Teamwork and Communication in Healthcare, Exams of Advanced Education

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PATIENT SAFETY: IHI PS 104 TEAMWORK

AND COMMUNICATION 2023 FULL EXAM

Effective health care teams have several important characteristics, including: (A) The ability to rehearse procedures together, like a choir or a sports team. (B) Stable membership; that is, they have the same people on the team from day to day. (C) Effective communication techniques. (D) The ability to achieve good results without strong communication. - C - Effective health care teams have a shared goal and effective two-way communication. The membership of the team may change frequently (Answer B), and it's quite possible for a health care team to consist of people who have never worked together before (Answer A). That makes strong, two-way communication a critical part of delivering safe care. Which of the following is likely to be the most immediate result of building an effective health care team? (A) Less costly health care (B) Safer care (C) Fewer delays in care (D) Elimination of waste in the system - B - The best answer is that care will be safer. For example, according to The Joint Commission, an estimated 80 percent of serious medical errors can be linked to miscommunication between caregivers when patients are transferred or "handed-over." One of the hallmarks of effective health care teams is frequent, two-way communication — a characteristic that would likely have an immediate and positive effect on care transitions and safety. While better teamwork can lead to fewer delays, elimination of waste, and even less costly care, these results would likely be secondary to an increase in safety. 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?

(A) Not a single complaint about unprofessional behavior has been filed by clinic members over the past year. (B) The providers work in rotating shifts and rarely need to transmit information from one shift to the next. (C) The team routinely takes a moment to discuss the plan and voice concerns before doing a procedure. (D) All of the above. - C - One of the main characteristics of strong health care teams is effective and frequent communication. The absence of unprofessional behavior (Answer A) does not necessarily mean the team is effective. And the failure to share information during shift changes is risky for patients (Answer B). One reason it's critical for caregivers to improve their teams' effectiveness is: (A) Effective teams reduce the risk of errors by providing a "safety net" for individual caregivers. (B) Effective teams limit the number of caregivers patients have to speak with, reducing confusion among patients and families. (C) Teams rely less on technology and more on human capabilities, thus leading to better care. (D) All of the above - A - Effective teams — teams whose members communicate often and reciprocally — act as a kind of "safety net" that can help prevent errors resulting from one member's fatigue or distraction, for instance. Effective teams may still use technology often, and it's likely that patients and families will encounter many members of the team. When considering your role within a health care team, it is important to keep in mind that: (A) No matter what profession you belong to, you will be a member of the team and must work intentionally toward making that team effective. (B) You may be part of a team, but will likely be able to work autonomously without much input or help from others. (C) Teamwork skills will come naturally to you, because we all learn them in other settings. (D) You will need to be a good team member until you become an expert in your field, at which point you probably won't need teamwork skills. - A - If you're entering any field in which you'll be caring for patients, it's a certainty that you

will be a member of a team; in fact, you may be a member of multiple teams. As such, you'll have the responsibility to communicate effectively, value the contributions of other members, and keep building your team's ability to provide excellent care. Teamwork skills don't come naturally to everyone (Answer C), but anyone can learn and practice them. What is "SBAR"? (A) A system for delivering information (B) A system for identifying areas for improvement (C) A system for confirming receipt of information (D) A system for assessing patient values - A - SBAR, which stands for "Situation- Background-Assessment-Recommendation," is a system for delivering information. It is an adaptation of a US Navy communication technique and can be an effective means to communicate urgent patient care issues. 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? (A) Increased the likelihood of error by repeating an order (B) Provided a read back (C) Used SBAR in communication (D) B and C - B - This is a read back, which is used to confirm receipt of information (SBAR is a system for delivering information). The pharmacist went through the step of verbally verifying the order from the nurse practitioner by repeating it back to him, which can catch mistakes. The additional time that a read back requires is not a waste. In fact, it may make work more efficient by decreasing the need for later calls for clarification. Use the following scenario to answer questions 8-9:

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? (A) Report this adverse event in the anonymous reporting system so that it can be investigated (B) Ask administrators to launch an investigation immediately to find out who was responsible for this adverse event (C) Apply the two-challenge rule. (D) Conduct a debriefing - D - Debriefings occur after events to find out what happened and what could be done better next time. The most effective debriefings happen soon after the event, while memories are fresh. However, the first priority is the patient's health - so debriefings should only occur after the patient is stabilized. 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? (A) Implement mandatory debriefings after the team works together on a patient. (B) Fire the physician who failed to respond in a timely way. (C) Stop using nursing assistants in the ICU. (D) Implement the use of critical language in the ICU. - D - Critical language (such as "I need some clarity") is an agreed-upon phrase or set of words that indicates to all members of a patient care team that there is a problem. It helps individuals who need to call attention to a problem but don't know what to say, especially if the patient is awake and listening; and it also serves as a red flag to team members that they need to stop and pay attention. Critical language might have helped the nursing assistant speak up more quickly when he observed problems with the patient's breathing. Debriefings, which occur after the event, would be a valuable source of learning, but they would not be sufficient to prevent an event like this one in the future.

Effective team leaders: (A) Have multiple degrees. (B) Are usually physicians. (C) Seek input from all members of the team. (D) Know the correct answer in any given situation. - C - Effective team leaders are not necessarily the ones with the most training, the most degrees, or the highest salary. And they don't always have all the answers. They do, however, seek feedback from all team members, recognizing that one person can't provide safe care alone. 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? (A) Closing the loop on test results (B) Using teach-back to confirm patient understanding (C) Calling the pharmacist to confirm the patient's medication list (D) Using an electronic medication reconciliation tool - B - The best answer is using teach back, which an effective tool for improving communication with patients, to prevent misunderstanding. An electronic medication reconciliation tool would only have been useful if it had been paired with a better explanation of the instructions for the patient. The medication list was correct, and there was no lost test result in the scenario. 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? (A) 5 percent (B) 30 percent (C) 50 percent

(D) 80 percent - D - The best answer is 80 percent. As transitions are happening, there tend to be many complicating factors: frequent interruptions, unfamiliarity between providers, and a great deal of information to communicate for a large number of patients. Amidst these challenges, it is easy for important information to get lost. Which of the following is NOT always a key part of the medication reconciliation process? (A) Collecting the list of the patient's medications and dosing information (B) Following up with the patient to ensure he or she takes the medication as prescribed (C) Confirming that the list makes sense (D) Documenting any changes - B - The three steps of medication reconciliation are verification (i.e., collecting the list of the patient's medications and dosing information), clarification (i.e., confirming that the list makes sense), and reconciliation (i.e., documenting any changes). Following up with patients to ensure they take the medication as prescribed is not one of the three steps, although it very well may be an important step in improving medication safety. Which is the following statements best describes the role of patients in ensuring safety across the continuum of care? (A) Patients have the responsibility to ensure their own safety. (B) Patients should always use a designated medication manager. (C) Patients often need to be able to act out precise recommendations when they leave the health care setting for home. (D) All of the above - C - Patients can play an important role in enhancing the safety of their own care — but it is not their responsibility to do so. It is ultimately the health system's responsibility to ensure patients are well-equipped to execute recommendations, especially complicated ones, when they leave the health care setting for home. Assigning a designated medication manager is an example of a human intervention to improve safety, which may make sense in some circumstances.

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). (A) The PCP communicates the referral for the sleep study to the specialist. (B) The patient makes an appointment for the sleep study with the specialist. (C) The specialist conducts the sleep study, and communicates the results and recommendation to the patient. (D) The PCP discusses the treatment plan with the patient, after communicating about it with the specialist. - D - The best answer is the PCP discusses the treatment plan with the patient, after communicating with the specialist about it. Ideally, the specialist clearly communicates the results of the evaluation and the care plan to the PCP in a timely manner, through a reliable process. In the nine- step closed loop referral process, step eight is that the PCP acknowledges receiving information from specialist and step nine, the final step, is that the PCP communicates the plan to the patient and family. When speaking with a patient who has limited understanding of health care terminology, which of the following words would you likely want to avoid? (A) "Adverse" (B) "Lipids" (C) "Abdomen" (D) All of the above - D - The best answer is all of the above. When possible, it is best to use simple language, and avoid complicated medical terminology or jargon. Each of these words has a simpler alternative, that is more commonly known. Try saying: "harmful" instead of "adverse"; "fats" instead of "lipids"; "belly" or "stomach" instead of "abdomen."