Archive for the ‘Best Practices’ Category


Wednesday, November 30th, 2011

PEARLA is a technique used for connecting strongly with someone in order to establish their trust when delivering suggestions for correcting unprofessional or disruptive conduct. The letters stand for:

  • P (Presence) – Look and see if you are fully present for the discussion or if you are distracted by other concerns or are overly emotional about the situation.
  • E (Empathy) – Use empathetic listening skills to actively express your understanding.
  • A (Acknowledge) – Acknowledge the importance to them and to everyone concerned of finding a solution to the problem.
  • R (Reflect/Reframe) – The goal is to reflect back what may be important to the person who is making the statement and provide an alternative way to view the situation that captures what matters most to that person.
  • L (Listen Openly) – Listening openly requires that you listen to the facts, listen to the emotions, notice the body language, and listen for the meaning behind the words.
  • A (Ask Clarifying Questions) – Ask open-ended questions to more fully understand the situation from the others point of view.

Four-Step Response

Wednesday, November 30th, 2011

The Four-Step Response process is a way of structuring a response to a situation that involves unprofessional conduct or disruptive behavior. It focuses on the skills of correcting the conduct through either engagement or enforcement processes. The intent is to deal with lapses in professional conduct using as informal an approach as possible, but escalating to more formal and enforcement driven approaches as necessary to correct the situation. The steps of the process are:

  1. Assess – Assess the risks involved in confronting or not confronting the situation, the skills required, and the outcomes desired.
  2. Adopt a Stance – Decide whether an engagement approach which is more collaborative in nature, or an enforcement approach which is more confrontative, is the right one for the situation.
  3. Connect and Correct – Using the principle of “Understand First, Explain Later”, and by using good rapport building and active listening skills, establish a strong and empathetic connection with the person involved. Talk about the problem and suggest alternate ways of handling the situation, and gain their commitment to altered behavior.
  4. Evaluate – Check to see if the intervention created the desired outcome, and if there are follow-up steps necessary.


Wednesday, November 30th, 2011

I PASS the BATON is a powerful tool that can be used for hand-off of care anytime the complete responsibility for the patient’s care passes from one entity to another, i.e., department to department or facility to facility. I PASS the BATON is a long acronym and usually the caregivers who adopt this tool build a checklist that uses the acronym as its foundation. The letters stand for:

  • I (Introduction) – Introduce yourself and your role/job
  • P (Patient) – Name, identifiers, age, sex, location
  • A (Assessment) – Present vital signs, chief complaint, symptoms and diagnosis
  • S (Situation) – Current status/circumstances
  • S (Safety Concerns) – Critical lab values/reports, allergies, alerts
  • B (Background) – Co-morbidities, previous episodes, current medications, family history
  • A (Actions) – What actions were taken or are required
  • T (Timing) – Level of urgency and timing/prioritization of actions
  • O (Ownership) – Who is responsible for care going forward, including patient and family
  • N (Next) – What will happen next? What is the plan?

Bedside Handoffs

Wednesday, November 30th, 2011

Change of shift report occurring at the patient’s bedside with these essential components:

  1. A standardized nursing report handoff tool.
  2. Bedside shift-to-shift report.
  3. Inclusion of the patient and family in the discussion of plans and goals of care including introductions.
  4. Two-person medical record check.

Patient Rounding

Wednesday, November 30th, 2011

Regular nursing rounds conducted hourly during the day and evening and every 2 hours during the overnight shift enable nurses to address proactively patient needs that would otherwise prompt use of the call light.

Speak Up

Wednesday, November 30th, 2011

A process encouraged by the Joint Commission to ensure that patients and family members have a voice in all care planning and are empowered to challenge their healthcare team related to their care plan including all orders, medications and test.


Wednesday, November 30th, 2011

a form of closed loop communication where a patient reads-back critical instructions or information to ensure the patient or responsible patient advocate fully understand their plan of care.


Wednesday, November 30th, 2011

Created by the National Patient Safety Foundation, AskMe3 should be used every time a patient talks with a doctor, nurse, or pharmacist by asking 3 questions to better understand your health.

  1. What is my main problem?
  2. What do I need to do?
  3. Why is it important for me to do this?


Wednesday, November 30th, 2011

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.

Task Assistance

Wednesday, November 30th, 2011

One method of providing mutual support is through task assistance. Task assistance is guided by situation monitoring because situation awareness allows team members to effectively identify the need for assistance by others on the team. To a certain degree, some of us have been conditioned to avoid asking for help because of the fear of suggesting lack of knowledge or confidence. Many people refuse to seek assistance when overwhelmed by tasks. In support of patient safety, however, task assistance is expected. What can happen when we are overwhelmed and we do not seek task assistance?