Why is it important that this team is practicing the STEP tool?
- How can the TeamSTEPPS STEP tool help us maintain situation awareness at all times and in all circumstances?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, October 3rd, 2014
206
Student’s Guide – That One Little Thing
Overview:
Each contact with a patient in a healthcare facility creates an opportunity to satisfy or dissatisfy that patient as a consumer. If careful attention is not paid, small incidents can color the overall perception of care.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the process patients go through when they sit down to fill out a survey of patient satisfaction.
- Generate a list of things a unit could do that, if implemented, would increase the unit’s ability to create satisfied patients.
- Adopt a plan to work toward eliminating dis-satisfiers of patient safety and increase the use of practices that lead to increase patient satisfaction.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What does this story illustrate about the importance of providing a consistent level of patient-centered care throughout the hospital?
- Describe the examples of excellent patient-centered care and poor patient-centered care in this story?
- How can you use information from patient surveys to improve care?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, October 3rd, 2014
205
Student’s Guide – The Sound Resounds
Overview:
This story is about a very important part of the patient experience – a clean, orderly, and quiet environment. Staff members can become desensitized to noises over time that disturb and annoy patients.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain the negative effect that unnecessary noise has on patients and their satisfaction with their hospital experience.
- Be able to define noise and list possible sources of noise affecting patients.
- Create a plan for conducting regular noise audits and awareness-raising sessions for fellow staff members.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- What does this story illustrate about the importance of viewing all hospital decisions through patients’ eyes?
- What can we do to ensure that noise is controlled and has a minimal impact on the well-being and satisfaction of patients?
- What can you do to eliminate unnecessary sources of noise?
Posted in Pro ED Guides, Student Guides | No Comments »
Friday, October 3rd, 2014
204
Student’s Guide – Fearing No Pain
Overview:
This story is about how communication about pain medications can be just as important as the selection, dosage, timing and administration of the medication itself. Patients need to understand pain management as well as any pain medications they may be taking.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Explain the role effective pain management has in overall patient satisfaction.
- Compare effective and ineffective approaches to communicating with patients about their pain and its management.
- Adopt a pain management strategy that includes and emphasizes complete and compassionate communication with patients.
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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How did Nancy’s explanation of pain management help to put Marsha and Terry at ease?
- How were Nancy’s actions an example of patient-centered care?
- What do we need to do to demonstrate to patients that we care about their experience of pain and that we are doing everything possible to minimize it?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
203
Student’s Guide – I Have Nothing More Important Than You!
Overview:
This story is about how contact with nurses will often be the primary difference in patients being satisfied with their care or not. Consistently caring, empathetic responses are absolutely necessary for a highly satisfying patient experience.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe ways you can engage patients to make an emotional connection.
- Adopt strategies that focus on the emotional needs of patients and families, not just clinical or administrative requirements.
- Demonstrate empathic, caring response to patients during episodes of indecision, anxiety, and concerns about the direction of their 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.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- How were Teresa’s actions an example of patient-centered care?
- How did Teresa attempt to see Toni’s concerns through her eyes, and how did that make a difference for Toni?
- How can we make an emotional connection with our patients on a regular basis?
Posted in Pro ED Guides, Student Guides | No Comments »
