Session 11:

Ayyy oh! This is the last lecture for the fundamentals course! I’m super excited that I have finished this class with all of you and hope that this momentum will carry over well into the future.

The topics for today are quality improvement and team work. Important things to remember are that there are topics covered that are basically lists and should be understood, but may not need to be memorized.

Teamwork and collaboration

QSEN – shared decision making respect, communication, respect, to achieve quality patient centered care.

  • there is shared power with the LIP  
  • work together as a team
  • respect the unique attributes that each team member has

Stages of team development (not necessarily linear, more fluid)

  1. Forming – excitement, anticipation, the beginning
  2. Storming – resistance, confusion, frustration, changing roles or positions
  3. Norming – acceptance of role and membership.
  4. Performing – interdependence, recognize strengths.
  5. Adjourning – end of the work, pride.

CRM – crew resource management

  • from aviation industry
  • addresses authority gradients
    • how to have a level of communication to allow people with lower power to be able to add their thoughts on the process, and recognizing the adverse situations.

Group think: restricts the flow of information and able to see all viewpoints of the scenario

disruptive behavior

  • verbal abuse, physical,

Learning from the leonard article

  • quality and safety
  • looking for team dysfunction related to culture
  • what we can learn from aviation to standardize communication
  • Power distance

Quality improvement

  • use data to monitor and improve outcomes and methods in the healthcare systems
  • completely dependent on data
    • how do I measure it?
    • what gets measured gets managed
  • florence nightingale – one of the first people to gather data and regulate hand washing
  • Never events
    • will not receive reimbursement
    • air embolism, CAUTI, DVT, Pressure ulcers, Falls, surgical site infections, MRSA during hospital stay.
  • Core measures – one consensus list, help determine what is done well and what needs improvement for people in the healthcare system
    • admittance, meds and time frame, interventions and diagnosis, can be improved to improve outcomes
  • PDSA – plan, do, study, act
    • system to improve systems
  • control chart is a chart that has a range that is “in control” ie. # of patients, the range is 4-6 patients and the actual data is added over the range
  • Gawande’s article
    • nurses needed to remind a provider to do missed steps
    • nurse is given the responsibility to make sure all the team members are following through the 5 steps
  1. wash hands
  2. clean pt’s skin
  3. sterile dressing
  4. wear a sterile mask, hat, gown, and gloves
  5. Place a sterile dressing over the catheter site
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