Interacting Effectively with a Multi-Disciplinary Team PDF

INTERACTING EFFECTIVELY WITH A MULTI- DISCIPLINARY TEAM MS A HAJAT OUTCOMES  Communication in the multidisciplinary environment  Relationships and status in the multidisciplinary team  Teamwork  History taking  Principles of ward & theatre practice Introduction The healthcare system...

INTERACTING EFFECTIVELY WITH A MULTI- DISCIPLINARY TEAM MS A HAJAT OUTCOMES  Communication in the multidisciplinary environment  Relationships and status in the multidisciplinary team  Teamwork  History taking  Principles of ward & theatre practice Introduction The healthcare system is rather complex and constantly changing- which requires all healthcare staff to work efficiently and collaboratively with a team. Through collaborative health practice health professionals from different professional backgrounds work together with patients and their families to improve patient outcomes, achieve the highest quality of healthcare, reduce healthcare costs and ultimately enhance organizational outcomes. Health care professionals from different disciplines who conduct individual assessments of a patient and independently develop a treatment plans are not considered an interprofessional team. For many years, In order to improve the quality of health care, the Institute of Medicine has endorsed interprofessional education as an important step in the advancement of health professional education.  What is interprofessional education “Interprofessional education involves educators and learners from 2 or more health professions and their foundational disciplines who jointly create and foster a collaborative learning environment.” IPE is an important pedagogical approach for preparing health professions students to provide patient care in a collaborative team environment. The goal of these efforts is to develop knowledge, skills and attitudes that result in interprofessional team behaviors and competence. Ideally, interprofessional education is incorporated throughout the entire curriculum Increase Quality Decrease stay Decrease Costs Reduce errors Goal of IPE The World Health Organization, National Academies of Practice , and the American Public Health Association are a few of the many organizations that have articulated support of IPE. Most notably, the Institute of Medicine (IOM) declared that ‘‘health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team to ensure that healthcare professionals understand the meaning of working effectively in a team, communicating productively, and understood each other’s roles. The goal of IPE is for students to learn how to function in an interprofessional team and carry this knowledge, skill, and value into their future practice 4 competencies for IPE  Values and ethics Work with individuals of other professions to maintain a climate of mutual respect and shared values. Place interests of patients and populations at center of interprofessional health care Respect the dignity and privacy of patients Embrace the cultural diversity and individual differences Respect the unique cultures, values, roles/responsibilities, and expertise of other health professions Work in cooperation with those who receive, provide and contribute to the care Develop a trusting relationship with patients, families, and other team members Demonstrate high standards of ethical conduct and quality of care Manage ethical dilemmas specific to interprofessional patient/ population centered care situations. Maintain competence in one’s own profession appropriate to scope of practice.  Roles and responsibilities Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of patients Communicate one’s roles and responsibilities clearly to patients, families and other professionals. Recognize one’s limitations in skills, knowledge, and abilities. Explain the roles and responsibilities of other providers and how the team works together to provide care, promote health, and prevent disease. Engage diverse professionals who complement one’s own professional expertise, to develop strategies to meet specific healthcare needs of patients. Use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective, and equitable. Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention. Interprofessional team An interprofessional team is composed of members from different health professions who have specialized knowledge, skills, and abilities. The goal of an interprofessional team is to provide patient- centered care in a collaborative manner. Interprofessional communication Improving the effectiveness of communication in healthcare is a global priority Ineffective communication in healthcare results in delayed treatment, misdiagnosis, medication errors, patient injury, or death. Interprofessional communication happens in synchronous and asynchronous means. Synchronous genres refer to communications happening in real time such as a meeting, ward round, handoff, or impromptu conversation. Asynchronously such as on white boards, through medication orders, or written progress notes Communication is not only verbal and written, it includes body language, attitude and tone. Example Traditionally, individual health professions have been trained primarily in their own schools or colleges by members of the same profession. Nurses are trained to be highly descriptive and physicians are trained to be succinct Physicians have noted frustration with nurse communications for “disorganization of information, illogical flow of content, lack of preparation to answer questions, inclusion of extraneous or irrelevant information, and delay in getting to the point”. Nurses indicated concerns with physician communications due to “perceived inattentiveness especially during night hours, unwillingness to discuss goals of care, and feeling that a list of signs and symptoms had to be provided instead of just stating what the nurse thought the clinical problem was” “The embracing of true multivocality by a team is the key to its achieving the kind of integrated communication required for effective collaboration” In your work place can you think of a positive and negative example of interprofessional teamwork? ? What is your role??? Professional identity INVESTIGATION- CLINICAL HISTORY Current history Social CLINICAL Family history HISTORY history Medical/ surgical Current history- Presenting signs and symptoms SYMPTOMS- WHAT THE PATIENT FEELS SIGNS- WHAT THE DOCTOR OBSERVES  Asking relevant questions NB!!!!!!!!!!!!!!!!!!!! QUESTIONS NEED TO BE RELATED TO PATIENTS SIGNS AND SYMPTOMS  EXAMPLES OF QUESTIONS Why have you come to see the Dr ? When did your symptoms first start ? Do you have a family history of ……? ABDOMINAL SYMPTOMS Do you feel the pain superficially/deep? Are you able to tolerate all food Do you experience loss of appetite Have you recently lost weight?  EXAMPLES OF QUESTIONS PAIN SYMPTOMS Show me where you feel the pain ? Does the pain move anywhere ? What kind of pain is it ? Stabbing, aching, throbbing, gripping, dragging, dull etc) How severe is the pain ? How often do you feel it & how long does it last? Does anything relieve it/ make it worse e.g food/posture?  EXAMPLES OF QUESTIONS FEMALE/ GYNAE RELATED QUESTIONS Is the pain related to your menstrual cycle When was your last normal period? How regular is your menstrual cycle? Do you have heavy menses? Do you have painful menses? How long does your period last? Do you have a family history of ……? Is this your first pregnancy? Were there any complications during a previous pregnancy?  EXAMPLES OF QUESTIONS FEMALE/ GYNAE RELATED QUESTIONS Do you have a vaginal discharge? Does the discharge cause itching? Does it have a strong smell Do you experience pain during intercourse? Do you feel the pain superficially/deep?  Medical / surgical history A ： Previous hospitalization B ： Illness C ： Trauma D ： Operations E ： Childhood diseases F : Current medication G : Allergies ： Hay fever ， asthma ， skin Food ， drugs, bee stings  Social history A ： Education B ： Employment C : Habits Appetite Use alcohol ， coffee ， tea ， tobacco Sexual habits D : Drug Use. Medicines Drug abuse  Family history History of disease which may be heredity or Where contact may play a role. Principles of ward and theatre practice 1. Get to know the surgeon, the different procedures and the image intensifier. This sounds straight forward but it’s an essential part of using a C-Arm in the OT. Every surgeon has their own process, getting to know how they perform a procedure, what they need at certain times and where you should be insures smooth communication and improves outcomes. When you fully understand how the C-Arm image intensifier works, including all of the settings and positions necessary during the procedure, it can speed up the surgery while making you look more professional and prepared at the same time. It’s a winning combination for the surgeon, the patient and your career. If you are working with a new surgeon or in a procedure you haven’t done before, talk to the surgeon or another radiographer who has performed the procedure beforehand and ask specific questions about C-Arm position and the necessary imaging settings. 2. Get setup for success. Preparing the little things before a surgical procedure can save you time and energy. Make sure to cover or drape your image intensifier using a sterile bag or cover. For all the other pieces of the C-arm that will get near the operating area, cover them with a sterile or non- sterile (depending on what OT rules dictate) sheet or bag. The five minutes it takes to put these covers in place will prevent any messy cleanup when everything is finished. And don’t forget to secure your plug. By fastening the main cord to the boom with a self-tightening safety knot you prevent any chance of outage as well as damage to the C-Arm if someone were to trip on it. In addition, connecting your power supply to the plug bank allows you to quickly identify which plug is yours when it’s time to cleanup. 3. Make sure you can see the monitors and access the control panel easily. Another seemingly obvious tip that can get overlooked during setup. Before you begin, make sure to face the monitor cart panel towards the spot where you will be standing. This small time saving effort provides you with easy access to the control panel if you need to manipulate the image. Not all image intensifiers will have this issue, but it’s important to remember for when you’re working on a C-Arm with a separate monitor cart.  4. Confirm your storage space. When you’re using an image intensifier with a hard drive, make sure to check the remaining hard-drive space before starting a new procedure. You don’t want to have to stop a procedure to free up space. Obviously if you’re using a non-digital system this won’t be an issue. 5. Double check the details and make sure the surgeon is operating on the correct side. Earlier in this blog, we suggested that you become familiar with the different procedures that require the use of a C-Arm in the operating theater. It’s also a good idea to periodically double-check the specific details of a procedure. It’s not only a good way to stay up to date with the procedure and stay prepared, but it also insures your surgeon is operating on the correct side. Believe it or not, accidents like this do happen. Double-checking can save the day and make you an invaluable member of any surgical team.  6. Watch the surgeon’s eyes when screening. One of the radiographer’s jobs is to minimize a patient’s exposure to radiation. By watching the surgeon’s eyes during the procedure, a radiographer can minimize the fluoroscopy time that the surgeon needs for the procedure. 7. Consider using a sequence acquisition when appropriate. In addition to video, modern mobile image intensifiers can store images as a sequence almost like a.gif file. This recording method enables the radiographer to record dynamic information that can be useful in a variety of procedures. It facilitates quick playback where small details can be examined more closely and the sequence can be looped for repeated examination.  8. Carefully move the C-Arm and don’t clean the image intensifier during open surgery. It goes without saying but we’re going to say it anyway. The operating theater needs to be a highly controlled clean room where everything is organized and sterile. During a C-Arm procedure, when it is necessary to move the C-arm, go slowly and make sure there’s proper clearance. Also, make sure to ask others for feedback to make sure nothing is accidently bumped. While the machine and room should be clean, any dust or cleaning solution could have catastrophic repercussions if they were to come in contact with a patient during surgery.  9. Use equipotential earthing for cardiac cases. Redundancy is often important when lives are on the line. This is why the image intensifier on your C-Arm has a separate earth lead. Use it to avoid static discharge during surgery. 10. Remember the basic principles of radiography. Finally, it’s always important to remember the big three of radiology, distance, shielding and time. In the operating theater, there will always be moments where you can utilize your knowledge of radiology in new or different ways. Consider the procedure and the desired results and manipulate the C-Arm to provide the surgeon with the best possible image and the patient with the least amount of exposure to radiation. Remember what areas are shielded and modify your techniques based on the radiation scatter cloud and where people are standing. Sterile environment There are more microbes on and in your body that cells that make up your body! While this is not generally a problem, and most of them are actually useful and necessary, some of them are not. The human body has many defense mechanisms that help prevent the not-so-good ones from causing problems. However, in the medical field, the majority of patients have a weakened immune defense due to infection, disease, or injury. Additionally, a good amount of patients undergo an invasive procedure that puts them at an increased risk for harmful pathogens bypassing the body’s defense system. Importance of the sterile environment Sterile technique is a term that refers to the practices and procedures that healthcare providers follow to prevent pathogens from being introduced to their patients during procedures. While it is typically stressed in operating rooms, many procedures are performed in a variety of healthcare settings that require sterile technique. Any time there is an opening in a patient’s skin or a device is inserted into an orifice or body cavity, there is a significant increase in the potential for infection. Sterile cleaning procedures or the use of sterile packaged single-use medical supplies are meant to eliminate medical instruments from causing infection. Additionally, the healthcare professional and all supplemental products must also be sterile or the cleanliness of the medical instruments will have little impact. Radiographers role in maintaining a sterile environment Radiographers, as healthcare workers, are thought to be at a significant risk of contracting and spreading diseases due to their close contact with patients and other hosts. The radiology department faces two significant challenges when conducting routine examinations: one is to control cross-infection between patients, and is to protect staff from infection, Radiographers must use standard infection control measures (SICP) to prevent Healthcare associated infections. Decreasing risk for healthcare professionals. Sterile environments not only reduce the risk of introducing pathogens to patients but also helps prevent any infection or disease the patient carries from being passed to their healthcare professionals. Aseptic technique and the use of personal protective equipment (PPE) on every patient, also known as standard precaution, is generally enough to reduce the risk to the healthcare professional when they come into contact with bodily fluids or surface pathogens. However, using sterile technique provides an additional layer of protection to both patient and health care provider by providing an environment that inhibits microbe activity completely. Saving money The healthcare industry, like every business, is concerned with saving money. Not only in the interest of the general population, but also at the heart of each medical company, the desire to provide quality care at the lowest cost to company and end-user is great. By providing a sterile environment, a great deal of money can be saved on the resources used to treat secondary infections and hospital- acquired infections. Additionally, it decreases the number of lawsuits and repeat patient visits. HR Pharmaceuticals understands the importance of sterility in the healthcare setting and makes products that help support the mission of the industry. Radiographers responsibilities Radiographers’ responsibilities for related infection control include: upholding a safe work environment, choosing suitable risk management and hazard control measures, using reduction or elimination methods that adhere to health and safety regulations. applying the right disinfectant principles and applications, sterilization and decontamination procedures, and precautions suggested for properly handling waste and spillage. References Forondo, C., McWilliams, B. & McArthur E. (2016). Interprofessional communication in healthcare: An intergrative review. Journal of nurse education in practice. Vol 19: 36-40 Forte, A. & Fowler, P. (2009). Participation in Interprofessional education: An evaluation of student and staff experiences. Journal of Interprofessional Care. Kim, J. Lowe, M. Srimvasan, V. Gairy, P & Sinclair. (2010). Enhancing capacity for Interprofessional Collaboration. A resolve to support program planning. Toronto Rehabilitation Institute, Toronto. Ontario. Manting. M (2014). Interprofessional Education & Obstetric Ultrasound. Journal of Ultrasound Obstetrics & Gynaecology. Strudwick, R. & Day, J. (2014). Interprofessional working in Diagnostic radiography. Radiography. Vol5,2. Treadwell, I & Havenga, H. (2013). Ten key elements for implementing interprofessional learning in clinical simulations. African Journal of Health Professions Education. Vol 5,2. Gareeballah A, Al-Sehli SM, Al-Mutairi RT, Gameraddin M, Alsharif W, Elzaki M, Alshoabi SA, Alsultan KD, Alzain AF, Omer AM, Hamd ZY. Assessment of the Knowledge and Practice of Infection Control among Radiographers in Saudi Arabia: A Cross-Sectional Survey Study. Healthcare (Basel). 2023 Oct 24;11(21):2817. doi: 10.3390/healthcare11212817. PMID: 37957961; PMCID: PMC10648768.