Archive for the ‘Pro ED Guides’ Category
Thursday, October 2nd, 2014
202
Student’s Guide – How Could This Happen?
Overview:
This story is about ensuring a safe and satisfying experience for mother and baby during the rapidly changing environment of Labor and Delivery. To prevent harm, use structured and reliable communication protocols.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Apply strategies and methods to ensure safe and timely closed-loop hand-offs between care providers.
- Apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy.
- Adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family.
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.
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 poor communication jeopardize patient safety in this story?
- What could have been done in this story to ensure better communications when Jessica’s care was handed off to Dr. Travers?
- If you were Susan, the nurse with a concern about Dr. Traver’s directions, what could you have said or done to better advocate for Jessica?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
201
Student’s Guide – Conduct Unbecoming
Overview:
This story is about what happens when an incidence of unprofessional behavior happens. If team members aren’t equipped with the tools to diffuse conflict or the ability to deal with unprofessional conduct effectively and quickly, the consequences for staff and patients can be harmful in more ways than one.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Define the DESC tool from TeamSTEPPS and identify how it can be used to correct incidents and patterns of unprofessional conduct.
- Arrange the debrief process to set up DESC discussions between the participants when disruptive interpersonal conflict affects the functioning of the team.
- Adopt the TeamSTEPPS DESC tool as the primary problem-resolution strategy for handling interpersonal conflict.
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: DESC Script
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
DESC: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.
DESC is a mnemonic for—
D = Describe the specific situation
E = Express your concerns about the action
S = Suggest other alternatives
C = Consequences should be stated in terms of impact on established team goals; strive for consensus
There are some crucial things to consider when using the DESC script:
- Time the discussion.
- Work on win-win.
- Frame problems in terms of personal experience and lessons learned. Choose a private location.
- Use “I” statements rather than blaming statements.
- Focus on what is right, not who is right.
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:
- Describe how Dr. Gonzalez’s behavior is detrimental to patient safety and the team’s effectiveness.
- How could Grace use the DESC tool to address her concerns about Dr. Gonzalez?
- How can we use the DESC tool to increase our ability to confront incidents and patterns of unprofessional conduct?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
200
Student’s Guide – When Egos Clash, It’s the Patients Who Lose
Overview:
This story is about how unprofessional conduct is a major cause of compromises in patient safety and affects the morale of the entire clinical team. All parties, regardless of role, seniority, or skill level, need to treat each other with respect and dignity.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Define the DESC tool from TeamSTEPPS and identify how it can be used to correct incidents and patterns of unprofessional conduct.
- Arrange the debrief process to set up DESC discussions between the participants when disruptive interpersonal conflict affects the functioning of the team.
- Adopt the TeamSTEPPS DESC tool as the primary problem-resolution strategy for handling interpersonal conflict.
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: DESC Script
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
DESC: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.
DESC is a mnemonic for—
D = Describe the specific situation
E = Express your concerns about the action
S = Suggest other alternatives
C = Consequences should be stated in terms of impact on established team goals; strive for consensus
There are some crucial things to consider when using the DESC script:
- Time the discussion.
- Work on win-win.
- Frame problems in terms of personal experience and lessons learned. Choose a private location.
- Use “I” statements rather than blaming statements.
- Focus on what is right, not who is right.
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:
- Describe how Cindy’s behavior is detrimental to patient safety and the team’s effectiveness.
- How could Dr. Janney use the DESC tool to address his concerns about Cindy?
- How can we use the DESC tool to increase our ability to confront incidents and patterns of unprofessional conduct?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
199
Student’s Guide – Don’t Look Back in Anger
Overview:
This story is about how patients, justified or not, can present staff with difficult interpersonal challenges that are sometimes hostile. The story demonstrates that even in the most trying circumstances, the best choice is to listen with compassion and empathy.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Recognize the importance of patient perspective in hostile situations.
- Describe how empathy can be used to diffuse patient/family anger.
- Adopt a huddle as a communication tool to support team members and enable them to manage patient/family expectations in hostile situations.
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.
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 Carol’s reaction to Carlota’s accusations serve to escalate the situation in this story?
- Describe how Estelle used empathy to curb Carlota’s anger and deescalate the situation.
- If you had been in Carlota’s shoes, how might you have perceived the situation?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
198
Student’s Guide – Empathize to Deescalate
Overview:
This story is about the challenge of diffusing a patient’s upset or anger, and how important it is for every team member to maintain an even keel when dealing with conflict, find ways to empathize with patients no matter how combative, and to listen with compassion.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify your attitude to conflict.
- Use empathy in situations charged with conflict to convey that you hear and understand what patients are saying.
- Establish a common goal through collaboration.
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.
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:
- Describe how Mindy effectively deescalated the conflict in this story.
- How did Mindy empathize with Carla?
- If you were in Mindy’s shoes, how might you have handled the situation differently?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
197
Student’s Guide – Toxic Handoff
Overview:
This story is about how a poor patient handoff can result in crucial information about the patient’s condition not being communicated, resulting in incomplete or inappropriate care decisions that can seriously endanger the patient’s safety.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Summarize the benefits for patient safety of having a structured handoff process.
- Identify tools to support an effective handoff (e.g., checklist).
- Develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients.
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: Handoffs
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.
Handoffs: When a team member is temporarily or permanently relieved of duty, there is a risk that necessary information about the patient might not be communicated. The handoff strategy is designed to enhance information exchange at critical times such as transitions in care. More important, it maintains continuity of care despite changing caregivers and patients. Handoffs include the transfer of knowledge and information about the degree of uncertainty (or certainty about diagnoses, etc.), response to treatment, recent changes in condition and circumstances, and the plan (including contingencies). In addition, both authority and responsibility are transferred. Lack of clarity about who is responsible for care and for decision-making has often been a major contributor to medical error (as identified in root cause analyses of sentinel events and poor outcomes).
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:
- Which parts of the handoff process were most challenging for this team?
- How could a structured handoff process have improved patient safety in this story?
- How could the hospital improve its handoff process to better address patient safety?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
196
Student’s Guide – Close the Loop
Overview:
This story is about patient discharge as a crucial activity to ensure their safety. It’s not enough for caregivers to simply communicate instructions—we must ensure that the patient and their family fully understand every detail using the check-back process.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
- Describe how check backs close the communication loop when exchanging information with patients and their families.
- Adopt check backs as a tool to effectively exchange information with patients and their families.
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.
- 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-Back: A Check-Back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked back.
Story Directions:
As you listen to and read the story, think about the things that you think the team members did well, and the things you think could lead to errors. Also, consider the questions below as you listen.
Reflection Questions:
- Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
- Describe how check backs could have helped to close the communication loop with this family.
- What do team members need to be able to do in order to effectively close the communication loop when exchanging information with patients about their care?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
195
Student’s Guide – Question Everything!
Overview:
This story is about a patient who is prescribed an inappropriate and dangerous dose of a drug, and how no one from the nurse carrying out the order to the pharmacist filling the order challenged the dosage that could have resulted in patient harm.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Describe how situation monitoring supports team functioning.
- Identify tools that enable team members to assertively voice concerns over patient care.
- Apply the Two-Challenge rule in situations where there are conflicting perspectives on patient 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.
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.
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 could the two-challenge rule have helped improve patient safety in this story?
- What barriers were present in this story that prevented Alice from questioning Dr. Racinelli’s orders?
- What skills do team members in this story need to develop to enable them to effectively advocate for patients?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
194
Student’s Guide – When There’s a Conflict, DESC It!
Overview:
This story is about dealing with difficult interpersonal conflicts that can often become personal if not properly managed. Using the DESC tool, even difficult situations that have the potential to become inflamed can be appropriately managed in a manner that is respectful, yet still assertive.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify and describe early elective C-section delivery (EED) scheduling protocol.
- Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
- Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: DESC Script
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
DESC Script: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.
DESC is a mnemonic:
D = Describe the specific situation;
E = Express your concerns about the action;
S = Suggest other alternatives; and,
C = Consequences should be stated. Ultimately, consensus should be reached.
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 changes in practices and protocols were causing concern in this story? Why were they important for patient safety?
- What barriers did Dr. Dorsey perceive in following the new protocol?
- How can we use DESC to reduce conflict related to changes in practices and protocols?
Posted in Pro ED Guides, Student Guides | No Comments »
Thursday, October 2nd, 2014
193
Student’s Guide – Safety Depends on Feedback
Overview:
This story is about how patient safety is everyone’s responsibility, and how all staff members are accountable for giving fellow team members feedback when their practices diverge from accepted safety norms and practices that have been adopted by the unit or the hospital.
Primary Learning Outcomes
After completing this lesson, you will be able to:
- Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
- Identify how situation awareness can help you identify problems that undermine patient safety.
- Use Feedback as a tool to challenge team members and advocate for patients.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Feedback
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Feedback: Another type of mutual support is feedback. Feedback is information provided for the purpose of improving team performance. The ability to communicate self-improvement information in a useful way is an important skill in the team improvement process. Feedback can be given by any team member at any time. It is not limited to management roles or formal evaluation mechanisms. Rules of effective feedback include the following:
- Timely—Feedback is most effective when the behavior being discussed is still fresh in the mind of the receiver;
- Respectful—The feedback should not be personal, and it should not be about personality. It should be about behavior;
- Specific—The feedback should relate to a specific situation or task;
- Directed—Goals should be set for improvement;
- Considerate—Be considerate of team members’ feelings when delivering feedback, and remember to praise good performance.
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 was the feedback tool utilized in this story?
- Why is it so important to always abide by evidence-based practices regarding patient safety?
- How did you feel about Dr. Walter’s reaction to Bridget’s questions?
Posted in Pro ED Guides, Student Guides | No Comments »
