Increasing Emotional Intelligence€¦ · Web viewInterprofessional collaborative (IPC) practice is a process whereby professionals from varying disciplines work together and value

Patient Journey 1

Running head: PATIENT JOURNEY

The Patient Journey – Transitions of Care

An Interprofessional Education (IPE) Group Activity

Dwight Davis

Juanita Hernandez

Julie Miles

Marilyn Staniland

The University of Texas at Arlington College of Nursing

In partial fulfillment of the requirements of

N6320 Leadership in Healthcare Systems

Donna L. Hamby, DNP, RN, APRN, ACNP-BC

June 25, 2017

PATIENT JOURNEY 2


An Interprofessional Education (IPE) Group Activity

Interprofessional collaborative (IPC) practice is a process whereby professionals from

varying disciplines work together and value the expertise and contributions of each team member

to provide safe, effective, patient-centered care (White, Dudley-Brown, and Terhaar, 2016;

Institute of Medicine, 2001; Interprofessional Collaborative Practice, 2016). Professionals often

do not understand the complementary roles of other collaborative partners, how to respectfully

communicate care coordination with impact, or how to share accountability for decisions that

ultimately impact patient care and outcomes (White et al. 2016). IPE is any learning activity that

acts as a vehicle by which individuals of an inter-disciplinary team learn how to communicate

and collaborate effectively to improve quality of care (Center for Advancement of

Interprofessional Education, 2005; New et al. 2015). Appendix A introduces a simulated IPE

activity that addresses various patient scenarios to challenge team collaboration, communication

and sharing of collective knowledge. Appendix B presents the accompanying participant self-

assessment tool.

The Four Competencies of IPE

Four core competencies guide the IPE model, which are values and ethics, roles and

responsibilities, interprofessional communication, and teamwork (IPEC, 2016; White et al.

2016)). The goal of values and ethics is to “maintain a climate of mutual respect and shared

values” (White et al. 2016 p. 267). The questions posed to participants of this IPE activity reflect

core patient values, such as the patient’s refusal to participate in care, or the team’s consideration

of the unique needs of the patient as an older adult. Thus, the game encourages the team to

discuss individual differences, build trust, and act with integrity and honesty in their interactions

PATIENT JOURNEY 3

with the patient and family (White et al. 2016). With roles and responsibilities, individuals are

expected to use their specialized knowledge collaboratively, while at the same time

acknowledging others’ expertise and capabilities to help assess and achieve patient-centered

goals (IPEC, 2016; White et al. 2016). The IPE activity presented in this paper highlights the

collective nature of the healthcare team and includes questions designed to challenge roles from

each discipline (New et al. 2015; Wilhaus, 2012). This dialogue fosters shared responsibility,

and advances understanding within the team to provide “care that is safe, timely, efficient,

effective and equitable” (White et al. 2016, p. 268). Healthcare teams must also develop

effective communication strategies to provide safe, uncompromised care (White et al. 2016;

IOM, 2001). Participants of this IPE activity will need to discuss barriers to discharge, and

identify ways to promote healthy outcomes as they move the patient through transitions of care.

Successful communicators will learn to express themselves with clarity, respect and consistency,

allowing others to do the same through active listening (IPEC, 2016; White et al. 2016).

Teamwork is the final core competency of the IPE model, and is directed at the team’s

accountability to share in collective problem-solving and decision-making, which are

characteristics of effective teams (IPEC, 2016; White et al. 2016). The goal of healthcare teams

is to provide safe, patient-centered care (IOM, 2001). The questions in this IPE are multi-

disciplinary in nature, requiring team members to engage in problem identification and decision-

making to promote a safe and efficient discharge. This activity fosters greater understanding and

challenges silo thinking (White et al. 2016).

Traditional Model versus Interprofessional Collaborative Model of Care

The IPE activity presented in this paper highlights how active learning can further

understanding and build positive interprofessional relationships that may promote positive

PATIENT JOURNEY 4

outcomes in patient-centered care (Wilhaus, 2015). White et al. (2016) describes teamwork

within the traditional health care model as professionals “working within a group where each

individual has agreed to use his or her own skills to achieve a common goal” (p. 264). The

tradition of “silo education and practice” (White et al. 2016, p. 274) is a barrier to true

interprofessional collaboration. TeamSTEPPS is an organization dedicated to improving

teamwork within an IPC model (Agency for Healthcare Research and Quality, 2011).

TeamSTEPPS identifies several key factors associated with successful teamwork: team

structure, communication, situation monitoring, team leadership and mutual support. In the IPC

model, team structure is interdisciplinary and non-linear communication is essential to positive

outcomes. All members are accountable for outcomes, assessment, and monitoring of patient

status and safety. Safety of patients and team members is the highest priority. Within this

teamwork structure, leadership is shared rather than hierarchical, and team members are

supportive of each other and the process (White et al. 2016; AHRQ, 2011). The IPE activity

presented in this paper capitalizes on the functional heterogenicity of the participants and

exemplifies the attributes of collaborative practice and successful teamwork. Communication is a

key component of the activity, requiring clarity and thoughtful deliberation. Patient monitoring

by the team is ongoing, each card presenting a new facet of patient care. Leadership by

consensus must be in place for the patient to move through the admission-discharge process.

Problems along the way highlight the effects of poor communication, gaps in care and safety,

unresolved conflict and lack of trust. This activity exemplifies how breaking down practice silos

and implementing new mental models of team building, where safe patient-centered care is

paramount, promotes a richer, more effective and efficient system of care (White et al. 2016).

PATIENT JOURNEY 5

References

Agency for Healthcare Research and Quality. (2011). TeamSTEPPS National Implementation

TeamSTEPPS curriculum tools and materials. Rockville, MD. Retrieved from

http://teamstepps.ahrq.gov/ abouttoolsmaterials.htm

Center for Advancement of Interprofessional Education. (2005). Interprofessional Education: A

definition. London: CAIPE. Retrieved from www.caipe.org.uk/

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st

century. Retrieved from: http://www.nationalacademies.org/hmd/~/media/Files/Report

%20Files/2001/Crossing-the Quality-Chasm/Quality%20Chasm%202001%20%20report

%20brief.pdf

Interprofessional Education Collaborative Expert Panel. (2016). Core competencies for

interprofessional collaborative practice: Report of an expert panel. Washington, DC:

IPEC.

New, S.N., Huff. D.C., Hutchison. L.C., Bilbruck, T.J., Ragsdale, P.S., Jennings, J.E., &

Greenfield, T.M. (2015). Integrating collaborative interprofessional simulation into pre-

licensure health care programs. Nursing Education Perspectives, 36(6), p. 397-398. doi:

10.5480/13-1108

Willhaus, J. (2012). Working towards interprofessional educational with simulation. Nursing

Education Perspectives. 33(12) p. 134.

White, K.M., Dudley-Brown, S., & Terhaar, M.F. (2016). Translation of evidence into nursing

and health care (2nd ed.). New York: Springer.

http://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf



http://www.caipe.org.uk/

PATIENT JOURNEY 6

Appendix A

The Patient Journey - Transitions of CareAn Interprofessional Collaborative Learning Activity

Objective of the Game: This interactive game requires teams to move through a series of case

scenarios randomly determined by the card deck, and discuss issues regarding movement of the

patient from admission to discharge. In this case, the teams will be composed of a physician,

nurse, pharmacist, and care transition manager (social worker). After each card is drawn, the

patient may move forward towards discharge, not move, or move backward. The team will

discuss what could be done by each of them in their role to prevent barriers to discharge and

provide the safest and most efficient care for the patient and family. The activity encourages

interprofessional collaboration and communication with each person in their professional role as

they provide their expertise and knowledge of their responsibilities (New et al. 2015; White et al.

2016). Each team will receive a patient and the goal will be to discharge the patient.

Personnel and Materials Required: A room large enough to accommodate at least 11 people

(minimum of 2 teams) and ten chairs for each team. A second option is to place chairs in a circle

with an admission and discharge chair identified. Have both teams move through the circle of

chairs.

The cards (attached) are separated, shuffled and stacked, face down.

The patient can be a person or an inanimate object such as a doll or stuffed animal. If the room is

large enough there can be more than two teams. Each team should have 10 chairs and four inter-

professional members. There should be at least one moderator for every two teams and one set of

cards for two teams.

PATIENT JOURNEY 7

Room Set up: Chairs should be set up with admission and discharge identified. The patient will

start in chair number 1 at admission. The cards will be placed faced down in an area both teams

can access. Each team member should be identified by role and assigned.

Flip a coin to see which team will draw the first card.

Directions: Draw a card and read the event in the patient journey out loud. Determine if your

patient is moving towards discharge and make those moves. If the first card is for negative

movement; stay in chair one. (in real life, this is a little bit like being placed in ER Hold).

Discuss what your team can do to optimize patient outcomes. Discuss how each member’s

actions helps or hinders the rest of the team and ultimately the patient’s journey. The next team

will take their turn and repeat the process. After all teams have drawn one card, the first team

draws a second card and the process continues. The final chair represents the day of discharge.

The first team to move their patient beyond the discharge chair is the winner. Once the game is

completed, moderator will facilitate a debrief for individuals to share their learnings and how

they may change their collaborative practices in the future.

PATIENT JOURNEY 8

MEDICATION RECONCILIATION: THE PATIENT DOES NOT KNOW WHAT MEDICATIONS OR DOSES HE IS ON BUT

BROUGHT A BAG WITH ALL OF THE MEDICATION BOTTLES. THE RN INPUTS EACH CURRENT MEDICATION INTO

THE PTA LIST

Move ahead 1 space.

Discuss situation in terms of inter-professional collaboration to help the patient be discharged

MEDICATION RECONCILIATION: THE PATIENT DOES NOT KNOW WHAT MEDICATIONS OR DOSES BUT HIS FAMILY

PROVIDES A COMPLETE UP TO DATE LIST OF MEDICATIONS, DOSES, AND PURPOSES ALONG WITH

ALLERGIES/REACTIONS.

Move ahead 2 spaces.

Discuss situation in terms of inter-professional collaboration to help the patient be discharged.

THE PATIENT DOES NOT KNOW WHAT MEDICATIONS OR DOSES HE IS ON BUT GAVE THE NAME OF HIS PHARMACY TO THE RN WHO WILL CALL IN THE

MORNING AND THEN THE MD AND PHARMACIST CAN RECONCILE THE PTA MED LIST.

Do not move forward; wait for next turn.


THE PATIENT REFUSES SCD AND DOES NOT AMBULATE OFTEN. THE RN DOES NOT REINFORCE IMPORTANCE

OF SCD. THE PATIENT DEVELOPS VTE IN THEIR LOWER EXTREMITY.

Move back 2 spaces.

Discuss situation in terms of inter-professional collaboration to help the patient be discharged

PATIENT JOURNEY 9

THE PATIENT HAS A PICC LINE AND NO MAINTENANCE ORDERS, THE CENTRAL LINE STAYS IN LONGER THAN

NEEDED AND DRESSING IS NOT CHANGED WITH PROPER STERILE TECHNIQUE BY THE RN. THE PATIENT GETS A

CLABSI.

Move back 2 spaces


THE PATIENT HAS A PICC LINE AND THE DOCTOR ORDERS A CENTRAL LINE MAINTENANCE BUNDLE WHICH

THE NURSE FOLLOWS. THE LINE IS REMOVED AS SOON AS NO LONGER INDICATED.

Move ahead 2 spaces


PATIENT JOURNEY 10

THE PATIENT REFUSES SCD AND DOES NOT AMBULATE OFTEN.

THE RN EDUCATES PATIENT ABOUT IMPORTANCE OF SCD. THE PATIENT DECIDES TO WEAR THEM.

Move ahead 1 space


THE PATIENT RECEIVES FLU SHOT ON SECOND DAY IN HOSPITAL.

.

Move ahead 2 spaces


collaboration to help the patient be discharged.Discuss situation in terms of inter-professional collaboration to help the patient be discharged.

PATIENT JOURNEY 11

THE PATIENT EATS BREAKFAST EVEN THOUGH THEY ARE NPO AND THE PROCEDURE IS DELAYED.

Move back 2 spaces


THE CTM IS WAITING FOR PRICING AND DOSES FROM PHARMACY FOR CHARITY MEDICATION REQUESTS FOR

PATIENT DISCHARGE

Do not move, wait for next turn


collaboration to help the patient be discharged.

THE PATIENT BECOMES SEPTIC AND MOVES TO A HIGHER LEVEL OF CARE.

Move back 2 spaces



THE PHARMACIST MANAGES THE VANCOMYCIN DOSING AND SENDS A REMINDER THROUGH THE ELECTRONIC

HEALTH RECORD THAT A TROUGH IS DUE. THE RN SENDS THE LAB. THE PATIENT RECEIVES THE CORRECT

DOSE.Move ahead 1 space


PATIENT JOURNEY 12

THE RN MISSES THE VANCOMYCIN TROUGH. THE PHARMACIST CANNOT ADJUST THE DOSE PROPERLY.

Move back 1 space


THE SURGEON DISCHARGES THE PATIENT BUT THE HOSPITALIST WON’T BE ON THE UNIT UNTIL 3 PM. THE

FAMILY IS IN THE HALL YELLING AT THE CHARGE NURSE..

Do not move; wait till next turn


collaboration to help the patient be discharged.Discuss situation in terms of inter-professional collaboration to help the patient be discharged.

PATIENT JOURNEY 13



THERE ARE DUPLICATE ORDERS FOR PAIN MEDICATIONS. THE DOCTOR WROTE AN ORDER FOR: 1 MG MORPHINE FOR MODERATE (4-7) PAIN AND NORCO 5, 2 TABLETS FOR

MODERATE (4-7) PAIN. THE RN CLARIFIES THE ORDER TO SEE WHICH IS TO BE GIVEN FOR MODERATE PAIN.

Do not move; wait for next turn.


collaboration to help the patient be discharged.

THE PATIENT IS OVER SEDATED AFTER THE PATIENT RECEIVES NORCO 10, XANAX, BENADRYL,

PHENERGAN, AND DILAUDID WITHIN 2 HOURS AND RAPID RESPONSE IS CALLED.

THE PATIENT IS SENT TO A HIGHER LEVEL OF CARE.Move back 2 spaces



THE PATIENT HAS A FOLEY AND IS MOBILE ON POST OR DAY ONE, THE FOLEY IS NO LONGER INDICATED AND

THE DR USED AN ORDER SET SO THE RN CAN REMOVE IT WHEN NOT INDICATED.

Move ahead 2 spaces


THE PATIENT IS OVER 65 YRS. OLD AND GETS BENZODIAZEPINE AFTER A PROCEDURE AND

DEVELOPS SUDDEN ONSET DELIRIUM. HE FALLS FROM THE BED AND HAS AN INJURY.

Move back 2 spaces



PATIENT JOURNEY 14




THE PATIENT HAS A FOLEY CATHETER AND INSISTS ON KEEPING IT FOR CONVENIENCE. SHE IS MORBIDLY

OBESE AND RNS AGREE DUE TO DIFFICULTY MOBILIZING HER. SHE DEVELOPS A CAUTI.

.Move back 2 spaces


PATIENT JOURNEY 15

THE PATIENT HAS A PICC LINE AND THE NURSES CAREFULLY FOLLOW THE MAINTENANCE ORDERS FOR CLEANING THE AND FLUSHING THE LINES. NO CLABSI

OR PHLEBITIS.

Move ahead 1 space


THE DOCTOR CONSULTS THE PHARMACIST AND DETERMINES THAT THE ANTIBIOTICS CAN BE GIVEN

THROUGH MIDLINE AND THEN PO AND THE PATIENT WILL NOT REQUIRE A PICC LINE FOR IV ACCESS.

Move ahead 1 space


PATIENT JOURNEY 16

THE RN, PATIENT, DR, & CTM DISCUSSED DISCHARGE MEDICATIONS DURING ROUNDING AND DETERMINED

THAT THE NEEDED MEDICATIONS WERE ON THE $4 LIST AND THE PATIENT COULD AFFORD THEM.



THE DOCTOR DISCHARGES THE PATIENT. THE CTM RECOGNIZES THE MEDICATION IS VERY EXPENSIVE AND

NOT COVERED BY THE PATIENT’S INSURANCE. THE PATIENT CANNOT AFFORD THE MEDICATION. AN

APPLICATION FOR CHARITY MEDS IS STARTED.

Move back 1 space


PATIENT JOURNEY 17

THE DAY BEFORE DISCHARGE, THE DOCTOR, RN, AND CTM, PLAN WITH THE PATIENT THAT INCLUDES

HAVING A FAMILY MEMBER PRESENT FOR TRANSPORTATION.

Move ahead 2 spaces


THE PATIENT HAS BEEN DISCHARGED AND HAS THEIR PAPERWORK BUT NO RIDE HOME. THEY SAY THEIR

FRIENDS, FAMILY AND NEIGHBORS ARE ALL UNAVAILABLE. THEY STAY IN THE ROOM UNTIL 7 PM

DESPITE PATIENTS IN ER HOLD AND PACU.

Move back 2 spaces


PATIENT JOURNEY 18

THE PATIENT INITIALLY REFUSED THE FLU SHOT AND NOW WANTS IT BEFORE LEAVING, THE RN HAS

REQUESTED IT VIA PROTOCOL ORDER. PHARMACY WILL SEND IT THROUGH THE TUBE SYSTEM.

Do not move; wait till next turn


THE PATIENT HAS BEEN DISCHARGED AND HAS THEIR PAPERWORK BUT NO RIDE HOME. THEY SAY THEIR

FRIENDS, FAMILY AND NEIGHBORS ARE ALL UNAVAILABLE. THE CTM PROVIDES A CAB VOUCHER

(DUE TO HOLDS IN ER).

Move ahead 1 space


PATIENT JOURNEY 19

THE DOCTOR FORGOT TO SIGN THE TRIPLICATE PRESCRIPTION AND HAS LEFT THE HOSPITAL. THE RN CALLS HIS CELL AND HE RETURNS TO THE UNIT RIGHT

AWAY TO SIGN THE PRESCRIPTION.

Do not move, wait for next turn.


THE DOCTOR FORGOT TO SIGN THE TRIPLICATE PRESCRIPTION AND HAS LEFT THE HOSPITAL. THE RN

HAS LEFT 2 MESSAGES WITH HIS ANSWERING SERVICE.

Move back 2 spaces


PATIENT JOURNEY 20

THE DOCTOR FORGOT TO SIGN THE TRIPLICATE PRESCRIPTION AND HAS LEFT THE UNIT. THE RN GOES TO THE OTHER UNIT TO GET THE PRESCRIPTION SIGNED.

Move ahead 1 space


THE DOCTOR SIGNED THE TRIPLICATE PRESCRIPTION AND

HANDED IT TO THE DISCHARGE RN.

Move ahead 2 spaces


PATIENT JOURNEY 21

THE PATIENT IS OUT OF BED TO THE REST ROOM OR IN THE ROOM TO SIT IN THE CHAIR FOR MOST MEALS.

Move ahead 1 space


THE FAMILY SAID THEY CAN NO LONGER CARE FOR GRANDMA AND WILL NEED TO FIND NEW LIVING

ACCOMMODATIONS. GRANDMA DOES NOT AGREE. THE CTM HELPS FIND AN AGREEABLE SOLUTION.

Move forward 1 space


PATIENT JOURNEY 22

THE PATIENT AMBULATES IN THE HALLS AT LEAST FOUR TIMES A DAY AND SITS IN THE CHAIR FOR ALL

MEALS.

Move ahead 2 spaces


THE PATIENT WAS FOUND ON FLOOR AND CANNOT RETURN TO SAME LIVING SITUATION. CTM MUST FIND

SKILLED NURSING FACILITY. THERE IS NO FAMILY TO ASSIST.

Move back 1 space


PATIENT JOURNEY 23

THE PATIENT IS VERY WEAK AND UNSTABLE. THE RN NOTIFIES THE DOCTOR WHO ORDERS HOME HEALTH AND HOME PT. THE CTM BEGINS THE INSURANCE

APPROVAL PROCESS.

Move back 1 space


THE PATIENT IS OVER 65 YRS. OLD AND GETS BENZODIAZEPINE AFTER A PROCEDURE AND

DEVELOPS SUDDEN ONSET DELIRIUM. HE NEEDS A SITTER.

. Move back 1 space


PATIENT JOURNEY 24

THE PATIENT IS ON 40 MG LOVENOX AND PHARMACISTNOTICES THE PATIENT HAS POOR RENAL FUNCTION; HE

CONTACTS THE DOCTOR AND OBTAINS ANUPDATED ORDER FOR 30 MG LOVENOX.



THE DOCTOR TOLD THE PATIENT THEY WERE DISCHARGED AND THEN CONTINUED ROUNDING. HE

DID NOT INPUT THE ORDERS FOR 2 HOURS. THE HUSBAND IS STANDING IN THE HALL WITH HIS ARMS CROSSED. HE TOLD THE NURSE HE IS LEAVING IN 20

MINUTES, WITH OR WITHOUT PAPERWORK.

Do not move; wait for next turn


PATIENT JOURNEY 25

PATIENT STAYS IN BED AND EXPERIENCES FUNCTIONAL DECLINE. DOCTOR CONSULTS PHYSICAL THERAPY AND

THEY RECOMMEND DISCHARGE TO REHAB. DOCTOR WRITES ORDER AND CTM BEGINS INSURANCE

APPROVAL PROCESS.

Move back 2 spaces


THE DOCTOR FORGOT TO SIGN THE TRIPLICATE PRESCRIPTION AND HAS LEFT THE HOSPITAL. THE RN

HAS LEFT 2 MESSAGES WITH HIS ANSWERING SERVICE.

Move back 2 spaces


PATIENT JOURNEY 26

THE RN COULD NOT LOCATE A NEEDED ANTIBIOTIC. SHE CALLED THE PHARMACY AND THEY ARE RE-

SENDING THROUGH THE TUBE STATION. Move forward 1 space


THE PATIENT DID NOT WANT TO BE DISCHARGED. AFTER BEING TOLD THAT THEY WOULD BE GOING HOME

TODAY THEY WERE FOUND ON THE FLOOR AND SAID THEY FELL AND WERE HURT.

Move back 2 spaces


PATIENT JOURNEY 27

Appendix BParticipant Self-Assessment Tool

To help us evaluate effectiveness of our IPE program, and offer you an opportunity to assess your own learning, please fill out the following self-assessment evaluation. We thank you for attending today’s workshop.

Strongly Agree

Agree Undecided Disagree Strongly disagree

The objectives of this activity were accomplished ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

This activity improved my understanding of howto be an effective team member ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

This activity helped me better understand how toimprove patient care/outcomes through collaboration ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

The format of this activity was helpful to my learning and development on interprofessional collaboration ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

I better understand how some actions of the interprofessional team can help the patient get to a timely discharge and how some actions can hinder patient discharge ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

I would recommend this activity to other departmentsin my hospital. ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

Mutual respect and trust of my co-workers’ capabilitiesis a foundation for effective collaboration and patientcare ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

I will work toward understanding the role of others and use their expertise to help me meet patient care goals. ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

Patient care will be enhanced when I actively listen to others and communicate my knowledge and ideas in a clear and consistent manner. ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

I will focus more on sharing patient care decisions with colleagues when I return to work. ⃝6 ⃝6 ⃝6 ⃝6 ⃝6

An Interprofessional Collaborative Learning Activity


Documents

Increasing Emotional Intelligence€¦ · Web viewInterprofessional collaborative (IPC) practice is a process whereby professionals from varying disciplines work together and value