QSEN Case Western Frances Payne Bolton School of Nursing

Quality and Safety Education for Nurses

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Impaired Perfusion High Risk Obstetrical Simulation

Posted by on Oct 6, 2015 in Teaching Strategies |

  Impaired Perfusion High Risk Obstetrical Simulation Because of low patient census and the inability to ensure high risk obstetrical patient experiences, securing student clinical opportunities is difficult. Using the principles of a “flipped classroom”, an eight hour high risk obstetrical simulation clinical was developed for fourth semester, senior level nursing students. The content focused on the concept of impaired perfusion. This learning strategy allowed for student learning in a safe environment (where student could do no harm) while focusing on quality patient-centered care.   Pre-briefing Power point presentation (outlined the agenda, outcomes, and expectations). Outcomes included prioritization, critical thinking, becoming more comfortable in the clinical setting, being confident in one’s own nursing skills, and knowing when to ask for help from others in order to ensure patient safety. Discussion on the patient safety initiative TeamSTEPPS. The key principles of team structure, leadership, situation monitoring, mutual support, and communication were highlighted. The reasons for simulation clinical instead of clinical at the hospital were explained (see above). Power point continued with a review of obstetrical content presented in past semesters. The concept of perfusion as it relates to OB high risk situations were presented. Preeclampsia (how it effects the body systems and organs, assessment, management and treatment) and hypertension in pregnancy were explained. Risks for other disorders (HELLP syndrome and Eclampsia) and intrauterine resuscitation methods were discussed.   Laboratory/Simulation Experience Group 1 independent paperwork Case studies of high risk OB situations–Drug use and domestic violence, preeclampsia, placental problems (abruption placentae and placenta previa, DIC and HELLP syndrome) Healthy people 2020 objectives (as they relate to the postpartum period) Fetal monitoring tracing Group 2 Skills Laboratory Simulation–students assigned to a “patient” being prepped for a cesarean section. Start an IV, prime tubing, program a pump, secondary (piggyback) and insert a Foley catheter (problem solve with minimal assistance from the instructor). “Trouble shooting” with IV pumps, piggybacks, and tubing and Foley catheter insertion. Unfolding Case Study: 30 week primigravida patient, determine if symptoms were normal or abnormal for gestation. Identify abnormal vital signs, key lab values, important nursing interventions, and plan ahead for emergencies. Role play calling doctor using SBAR. Patient progressed...

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Simulated Medication Adherence Exercise

Simulated Medication Adherence Exercise

Posted by on Oct 1, 2015 in News |

This simulated assignment was developed as part of a junior level pharmacology course and involves students following a mock patient medication regimen for a period of ten days. The purpose of the assignment is to help students gain an understanding of complex medication regimens followed in a home or hospital setting and the importance of the nurse’s role in patient teaching related to pharmacologic therapy, as well as to value actual patient experiences. In order to simulate the types of medications the students would most likely be encountering in the clinical setting, medication lists were obtained from clients at our Nurse Managed Wellness centers assuring HIPPA guidelines were followed. Five different medication regimens were developed using partial client lists that included between five to seven different oral medications. Pill bottles were purchased by the lab coordinator and labels were created for each bottle with the name of the medication and the frequency of administration. Various types of candy were used as the mock pills. The pill bottles for each of the five regimens were placed in storage sized plastic bags. Each student received a bag that contained the medication regimen they were to follow. Students were made aware on the first day of class that they would be receiving an assignment related to medication adherence that would be worth 5% of their grade. No further instructions were provided in advance in order to closely mimic an actual client experience of receiving prescriptions for multiple medications with only having limited information. Students were expected to take all of the mock medications as directed unless they had an intolerance to glucose, lactose, gluten, or allergies to one of the candy products. Students were given three weeks to complete the assignment. For the assignment, students were directed to develop a medication schedule that included: the most likely reason the medication was prescribed; medication interactions; dosing instructions regarding meals or dietary interactions; and the rationale for timing decisions before beginning to take the mock medication regimen. Students were encouraged to modify their diets to reflect their probable health conditions. In addition to the medication schedule, students had to submit a 1.5-2.5 page reflective...

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“Elder” Centered Care: Flipping the concept map

“Elder” Centered Care: Flipping the concept map

Posted by on Oct 1, 2015 in News |

This clinical activity is used to teach students to create an elder centered plan of care. In preparing to understand more about elders the student will review the following learning modules (Knowledge) produced by UMMS (University of Massachusetts Medical School) Senior Patient Navigator Program ©. href=”http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20I.pdf”>Module I: Communicating with Older Adults href=”http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20II.pdf”>Module II: Geriatric Prescribing href=”http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20III.pdf”>Module III: Geriatric Specialty-Specific Considerations href=”http://www.umassmed.edu/uploadedFiles/AGE/Navigator/Navigator%202013-Mod%20IV.pdf” Module IV: End-of-Life Care and Considerations Quality Improvement Students will identify an elderly client (see criteria below) while at clinical.  They will identify the aged related changes and the body system changes that occur (Knowledge, Skills). Older than 65 years Has a recurrent hospitalization due to chronic illness Poly-pharmacy or medication reconciliation concerns End of life care Dementia/Delirium/Alzheimer’s disease Falls Client information that is gathered will help the student to prepare a case study presentation (Knowledge, Skills). The students identify the role of the nurse and hospital team in providing elder specific care, valuing what the team identifies as specific and specialized needs for elderly clients within the acute care environment. (Attitudes) Utilizing a standard concept map format the student will create a geriatric focused plan of care including patient centered interventions and present their case to the clinical group in post conference (Knowledge, Skills). Patient Centered Care Students will gain knowledge, understanding, and value their client by learning the preferences and expressed needs of their elder, family, and community. (Knowledge, Skills, Attitudes). Students will discuss in their presentation and paper how they provided elder specific nursing care, interventions, and goals, which promoted a more patient-centered environment (Knowledge,...

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I-SBAR reporting for the nursing student

Posted by on May 8, 2015 in Teaching Strategies |

  Students are introduced to the concept of communication and I-SBAR reporting/safe patient handoff through lecture.  To reinforce taught material through application, students are provided with the I-SBAR reporting activity.  Students can complete this I-SBAR activity in lecture as a learning strategy, in a post conference to emphasize the content to the clinical environment, or as an independent study.  This activity can be completed individually, as a group, or both.  Students are given a blank I-SBAR form (attachment 1). Students are required to review nurse statements from a “Shift report handoff” (attachment 2) and apply these statements to the appropriate section on the I-SBAR form.   Students are asked to address critical thinking questions that support patient-centered care, safety, teamwork and collaboration (attachment 3).  Faculty is provided with a grading rubric and an answer key (attachment 4). The time allotted for this activity is 30 minutes.  A debriefing can occur to discuss the activity and critical thinking questions as a group. This learning strategy relates to quality and safety in education as I-SBAR reporting supports the National Patient Safety Goal #2, “to improve effectiveness of communication among caregivers.”    In addition, with the use of this I-SBAR activity, it allows students and educators the opportunity to assess the value of I-SBAR reporting which will enhance the quality of patient-centered...

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Medication Error Reporting Form

Posted by on May 5, 2015 in Teaching Strategies |

The Medication Error Reporting Form was created to help students link the process of medication math problems in the classroom with potential patient outcomes as a result of calculation errors. Entry-level student’s that have minimal exposure to the clinical setting often have a difficult time understanding how medication math errors on a quiz or exam in the classroom are directly related to clinical patient safety. As a result, many students may make the same errors repeatedly because they fail to understand the dangers that exist for the patient related to their error. Strategy Implementation: Students are given medication math questions on selected quizzes and exams in their corresponding nursing course. If a student calculates a medication math question incorrectly, the question is treated as a medication error incident with a simulated patient, Susie Smith. The student must complete a medication error reporting form. The medication error reporting form requires the student to calculate the safe and correct dose which is verified by the course instructor. The student is then required to investigate what the medication is commonly given for and what are the potential adverse effects that Susie Smith may experience as a result of their medication error. Students are asked to identify safety measures that may help to prevent similar medication errors from occurring again and the student must reflect on how the medication error reporting form has changed their view of medication calculations and medication administration to patients. In conclusion, the student must sign the medication error reporting form to take accountability for the error just as a registered professional nurse would be required to sign a hospital incident...

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