Keeping Patients Safe Part 1: Team Working

Interprofessional EducationDentistry, Medicine, Nursing

& Health Sciences

Introduction to Inter Professional Education

September 8th & 9th 2015

“In the activity, the team

identified the skills of each member, and

organized itself to best use

these skills”

We then had to prioritize the patients depending on the severity of their injuries. My group also took age in to consideration when triaging as we thought this would impact on the well-being of the people. By listening and bouncing ideas of each other we managed to complete this task and numbered our patients in order of severity. By keeping the care and safety of our patients as our main priority we didn't spend too long debating and make quick, well thought out decisions. 

Human Factors, Non-Technical Skills

Cognitive Skills

Situation Awareness Gathering informationRecognising & understandingAnticipating future states

Decision Making Defining the problemIdentifying optionsBalancing risks & selecting optionsReassessing/reviewing outcomes

Task ManagementPlanning and preparingPrioritisingProviding & maintaining standardsIdentifying and utilising resources

Social SkillsCommunication

Giving information clearly & conciselyIncluding context & intentReceiving informationIdentifying & tackling barriers

Team WorkingSupporting othersSolving conflictsExchanging informationCoordinating activities

Leadership Using authority & assertivenessMaintaining standardsPlanning & prioritizingManaging workload & resources

FollowershipFollowers may lack authority but they do not lack power and influenceFollowers can be agents of changeFollowers who do something are better than followers who do nothingFollowership involves a personal commitment to influence others (i.e. speak up)

Personal Resource Skills

Stress & Fatigue ManagementIdentifying symptomsRecognising effectsImplementing coping strategies

Watch the video and be prepared to discuss questions in your teams

Which was the clearest sign that Dr Dan was under stress?

1. He swore a lot2. He was overly assertive3. He appeared distracted4. You could see it in his eyes5. He kept making careless

errors

What was the most effective way in which Dr Dan ensured individual team members were aware that they were the person he was communicating with?

1. He spoke directly to them2. He referred to them by name3. He appeared to look in their direction4. He made appropriate gestures towards

them5. He raised the tone of his voice

How does Dr Dan ensure that team members understand what they have to do as part of the team?

1. Give clear directions2. Speaks loudly and slowly3. Ensure they know to follow standard

protocols4. Uses jargon and acronyms to shorten

commands5. Ensure risk assessments are constantly

performed

What was the most important thing that Dr Dan did to ensure the team understood his communication about the extrication process?

1. He ensured that his voice could be heard above the surrounding noise

2. He gave clear commands3. He ensured that he had a response that

everyone was ‘clear and happy’ with the instructions

4. He continually talked through all stages of the extrication

5. He detailed that the extrication command would be ‘Ready, Brace, Slide’

How does Dr Dan lead the team?1. Constantly supervises everything they

do2. Structures and regulates team

processes to meet shifting contingencies

3. Ensures they appreciate the evidence-base for what they’re being asked to do

4. Relies on their professionalism to let him know if they have any problems

5. Appoints a second team leader, and delegates supervision to them

“My contributions come in many forms like all of my team mates. There are certain instances throughout the given tasks where, like everyone, I gave my opinion on things. There are also times where I fill up empty posts so that each task flows fluidly and times where I would co-operate with the assigned leader and do what they ask for. “

“There is no such thing as a job too lowly for a doctor to be done especially not in a disaster.”

Keeping Patients Safe Part 2: Involving Patients and Carers

Interprofessional EducationDentistry, Medicine, Nursing

& Health Sciences

Team Discussion 1:How does the NHS learn from patients? Daily conversations Questionnaires Patient experience surveys Patient engagement forums Comments/ cards/ suggestion boxes Specific forums for patients and carers

who cannot communicate in the spoken language of English, who are hard of hearing and/or have other sensory impairments which may cause barriers to communication

http://www.nhstayside.scot.nhs.uk/GoingToHospital/GiveUsFeedback/index.htm

NHS Tayside: Learning, Action & Improvements

Team Discussion 2:What problems should we ask patients & carers about?

1. Doctors’ answers to questions not clear2. Nurses’ answers to questions not clear3. Staff gave conflicting information4. Doctor didn’t discuss anxieties or fears5. Doctors sometimes talked as if I wasn’t there6. Not sufficiently involved in decisions about treatment and care

7. Not always treated with respect and dignity8. Nurses didn’t discuss anxieties and fears9. Not easy to find someone to talk to about concerns10. Staff did not do enough to control pain11. Family didn’t get opportunity to talk to doctor

12. Family not given information needed to help recovery

13. Purpose of medicines not explained14. Not told about medication side effects15. Not told about danger signals to look for at home

Jenkinson et al 2002The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries. International Journal for Quality in Health Care 14: 353-8.

Meet Laura Having a daughter with a severe

learning disability and ongoing medical needs has meant many trips to doctors, hospitals, dentists: the list goes on

We have experienced bad practice and poor attitudes on many occasions and this in turn leads to a poor service with negative outcomes for my lovely daughter

Communicating with Laura

Laura is a fantastic character but due to her severe learning disability and complex communication disorder she uses her behaviour to communicate her needs

If those needs are not meet she will then display “challenging or self-injurious behaviour”

Getting it Right for LauraWhy Laura could use challenging behaviour within a medical setting:

Pain and feeling physically unwellFear and anxietyUnfamiliar environment and peopleDisruption to her usual routineStaff attitude and lack of experience

Building Trust with Laura and her Mum

https://www.rcn.org.uk/__data/assets/pdf_file/0004/466078/01_The_15_Steps_Challenge_toolkit.pdf

Team Discussion 3:What Would You Look For? Welcoming

Safe

Caring and involving

Well organised and calm

What Made a Difference to Laura and her Mum?Well they listened to me, Laura’s

mum, remember parents and carers are the experts they have a wealth of information on the person they support

We worked together to plan the best way to treat Laura as quickly and effectively without causing her or I unnecessary distress

What Mattered?There was good communication at

all times between staff and myselfThey gave clear instructions on

what treatment they would try first, if sedation was needed then how it would be used

How she would be afterwards so I could plan for support to take her home

Ongoing good practiceThe dental clinic staff continue

with their good practice in Laura’s follow up treatment

The staff are proactive and have Laura along just to sit in the treatment room

The staff let her hold the brush or mirror so she knows that they won’t hurt

All I want for Laura is the health care provision that I would expect for my other two children and Laura’s learning disability should never be a barrier to that.

Do You Want to Improve Healthcare?

Come along to our ‘Learning Partnerships’ evening to hear how students can be change agents for patients and the public.

When: Thursday 25th NovemberRegistration 4.45pm for 5.00Where: Lecture Theatre 4, Dalhousie Building

http://blogs.cmdn.dundee.ac.uk/ihi-dundee/