Effective Communication and Teamwork in Healthcare, Exams of Advanced Education

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IHI PS 104 AND PS 105 STUDY SOLUTION

UPDATE QUESTIONS AND ANSWERS

Effective health care teams have several important characteristics, including: - Effective communication techniques or A and C Which of the following is likely to be the most immediate result of building an effective health care team? - Safer care As a nurse practitioner in a small, rural urgent care clinic, you believe that your clinic team works well together. Which of the following facts would best support your belief? - The team routinely takes a moment to discuss the plan and voice concerns before doing a procedure. One reason it's critical for caregivers to improve their teams' effectiveness is: - Effective teams reduce the risk of errors by providing a "safety net" for individual caregivers or Ineffective teams can contribute to unsafe events and situations. When considering your role within a health care team, it is important to keep in mind that: - No matter what profession you belong to, you will be a member of the team and must work intentionally toward making that team effective. When teams communicate poorly in health care, consequences can sometimes include: - All of the above What is "SBAR"? - A system for delivering information Linda, a pharmacist at an outpatient pharmacy for a medium-sized medical group, receives a call from John, a nurse practitioner in the cardiology clinic. John tells Linda he needs to call in a new prescription for hydrochlorothiazide at 50 mg once a day for Ms. Krane. At the end of the conversation Linda says to John, "Okay, so you want Ms. Joanne Krane to have a new prescription for hydrochlorothiazide at 50 mg by mouth once a day. Thirty pills and six refills." What has Linda just done?

• Provided a read back

You are a member of an intensive care unit team in a regional hospital. This morning, a patient had an unexpected severe allergic reaction (anaphylaxis) after being given a penicillin derivative. There was a significant delay in getting the physician involved and beginning treatment for this life-threatening condition. Fortunately, the patient is now stable and does not seem to be experiencing any lasting effects. At this point, what would an effective team leader do? - Conduct a debriefing The unit leaders are trying to figure out what changes they should make to prevent this treatment delay from happening again. Given what you know about the incident, what change would you recommend? - Implement the use of critical language in the ICU. Effective team leaders: - Seek input from all members of the team. In health care, briefings: - Are a type of structured communication. SBAR stands for: - Situation, Background, Assessment, Recommendation When you arrived at the unit today and listened to the change of shift report, you heard about a patient named Jane W. According to the tape-recorded signout, Jane "is a 57-year-old woman with abdominal pain and vomiting. She has pain medications ordered p.r.n. [as needed]." During your shift, Jane does not request pain medications. Near the end of your shift, however, you get a call from Jane's daughter. Distraught, she asks why nobody is treating her mother's pain. When you explain that Jane has not requested any pain medications, her daughter exclaims, "But she's had a stroke! She can't use the call light! What kind of place are you running over there?" How might the transition between providers ("hand-over") have contributed to this situation? - The handoff was too brief and failed to include important information. Which of the following actions is essential for closed-loop communication? - The receiver repeats to the sender what he has heard. Effective structured communication: - Includes SBAR, briefings, and debriefings.

A patient's primary care provider (PCP) prescribes him a new diuretic because of a change in his insurance. It is intended to replace his previous medication. However, when he gets home, he is confused and takes both the previous and the new diuretic. He becomes dehydrated and ends up in the hospital. Which of the following process improvements would have been the best option for the PCP to prevent this adverse event? - Using teach-back to confirm patient understanding According to US studies, approximately what portion of serious adverse events can be linked to miscommunication between caregivers when patients are transferred or handed over? - 80 percent Which of the following is NOT always a key part of the medication reconciliation process? - Following up with the patient to ensure he or she takes the medication as prescribed Which is the following statements best describes the role of patients in ensuring safety across the continuum of care? - Patients often need to be able to act out precise recommendations when they leave the health care setting for home. A primary care provider (PCP) refers her patient to a specialist for a sleep study. Which of the following steps would represent the END of a closed-loop referral process? (Hint: Think of the nine-step process this lesson recommends). - The PCP discusses the treatment plan with the patient, after communicating about it with the specialist. When speaking with a patient who has limited understanding of health care terminology, which of the following words would you likely want to avoid? - All of the above When an error occurs, which of the following is generally the proper order of prioritization? - Care for the patient, communicate with the patient, report to all appropriate parties, check the medical record. You're a new resident (house officer). At 2:00 AM, you receive a phone call about a patient you are covering who has diabetes. The patient has an elevated blood sugar of 375. You order 12 units of NovoLog (rapid-acting) insulin and ask the nurse to check the sugar again in one hour and call you back. One hour later, the

sugar is 280, so you order another 10 units. By 4:00 AM, the patient's sugar is dangerously low at 45. You realize that NovoLog insulin takes two to three hours to reach peak effect. By rechecking the patient's glucose after only one hour and giving more insulin so quickly, you set the patient up for an episode of hypoglycemia. Why is it important to communicate with the patient about this event? - Open sharing of this type of information is necessary if patients are to trust their caregivers. Which of the following is true regarding communication about adverse events with patients? - In some cases, the care team may decide for medical reasons to defer communication with a patient about an upsetting incident. If you are responsible for the initial communication with the patient about the error, which of the following should you be sure to do? - Let the patient and family know who is available to help them. Your organization has a voluntary reporting system for errors. Which of the following incidents should you report? - Both A and B Janice is a nurse on the orthopedics unit. This night, she is caring for five patients, as well as a new admission from the emergency department. While juggling patient care, she calls the on-call resident (house officer) about Mrs. Bernardo, who is in significant pain from a fractured hip. Janice hastily writes down the morphine order from the resident and is then called away when another patient falls out of bed. An hour later, she realizes, to her dismay, that she has not yet given Mrs. Bernardo her pain medication. When she rushes into the room, the patient is crying and asking, "Why won't someone help me?" Janice quickly administers the morphine. When discussing the event a little while later with Mrs. Bernardo, the most appropriate initial comment would be: - "How is your pain?" Janice is a nurse on the orthopedics unit. This night, she is caring for five patients, as well as a new admission from the emergency department. While juggling patient care, she calls the on-call resident (house officer) about Mrs. Bernardo, who is in significant pain from a fractured hip. Janice hastily writes down the morphine order from the resident and is then called away when another patient

falls out of bed. An hour later, she realizes, to her dismay, that she has not yet given Mrs. Bernardo her pain medication. When she rushes into the room, the patient is crying and asking, "Why won't someone help me?" Janice quickly administers the morphine. Why is it important for Janice to apologize to Mrs. Bernardo for the delay in her pain medication? - An apology is needed to maintain provider-patient trust. Janice gives the following apology to Mrs. Bernardo: "Mrs. Bernardo, there was a delay in you receiving your pain medication that should not have happened. I am very sorry that you had unnecessary pain. The doctor gave me the order to give you a dose of morphine. However, I was caring for another patient who had fallen, and I got distracted and did not give you the medication as quickly as I should have. Again, I just want you to know how sorry I am that this happened." Which one of Aaron Lazare's four components of an apology is missing in Janice's apology? - Reparation When giving an explanation for why an adverse event happened, it can sometimes be a good idea to: - Say something like, "There is just no excuse for what happened." According to researchers, which of the following is a common reason why caregivers choose not to communicate when something bad happens? - They fear disapproval. According to a survey in The Lancet, when patients and families pursue lawsuits against their providers, which of the following is one of the things they want most? - An explanation Who of the following people might be appropriate to include in an initial conversation with a patient about a medical error in his or her care? - All of the above Which of the following statements about apologizing after a medical error is always true: - None of the above Janice is a nurse on the orthopedics unit. This night she is caring for five patients, as well as a new admission from the emergency department. While juggling

patient care, she calls the on-call resident (house officer) about Mrs. Bernardo, who is in significant pain from a fractured hip. Janice hastily writes down the morphine order from the resident and is then called away when another patient falls out of bed. An hour later she realizes, to her dismay, that she has not yet given Mrs. Bernardo her pain medication. When she rushes into the room, the patient is crying and asking, "Why won't someone help me?" Janice quickly administers the morphine. Why is it important for Janice to apologize to Mrs. Bernardo for the delay in her pain medication? - A and B When giving an explanation for why an event happened, it is always important to:

• Be factual. You sit down with a patient to break the bad news about a lapse in follow-up on a lung mass detected in a recent chest x-ray. Which of the following is important information to include in this first discussion? - Your intention to prevent this type of error from happening again When an adverse event befalls a patient, who are the "second victims" according to Dr. Albert Wu? - The caregivers involved in the error As the Health Unit Coordinator (HUC), it is your job to enter orders from providers into the computer system. You check charts every couple of hours for new orders, unless the providers "flag" the chart by turning a dial on its side to red — in which case, you check the chart right away. On a particularly busy day, you see a chart tucked in a corner and realize that you have not looked at it in at least six hours. Worse, you check the order dial and see that it's partly red. On the order sheet are orders for "STAT" pain medications and antibiotics for a new patient. You quickly input the orders, your heart pounding. Three hours later, the patient is transferred to the intensive care unit with worsening sepsis (infection). When your supervisor informs you about what happened, you go numb thinking about those six hours and the cost to the patient. What should ideally happen? - She should speak calmly with you about what happened and how you're feeling about it. Why is it important for the organization to offer you help and support at this time? - Offering support helps prevent depression or decreased job satisfaction.

Based on what you know about the incident, which of the following statements seems to be a fundamental attribution error? - "The HUC almost killed someone yesterday because she doesn't pay enough attention." Which of the following is a support mechanism that might be available to caregivers after traumatic events? - The Employee Assistance Program or all the above Which of the following is the best explanation for why caregivers involved in medical errors are "second victims" according to Dr. Albert Wu? - They experience their own trauma. As the Health Unit Coordinator (HUC), it is your job to enter orders from providers into the computer system. Direct provider order entry is planned for your hospital next year when the electronic health record is implemented. You check charts every couple of hours for new orders, unless the providers "flag" the chart by turning a dial on its side to red — in which case, you check the chart right away. On a particularly busy day, you see a chart tucked in a corner and realize that you have not looked at it in at least six hours. Worse, you check the order dial and see that it's partly red. On the order sheet are orders for "STAT" pain medications and antibiotics for a new patient. You quickly input the orders, your heart pounding. Three hours later, the patient is transferred to the intensive care unit with worsening sepsis (infection). After you find out what happened to the patient, which of the following might be a sign that you are experiencing adverse consequences from the event? - All of the above Rumors quickly spread on your unit. The next day you overhear a nurse telling another nurse, "The HUC almost killed someone yesterday with her carelessness." What does this comment exemplify? - Fundamental attribution error According to a study by Scott and colleagues, what is a common type of support caregivers ask for after adverse events? - Early identification of suffering