Author Archive
Friday, October 10th, 2014
189
Instructor’s Guide – Your Patients and Family See What You Can’t See
Overview:
This story is about the importance of team debriefs. Teams often fail to learn as much as they can from critical incidents by not taking adequate time to report, discuss and examine errors in patient care. Teams are destined to repeat the same mistakes if they fail to debrief.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Examine team practices to promote cross-monitoring of high risk procedures including medication administration.
- Generate policies and practices to limit distractions and multitasking during critical care practices.
- Design a process for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns.
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: Cross Monitoring
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.
Cross Monitoring: Cross Monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
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 does this story illustrate the importance of cross monitoring?
A: Cross-monitoring is one way to check the accuracy of another nurse. This should be done every time a “high alter” medication is given. It includes not only checking the doctor’s order, but also ensuring it is the correct dosage.
A: In this situation it was important to check the medication and the appropriate dose. Without further cross monitoring, the patient would have received the wrong dosage.
- If Beverly had dismissed Cynthia’s concerns as she was about to do, what might have happened?
A: The patient would have received the wrong dose of a very lethal drug.
- How can we include the patients and families as members of the clinical care team and ensure that they have the opportunity to ask questions and express concerns before important procedures or medication administrations?
A: The patient and family members should feel encouraged to be a part of the team. They often have knowledge and experience the healthcare member may benefit from knowing.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That no one double checked the dosage or strength of the medication. It is not enough to only check the doctor’s order, but the dosage as well.
A: The patient would have received an extremely high and potentially lethal dose of the medication.
- How can we make sure our cross-monitoring of important procedures or medication administrations are not compromised by multitasking or staff changes?
A: Each of us must keep the patient the priority of our care. It is easy to get distracted by conversations or other patient activities, but medication administration should not be compromised.
A: This is a great example to keep in mind when patients or family members want to know more about medication or procedures their loved ones are receiving. They often have very valuable information, but it should not compromise patient care.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Design a cross monitoring checklist for this team to use for high-risk medication administration, like chemotherapy.
- Develop a protocol for involving families and patients in high-risk medication administrations, like chemotherapy.
- Imagine that Cynthia was not there to intervene for Inez. What might have happened? Write the incident report, with what you believe might be the consequences to Inez, the nurses, and the hospital.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Examine team practices to promote cross-monitoring of high risk procedures including medication administration. |
Student struggles to examine team practices to promote cross-monitoring of high risk procedures including medication administration. |
Student can examine team practices to promote cross-monitoring of high risk procedures including medication administration, but needs further practice. |
Student can accurately examine team practices to promote cross-monitoring of high risk procedures including medication administration. |
| Generate policies and practices to limit distractions and multitasking during critical care practices. |
Student struggles to generate policies and practices to limit distractions and multitasking during critical care practices. |
Student can generate policies and practices to limit distractions and multitasking during critical care practices, but needs further practice. |
Student can accurately generate policies and practices to limit distractions and multitasking during critical care practices. |
| Design a process for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns. |
Student struggles to design a process for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns. |
Student can design a process for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns, but needs further practice. |
Student can accurately design a process for including patients and family members before each important procedure or medication administration, informing them of processes and risks, and listening to any concerns. |
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
- Call Out
- Check Backs
- Collaboration
- Cross Monitoring
- Feedback
- STEP
- “Speak Up”
- CUS
- Debriefs
- Handoffs
- Huddles
- Two-Challenge Rule
- AskMe3
Posted in Pro ED Guides, Teacher Guides | No Comments »
Friday, October 10th, 2014
188
Instructor’s Guide – Advocate for a Smooth Delivery
Overview:
This story is about an expectant mother and the timing of a scheduled C-section delivery. The physician’s schedule, not the gestation age of the fetus, becomes the primary scheduling concern. Reducing or eliminating early elective deliveries has been shown to be safer for newborns.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain and apply the TeamSTEPPS strategy of advocacy for the patient and express concerns assertively when there is a scheduled early elective delivery with no apparent medical necessity.
- Develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication.
- Explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Advocacy and Assertion
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Advocacy and Assertion: Advocacy and assertion interventions are invoked when a team member’s viewpoint does not coincide with that of a decision maker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to employ advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person’s view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- Describe Dr. Burdy’s deviation from Evidence-Based Practices in this story. Do you believe her deviation was warranted? Why or why not?
A: Care based on evidence based practice ensures patient safety. There are often several reasons why evidence based practice should be used. It is based on facts and research and not a healthcare professionals opinion or convenience.
A: In this situation the family did not want a different OBGYN, however because their doctor was going on vacation they agreed with her decision to deliver the baby early.
- What could Beverly have done or said to better advocate for the patients and their newborn? How could the TeamSTEPPS tool of Advocacy and Assertion have helped her?
A: Beverly could have suggested they ask about options aside from having their baby delivered early. Many times patients don’t feel comfortable standing up to a doctor or disagreeing with their decision.
- How is this story a non-example of patient-centered care?
A: This example does not reflect patient-centered care because the baby was delivered according to the doctor’s schedule and not the schedule that should have been used. There was not a medical reason to deliver the baby early, except that it was convenient for the doctor.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That potential harm occurred because evidence based practice was not followed. The family did not seem to have an advocate or someone they could speak to about the decision to deliver their baby early.
- What one thing can you do to ensure that elective deliveries less than 39 weeks are reduced?
A: One way is to provide the obgyn’s with research and evidence that supports elective deliveries over 39 weeks gestational age.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a brochure for expecting parents on the risks inherent with elective deliveries at 39 weeks or less.
- Recall the portion of the story when Beverly recognizes Dr. Burdy’s comment about delivering the baby at 37 weeks carries significant risks. Rewrite this portion of the story with Beverly using assertive statements to advocate for the patients.
- Pretend you are investigating this incident on the hospital’s behalf after the fact. Write a report that details what went wrong, who was at fault, how the situation should have been handled, and the consequences (as well as potential consequences) of the actions.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Explain and apply the TeamSTEPPS strategy of advocacy for the patient and express concerns assertively when there is a scheduled early elective delivery with no apparent medical necessity. |
Student struggles to explain and apply the TeamSTEPPS strategy of advocacy for the patient and express concerns assertively when there is a scheduled early elective delivery with no apparent medical necessity. |
Student can explain and apply the TeamSTEPPS strategy of advocacy for the patient and express concerns assertively when there is a scheduled early elective delivery with no apparent medical necessity, but needs further practice. |
Student can accurately explain and apply the TeamSTEPPS strategy of advocacy for the patient and express concerns assertively when there is a scheduled early elective delivery with no apparent medical necessity. |
| Develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication. |
Student struggles to develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication. |
Student can develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication, but needs further practice. |
Student can accurately develop an assertive statement to be used by team members to voice concerns over scheduled elective deliveries less than 39 weeks without medical indication. |
| Explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family. |
Student struggles to explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family. |
Student can explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family, but needs further practice. |
Student can accurately explain the increased risks to the newborn with deliveries less than 39 weeks without medical indication to the patient and their family. |
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
- Cross Monitoring
- Feedback
- CUS
- Debriefs
- Handoffs
- Huddles
- Two-Challenge Rule
- AskMe3
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
187
Instructor’s Guide – Those Who Don’t Debrief are Destined…
Overview:
This story is about the importance of team debriefs. Teams often fail to learn as much as they can from critical incidents by not taking adequate time to report, discuss, and examine errors in patient care. Teams are destined to repeat the same mistakes if they fail to debrief.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction.
- Describe the importance of integrating family members as an important source of patient information and medical history, especially if the patient is incapacitated or impaired.
- Adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization.
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: Debriefs
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.
Debriefs – To conduct a debrief:
- Facilitate the discussion as a leader by asking questions related to team performance. What did we do well?
- Recap the situation, background, and key events that occurred.
- As a team, assess how the following played a role in the performance of the team:
- Team Leadership
- Situation Awareness
- Mutual Support
- Communication
- Then summarize lessons learned and set goals for improvement.
- This checklist can be used by the team during a debriefing to ensure that all information is discussed.
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 does this story illustrate the importance of debriefing?
A: Debriefs are used to share information and improve the effectiveness of teamwork. In this case, a debrief could have focused on the understanding of ACLS protocol and Code standards. It could have also been used as a time to answer questions related to the care provided in a code and to improve a potential code in the future.
- What can be done to consistently engage the family as a potential source of key patient information?
A: In this situation the patient was not able to provide a medical history. Therefore, the family may be able to provide lifesaving information and aid in the treatment of the patient.
- Why is it important to speak up and advocate for patient safety, regardless of hierarchy, in emergent situations?
A: The patient needs to be the priority and not the concern of hierarchy. This is when cross monitoring or feedback would be an effective way to advocate for the patient. The rank of the doctor or the nurse should not be as much of a concern as the need to provide the best care for the patient possible.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The resource the family can be during an emergency situation is vital to patient care. Also, it is apparent that debriefs need to be a regular part of team building and learning new lessons. It is not appropriate to continue to practice in the same manner
- How can you help make debriefs a consistent team practice for learning and improvement?
A: One way is to establish a debrief session after every code. This is one way to address current issues or potential needs. It may take a few tries before it becomes routine, but as the team continues this practice it will become routine.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Write or act out the dialogue for the debrief that should have happened after Mr. Pearson’s close call.
- Create a checklist for collecting information from family members in emergent situations.
- Design a protocol for conducting debriefs after a critical incident, including ground rules for how team members should deliver and respond to criticism.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement and self-correction. |
Student struggles to explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction. |
Student can explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction, but needs further practice. |
Student can accurately explain how and why to integrate team debriefs into regular practice to promote team learning, error management, continuous improvement, and self-correction. |
| Describe the importance of integrating family members as an important source of patient information and medical history, especially if the patient is incapacitated or impaired. |
Student struggles to describe the importance of integrating family members as an important source of patient information and medical history, especially if the patient is incapacitated or impaired. |
Student can describe the importance of integrating family members as an important source of patient information and medical history, especially if the patient is incapacitated or impaired, but needs further practice. |
Student can accurately describe the importance of integrating family members as an important source of patient information and medical history, especially if the patient is incapacitated or impaired. |
| Adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization. |
Student struggles to adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization. |
Student can adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization, but needs further practice. |
Student can accurately adopt strategies and systems for recording and sharing lessons learned from debriefs with others team members and across the organization. |
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:
- Call Out
- Check Backs
- Task Assistance
- Cross Monitoring
- Debriefs
- Feedback
- STEP
- 3Ws – Who I am, What I am Doing, and Why I Care
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
186
Instructor’s Guide – When Concerned, It’s Time to Huddle
Overview:
This story is about a patient who 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. If only the caregivers had taken the time to huddle.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Identify the types of situations where huddles could be used to advantage in coordinating patient care.
- Explain how and when huddles should be conducted.
- 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:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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 requiring the need 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
- Where in this story could the care team have used huddling to better coordinate care?
A: By using a huddle, Caroline could have told Dr. Feldman that Harry was intending on leaving and the lab results were not back. She could have updated the team on his desire to leave and the seriousness of the situation. She could have told Harry the seriousness of his situation and the potential adverse effects if he were to leave the office
- What barriers to using the concept of huddling occurred in this story, and how could they be overcome?
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.
- How do huddles promote more patient-centered, safe care from all staff?
A: It allows every team member to be aware of the current situation. It also allows builds team work and collaboration between team members. 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.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The patient 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.
- How can your team use huddling to better coordinate patient care?
A: A team huddle is a way of getting all team members on the same page and aware of a particular situation. 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.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Develop a list of situations where huddles could be used to help coordinate patient care. Share your list with a partner or the class for discussion.
- Write or act out a dialogue for a scenario in which a huddle would be appropriate.
- Create a poster or graphic that reminds colleagues of the importance of huddles and their benefits for patient safety and care.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Identify the types of situations where huddles could be used to advantage in coordinating patient care. |
Student struggles to identify the types of situations where huddles could be used to advantage in coordinating patient care. |
Student can identify the types of situations where huddles could be used to advantage in coordinating patient care, but needs further practice. |
Student can accurately identify the types of situations where huddles could be used to advantage 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. |
| Adopt huddles as a normal problem-solving event for improved patient care. |
Student struggles to adopt huddles as a normal problem-solving event for improved patient care. |
Student can adopt huddles as a normal problem-solving event for improved patient care, but needs further practice. |
Student can accurately 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:
- Huddles
- Advocacy and Assertion
- 3Ws – Who I am, What I am Doing, and Why I Care
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
185
Instructor’s Guide – When in Doubt, Use the 2-Challenge Rule
Overview:
This story is about when safety protocols in any area are not being followed and patient safety is at risk. It is the responsibility of all team members to speak up and challenge the direction the patient’s care is taking to ‘stop the line’ if their concerns can’t be quickly resolved.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- State the Two-Challenge Rule from TeamSTEPPS.
- Demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk.
- Adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned.
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 Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Two Challenge Rule
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Two Challenge Rule: It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- How does this story illustrate the importance of using the Two Challenge rule to ‘stop the line’ for patient safety?
A: The two challenge rule was necessary in this situation and kept the patient from harm. Safe practices include counting the sponges and equipment once the surgery is complete. This post operative step is necessary before suturing the patient and sending them to the recovery room.
- When is it appropriate to deviate from evidence-based practice, as Dr. Charles requested in this story?
A: There should never be a time when Evidence-Based Practices should be ignored or altered.
- Why is it important to speak up and advocate for patient safety, regardless of hierarchy?
A: Juanita was appropriate when she spoke to the surgeon regarding the missing sponge. She provided the necessary information to the surgeon and ensured that Patient Safety was the top priority.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The importance of advocating for the patient, even when it is uncomfortable. Also, doing an accurate count of all instruments and sponges is a requirement. The surgeon did not believe he was wrong; however patient safety should be the priority for all health care providers.
- Why is there conflict when challenging other team members related to patient safety?
A: Information conflict can be difficult to discuss, but by using the CUS technique it is possible. In this situation the surgeon did not believe he had made a mistake, however the nurse was correct in pointing out the error to the surgeon.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Think of a scenario in which you might need to use the Two-Challenge Rule. Describe your scenario and how you might apply the rule.
- Rewrite the end of this story assuming that Juanita did not insist on x-raying the patient. What might the consequences have been for the team, Dr. Charles, the patient, and the hospital?
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| State the Two-Challenge Rule from TeamSTEPPS. |
Student struggles to state the Two-Challenge Rule from TeamSTEPPS. |
Student can state the Two-Challenge Rule from TeamSTEPPS, but needs further practice. |
Student can accurately state the Two-Challenge Rule from TeamSTEPPS. |
| Demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk. |
Student struggles to demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk. |
Student can demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk, but needs further practice. |
Student can accurately demonstrate using the Two-Challenge rule to ‘stop the line’ when patient safety is at risk. |
| Adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned. |
Student struggles to adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned. |
Student can adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned, but needs further practice. |
Student can accurately adopt the Two-Challenge Rule to successfully manage information conflict between team members when patient care is questioned. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:
- Two-Challenge Rules
- Advocacy and Assertion
- CUS
- 3Ws – Who I am, What I am Doing and Why I Care
- PEARLA
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
184
Instructor’s Guide – Step Up to Safety
Overview:
This story illustrates how adherence to protocols, closed loop communication, documentation, and building time for improved decision making are important strategies to safely manage spikes in workload.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the potential effects workload ‘spikes’ have on patient safety.
- Describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory.
- Generate and adopt strategies to eliminate workarounds especially during high workload periods.
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.
- Evidence-Based Practice (EBP): Integrate best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: 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?
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- What safety protocols did Mary ignore? What barriers did she feel kept her from following those protocols?
A: Mary was not initially putting her patients in danger, but her lack of shared decision-making and closed-loop communication had a negative impact on patient safety. She did not want to wait for pharmacy to clear the medication and put it in the pyxis.
- How could the use of the STEP process improved the chaos in the emergency department in this story?
A: High workload periods make it difficult to think clearly and accurately. Health care professionals must be diligent to provide quality safe patient care no matter how busy their assignment may be. The fatigue and stress level were very high on the unit during this scenario.
- Why is it more difficult to follow established safety protocols during high workload periods?
A: Harm occurred to a patient because the nurse was trying to provide care for her patient, but did not use appropriate communication, ‘check-backs’, or closed loop communication. She could have avoided this scenario if she would have waited for the appropriate checks to be made instead of rushing forward with her work.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: The use of ‘check-backs’ allow for discussion and reflection to be made with each patient. Although it may be subtle, the use of ‘check-backs’ is another check and allows for more thorough patient care. Rushing to get things done does not always end in a good result for the patient.
- What one thing can you do to ensure patient safety during high workload periods?
A: It is often hard to slow down during high workload periods, but it necessary for patient safety. It is important the correct checks and communication are done, no matter what situation is present for the nurse. This may be even more critical during high workload periods due to the increased stress and chaos of the situation.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation for staff that teaches them about the STEP process and how it can be applied to improve patient safety and care.
- Work with a partner to develop a list of errors that are caused by workload spikes, and brainstorm ways to reduce those errors using best practices for closed loop communication, managing interrupts, and limiting over-reliance on memory. Compare your ideas with the class for discussion.
- Make a checklist that helps staff eliminate workarounds during high workload periods.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the potential effects workload ‘spikes’ have on patient safety. |
Student struggles to describe the potential effects workload ‘spikes’ have on patient safety. |
Student can describe the potential effects workload ‘spikes’ have on patient safety, but needs further practice. |
Student can accurately describe the potential effects workload ‘spikes’ have on patient safety. |
| Describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory. |
Student struggles to describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory. |
Student can describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory, but needs further practice. |
Student can accurately describe practices to reduce the potential for errors during workload ‘spikes’ including closed loop communication, managing interruptions, and limiting an over-reliance on memory. |
| Generate and adopt strategies to eliminate workarounds especially during high workload periods. |
Student struggles to generate and adopt strategies to eliminate workarounds especially during high workload periods. |
Student can generate and adopt strategies to eliminate workarounds especially during high workload periods, but needs further practice. |
Student can accurately generate and adopt strategies to eliminate workarounds especially during high workload periods. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:
- Huddles
- Check-Backs
- Debriefs
- Cross Monitoring
- SBAR
- Call Out
- Handoff
- Task Assistance
- Speak Up
- 3Ws – Who I am, What I am Doing, and Why I Care
- STEP
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
183
Instructor’s Guide – I’M SAFE When I Reach Out
Overview:
This story focuses on care for the caregiver, sometimes referred to as resilience. The stress of caring for patients can lead to chronic fatigue, burnout, and unprofessional behaviors. All team members have a responsibility to recognize and respond when team members become overwhelmed.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Summarize the elements of the resilience self-assessment tool, I’M SAFE.
- Describe the importance of evaluating team members’ fitness for duty by identifying cues of stress, fatigue, and burnout.
- Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with severe stress.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
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.
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 the “I’M SAFE” protocol have helped in this story?
A: It’s important that nurses can recognize when they have limitations. The safety of the patient needs to be the first priority.
- What does this story illustrate about the importance of recognizing and managing stress, fatigue, and burnout among a team?
A: Stress, fatigue, and burnout can happen to anyone, but if nurses are not aware of it they can easily become overwhelmed. This in turn can negatively affect patient care.
- What do you feel June did well in this story? What could she do better?
A: She noticed there was an issue with Francis and addressed her privately about how she was doing. She may need to address some of the negative comments made by the other staff in the future to prevent potential bullying and hazing.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That stress, fatigue, and burnout can happen to anyone. Every nurse to subject to burnout and they need to be aware of the signs so that patient safety remains the primary focus and not the stress of the nurse.
- What is one thing you could do to improve your ability to recognize and manage stress among team members?
A: Review the “I’M SAFE” steps and ensure team members are also aware of those steps. Another way to recognize stress is to continue to keep an open dialogue with staff members. Allow the staff to express their feelings and to state when they are overwhelmed with their assignment.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation to introduce others to the “I’M SAFE” tool.
- Develop a checklist for recognizing burnout, fatigue, and stress in colleagues.
- Brainstorm some ways that leaders can encourage open sharing among team members to avoid situations where severe stress becomes a liability to patient care and safety.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Summarize the elements of the resilience self-assessment tool, I’M SAFE. |
Student struggles to summarize the elements of the resilience self-assessment tool, I’M SAFE. |
Student can summarize the elements of the resilience self-assessment tool, I’M SAFE, but needs further practice. |
Student can accurately summarize the elements of the resilience self-assessment tool, I’M SAFE. |
| Describe the importance of evaluating team members’ fitness for duty by identifying cues of stress, fatigue, and burnout. |
Student struggles to describe the importance of evaluating team members’ fitness for duty by identifying cues of stress, fatigue, and burnout. |
Student can describe the importance of evaluating team members’ fitness for duty by identifying cues of stress, fatigue, and burnout, but needs further practice. |
Student can accurately describe the importance of evaluating team members’ fitness for duty by identifying cues of stress, fatigue, and burnout. |
| Adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with severe stress. |
Student struggles to adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with severe stress. |
Student can adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with severe stress, but needs further practice. |
Student can accurately adopt strategies and methods for open sharing among team members and leaders for early identification of individuals with severe stress. |
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:
- I’M SAFE
- CUS
- Huddles
- Cross Monitoring
- Feedback
- Collaboration
- Task Assistance
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
182
Instructor’s Guide – Trust Your Instincts: Cross Monitor!
Overview:
This story addresses the issue of cross monitoring as it relates to error prevention. A work environment that encourages staff to openly share concerns related to the safety of the patients is necessary for optimal patient care and experience.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Describe the importance of applying reporting principles without fear of retribution or punishment.
- Explain the necessity of integrating reporting daily as a feedback mechanism and safety improvement system.
- Describe the importance of creating a just culture to improve front line reporting.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Cross Monitoring
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.
Cross Monitoring: Cross Monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- What should Allison have done when she discovered Sarah’s injuries?
A: Allison needed to report these findings right away, as she was not sure where the bruises originated. This is a very serious situation and needs to be reported immediately.
- What issues regarding the staff’s attitude towards reporting need to be addressed in this nursing home?
A: Allison was concerned about reporting the bruises because it would require a large amount of paperwork. She also didn’t think it was a serious issue.
A: Sarah’s daughter could have let the staff know as soon as she dropped Sarah off for the day what had happened. The issues related with the bruises could have been avoided if Sarah’s daughter would have said something first.
- How could better cross-monitoring have helped improve patient safety and CNA willingness to report in this nursing home?
A: It would be good if the staff were aware of cross monitoring and that it is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team. It works to ensure that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety are the result.
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: A thorough assessment of each patient is necessary and important. This could have potentially been a very serious situation
- What one thing can you do to improve voluntary reporting of patient safety or service events?
A: The supervisor may know something the CNA does not know. Also, the supervisor is trained regarding skin care assessments and potential abuse reporting.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Think about what Allison should have done when she discovered Sarah’s injuries. Rewrite the dialogue between her and Colleen with Allison reporting Sarah’s injuries appropriately.
- Design a presentation for the staff at this nursing home on the importance of proactive front line reporting, including its benefits and the consequences of not reporting incidents and injuries.
- Create a checklist for the CNAs in this nursing home that reminds them to integrate reporting daily as a feedback mechanism and safety improvement system.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Describe the importance of applying reporting principles without fear of retribution or punishment. |
Student struggles to describe the importance of applying reporting principles without fear of retribution or punishment. |
Student can describe the importance of applying reporting principles without fear of retribution or punishment, but needs further practice. |
Student can accurately describe the importance of applying reporting principles without fear of retribution or punishment. |
| Explain the necessity of integrating reporting daily as a feedback mechanism and safety improvement system. |
Student struggles to explain the necessity of integrating reporting daily as a feedback mechanism and safety improvement system. |
Student can explain the necessity of integrating reporting daily as a feedback mechanism and safety improvement system, but needs further practice. |
Student can accurately explain the necessity of integrating reporting daily as a feedback mechanism and safety improvement system. |
| Describe the importance of creating a just culture to improve front line reporting. |
Student struggles to describe the importance of creating a just culture to improve front line reporting. |
Student can describe the importance of creating a just culture to improve front line reporting, but needs further practice. |
Student can accurately describe the importance of creating a just culture to improve front line reporting. |
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:
- Cross Monitoring
- Huddles
- STEP
- Advocacy and Assertion
- Handoffs
- Debriefs
- Patient Rounding
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
181
Instructor’s Guide – Advocate for Patient Safety
Overview:
This story addresses the importance of effective and consistent forms of team communication. Staff should feel empowered to speak up, assert, and advocate on behalf of the patient and the team regardless of perceived organizational hierarchies.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy.
- Analyze the conditions for calling team huddles in emergent situations to improve problem solving.
- Explain and 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.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Advocacy and Assertion
Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.
Advocacy and Assertion: Advocacy and Assertion interventions are invoked when a team member’s viewpoint does not coincide with that of a decision maker. In advocating for the patient and asserting a corrective action, the team member has an opportunity to correct errors or the loss of situation awareness. Failure to employ advocacy and assertion has been frequently identified as a primary contributor to the clinical errors found in malpractice cases and sentinel events. You should advocate for the patient even when your viewpoint is unpopular, is in opposition to another person’s view, or questions authority. When advocating, assert your viewpoint in a firm and respectful manner. You should also be persistent and persuasive, providing evidence or data for your concerns.
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- How could Beth have been more assertive in her advocacy for Tracy?
A: The nurse knew the fetal heart monitor indicated there was a potential problem, but she did not make that clear enough to the OBGYN.
- Describe the importance of advocacy using examples from this story and from your own experiences.
A: She only hinted suggestions to the doctor. She did not state her concern or that she was uncomfortable with the situation. This is fairly common with nurses are new to a unit or unfamiliar with the situation.
- What does this story illustrate about the importance of including the family and patient in decision-making for emergent situations?
A: She continued to monitor the baby and mother. She also began to prepare the family for potential issues. She told them the doctor would most likely be coming in with more information for them.
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: Being proactive and noting a concern is an important part of patient care. The nurse Beth could have used ‘CUS’ earlier in the scenario when she noted the potential problem with the fetal heart tones.
- What one thing can you do to improve your communication with team members during emergent situations while including patients and families?
A: Be direct and state the actual concern with the doctor. Do not assume the doctor or other health care professions see the same thing you do or understand what your concerns are if you don’t say them.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Create a presentation for team members on assertive statements and advocacy, and the importance of expressing safety concerns, regardless of hierarchy. Be sure to address the importance of doctors considering the concerns of nurses and techs.
- How might a team huddle have averted this scenario? Describe what points you would have included in a team huddle, and how they might have helped improve Tracy and Eddie’s patient experience.
- Work with a partner to brainstorm communication methods and strategies for improving decision making during emergent situations that include the patient and family. Share your ideas with the class, and work together create a top ten list of your best ideas.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy. |
Student struggles to apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy. |
Student can apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy, but needs further practice. |
Student can accurately apply assertive statements or signal phrases to express safety concerns among team members regardless of hierarchy. |
| Analyze the conditions for calling team huddles in emergent situations to improve problem solving. |
Student struggles to analyze the conditions for calling team huddles in emergent situations to improve problem solving. |
Student can analyze the conditions for calling team huddles in emergent situations to improve problem solving, but needs further practice. |
Student can accurately analyze the conditions for calling team huddles in emergent situations to improve problem solving. |
| Explain and adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family. |
Student struggles to explain and adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family. |
Student can explain and adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family, but needs further practice. |
Student can accurately explain and adopt new communication methods and strategies for improving team decision making during emergent situations that include the patient and family. |
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
- CUS
- Two-Challenge Rule
- Huddles
- Briefs
- Debriefs
- Feedback
- Advocacy and Assertion
- Collaboration
- Call-Out
- Cross Monitoring
- “Speak-Up”
Posted in Pro ED Guides, Teacher Guides | No Comments »
Thursday, October 9th, 2014
180
Instructor’s Guide – Cross Monitor for Patient Safety
Overview:
This story is about how cross monitoring helps maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it allows team member to self-correct their actions and provides a safety net or error-prevention mechanism for the team.
Primary Learning Outcomes
After completing this lesson, the student will be able to:
- Compare written orders in the context of the entire patient care plan to ensure accuracy.
- Explain and adopt strategies to limit distractions, interruptions, and multitasking during critical care activities.
- Describe the importance of applying cross monitoring skills across the team regardless of position, status, or hierarchy to create trust and prevent errors.
QSEN Pre-Licensure Competencies
The following QSEN competencies are addressed in this lesson:
- Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.
- Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
QSEN Teamwork & Collaboration Enrichment
TeamSTEPPS® Best Practice: Cross-Monitoring
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.
Cross Monitoring: Cross Monitoring is used by fellow team members to help maintain situation awareness and prevent errors. Commonly referred to as “watching each other’s back,” it is the action of monitoring the behavior of other team members by providing feedback and keeping track of fellow team members’ behaviors to ensure that procedures are being followed appropriately. It allows team members to self-correct their actions, if necessary. Cross monitoring is not a way to “spy” on other team members, rather it is a way to provide a safety net or error-prevention mechanism for the team, ensuring that mistakes or oversights are caught early. When all members of the team trust the intentions of their fellow team members, a strong sense of team orientation and a high degree of psychological safety result.
Reflection Questions:
Students will answer reflection questions upon completing the story. These questions are aligned with the QSEN competencies and are designed to help the student reflect on both the content of the story and the QSEN competencies addressed by the story.
*Following each question are some potential answers
- Why is it important to compare written orders in the context of the entire patient care plan?
A: Because nurses are responsible for the care given to each patient, even if the doctor or another health care professional has not done the right thing in a previous situation.
- How can we limit distractions, interruptions, and multi-tasking during critical care activities?
A: Be sure to use proper handoff when giving report to another health care professional.
A: Stay focused on the task at hand and try not to get distracted and behind in patient care, charting, or daily tasks.
- What does this story illustrate about the importance of cross-monitoring?
A: Cross-monitoring is important because new orders may be entered the nurse needs to be sure they are appropriate for the patient.
A: Don’t hesitate to ask for clarification on an order if you are unsure. This may be to another nurse, the charge nurse, or a doctor.
Discussion Questions:
Use discussion questions for face to face or online discussion boards to get students to further reflect on the content of the story together.
*Following each question are some potential answers
- What can we learn from this story?
A: That change of shift report can be a chaotic time, even if there isn’t a code at the same time.
A: It’s important to have a good handoff even when other things are occurring in the hospital.
- What one thing can you do to improve mutual trust among your team so you always ‘have each other’s back’ regardless of individual personalities?
A: It was important that Diane did not leave until the current situation was handled. She stayed until the handoff was complete.
A: It was appropriate for Carol to call Diane at home. Diane may have known some information about the change in medication dosage and avoided a call to the doctor.
A: Diane made it clear that she was willing to call the doctor, even if he was going to become upset. The patient needs to be the first priority.
Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.
- Imagine what might have happened if Diane did not facilitate the three way call to Dr. Jackson. Rewrite the ending of the story as if Diane had not stepped in.
- Brainstorm ways to limit distractions, interruptions, and multitasking during critical care activities. Share with a partner and discuss and refine your lists.
- Create a presentation on the importance of cross-monitoring, including suggestions for building trust across the team.
Measuring Student Mastery:
| Learning Outcome |
Level 1 |
Level 2 |
Level 3 |
| Compare written orders in the context of the entire patient care plan to ensure accuracy. |
Student struggles to compare written orders in the context of the entire patient care plan to ensure accuracy. |
Student can compare written orders in the context of the entire patient care plan to ensure accuracy, but needs further practice. |
Student can accurately compare written orders in the context of the entire patient care plan to ensure accuracy. |
| Explain and adopt strategies to limit distractions, interruptions, and multitasking during critical care activities. |
Student struggles to explain and adopt strategies to limit distractions, interruptions, and multitasking during critical care activities. |
Student can explain and adopt strategies to limit distractions, interruptions, and multitasking during critical care activities, but needs further practice. |
Student can accurately explain and adopt strategies to limit distractions, interruptions, and multitasking during critical care activities. |
| Describe the importance of applying cross monitoring skills across the team regardless of position, status, or hierarchy to create trust and prevent errors. |
Student struggles to describe the importance of applying cross monitoring skills across the team regardless of position, status, or hierarchy to create trust and prevent errors. |
Student can describe the importance of applying cross monitoring skills across the team regardless of position, status, or hierarchy to create trust and prevent errors, but needs further practice. |
Student can accurately describe the importance of applying cross monitoring skills across the team regardless of position, status, or hierarchy to create trust and prevent errors. |
Story-Specific Best Practices and Proven Tools:
In addition to the ideas generated by students and mentioned in the activities, there are established best practices that may be appropriate to introduce or reference during this lesson to support communication. Some best practices to consider for improving team communication include:
- Huddles
- STEP
- Cross-Monitoring
- Advocacy and Assertion
- SBAR
- Handoffs
Posted in Pro ED Guides, Teacher Guides | No Comments »
