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126 – Almost Routine Instructor’s Guide

Friday, September 19th, 2014

126

Instructor’s Guide – Almost Routine


Overview:
Central Line-Associated Blood Stream Infections (CLABSIs) cause up to 60,000 preventable deaths in the U.S. each year. This story highlights how deviation from evidence-based protocols and checklists can place the patient at risk for CLABSI, and how the CUS technique can help improve team member collaboration and patient safety.

 


Primary Learning Outcomes

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

  • Describe safe, evidence-based practices related to central line insertions
  • Develop a checklist that includes proper protocols for a central line insertion scenario
  • Understand and adopt critical language to ‘stop the line’ when deviation from protocols occurs, regardless of professional hierarchies using the CUS technique.

 

 

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: 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 health care 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.
    1. CUS Technique:
    2. First, state your Concern.
    3. Then state why you are Uncomfortable.
    4. 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.

  • What safety protocols that can help prevent the risk of CLABSI were violated in this scenario?
  • QSEN requires you to discriminate between valid and invalid reasons for modifying evidence-based clinical practice based on clinical expertise or patient/family preferences. Do you think Dr. Long’s deviations from EBP in this scenario were valid or invalid? Explain your reasoning.
  • Thinking about the TeamSTEPPS best practice “CUS” described earlier, when and how could Carly have employed this technique to better advocate for her patient’s safety?

 

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.

  • What can we learn from this story?
  • What other issues regarding patient care and advocacy need to be addressed in this scenario?
  • How could this scenario have been prevented?

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. Use one or more to help expand and measure your students’ understanding of the primary learning outcomes for this lesson.

  • Develop a graphic or poster checklist that details the safe practices related to central line insertions
  • Identify what you believe to be the three most critical errors committed by the staff in the story, and describe how they should have been handled
  • How could Carly have used the TeamSTEPPS “CUS” tool to better advocate for Mrs. Sturgis? Write out the dialogue and/or act it out for the class.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe safe, evidence-based practices related to central line insertions Student had difficulty describing EBPs related to central line insertion and requires some remediation in the topic. Student described some EBPs, but lacked detail or omitted some EBPs related to central line insertion. Student described evidence-based practices related to central line insertion in detail in writing and/or orally.
Develop a checklist that includes proper protocols for a central line insertion scenario Student’s checklist did not include proper protocols and requires additional instruction. Student’s checklist omitted some proper protocols or lacked detail. Student’s checklist included all proper protocols.
Understand and adopt critical language to ‘stop the line’ when deviation from protocols occurs, regardless of professional hierarchies using the CUS technique. Student struggled with applying the CUS technique to the scenario and requires remediation on the topic of critical language. Student demonstrated some understanding of critical language and the CUS technique, but lacked detail or omitted some critical details. Student demonstrated understanding of critical language and the CUS technique in writing and/or through re-enactment.

 


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:

  • CUS
  • 3Ws- Who I am, What I am Doing, and Why I Care
  • Advocacy and Assertion
  • More

 

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124 – No One Thing Killed Elias Smith Instructor’s Guide

Friday, September 19th, 2014

124

Instructor’s Guide – No One Thing Killed Elias Smith


Overview:
This story is about how healthcare organizations are often ill-equipped to respond to the crisis following unexpected death or harm to a patient due to medical errors, and how an organization can establish an effective crisis management team to transparently respond to the family.

 


Primary Learning Outcomes

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

  • Describe and apply family-centered principles to respectfully disclose medical errors.
  • Describe a crisis management response to medical errors that considers the caregivers.
  • Explain how to convey medical error information to families in lay terms using transparency and empathy.

 

 

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.

 

Reflection Questions:

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

  1. Describe the actions of the CEO that you felt demonstrated his application of family-centered principles to respectfully disclose the medical errors in Elias’s case.
    A: He listened to the family and showed empathy to them. He also stated he would investigate the situation and gather all of the information before contacting the family. He did not try to cover up or hide any information.
  2. What safety errors occurred in this story? How did the hospital system fail Elias?
    A: Each nurse noticed a slight change in the patient condition, but did not aggressively pursue the issues. For example, the nurse that called the one of the doctors did not follow through with the call.
  3. Why is empathy important in responding to the family? How was empathy used effectively in this story?
    A: By using empathy the CEO of the hospital was able to communicate clearly with the family. By using empathy and therapeutic communication the family felt welcome to continue their dialogue with the CEO, doctors and medical staff.

 

Discussion Questions:

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

  1. What can we learn from this story?
    A: That empathy and therapeutic communication allow for open dialogue and continued communication.
  2. What could I do to improve my crisis management response to show empathy for families, demonstrate transparency, and consider care for the caregiver?
    A: Try not to become defensive when family members are discussing their pain or disappointment. Allow them to state their frustrations and acknowledge their pain and frustration.

 

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • List each of the safety errors that occurred in this story, and describe how each could have been prevented.
  • What do you think Robert’s next steps should be to address the issues related to Elias’ death? Design a plan for his staff to ensure the mistakes made in this case are addressed in the future.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe and apply family-centered principles to respectfully disclose medical errors.  Student struggles to describe and apply family-centered principles to respectfully disclose medical errors. Student can describe and apply family-centered principles to respectfully disclose medical errors, but needs further practice. Student can accurately describe and apply family-centered principles to respectfully disclose medical errors.
Describe a crisis management response to medical errors that considers the caregivers.  Student struggles to describe a crisis management response to medical errors that considers the caregivers. Student can describe a crisis management response to medical errors that considers the caregivers, but needs further practice. Student can accurately describe a crisis management response to medical errors that considers the caregivers.
Explain how to convey medical error information to families in lay terms using transparency and empathy. Student struggles to explain how to convey medical error information to families in lay terms using transparency and empathy. Student can explain how to convey medical error information to families in lay terms using transparency and empathy, but needs further practice. Student can accurately explain how to convey medical error information to families in lay terms using transparency and empathy.
 



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
  • CUS
  • Two-Challenge Rule
  • Huddles
  • STEP
  • Collaboration
  • SBAR
  • Handoff
  • I PASS the BATON

 

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123 – A Tale of Two Patients Instructor’s Guide

Friday, September 19th, 2014

123

Instructor’s Guide – A Tale of Two Patients


Overview:
This is a story about how excellence in healthcare delivery requires attending to the needs, wants, feelings, insecurities, and anxieties of each and every patient and their families in addition to treating their medical problem.

 


Primary Learning Outcomes

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

  • Explain and adopt the 3Ws when interacting with patients and families.
  • Describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families.
  • Explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical.

 

 

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: 3 Ws & Bedside 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 health care professionals.

     

  • 3 Ws- Who I Am, What I am Doing, and Why I Care was originated by the Florida Hospital System as a simple, yet effective way to reliably greet, engage, and activate patients and families

 

  • Bedside Handoffs: Change of shift report occurring at the patient’s bedside with these essential components:
    • A standardized nursing report handoff tool
    • Bedside shift-to-shift report
    • Inclusion of the patient and family in the discussion of plans and goals of care including introductions.
    • Two-person medical record check

 

Reflection Questions:

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

  1. How did the use of the 3Ws improve Sheila’s experience?
    A: She was informed regarding who was present and what to expect. She felt like she was a part of the health care team.
  2. What effect did the staff conversations, actions, and norms have on Betty’s perception of their competence and her overall impression of the hospital?
    A: Betty felt as if she was a nuisance or a problem for the staff. She did not feel involved in her own care. Her husband was also made to feel as if he was in the way.
  3. How did the use of bedside handoffs at Sheila’s hospital impact her experience?
    A: She felt that the staff were interested in her needs and concerns. She also believed they cared about her and her wishes.

Discussion Questions:

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

  1. What can we learn this story?
    A: That patients are always listening, even if we don’t think they are. They are very aware of the attitudes and actions made by the health care team members.
  2. What one or two things could you personally do to ensure patients feel included and not an object of care?
    A: One was is to use the 3W’s and to include the patient in their own care. Patient-centered care means that health care professionals need to keep the patient informed of what they are doing, why they are doing it and that they care.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Create a Venn Diagram to compare and contrast Betty and Sheila’s patient care experiences. Write a paragraph to summarize your findings.
  • Practice using the 3Ws in a variety of scenarios. Work with a partner to write five short patient care scenarios and explain how you would use the 3Ws to help put the patient at ease.
  • Make a poster that could remind you co-workers to focus on patient-centered care. Include some of the techniques from this story that you found useful or effective.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Explain and adopt the 3Ws when interacting with patients and families. Student struggles to explain and adopt the 3Ws when interacting with patients and families. Student can explain some use of the 3Ws when interacting with patients and families, but needs more practice. Student can accurately explain and adopt the 3Ws when interacting with patients and families.
Describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families. Student struggles to describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families. Student can describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families, but needs more practice. Student can accurately describe the importance of monitoring and modifying staff conversations, actions and norms regarding non-patient centered ‘chit chat’ in the presence of patients and families.
Explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical. Student struggles to explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical. Student can explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical, but needs more practice. Student can explain how to integrate patient and family members in conversations during care transitions (handoffs) whenever practical. 

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:

  • 3Ws- Who I Am, What I am Doing, and Why I Care
  • Bedside Handoffs

 

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

122 – The Rule of Six Instructor’s Guide

Friday, September 19th, 2014

122

Instructor’s Guide – The Rule of Six


Overview:
This story is about a patient being discharged following a readmission for pneumonia. A Care Transitions nurse uses patient coaching skills and motivational interviewing techniques with the patient to focus on important aspects of caring for himself at home to prevent readmission.

 

 

Primary Learning Outcomes

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

  • Explain the need for effectiveness of patient coaching in helping patients at risk of readmission.
  • Distinguish the difference in aftercare patient coaching from traditional patient education.
  • Describe patient coaching techniques suitable for use during patient discharge sessions.

 

 

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

  1. What can we learn from this story about the limits of teaching and the value of coaching?
    A: More information is often not what is required, but how to actually use the information we alreay know.
    A: Coaching helps patients use the information they have to find solutions to challenges they face with their healthcare.
    A: Active listening allows to establish a plan of care that is patient centered, meaningful and more likely to result in improved patient outcomes.
  2. Describe the ways that Peggy worked with Mr. Falcone to overcome obstacles that might put him at higher risk for readmission?
    A: Identifying financial issues related to the costs of care.
    A: Reviewing family and social support resources not fully appreciated.
    A: Emphasizing the reality of the clinical issues Mr. Falcone is facing.
  3. What coaching techniques did you learn from this story that you might be able to use in your role?
    A: The following are important coaching techniques demonstrated in this story: 1. Listen, listen, listen. 2. Establish repotoire. 3. Allow the patient to identify solutions

 

Discussion Questions:

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

  1. What else can we learn from this story?
    A: Labeling and judging are ineffective in developing a patient centered approach to care.
    A: Often times patients have solutions to their problems that have not been appreciated or identified.
    A: Coaching is oftern more effect at meeting our patient’s needs than additional education.
  2. How could you ensure that you coach patients before they leave your direct care?
    A: Incorporate coaching into the care planning for patients.
    A: Identify opportunities to enhance the staff’s awareness of the value of coaching.
    A: Include specific coaching metrics as part of the transition or discharge process.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Read the article “Health Coaching for Patients”
  • Create a presentation to help your co-workers understand the difference between patient education and coaching, and how to apply coaching on the job.
  • Try out Peggy’s “Rule of Six” strategy. Develop a scenario in which a patient would need coaching, and think of six ways that your patient could overcome his or her obstacles to meet your aftercare goal.
  • Create a two-column chart that compares and contrasts key words and phrases associated with aftercare coaching and traditional patient education.

 

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Explain the need for effectiveness of patient coaching in helping patients at risk of readmission. Student struggles to explain the need for effectiveness of patient coaching in helping patients at risk of readmission. Student can explain some of the need for effectiveness of patient coaching in helping patients at risk of readmission, but needs practice. Student can explain the need for effectiveness of patient coaching in helping patients at risk of readmission.
Distinguish the difference in aftercare patient coaching from traditional patient education. Student struggles to distinguish the difference in aftercare patient coaching from traditional patient education. Student can distinguish some of the differences in aftercare patient coaching from traditional patient education, but needs more practice. Student can accurately distinguish the difference in aftercare patient coaching from traditional patient education.
Describe patient coaching techniques suitable for use during patient discharge sessions. Student struggles to describe patient coaching techniques suitable for use during patient discharge sessions. Student can describe some patient coaching techniques suitable for use during patient discharge sessions, but needs more practice. Student can accurately describe patient coaching techniques suitable for use during patient discharge sessions.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


Story-Specific Best Practices and Proven Tools:

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

  • Check-Backs
  • Collaboration
  • Handoff

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

121 – It’s Dangerous to Judge Instructor’s Guide

Friday, September 19th, 2014

121

Instructor’s Guide – It’s Dangerous to Judge


Overview:
This story is about how persistent negative labeling can become ingrained in a culture, making it an acceptable norm. The end result can be poor quality or inappropriate, even unsafe care, misdiagnosis, and significant patient dissatisfaction, for which the patient may be blamed.

 


Primary Learning Outcomes

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

  • Explain why labeling behavior puts patient safety at risk
  • Describe the importance of demonstrating equal regard for all patients regardless of socioeconomic, racial, or other factors.

 

 

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

  1. What are the risks to patient safety when we label and judge people?
    A: As demonstrated in the story, labeling and judging leads put the healthcare provider at risk for providing poor and inadequate care.
    A: Labeling and judging can lead to inadequate clinical assessment.
    A: Labeling and judging positions healthcare providers to fail to actively listen which is required to understand a patient’s preferences values and needs.
  2. How does this story illustrate examples of patient-centered care?
    A: Sam demonstrated the ability to look beyond the label.
    A: Sam demonstrated the ability, in a difficult professional environment, to focus on a patient centered approach to care.
    A: Sam demonstrated compassion and respect for his patient.

 

Discussion Questions:

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

  1. What can we learn from this story?
    A: The healthcare delivery system is flawed and as such we often see an overutilization of the Emergency Department for non-urgent issues.
    A: A patient centered approach to care is what is most appropriate and results in an enhanced patient experience.
    A: Active listening and thorough assessment skills support a patient centered care plan.
  2. What could you do to help create an environment that is respectful for all of our patients regardless of personal biases?
    A: Senior and seasoned staff and medical professional should model interprofessional respect for physicians in training, which in turn leads to an environment conducive to patient respect.
    A: Actively listen not only to clinical symptoms, but patient’s preferences, values, and needs.
    A: Pause for self-assessment in order to better understand our personal biases and how they may contribute to being judgmental.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Create a presentation about how labeling behavior puts patient safety at risk. Include examples from this story, from personal experience, or the experience of friends or family.
  • Create a checklist that will help the staff of this ER better assess their patients and remember not to let engage in labeling behavior, regardless of socioeconomic, racial, or other factors.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Explain why labeling behavior puts patient safety at risk Student struggles to explain why labeling behavior puts patient safety at risk. Student can explain some reasons why labeling behavior puts patient safety at risk, but needs more practice. Student can accurately explain why labeling behavior puts patient safety at risk.
Describe the importance of demonstrating equal regard for all patients regardless of socioeconomic, racial, or other factors.  Student struggles to describe the importance of demonstrating equal regard for all patients regardless of socioeconomic, racial or other factors. Student can describe some of the importance of demonstrating equal regard for all patients regardless of socioeconomic, racial or other factors, but needs more practice. Student can accurately describe the importance of demonstrating equal regard for all patients regardless of socioeconomic, racial or other factors.

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
  • DESC Script
  • Cross Monitoring
  • Feedback
  • Check-backs
  • “Speak Up”
  • Advocacy and Assertion
  • 3Ws- Who I Am, What I Am Doing, and Why I Care

 

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

120 – Doctor, I’m Concerned… Instructor’s Guide

Thursday, September 18th, 2014

120

Instructor’s Guide – Doctor, I’m Concerned…


Overview:
This story is about what happens when a patient is allowed to leave a cardiac clinic without critical test results being examined and resolved because the protocols for allowing a patient to leave were either non-existent or not followed by the staff.

 


Primary Learning Outcomes

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

  • Demonstrate and apply critical language to advocate for patient safety.
  • Demonstrate the ability to explain the “why” to patients related to safe practices and protocols.
  • Describe the use of a team huddle for problem-solving related to all patient safety concerns.

 

 

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: Team 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 health care professionals.

  • A team huddle is an ad hoc meeting to discuss issues, realign resources, and modify the plan.

 

Reflection Questions:

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

  1. What critical language could Caroline have used with Dr. Feldman? With Harry?
    A: Caroline could have told Dr. Feldman that Harry was intending on leaving and the lab results were not back. She could have told Harry the seriousness of his situation and the potential adverse effects if he were to leave the office.
  2. Describe how Caroline could have better explained the “why” to Harry in this story.
    A: Caroline needed to remember that as an educator she is responsible to inform Harry of the seriousness of his situation. He may be feeling fine, but his heart was at increased risk of a heart attack.
  3. How could a team huddle have prevented the problem in this story?
    A: A team huddle would have informed the cardiologist and nurses of the current situation. Although this may have turned out differently, every situation should be treated in a serious manner. A team huddle would have allowed the team to hear Caroline’s concerns and provide her with support or feedback.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The patient has the right to leave or sign out against medical advice (AMA), however the nurse is responsible to provide the patient with accurate information. The patient can then make a sound decision based on knowing the information.
  2. What’s one thing you could do to advocate, assert, and ‘explain the why’ to ensure your patients are safe?
    A: It is important to provide each patient with accurate and precise information. The nurse should not provide information to scare the patient, but to provide them with the information in order to make an educated decision.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Write a script that demonstrates how Caroline could have used critical language to ‘explain the why’ to Harry, about why he should stay to wait for his results. Act out the script or share with the class for discussion.
  • Write a dialogue between Caroline and Dr. Feldman demonstrating how she could have used critical language to advocate for Harry, successfully countering Dr. Feldman’s objections.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Demonstrate and apply critical language to advocate for patient safety. Student struggles to demonstrate and apply critical language to advocate for patient safety. Student can demonstrate and apply some aspects of critical language to advocate for patient safety, but needs more practice. Student can demonstrate and apply critical language to advocate for patient safety.
Demonstrate the ability to explain the “why” to patients related to safe practices and protocols.  Student struggles to demonstrate the ability to explain the ‘why’ to patients related to safe practices and protocols. Student can demonstrate some ability to explain the ‘why’ to patients related to safe practices and protocols, but needs more practice. Student can accurately demonstrate the ability to explain the ‘why’ to patients related to safe practices and protocols.
Describe the use of a team huddle for problem-solving related to all patient safety concerns.  Student struggles to describe the use of a team huddle for problem-solving related to all patient safety concerns. Student can describe some of the use of a team huddle for problem-solving related to all patient safety concerns, but needs more practice. Student can accurately describe the use of a team huddle for problem-solving related to all patient safety concerns.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 


Story-Specific Best Practices and Proven Tools:

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

  • CUS
  • Two-Challenge Rule
  • STEP
  • Feedback
  • Advocacy and Assertion
  • 3Ws- Who I Am, What I am Doing, and Why I Care

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

119 – Organizational Antibodies Instructor’s Guide

Thursday, September 18th, 2014

119

Instructor’s Guide – Organizational Antibodies


Overview:
This story is about how one IT director learned through trial and error to gain the support of medical staff through carefully orchestrated EMR implementation planning, a must for any change initiative to succeed.

 


Primary Learning Outcomes

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

  • Describe the importance of creating understanding and buy-in related to change
  • Analyze and explain the risks and benefits of the change at the frontline.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Quality Improvement (QI): Use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

Reflection Questions:

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

  1. Why is the use of EMR and other technologies important for quality patient care?
    A: Clinical decision support tools and enhanced communications between disciplines will enhance patient care and ultimately improve patient outcomes.
    A: Improved efficiencies included with fully implemented effective EMRs are associated with reducing in unnecessary redundancies.
    A: Standardized reporting allows for enhanced query capabilities and tracking of quality metrics.
  2. Describe the actions in the story that helped create buy-in amongst the ED doctors. Why do you think they were so effective?
    A: Actively listen.
    A: Provide a reminder that the previous system was at the end of life functionally, the change was not embarked upon just for the sake of change, but to improve patient care.
    A: Empowerment of the end users, in this case, physicians, demonstrate that stakeholder engagement will lead to more effective implementations.
  3. What things could you do to promote understanding and buy-in related to change initiatives?
    A: Plan ahead, and plan well.
    A: Engage all the stakeholders and develop a communication and deployment strategy that involves representatives from the various groups.
    A: Listen for learning opportunities as the new system experience issues and delays.

Discussion Questions:

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

  1. What can we learn from this story?
    A: The importance of planning for large-scale change or implementation of new technologies.
    A: The importance of effective communication with all aspects of healthcare to include interprofessional relationships.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Describe why it is important that people on all levels of the organization are involved in the implementation of important changes.
  • Dissect Jim’s directions to Connie. Make a To Do/Not To Do guide for implementing a change like the one in the story.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe the importance of creating understanding and buy-in related to change Student struggles to describe the importance of creating understanding and buy-in related to change. Student can describe some aspects of the importance of creating understanding and buy-in related to change, but needs more practice with the topic. Student can accurately describe the importance of creating understanding and buy-in related to change.
Analyze and explain the risks and benefits of the change at the frontline. Student struggles to analyze and explain the risks and benefits of the change at the frontline. Student can analyze and explain some aspects of the risks and benefits of the change at the frontline, but needs more practice. Student can accurately analyze and explain the risks and benefits of the change at the frontline.

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

 

 

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118 – The Perfect Storm Instructor’s Guide

Thursday, September 18th, 2014

118

Instructor’s Guide – The Perfect Storm


Overview:
This story is about how handoffs are the single most error-prone event in the patient continuum of care. Ineffective communication, coupled with distractions and an incomplete patient assessment, can often lead to a sentinel event.

 


Primary Learning Outcomes

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

  • Describe and demonstrate a structured patient handoff, including a verbal check back from the team member receiving the patient.
  • Describe the importance of designing a team structure that ensures the team leader is not pulled away from coordinating care across the unit.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

 


QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: 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 health care professionals.

    • 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 communicate, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked.

 

Reflection Questions:

Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.

  • What do you feel was Juan’s biggest error in the story? What should he have done instead?
  • How could the use of check-backs helped to avoid the problem in this story?
  • How could Chelsea ensure that this problem never occurs in her unit again?

Discussion Questions:

Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.

  • What can we learn from this story?
  • What is one thing you can do to ensure you provide a thorough report and safe handoff for every patient?

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Write a script for the patient handoff that should have occurred with Mrs. Schulte. Be sure to include check-backs in your dialogue. If time permits, have students perform their scripts with a partner.
  • Think about Chelsea’s role in the unit. Design a team structure that ensures that she is not pulled away from coordinating care in the unit, and delineates each team member’s responsibilities in assessing and managing patient care.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe safe practices during all surgical procedures related to post-operative counts ensuring that no retained foreign objects remain. Student struggles to describe safe practices during surgical procedures related to post-operative counts ensuring that no RFOs remain. Student can describe some safe practices during surgical procedures related to post-operative counts ensuring that no RFOs remain, but needs more practice. Student can accurately describe safe practices during surgical procedures related to post-operative counts ensuring that no RFOs remain.
Recall and describe methods and strategies to ‘stop the line’ when surgical counts are questioned for accuracy. Student struggles to recall and describe methods and strategies to ‘stop the line’ when surgical counts are questioned for accuracy. Student can recall and describe some methods and strategies to ‘stop the line’ when surgical counts are questioned for accuracy, but needs more practice. Student can accurately recall and describe methods and strategies to ‘stop the line’ when surgical counts are questioned for accuracy.
Describe and adopt team-based behaviors to successfully manage information conflict between team members. Student struggles to describe team-based behaviors to successfully manage information conflict between team members. Student can describe and demonstrates some adoption of team-based behaviors to successfully manage information conflict between team members, but needs more practice. Student accurately describes and adopts team-based behaviors to successfully manage information conflict between team 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:

  • Huddles
  • STEP
  • Check-backs
  • Cross Monitoring
  • SBAR
  • Call-Out
  • Handoff
  • Task Assistance
  • I PASS the BATON
  • “Speak Up”
  • 3Ws – Who I Am, What I am Doing, and Why I Care

 

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117 – Empowered to Challenge Instructor’s Guide

Thursday, September 18th, 2014

117

Instructor’s Guide – Empowered to Challenge


Overview:
This story is about how retained foreign objects (RFOs) during surgery can result in significant harm due to infection and other complications, and speaking up is crucial when the instrument count is inaccurate. Protocols must be followed during surgical counts to ensure an RFO is not left behind that could be deadly to a patient.

 


Primary Learning Outcomes

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

  • Describe safe practices during all surgical procedures related to post-operative counts ensuring that no retained foreign objects remain.
  • Recall and describe methods and strategies to ‘stop the line’ when surgical counts are questioned for accuracy.
  • Describe and adopt team-based behaviors to successfully manage information conflict between team members.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

 

QSEN Evidence-Based Practice 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.

 

  • 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:

    1. First, state your Concern.
    2. Then state why you are Uncomfortable.
    3. 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.

  • Describe safe practices during all surgical procedures related to post-operative counts ensuring that no retained foreign objects remain.
  • What does this story illustrate about the importance of using Evidence-Based Practices, like the rules for accounting for all surgical instruments, at all times? Under what circumstances do you feel they can be ignored or altered?
  • Describe how Juanita’s use of the CUS technique prevented a larger issue for Mrs. Gatlin. Why was this 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.

  • What can we learn from this story?
  • How can you manage information conflict more effectively when working with your team?
  • What is one thing you could do to ‘stop the line’ for patient safety?

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Read the article “The Prevention of Retained Foreign Bodies After Surgery”. Create a short presentation or poster describing the most important reminders or steps a team should take to prevent RFOs in surgery.
  • Imagine Juanita had not advocated for the patient and stood up to Dr. Charles. Research what might have happened to Mrs. Gatlin if the sponge had been left after the surgery. Present your findings.
  • Think of another scenario in which “stopping the line” or stopping a procedure or action is necessary for patient safety. Describe your scenario, and how you could use the CUS technique to ensure patient safety. Present your scenario to the class for discussion.

 



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Describe and demonstrate a structured patient handoff, including a verbal check back from the team member receiving the patient. Student struggles to describe and demonstrate a structured patient handoff, including a verbal check back from the team member receiving the patient. Student can describe and demonstrate some aspects of a structured patient handoff, including a verbal check back from the team member receiving the patient. Student can accurately describe and demonstrate a structured patient handoff, including a verbal check back from the team member receiving the patient.
Describe the importance of designing a team structure that ensures the team leader is not pulled away from coordinating care across the unit. Student struggles to describe the importance of designing a team structure that ensures the team leader is not pulled away from coordinating care across the unit. Student can describe some aspects of the importance of designing a team structure that ensures the team leader is not pulled away from coordinating care across the unit, but needs more practice. Student can accurately describe the importance of designing a team structure that ensures the team leader is not pulled away from coordinating care across the unit.

Additional Story-Specific Resources:

For additional information on improving team communication, please consult the following articles and resources in Further Reading:

 

 


Story-Specific Best Practices and Proven Tools:

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

  • CUS
  • Two-Challenge Rule
  • Huddles
  • STEP
  • Debriefs
  • Cross-monitoring
  • Feedback
  • Advocacy and assertion
  • DESC Script
  • Collaboration
  • Call-Out
  • 3 Ws – Who I Am, What I Am Doing, and Why I Care
  • PEARLA

 

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116 – Why Not Instructor’s Guide

Thursday, September 18th, 2014

116

Instructor’s Guide – Why Not


Overview:
This story is about how patient choice can improve the patient experience by better meeting patients’ emotional needs. To do this, healthcare professionals must see exceptional care from the patient’s perspective and act as a navigator of the system of care.

 


Primary Learning Outcomes

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

  • Generate strategies and methods to meet the emotional needs of the patient.
  • Examine patient and family policies and practices to ensure they provide choice and are patient-centered.
  • Describe and adopt strategies to act as a system navigator for patients, not a system enforcer.

 


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
  1. How were Charlie’s emotional needs met in this story?
    A: A patient centered approach required active listening.
    A: A patient centered approach requires considering the patient’s requests are unique and may require changes to the workflow.
    A: Patient’s emotional needs were considered and addressed by the Anethesiologist and surgical nurse.
  2. Who in this story acted as a system navigator for Charlie? Who acted as a system enforcer?
    A: The surgical nurse was the system navigator
    A: The Anesthesiologist was the enforcer, encouraging the doubting CRNA to support this patient’s request.
  3. What do you believe are the characteristics of someone who acts as a system navigator for patients?
    A: A system navigator is the healthcare professional that has institutional knowledge and functions with a patient centered focus to advocate for the patient in order to enhance their experience 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

  1. What can we learn from this story?
    A: People, including healthcare providers, are change averse.
    A: Having a patient centered approach to care requires acceptance of other view points and consideration of cultural, spiritual and emotional needs.
    A: A patient centered approach is enhanced by communication and teamwork.
  2. What is one thing you could do to meet both the clinical and emotional needs of your patients?
    A: Actively listen to each patient’s needs. Being fully present and allowing patients to communicate what is important to them, is therapeutic in and of itself.

 

Suggested Classroom Mastery Activities:

These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Read the article “What Patient-Centered Should Mean: Confessions of an Extremist”
    How do Berman’s views on patient-centered care correspond with your own? Describe three “A-HA” moments or points of interest that you took from the article.
  • Make a list of strategies and methods that you believe could help meet the emotional needs of patients in a variety of situations you might encounter. Work with a partner or small group to create a presentation of your Top Ten Ways to Deliver Patient-Centered Care.



Measuring Student Mastery: 

Learning Outcome Level 1 Level 2 Level 3
Generate strategies and methods to meet the emotional needs of the patient.  Student struggles to generate strategies and methods to meet the emotional needs of the patient. Student can generate some strategies and methods to meet the emotional needs of the patient, but needs more practice. Student can generate strategies and methods to meet the emotional needs of the patient.
Examine patient and family policies and practices to ensure they provide choice and are patient-centered. Student struggles to examine patient and family policies and practices to ensure they provide choice and are patient-centered. Student can examine patient and family policies and practices to ensure they provide choice and are patient-centered, but needs more practice in classification. Student can examine patient and family policies and practices to ensure they provide choice and are patient-centered.
Describe and adopt strategies to act as a system navigator for patients, not a system enforcer. Student struggles to describe and adopt strategies to act as a system navigator for patients, not a system enforcer. Student can describe and adopt some strategies to act as a system navigator for patients, not a system enforcer, but needs more practice in application of the skill. Student can describe and adopt strategies to act as a system navigator for patients, not a system enforcer.

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
  • 3Ws – Who I Am, What Am I Doing, and Why I Care
  • Speak Up

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

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