Intro to Advance Med. Surg. (NURS 480-Week 1)Complete Solution Guide

Evidence Based Practice Problem solving approach to clinical decision making Where research has indicated best practices that improve or save, patient lives, lower length of stay, and improve mortality rates better safety=better quality of care Safety & Quality Improvement -National Patient Safety Goals The Joint Commission Teamwork & Collaboration Work with interdisciplinary team members -communication is KEY Situation (Dx Admission) Background (Hst) Assessment (Data) Recommendation (interventions) Teamwork & Collaboration (Holistic Multudisciplinary approach) Using a holistic multidisciplinary approach: In critical care, the need for a multidisciplinary approach increases. Several physician specialties, may be involved in the care of the patient. Physical therapists, respiratory therapists, pharmacists, occupational therapists, case managers, social workers, dieticians, and dialysis nurses may all be involved in attaining outcomes in the care of one patient WHO COORDINATES ALL OF THESE PEOPLE? THE NURSE!! Teamwork & Collaboration (Delegation) Right task Right circumstance Right person Right supervision Right direction & communication Communication Communication is paramount Ineffective communication is the #1 cause of sentinel events in the hospital #2 medication 1-Read back of standard orders 2-Use of standard abbeviations 3-Timely & accurate reporting of critical lab results 4-Standardization of "handoff communication" Factors that make communication difficult a. Noisy work environment b. Different accents, dialects and pronunciation patterns c. Interruptions d. Unfamiliar drug names or terminology e. Medications with sound-alike names f. Reliance on memory when writing down an order at a later time g. Speed at which orders are carried out h. Little time for correction i. The tendency of the person giving the order to expect the person taking the order to understand what is being said Safety measures to ensure concise communication i. Ask for correct spellings if unsure ii. Spell out numbers when repeating back orders iii. Record a verbal order directly onto a physician order sheet or CPOE iv. Restrict verbal/telephone orders v. Include the purpose of the drug on the order sheet vi. Avoid "Do Not Use" abbreviations vii. SBAR Communication with patients and significant others a. Need to evaluate the patient's ability to see and hear b. Assess the effect of stress when speaking with the patient and/or family. High stress decreases the ability to process information. c. Consider cultural and education factors in the learning process d. Provide direct, consistent communication in language that is readily understandable to the patient and family member e. Repeat information frequently. f. If you don't know the answer to a question, admit it and instruct the family that you will find the answer. g. NEVER FORGET: You are the patient advocate! It is your responsibility to assure the patient/family member has the information needed to make informed decisions regarding care Teaching/Learning Principles with critically ill patients/family members (Characteristics of Adult Learners) Malcom Knowles Adults value -self-direction -are motivated to learn when they perceive that they have a need to learn -bring a variety of life experiences to the learning situation