Collaboration And Teamwork PDF

COLLABORATION AND TEAMWORK Week 8 Fall 2024 1 COLLABORATIVE HEALTH CARE  A client-centered approach in which members of different health care professions come together and work toward a common goal  Goal: improving and restoring a client’s health  Safety...

COLLABORATION AND TEAMWORK Week 8 Fall 2024 1 COLLABORATIVE HEALTH CARE  A client-centered approach in which members of different health care professions come together and work toward a common goal  Goal: improving and restoring a client’s health  Safety, quality of care, and health care outcomes are improved  Promoting collaboration and teamwork is one of the national initiatives for nurses to improve health  Collaborative practices include competencies in:  Communication, shared decision making, conflict management, leadership, client-centered care, ethics, delegating/supervising care, assist with discharge planning, continuity of care (safe transition of care) 2  tranforming care INTERPROFESSIONAL TEAM for social work  A setting in which two or more professionals work together  Benefits Improved access to and coordination of health care services Greater efficiency of client referral and client-care services Increased quality of community health services Decrease in complications, length of stay, sentinel events, mortality, and staff turnover Hath 3  Disposition INTERPROFESSIONAL TEAM goingtovened Otherfacilitiesplaces  Utilizing interprofessional engagement improves quality of and satisfaction with care, client’s overall experience  TeamSTEPPS Interprofessionalstragies  Team Strategies FOC  Tools to Enhance Performance on strategies  Patient Safety Skills → Focuses on strategies and skills needed to improve and enhance collaboration and teamwork to ensure client safety and optimal outcomes 4 TEAMSTEPPS: PRIMARY TEAMWORK SKILLS Team structure: Identify who is on the team or who should be included in the team Communication: Utilize strategies to communicate effectively among the identified team Leadership: Identify strategies to effectively lead teams and support the team’s use of these strategies Situation monitoring: Encourage team members to be aware of and understand the teams’ performance and the impact it has on the clients’ outcomes Mutual support: Support the team by providing feedback to assist them to function better as a team (distribute workload, manage conflict) 5 REFERRALS & CONSULTS  Part of the collaborative process  Consultation/Consult  When one provider formally requests another provider’s input or advice in a different specialty area  Referral Delegatingthemanagementofcare  Provider (PCP) is delegating responsibility for management of care to another provider (specialist)  Transfer of care is to systemically turn care over to another provider  Nurses’ input and actions are needed to reduce gaps in care  Can increase the risk of fragmented care  Result in…. duplicate orders, wasted resources, increased costs, missed needs, errors, confusion, negative consequences 6 knowthise additions 7  STRATEGIES TO PROMOTE COLLABORATION  Zero-tolerance policy for acts of incivility, bullying, harassment, intimidation, or violence  Incivility and bullying will not be tolerated  Incivility: behaviors in the workplace that negatively affect others  Bullying: recurring behavior of unwelcome action(s) intended to harm, humiliate, or distress another  Destructive to teamwork, collaboration, communication, job satisfaction, productivity  Conflict management  Method to settle disagreements peacefully and respectfully houldbe  Compromise and accommodation to each handledw other’s needs, avoidance, mutual respect, Positive active listening, using empathy, deep breathing (before speaking) 8 Conflict resolution skills matter Vertical violence Eence title Iten knowthis knowthis 9 STRATEGIES TO PROMOTE COLLABORATION  Cognitive Rehearsal  Visualizing a difficult scenario ahead of time to prepare for constructive actions and example responses when the situation arises  Thinking ahead helps to be successful in resolving the issue  Emotional Intelligence  The ability to face, understand, and feel emotions, and act accordingly  The ability to manage stress, adapt to situations, efficiently coping  Having mindfulness of feelings or emotions that can have an effect on actions, decisions, and critical thinking  Elements: self-awareness, self-regulation, motivation, empathy, social skills 10 SAFETY & NATIONAL PATIENT SAFETY GOALS Week 8 Fall 2024  Identify clients Improve staff Use medications Use alarms correctly communication safely safely Prevent hospital Identify client Prevent adverse acquired infections safety risks: suicide events in surgery EÉ NATIONAL PATIENT SAFETY GOALS CREATED BY THE JOINT COMMISSION (STARTED IN 2003), UPDATES YEARLY FOCUS ON CLIENT SAFETY, SAFE DELIVERY OF CARE, AVOIDANCE OF ADVERSE EFFECTS alwaysbed alwaysnegative unintended 12  Use of two client identifiers openended  Name, DOB, designated hospital number, telephone number whatisyour  Two-step process IDaffirms that the staff has identified toidentify theperson the appropriate funname client for the given medication, treatment, procedure, or care  Should be asked as an open question, not confirmation  Confirm with hospital ID wristband or EHR  Assigned room number should not be used for ID purposes!  Barcode scanning  Used at the time of medication administration 1. IDENTIFYING CLIENTS CORRECTLY 13  Refers to reporting critical results promptly  Lab or diagnostic results that are outside the expected reference range and may be life-threatening  Follow facility guidelines:  The definition of a critical result A time frame when results must be reported to the provider withinanhrors   Written documentation of the notification  Should never be given over voicemail Too  Always directly convey to the provider in person or by telephone name ofprovider when you 2. IMPROVE STAFF COMMUNICATION document 14 Label all medications writetheRightsof nameofmedication medication dosage Solutions, syringes, containers time Should be discarded if without label wdehiebedomoreblood Decrease errors associated with anticoagulants mjjitii.ie Review weight, renal & hepatic function, dose, frequency of dose, & interaction potential Inform risks and benefits of the medication, required lab monitoring, medication-food interaction Reconcile client's medications Assess current home medications, compare home meds with new meds Include OTC, supplements If from another facility, identify medications that client was taking currently Identify any discrepancies or potential interactions Usually nurses performs on admission, then on transfer or discharge Provider determines if meds should continue, hold, add, or discontinue during hospitalization 3. USE MEDICATIONS SAFELY 15  Intended to warn about a potentially serious event may be occurring  Audible alert devices are embedded into medical equipment  Can indicate machine malfunction  May experience ‘alarm fatigue’  Sensory overload from noise pollution  Can become desensitized to alarms  Reduced reaction time to the alert  Facilities’ alarm system policies should be in place  Learn about safety measures of alarm systems  Identify alarms that require immediate attention 4. USE ALARMS SAFELY 16  Nosocomial infections occur in more than 500,000 people annually (HP 2030)  Four common types:  Central line-associate bloodstream infection (CLABSI)  Catheter-associated urinary tract infection (CAUTI)  Surgical-site infection (SSI)  Ventilator-associated pneumonia (VAP)  Commonly caused by multidrug-resistant organisms (MDROs)  Increases length of stay, cost, mortality rates  Single most important step to prevent spread of infection? 5. PREVENT HOSPITAL-ACQUIRED INFECTIONS 17  alwayshavetobe monitor  Suicide: death resulting from self-injurious behaviors performed with intent to die  10th leading cause of death, 2nd in ages 10 to 34 in US  If admitted for behavioral health, must be screened for suicidal ideation (i.e., suicide risk screening tool)  Must ask directly about suicidal thoughts, plan, and injury behaviors  If at risk, must have constant surveillance  Potentially harmful items must be removed  Search items brought into client’s room  Visitation is limited 6. IDENTIFY CLIENT SAFETY RISKS: REDUCE RISK OF SUICIDE Columbia-Suicide Severity Rating Scale (C-SSRS) 18  Adverse event  Situation or circumstance that causes unexpected harm to client  Prevention is crucial to minimize adverse events  Safety checks before beginning any invasive procedure or surgery  Use two client identifiers (full name, DOB)  Mark the surgical site if possible (when more than one potential site: extremities, spine, breast)  Perform a time-out in the operating/procedure room 7. PREVENTION OF ADVERSE EVENTS IN SURGERY 19  Former National Patient Safety Goals that are now routinely used and are now retired  More than 250 standards  Medical error prevention  Competency of health care professionals  Rights of and education of clients  Management of medications  Emergency preparedness  Standards of Compliance STANDARDS OF COMPLIANCE 20  3 key elements  Commitment to consistently follow safe operations  A just culture without punishment  Just culture focus on solving and identifying issues rather than blaming  A commitment by the organization (ensure resources, collaboration)  Nurses' role: the final safety net between a potential error and the client  Work environment role:  All levels must be deeply committed  Address areas of risk promptly  Must follow through on steps for a positive outcome CULTURE OF SAFETY 21  Handoffreports CULTURE OF SAFETY INITIATIVE atbedsides  ‘Transforming Care at the Bedside’ plan  Have nurses spend 70% of their time at the bedside performing direct care  The more time nurses spend at the bedside, the less likely clients are to have safety issues  i.e., hourly rounding and handoff report at bedside  Strengthen management through leadership development programs  Implement a rapid-response (RRT) team  A dedicated group whose responsibility is to proactively provide skills to the bedside during a status change  Members: ICU nurse, respiratory therapist, critical care provider  Facilities should have policies about RRT to avoid delay in care (criteria, how to call, who is on team)  Create frameworks for standardized communication  Between nurse-nurse, nurse-provider ISBARR (identity, situation, background, assessment, recommendation, and read back) 22  medicalhistorygeneralabbrevation 97 Bregenester  p y adverse_Effusion know examples Client safety Sentinel event Near miss Adverse event event (Never event) Didn'thappen Potential error Unexpected Situation or Critical that could event with or circumstance adverse have caused without injury that caused event that harm Potential to unexpected caused Caught and cause harm harm severe harm avoided to the client surgreyonthewrong side TYPES OF UNEXPECTED EVENTS 23  A tool to report unexpected events  Used as a tracking system to prevent future occurrences  Internal report for the facility, provide opportunity to investigate with information to help prevent future unexpected incidents  Quality improvement  Action plans can be created  Examples: P  Fife Accident or injury of a client, staff member, or a visitor r  Unexpected vaccine or drug reaction  Administration of wrong medication  Lost items  Exposure to blood, bodily fluid, or other infectious material on the skin, eyes, or mucous membranes urine OCCURRENCE (INCIDENT) REPORTING 24 AGENCY FOR HEALTHCARE RESEARCH & QUALITY (AHRQ) 10 RECOMMENDATIONS FOR FACILITIES TO IMPROVE SAFETY 25 Client safety Nurse safety  Using siderails  Proper handling of sharps  Following rights of medication  Knowledge about potential administration exposure to bodily fluids or  Awareness of client allergies Redband infectious pathogens  Proper use of restraints  Proper body mechanics  Prevention of pressure injuries  Knowledge of fire, chemical, radiation safety  Appropriate use of aseptic technique Tannotbecontempted withanything SAFETY ISSUE CONSIDERATIONS 26 ELECTRICAL SAFETY  Check for faulty electrical equipment  Intactness: should not be frayed (worn) or creased (wrinkled)  Check for ground fault circuit interrupter (GFCI) protection  Three-pronged outlet  Causes currents to enter ground, not a person  No sparking should occur  Use safe work practices  Avoid plugging and unplugging near water, standing in wet area, or wet hands  Avoid rolling bed over electrical cords  Unplug by grasping the plug, do not pull on the cord to unplug Avoid using extension cords  fallrisks  Remove unsafe devices from client area and notify appropriately 27 CHEMICAL SAFETY  Can enter the body in four ways:  Inhalation: breathing in fumes or air  Contact with skin or eyes  Ingestion: direct (swallowing) or indirect (contamination of hands)  Injection (needle stick injury)  Use appropriate personal protective equipment (PPE)  Masks, eye protection, gown ,gloves, hair caps  Safety data sheets (SDSs) = chemical label  Includes information, enable to identify risks of exposure, should be accessible to all staff  If exposed, determine the chemical involved  Remove the chemical from area  Eye washing stations, emergency showers areas, remove and dispose contaminated clothes/shoes in 2 biohazard bags Doublebags  Report ASAP, be familiar with policy/procedures 28  Xrayhas carcineer tradition Risk of radiation exposure is proportional to exposure time and distance from source of radiation Fradiati  CT scan vs x-ray? ignexposureradiationisused  Use smallest amount possible in all imaging studies  Risks and benefits should be weighed prior to ordering Yberadiation imaging study  Check for pregnancy, withhold if pregnant or any doubt  Warning signs must be posted about the use of radiation or storage of radioactive supplies  Principles to assure safety  Reduce time  Increase distance (step away)  Use shielding, use PPE when handling any body fluids RADIATION SAFETY 29 know characteristics Infants &0 4 School-Age Adolescents Adults Preschoolers Burn injuries Drowning Similar to school Alcohol & Aspiration Vehicle safety age smoking YnIIemYun Bullying Mental Suffocation Sports & water Poisoning safety Substance use, disorders Drowning Firearm safety sexual practices Workplace Internet safety Driving in accidents Falls excess speed Falls (older: 65 Vehicle safety limits or older) Suicide Social media AGE-RELATED CONSIDERATIONS OF SAFETY RISKS 30  Hospital-acquired infections Burn or electrical shock could receive Pa4,9 duty andyou Blood transfusion incompatibility If you arebloodtypeA Injury related to a fall or trauma Ineffective and unsafe insulin usage Deep vein thrombosis (DVT) Bloodclotindeepvein swelling Pressure injury (decubitus ulcer or bedsore) HOSPITAL-ACQUIRED INJURY: TJC’S “ZERO HARM TO CLIENT” POLICY 31 SCREENING TOOLS Mild risk: 15-18 Moderate risk: 13-14 High risk: 10-12 Severe risk: less than 9 32 HOME HAZARD ASSESSMENT  To ensure client’s home is as free from hazards as possible to decrease risk of injury or death  Done for clients who are at increased risk for injury due to:  Fall Knownis  Recent surgery  Dementia  Bathroom 33 HOME HAZARD ASSESSMENT (ATI, PAGE 4)  Bedroom  Use a lower bed  Install a floor mat alarm, motion sensor alarm, or video monitor for client’s who have mobility or cognitive issues  Kitchen  Place commonly used items within reach to avoid using a step stool  Invest in a stove with an automatic shut-off mechanism  Turn pot handles toward back of the stove to avoid accidental burns if knocked or pulled over  General  Install bright (well-lit) lighting  Handrails for stairways, mark edges of stairs with brightly colored tape to alert client  Remove loose rugs, secure electrical cords to the edges of the floor  Keep animal food bowls away  Paint walls one color to increase visibility and orientation  Place medications out of reach of children Remove/replace uneven flooring throughout the home 34  QUESTION A nurse is discussing steps to reduce home hazards. Which of the following statements should the nurse include in the teaching? Blade A. “Use a manual razor for shaving” B. “Secure electrical cords to the edges of the floor” e C. “Reduce the water heater temperature to 54.4 ◦C (130◦F)” D. “Use several paint colors throughout the house” 35 Install fire alarms and carbon monoxide detectors on every floor Place fire extinguishers on every floor Maintain a passable pathway to the exit Identify two exit points from each room, purchase recue ladder for multilevel homes Practice an escape plan in the event of fire at least 2x/year Make sure electrical outlets are not overcrowded with plugs Unplug small appliances, when not in use Replace broken or exposed electric cords Teach “Stop, Drop, and Roll” while covering face if their clothes/skin catch on fire Do not be near or touch space heaters, do not place anything into the space heater HOME FIRE SAFETY & RESCUE 36  Post ‘No Do not wear Keep gas Smoking’ signs oxygen when stoves at least inside and cooking 10 feet away outside Install smoke Do not use oil- NEVER smoke alarms, based lotions, with medical maintain fire aerosol sprays O2 in home extinguisher FIRE SAFETY WITH OXYGEN 37  Employee training essential Staff should know roles and responsibilities Know the location and operation of the fire extinguishers and pull station to activate fire alarm Know the location of fire, all fire exits RACE acronym to guide staff response to an identified fire PASS acronym for fire extinguisher usage FIRE SAFETY IN THE HEALTHCARE FACILITY 38  Vertical Lateral evacuation Safety precautions evacuation oooo Moved on the Relocated to a Close all doors same floor to a different floor Wrap clients in a safe location Those closest to blanket covering Preferred method the fire should be their face moved first Stay low to ground when moving, crawl if necessary Do not run or panic HEALTHCARE EVACUATION: TWO TYPES 39 Run First thing to do if possible Hide If you cannot run, find a secure environment to hide Fight If the other two are not an option, fight for your life against the active shooter ACTIVE SHOOTER Definition: a person who is actively murdering or attempting to murder multiple individuals in a group setting 40 Video monitoring Useful only when carefully monitored by an observer whose primary responsibility is to monitor and respond in a timely manner Several clients can be monitored at once by one staff member Central video terminal: two-way feedback system allows to talk to clients through intercom Bedside sitter for direct observation for high-risk injury clients May lead to fragmented care when sitter is present Helps with high risk for falls, elopement & suicidal ideation Other Hourly rounding, timely answering of call lights, movement alarms GENERAL SAFETY INTERVENTIONS FOR AT-RISK FOR INJURY CLIENTS 41 initien is Cognitive Environmental Physical disorders Other factors influences factors Stroke Sleep disorders Room clutter Medications Amputation Impulsiveness Poor lighting Age Recent surgery Disorientation Slippery floors Bathroom Multiple sclerosis Dementia frequency nocturia Visual Seizures Staffing level of impairment the unit Weakness Attached to an Unsteady gait equipment (i.e., IV, tubes) Orthostatic hypotension BP FALL RISK Fall: “unplanned descent to the floor with or without injury” 42 Non-skid footwear, colored wristband Keeping bed in low position, keep assisted devices nearby Locking wheels of bed Placing brakes on wheelchairs Maintaining a clutter-free environment, eliminate safety hazards Adequate lighting Placing call light and belongings within reach Fall prevention education for clients fallsyoudo on admission FALL PRECAUTIONS Assessment Yellowband 43   Restraint  Purpose: to limit client’s movement and function for their own safety and safety of others  Restrict movement as little as is necessary  Should be a last resort to achieve safety for the shortest duration necessary  Restraints should never interfere with treatment  First try (less restrictive measures)  Engage client in social interaction, diversional activities  De-escalate situation  Place them closer to the nurses’ station  Encourage family members’ presence at bedside, have a sitter at the bedside  Use chair or bed alarms  Remind and reorient the client to not get out of bed  Indications for use include:  Unnecessary movement that is considered unsafe  Attempting to remove needed medical items (e.g., feeding tubes, IV or indwelling catheters, breathing devices)  Aggression or combativeness  A danger to self or others USE OF RESTRAINTS & SECLUSION TO PREVENT INJURY moleconsent 44  Physical Mechanical Chemical Barrier Seclusion Manually Use of Use of Restraining Placing client holding or materials, sedative through a in a locked immobilizing straps, fabric medications barrier to limit room without the client to fasten to reduce movement consent Short-term around wrists movement or Concave Found in situation or or ankles control mattress, inpatient procedure Least behavior lapboards psychiatric Can cause restrictive: Follow attached to setting injury to the mittens medication chairs, bed client Most rights enclosure restrictive: four Monitor for All 4 siderails point side effects up (except Never tie to with infants the siderails and toddlers) Bedframe encloseing TYPES OF RESTRAINTS thebed 45 Soft wrist restraint 46  Explain the need for restraints  Must obtain order from provider  Physical injuries and psychosocial trauma may  Reasons for restraint occur  Type of restraint  Frequent assessment needed  Location of application  Circulatory, respiratory, skin checks, v/s  Lenth of time of use  Remove with assessment (at least q 2 hours)  Must be renewed every 24 hours  Rights to maintain hygiene, eliminate, ROM  Documentation exercises, receive adequate nutrition  Alternative measures to avoid restraints  Should be discontinued or revised as soon as possible  Time of application and removal  Client’s behavior while in restraints  Need for restraint must be re-evaluated every 24 hours for mechanical restraints  Type of restraint and location  Do not secure restraint by tying on side rail, use a  Type & frequency of care provided quick release knot  Condition of body parts  Apply that two fingers can be inserted between  Client’s response the restraint and the client’s skin NURSING INTERVENTIONS FOR CLIENTS IN RESTRAINTS 47 QUESTION A nurse is preparing to apply wrist restraints to a client. Which of the following actions by the nurse is incorrect? a. Pad bony prominences before applying the restraint. b. Apply the restraint so that two fingers can be inserted between the restraint the client’s wrist. c. Secure the restraint by tying it to the side rail of the bed. on d. Use a quick-release knot when securing the restraint. 48 Preseizure Ensure suction equipment, oral airway, and oxygen is set up at bedside Check baseline vital signs Establish two IV sites Ensure siderails are padded Remove constrictive clothing, jewelry Ask client to tell you if they feel an aura feelingthatthepatientknowaseizure.iscoming During a Seizure Call for immediate help, note the onset time measuretime Do NOT leave the client, assess at bedside (monitor, v/s, ABCs, mental status) Place in side-lying position to prevent aspiration Protect the head, maintain airway patency Remove objective that may cause a danger, loosen tight or restrictive clothing around the neck Do not hold client down Post Seizure testing Obtain laboratory results as necessary (toxicology screen, drug level) Assess gag reflex before giving anything to eat or drink Imaging studies or electroencephalogram (EEG) as necessary electricactivityinthebrain SEIZURE PRECAUTIONS Seizure definition: abnormal electrical activity in the brain resulting in temporary brain dysfunction 49  lift Iana Lifting & Moving Assistive Devices Hoyer lift Ceiling lift 4049ft Slide or turn sheet Sit-to-stand lift Ceiling lift Side or turn sheet PREVENTING WORK- RELATED INJURIES 50 Clear the area where the client will be moving Follow manufacturer's instructions, check maximum weight of the lift device Become comfortable with the device (hands-on training) Know client capabilities and condition Use a proper sling size, make sure client is centered Have another team member assist you Secure and lock brakes Never leave the client unsupervised while in the lift Perform safety check before lifting SAFE PRACTICES WHEN HANDLING LIFT DEVICE 51