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197 – Toxic Handoff Instructor’s Guide

Friday, October 10th, 2014

197

Instructor’s Guide – Toxic Handoff


Overview:
This story is about how a poor patient handoff can result in crucial information about the patient’s condition not being communicated, resulting in incomplete or inappropriate care decisions that can seriously endanger the patient’s safety.

 


Primary Learning Outcomes

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

  • Summarize the benefits for patient safety of having a structured handoff process.
  • Identify tools to support an effective handoff (e.g., checklist).
  • Develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Handoffs

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

Handoffs: When a team member is temporarily or permanently relieved of duty, there is a risk that necessary information about the patient might not be communicated. The handoff strategy is designed to enhance information exchange at critical times such as transitions in care. More important, it maintains continuity of care despite changing caregivers and patients. Handoffs include the transfer of knowledge and information about the degree of uncertainty (or certainty about diagnoses, etc.), response to treatment, recent changes in condition and circumstances, and the plan (including contingencies). In addition, both authority and responsibility are transferred. Lack of clarity about who is responsible for care and for decision-making has often been a major contributor to medical error (as identified in root cause analyses of sentinel events and poor outcomes).

 

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. Which parts of the handoff process were most challenging for this team?
    A: It was most challenging for this team when the ER was busy and the work load continued to increase. Also – they did not have a good way to provide patient handoff care information from one healthcare professional to another. The doctor assisting with the discharge was not informed of the necessary discharge information.
  2. How could a structured handoff process have improved patient safety in this story?
    A: A structured handoff process would have helped in this situation, because the patient had tests ordered, but there was not follow-up to those tests. In this scenario it is unclear if any type of handoff was given between the healthcare professionals.
  3. How could the hospital improve its handoff process to better address patient safety?
    A: The use of SBAR could be used when transferring information from one healthcare team to another. The discharge doctor could have instructed the family to stay until all test results were received.

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 Team STEPPS handoff when patient care is transferred from one person to another. The healthcare team is responsible to provide quality care to the patient. This includes noting and following up with lab and test results prior to discharge.
  2. What can you do to reduce the potential for failed handoffs?
    A: One way is to implement bedside handoffs for every patient in the hospital. Another way to reduce the potential for failed handoffs is to identify a specific tool to be used when providing handoff, for example SBAR.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Develop a checklist that could help the team conduct a structured and effective handoff.
  • Create a presentation that teaches your colleagues about the importance of handoffs and their benefits for patient safety.
  • Research and describe what might have happened if Jody’s parents didn’t act so quickly in bringing him back to the emergency department. What might the consequences have been for him and for the hospital?

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Summarize the benefits for patient safety of having a structured handoff process Student struggles to summarize the benefits for patient safety of having a structured handoff process Student can summarize the benefits for patient safety of having a structured handoff process, but needs further practice. Student can accurately summarize the benefits for patient safety of having a structured handoff process
Identify tools to support an effective handoff (e.g., checklist) Student struggles to identify tools to support an effective handoff (e.g., checklist) Student can identify tools to support an effective handoff (e.g., checklist), but needs further practice. Student can accurately identify tools to support an effective handoff (e.g., checklist)
Develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients  Student struggles to develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients. Student can develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients, but needs further practice. Student can accurately develop a handoff process that ensures all relevant information is available to the team prior to discharge and that this information is shared with patients.

 

 

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
  • Handoff
  • Bedside Handoffs
  • Check-Backs
  • 3Ws – Who I am, What I am doing, and Why I care
  • AskMe3

 

 

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196 – Close the Loop Instructor’s Guide

Friday, October 10th, 2014

196

Instructor’s Guide – Close the Loop!


Overview:
This story is about patient discharge as a crucial activity to ensure their safety. It’s not enough for caregivers to simply communicate instructions—we must ensure that the patient and their family fully understand every detail using the check-back process.

 


Primary Learning Outcomes

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

  • Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
  • Describe how check backs close the communication loop when exchanging information with patients and their families.
  • Adopt check backs as a tool to effectively exchange information with patients and their families.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

  • Patient-Centered Care: Recognize the patient or designee as the source of control and full partner in providing compassionate and coordinated care based on respect for patient’s preferences, values, and needs.
  • Safety: Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.
  • Teamwork and Collaboration: Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care.

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Check-Backs

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

 

Check-Back: A Check-Back is a closed-loop communication strategy used to verify and validate information exchanged. The strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Typically, information is called out anticipating a response on any order which must be checked back.

 

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. Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
    A: This could have been done when the patient was still in the hospital, during discharge, or when the follow-up phone call was made to the patient’s home. In fact, it should have been done at all three of these times. This would have provided the patient and her son with multiple opportunities to ask for clarification.
  2. Describe how check backs could have helped to close the communication loop with this family.
    A: Good communication, thinking ahead, and asking questions are an important part of nursing work. There was not a time during this scenario that anyone asked the family questions regarding the need to make an upcoming appointment or for filling the medication prescription.
  3. What do team members need to be able to do in order to effectively close the communication loop when exchanging information with patients about their care?
    A: One way is to verbalize the things that are missing or that have not been previously discussed. The discharge nurse could have made a checklist to be completed by the family upon discharge. The nurse that made the follow-up phone call could have asked open ended questions about the care of the patient and direct questions related to the dialysis appointment and medication administration.

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: Good communication, thinking ahead, and making observations is an important part of nursing work.
  2. How can you ensure that you close the communication loop with patients and their families when you are talking with them about their care?
    A: One way is for a nurse to start the discharge information process much earlier than the actual discharge time. Let the patient know they can ask questions at any time and to repeat necessary information as needed. The nurse should provide information and then ask the patient to restate what was said in their own words. Once the discharge information has been given it is a good time to ask if they have any questions or concerns before the actual discharge.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Describe the 3 points in this story where staff should have verified that the patient or her son understood the message. Explain how the staff could have better handled each of these points.
  • Create a presentation that teaches your colleagues about Check-Backs and their importance.
  • Develop a protocol and checklist for the staff in this story that helps them ensure that patients and their families are actively involved in the discharge process.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.  Student struggles to identify at least 3 points in this story where staff should have verified that the patient or her son understood the message. Student can identify at least 3 points in this story where staff should have verified that the patient or her son understood the message, but needs further practice. Student can accurately identify at least 3 points in this story where staff should have verified that the patient or her son understood the message.
Describe how check backs close the communication loop when exchanging information with patients and their families.  Student struggles to describe how check backs close the communication loop when exchanging information with patients and their families. Student can describe how check backs close the communication loop when exchanging information with patients and their families, but needs further practice. Student can accurately describe how check backs close the communication loop when exchanging information with patients and their families.
Adopt check backs as a tool to effectively exchange information with patients and their families.  Student struggles to adopt check backs as a tool to effectively exchange information with patients and their families. Student can adopt check backs as a tool to effectively exchange information with patients and their families, but needs further practice. Student can accurately adopt check backs as a tool to effectively exchange information with patients and their families.

 

 

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
  • I PASS the BATON
  • 3Ws – Who I am, What I am doing, and Why I care
  • AskMe3

 

 

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195 – Question Everything! Instructor’s Guide

Friday, October 10th, 2014

195

Instructor’s Guide – Question Everything!


Overview:
This story is about a patient who is prescribed an inappropriate and dangerous dose of a drug, and how no one from the nurse carrying out the order to the pharmacist filling the order challenged the dosage that could have resulted in patient harm.

 


Primary Learning Outcomes

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

  • Describe how situation monitoring supports team functioning.
  • Identify tools that enable team members to assertively voice concerns over patient care.
  • Apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: “Two Challenge Rule”

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

 

Two Challenge Rule: It is important to voice your concern by advocating and asserting your statement at least twice if the initial assertion is ignored (thus the name, “Two-Challenge rule”). These two attempts may come from the same person or two different team members. The first challenge should be in the form of a question. The second challenge should provide some support for your concern. Remember this is about advocating for the patient. The Two-Challenge tactic ensures that an expressed concern has been heard, understood, and acknowledged.

 

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 could the two-challenge rule have helped improve patient safety in this story?
    A: In this story no one challenged the Thorazine order or dosage. The two-challenge rule may have helped in this case due to the use of the medication and the high dosage. The pharmacist and the nurse could have questioned the order before administering the medication.
  2. What barriers were present in this story that prevented Alice from questioning Dr. Racinelli’s orders?
    A: She did not question the order because she was not familiar with Thorazine being used for hiccups. She also did not double check the amount of medication ordered. She did not speak up when she thought it may be an incorrect order.
  3. What skills do team members in this story need to develop to enable them to effectively advocate for patients?
    A: Team staff members could develop “Speak Up” or work on more advocacy and assertion. Assertion was not demonstrated in this story in regards to the new medication order.

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: New orders need to be checked before any medication is administered to the patient. It is important to double check orders, and also to determine if they are appropriate for the patient.
  2. What tools can I use to effectively advocate for patient safety?
    A: Patient safety needs to be a priority for every health care provider. In this situation advocacy and assertion could be more established within the health care team. The nurse did not speak up when she received the order and the pharmacist did not question the order or the dosage for this patient.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • Research what adverse effects might have come from Dr. Racinelli’s overdose of Thorazine. Present your findings.
  • Create a presentation for colleagues on the Two-Challenge Rule, and its importance in protecting patient safety.
  • Write a dialogue in which Alice uses the Two Challenge Rule to question Dr. Racinelli’s decision to prescribe such a large dose of Thorazine for Shane’s hiccups.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe how situation monitoring supports team functioning. Student struggles to describe how situation monitoring supports team functioning. Student can describe how situation monitoring supports team functioning, but needs further practice. Student can accurately describe how situation monitoring supports team functioning.
Identify tools that enable team members to assertively voice concerns over patient care. Student struggles to identify tools that enable team members to assertively voice concerns over patient care. Student can identify tools that enable team members to assertively voice concerns over patient care, but needs further practice. Student can accurately identify tools that enable team members to assertively voice concerns over patient care.
Apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes.     Student struggles to apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes. Student can apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes, but needs further practice. Student can accurately apply the Two-Challenge rule in situations where there are conflicting perspectives on patient care outcomes.

 

 

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
  • Collaboration
  • I’M SAFE
  • SBAR
  • Two Challenge Rule
  • 3Ws – Who I am, What I am doing, and Why I care
  • AskMe3
  • “Speak Up”

 

 

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194 – When There’s a Conflict, DESC It! Instructor’s Guide

Friday, October 10th, 2014

194

Instructor’s Guide – When There’s a Conflict, DESC It!


Overview:
This story is about dealing with difficult interpersonal conflicts that can often become personal if not properly managed. Using the DESC tool, even difficult situations that have the potential to become inflamed can be appropriately managed in a manner that is respectful, yet still assertive.

 


Primary Learning Outcomes

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

  • Identify and describe early elective C-section delivery (EED) scheduling protocol.
  • Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
  • Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: DESC Script

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

 

DESC Script: What if a conflict has become personal in nature? The DESC script can be used to communicate effectively during all types of conflict, and is most effective in resolving personal conflict. The DESC script is used in the more conflicting scenarios in which behaviors aren’t practiced, hostile or harassing behaviors are ongoing, and safe patient care is suffering.

 

DESC is a mnemonic:

D = Describe the specific situation;

E = Express your concerns about the action;

S = Suggest other alternatives; and,

C = Consequences should be stated. Ultimately, consensus should be reached.

 

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 changes in practices and protocols were causing concern in this story? Why were they important for patient safety?
    A: The change in practice was related to delivering babies that were less than 40 weeks gestation. The change in practice and protocol were put into place in order to improve patient outcomes. Babies that are delivered closer to their due date do better than those who are delivered early.
  2. What barriers did Dr. Dorsey perceive in following the new protocol?
    A: He felt that patient satisfaction scores would go down because patients would not be able to make their own C-section date. He stated that patient satisfaction was just as important as patient safety.
  3. How can we use DESC to reduce conflict related to changes in practices and protocols?
    A: DESC can be used to reduce conflict because the focus is on the patient and reaching positive outcomes. It is not about achieving personal goals.

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: Being proactive and confronting the doctor was necessary in this situation. Patient safety was the primary concern and the nurse emphasized this information. It may be hard to confront a doctor or another nurse, but there may be times when it is necessary.
  2. What can I do to practice using DESC?
    A: One way to practice DESC is to think of a scenario and practice working through DESC with another co-worker. They can objectively hear your approach and give you pointers or corrections, if needed. It may also help to write down the necessary information. This will help you to stay focused and on track during the potentially uncomfortable conversation.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting.  

  • Create a presentation or brochure describing early elective C-section delivery and its possible consequences.
  • Think of another scenario where an EED is scheduled. Write a dialogue that uses a DESC script to express your concerns about non-compliance with EED scheduling protocol.
  • Develop a presentation that teaches the DESC Script tool to your colleagues as a way to avoid medical errors and lapses in safety. Use an EED situation as an example in your presentation.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify and describe early elective C-section delivery (EED) scheduling protocol.   Student struggles to identify and describe early elective C-section delivery (EED) scheduling protocol. Student can identify and describe early elective C-section delivery (EED) scheduling protocol, but needs further practice. Student can accurately identify and describe early elective C-section delivery (EED) scheduling protocol.
Explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol. Student struggles to explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol. Student can explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol, but needs further practice. Student can accurately explain how you can use a DESC script to express concerns about non-compliance with your unit’s EED scheduling protocol.
Develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.      Student struggles to develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes. Student can develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes, but needs further practice. Student can accurately develop a DESC script for reducing conflict around EED scheduling that includes information about the impact and consequences of EEDs on team goals and patient outcomes.

 

 

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
  • Cross Monitoring
  • Collaboration
  • DESC Script
  • Feedback
  • PEARLA

 

 

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193 – Safety Depends on Feedback Instructor’s Guide

Friday, October 10th, 2014

193

Instructor’s Guide – Safety Depends on Feedback


Overview:
This story is about how patient safety is everyone’s responsibility, and how all staff members are accountable for giving fellow team members feedback when their practices diverge from accepted safety norms and practices that have been adopted by the unit or the hospital.

 


Primary Learning Outcomes

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

  • Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
  • Identify how situation awareness can help you identify problems that undermine patient safety.
  • Use Feedback as a tool to challenge team members and advocate for patients.

 

 

QSEN Pre-Licensure Competencies

The following QSEN competencies are addressed in this lesson:

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

 

 

QSEN Teamwork & Collaboration Enrichment

TeamSTEPPS® Best Practice: Feedback

Team Strategies to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based set of teamwork tools, aimed at optimizing patient outcomes by improving communication and teamwork skills among healthcare professionals.

 

Feedback: Another type of mutual support is feedback. Feedback is information provided for the purpose of improving team performance. The ability to communicate self-improvement information in a useful way is an important skill in the team improvement process. Feedback can be given by any team member at any time. It is not limited to management roles or formal evaluation mechanisms. Rules of effective feedback include the following:

  1. Timely—Feedback is most effective when the behavior being discussed is still fresh in the mind of the receiver;
  2. Respectful—The feedback should not be personal, and it should not be about personality. It should be about behavior;
  3. Specific—The feedback should relate to a specific situation or task;
  4. Directed—Goals should be set for improvement;
  5. Considerate—Be considerate of team members’ feelings when delivering feedback, and remember to praise good 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. How was the feedback tool utilized in this story?
    A: In this situation Bridget was direct, timely, respectful, and specific. She focused on the patient and patient safety and not on herself and her own feelings.
  2. Why is it so important to always abide by evidence-based practices regarding patient safety?
    A: Evidence based practice is the standard of care each patient should be receiving.
    A: There should never be a time when Evidence-Based Practices should be ignored or altered.
  3. How did you feel about Dr. Walter’s reaction to Bridget’s questions?
    A: Bridget was appropriate when she spoke to Dr. Walters regarding his lack of hand hygiene. She provided necessary feedback to the doctor and ensured that patient safety was the top priority. Dr. Walters received this information and agreed with Bridget. He treated her with respect and agreed that hand hygiene should be more of a 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

  1. What can we learn from this story?
    A: The importance of providing feedback to other health care professionals. It would have been very easy for Bridget to wait a few weeks or more before saying anything to the doctor, but she did not. Patient safety should be the priority for all health care providers. It may be hard to receive feedback at times, but it is important to remember it is for the safety of the patient.
  2. How can I use Feedback to advocate for patient safety?
    A: Feedback can be difficult to use if you are new to a hospital or clinic. However, it is important to advocate for the patient. Many times it is difficult to bring up a difficult subject, but by using the feedback tool it is possible. By being timely, respectful, specific, direct and considerate you are able to focus on the needs of the patient. The priority of the healthcare team should focus on the patient and not on feeling hurt or offended by the feedback.

 

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 teach others about the concept of “Feedback”. Create your own situation in which to demonstrate the concept.
  • Describe another situation where situation awareness could help improve patient safety. Write a dialogue or act out a scene where feedback is employed to help improve the patient’s experience and safety.
  • Imagine if Dr. Walters had a different reaction. Write out a dialogue in which Dr. Walters responds to Bridget’s criticism defensively, and think of a response that could respectfully drive her point home.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions. Student struggles to recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions. Student can recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions, but needs further practice. Student can accurately recognize situations in which it is important to advocate for patient safety even if it may lead to a conflict or differing positions.
Identify how situation awareness can help you identify problems that undermine patient safety.  Student struggles to identify how situation awareness can help you identify problems that undermine patient safety. Student can identify how situation awareness can help you identify problems that undermine patient safety, but needs further practice. Student can accurately identify how situation awareness can help you identify problems that undermine patient safety.
Use Feedback as a tool to challenge team members and advocate for patients.    Student struggles to use Feedback as a tool to challenge team members and advocate for patients. Student can use Feedback as a tool to challenge team members and advocate for patients, but needs further practice. Student can accurately use Feedback as a tool to challenge team members and advocate for patients.

 

 

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
  • Cross Monitoring
  • Check-Backs
  • STEP
  • SBAR
  • “Speak Up”

 

 

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

191 – Cross Monitor to Address Adverse Drug Events Instructor’s Guide

Friday, October 10th, 2014

191

Instructor’s Guide – Cross Monitor to Address Adverse Drug Events


Overview:
This story addresses the issue of cross monitoring as it relates to adverse drug events (ADEs). Proper communication protocols between physicians and nursing staff are essential to prevent patient ADEs.

 


Primary Learning Outcomes

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

  • Describe challenges in ensuring medication safety.
  • Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
  • Explain the importance of using evidence-based communication measures to improve medication safety in a 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: 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

  1. What evidence-based practices were violated in this story? Were the violations warranted?
    A: The violation noted in this scenario is related to an adverse drug event. This patient had been prescribed a sulfonamide and warfarin at the same time. This in turn created an adverse drug even.
  2. What assumptions about patient safety did the nurses in this story make? Why were they detrimental?
    A: The nurse assumed the doctor new about the Coumadin and wanted to continue with the antibiotic. Her assumptions were detrimental because the patient had an adverse drug reaction and that in turn affected the patient.
  3. How could cross monitoring help this unit provide better patient care and safety?
    A: Cross monitoring would have alerted the doctor to the potential adverse drug event. It would have also given the nurse a chance to discuss her concerns with 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

  1. What can we learn from this story?
    A: The nurse could have discussed this potential adverse drug event with the doctor. It is also important to note that nurses are responsible for the side effects of medications that are given to the patient. The doctor may have prescribed the medication, but the nurse is responsible for monitoring the effects of the medications and to anticipate potential problems that may occur.
  2. What can I do to ensure that I monitor situations to ensure medication safety?
    A: The nurse must be proactive and advocate for the patient first. The doctor may not change the medication order, but the nurse needs to advocate for the patient. Also, if the medication regime was not altered then the nurse should be monitoring for potential adverse side effects.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • What challenges exist when trying to ensure medication safety? Make a list of the challenges and their possible solutions.
  • Develop a step-by-step protocol for improving medication safety, which includes the empowerment of patients.
  • Create a presentation that could help teach a team about cross monitoring and other evidence based communication tools to help ensure patient safety during medication administration.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Describe challenges in ensuring medication safety. Student struggles to describe challenges in ensuring medication safety. Student can describe challenges in ensuring medication safety, but needs further practice. Student can accurately describe challenges in ensuring medication safety.
Identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. Student struggles to identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking. Student can identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking, but needs further practice. Student can accurately identify steps to improve medication safety, including empowering patients to be aware of the medications they are taking.
Explain the importance of using evidence-based communication measures to improve medication safety in a unit.  Student struggles to explain the importance of using evidence-based communication measures to improve medication safety in a unit. Student can explain the importance of using evidence-based communication measures to improve medication safety in a unit, but needs further practice. Student can accurately explain the importance of using evidence-based communication measures to improve medication safety in a 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:

  • Advocacy and Assertion
  • Cross Monitoring
  • Check-Backs
  • STEP
  • SBAR
  • “Speak Up”

 

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

190 – Safety Practices Depend on Advocacy and Assertion Instructor’s Guide

Friday, October 10th, 2014

190

Instructor’s Guide – Advocate for a Smooth Delivery


Overview:
This story is about when we witness team members depart from evidence-based safety practices designed to minimize risk, and how we can best intervene when it’s often difficult or uncomfortable to speak up assertively to confront unsafe practices.

 


Primary Learning Outcomes

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

  • Identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS.
  • Explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.
  • Describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.

 

 

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

  1. What evidence-based practices were violated in this story? Were the violations warranted?
    A: The violations noted in this story are related to evidence based practice and maintaining a sterile field.
    A: The violations in this story do not appear to be an intentional violation, but rather a change in practice. However, the current practice is not acceptable and breaches the standards of care.
  2. What barriers to patient advocacy did Celeste face?
    A: She was new to the role and did not know how much she could say. She also did not know enough about the culture of the operating room. She did not know if this was an intentional violation of sterility or something that had been in practice for a long time.
  3. How might she have overcome them to better advocate for the patient in this story?
    A: Celeste needs to remember that patient care is the priority. It may be difficult at times to speak up in a new situation, but the safety of the patient needs to be more important than feeling uncomfortable about the situation.

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: All team members need to be able to hold each other accountable for their behavior. This should be done out of mutual respect and not out of personal interest.
    A: There may be times when small changes over time are not best for the patient. The nurses did not intend to cause harm to the patient, but because they contaminated the sterile field, patient care was compromised.
  2. What steps can you take to ensure you feel able to assert yourself and advocate for the patient if another team member takes a safety-compromising shortcut?
    A: Good teamwork needs to be demonstrated by everyone on the team. Mutual respect and shared-decision making needs to be established by the senior leadership. However, if this is not the case, then everyone needs to be able to speak up and advocate for the patient.

 

Suggested Classroom Mastery Activities:
These activities can be tailored for individuals or groups in a face to face or online setting. 

  • What are some of the barriers we experience when we attempt to advocate for a patient or assert a concern when we see shortcuts being taken? Develop a list of barriers and possible solutions for overcoming them.
  • Think of an assertive statement that Celeste could have used in this story. Share your statement with the class and work to decide which statements would be most effective.
  • Develop a protocol that could be used by a team when a team member takes a shortcut. Include an assertive statement and steps to maintain the team’s progress and the team member’s dignity without compromising patient safety.

 



Measuring Student Mastery:

Learning Outcome Level 1 Level 2 Level 3
Identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS. Student struggles to identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS. Student can identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS, but needs further practice. Student can accurately identify the responsibilities of each team member under the Advocacy and Assertion strategy in TeamSTEPPS.
Explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.   Student struggles to explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety. Student can explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety, but needs further practice. Student can accurately explain and apply the strategy of advocacy for the patient and expressing concerns assertively when shortcuts are being taken that compromise patient safety.
Describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.  Student struggles to describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken. Student can describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken, but needs further practice. Student can accurately describe and adopt an assertive statement or a signal phrase to be used by team members to voice concerns when shortcuts are being taken.

 

 

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
  • Cross Monitoring
  • CUS
  • Two-Challenge Rule

 

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

189 – Your Patients and Family See What You Can’t See Instructor’s Guide

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

  1. 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.
  2. 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.
  3. 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

  1. 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.
  2. 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.

 

 
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
  • Call Out
  • Check Backs
  • Collaboration
  • Cross Monitoring
  • Feedback
  • STEP
  • “Speak Up”
  • CUS
  • Debriefs
  • Handoffs
  • Huddles
  • Two-Challenge Rule
  • AskMe3

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188 – Advocate for a Smooth Delivery Instructor’s Guide

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

  1. 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.
  2. 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.
  3. 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

  1. 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.
  2. 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.

 

 
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
  • Cross Monitoring
  • Feedback
  • CUS
  • Debriefs
  • Handoffs
  • Huddles
  • Two-Challenge Rule
  • AskMe3

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

187 – Those Who Don’t Debrief are Destined… Instructor’s Guide

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

  1. 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.
  2. 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.
  3. 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

  1. 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
  2. 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.

 

 
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:

  • Call Out
  • Check Backs
  • Task Assistance
  • Cross Monitoring
  • Debriefs
  • Feedback
  • STEP
  • 3Ws – Who I am, What I am Doing, and Why I Care

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