CUSP for VAP: EVAPShadowing Another ProfessionalKathleen Speck, MPHNovember 14, 2013

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Objectives

• Explain the benefits of shadowing another professional

• Describe the Shadowing Another Professional tool’s steps

• Develop recommendations for improving communication with the professional you shadow

SHADOWING ANOTHER PROFESSIONAL: WHY IS THIS IMPORTANT?

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Communication and Understanding

• Healthcare delivery is multidisciplinary• Providers from each discipline need to

be able to communicate with each other• Lack of understanding can inhibit

effective coordination of patient care

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Benefits of Shadowing

• Allows a broader perspective of the role other disciplines play in patient care

• Can help identify communication practices, problems, defects, and – Their effects on collaboration and

teamwork– Their efforts on patient outcomes

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Shadowing Improves Relationships

• Now I understand what you are doing and why you do it that way

• Now I can see that it is your responsibility to do this task

• Now you can see what I do and why I am doing it this way

• Now we can work together to improve our patient care practices as a team

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When Should You Shadow?

• When embarking on a new quality project involving multidisciplinary providers

• When new staff are oriented• When staff on your unit are unfamiliar with

responsibilities and practice domains of another discipline

• When there is little collaboration between disciplines on your unit

• If your unit’s patient safety score is poor in teamwork in safety

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Shadowing Another Professional Tool

Why should I use a tool?• This tool offers a structured approach to

identify and improve on defects in communication, collaboration and teamwork.

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What are the steps?

• Review the tool prior to your shadowing experience– Edit as needed

• Follow fellow worker through daily activities– Try to schedule 4 hours for this activity

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What do you do with the information?

• Review list of communication and teamwork problems– Don’t focus on what was done wrong – Watch

for opportunities to increase efficiency and communication

• Discuss what you learned • Make a plan for any noted problems

SHADOWING ANOTHER PROFESSIONAL TOOL: DEBRIEFING

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Section I: What happened?

• Outline your observations• Put yourself in the other provider’s shoes

and view the world through his or her eyes

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Section II: Put the pieces together

• Use the framework to help identify issues that affect patient care and teamwork climate in the unit– communication issues– teamwork issues

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1. Were any healthcare providers difficult to approach?

• How did that impact the provider you followed?– Obtained an order, ignored, etc.

• What was the final outcome for that patient?– Delay in care, etc.

• Did the unapproachable provider detract from the teamwork climate?

• Did the provider you shadowed seem comfortable?

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2. Was one provider approached more often for patient issues?

• Was it because another provider was difficult to work with?

• If so, what patient care issues evolved?– Delay in care delivery– Provider overwhelmed

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Questions 3 and 4

3. Did you observe an error in transcription of orders by the provider you followed?4. Did you observe an error in the interpretation or delivery of an order?

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5. Were patient problems identified quickly?

• Were they handled as you would have dealt with them? Why or why not?

• Were there obstacles that prevented effective handling of the situation (e.g., lack of staff, equipment)?

• Did the provider seek help from a supervisor?

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6. If you shadowed a nurse…

• Were the nurse’s pages returned quickly?

• Were medications available when they were due? What was the wait time? How did the nurse react if it was late?

• Could the delay have affected the patient’s outcome?

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7. If you shadowed a physician…

• Were there obstacles in returning calls or pages? What were the obstacles?

• Did other factors affect the physician’s ability to see patients?

• Did the physician receive clear information or instructions?

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8. If you shadowed a pharmacist…

• Did the pharmacist face obstacles in dispensing on time? What were the obstacles?

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9. If you shadowed a respiratory therapist…

• Is the RT also responsible for the care of patients on other units?– Does this affect timely care?– Are the tasks different on different units?

• Are the patient care tasks clearly delineated between nursing and RT responsibilities? Is there confusion regarding who is supposed to do what?

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10. How would you assess handoffs?

• During the hand-off were verbal or written communications clear, accurate, clinically relevant and goal directed?– Did the outgoing team debrief the

oncoming team regarding the patient’s condition?

– If no, why not?

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11. How would you assess communication during a crisis?

• Were verbal or written communications clear, accurate, clinically relevant, and goal directed?– Did the team leader quickly explain and

direct the team regarding the plan of action?

– If no, why not?

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12. How would you assess provider skill?

• Did the provider seem skilled at all procedures he or she performed?– If not, did he or she seek a supervisor for

assistance?

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13. How would you assess staffing?

• Did staffing affect care delivery?– If yes, why?

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Section III

• Now that you have shadowed, what will you do differently to communicate more effectively?– How can you increase teamwork?– How can you facilitate the shadowed

discipline’s work?– How can you improve handoffs?

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Section IV

• What suggestions do you have for improving teamwork and communication?– What would you recommend to the person

you shadowed?– What would you recommend to your unit’s

manager?

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Summary

• Shadowing– Is one of the CUSP tools– Can bring greater understanding between

providers of different disciplines– Can improve communication and teamwork

on the unit, improving the culture of safety