1/17/2013. Preparing Collaboration Ready Practitioners Interprofessional Education. Speaker Introduction. Webinar Objectives. Background Information

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1 Disclosures There is no conflict of interest or relevant financial interest by the faculty or planners of this activity. AACN does not endorse any commercial product related to this activity. The entire webinar and the program evaluation must be completed to earn contact hours. This webinar will be recorded and available until January 17, 2016 Preparing Collaboration Ready Practitioners Interprofessional Education CAROL F. DURHAM, EdD, RN, ANEF a n d MARTINA S. HARRIS, EdD, RN Speaker Introduction Webinar Objectives Dr. Carol F. Durham Dr. Martina S. Harris At the completion of this webinar the participant will: Discuss inter-professional education in a broader context. Define the Interprofessional Education Collaborative (IPEC) core competencies. Describe education strategies to engage learners in meaningful educational experiences to improve their teamwork and communication skills. Background Information Of 270,491 deaths, 238,337 were potentially preventable ( ) 400,000+ medication errors per year $8-29Billion spent annually Who is responsible for the issue of patient safety? 1

2 Root Cause Analysis of Sentinel Events Reviewed by The Joint Commission ( ) Who is responsible? 2011 Human Factors Leadership 2010 Communication % 10% 20% 30% 40% 50% 60% 70% 80% 90% How do we avoid this If we are teaching as we were taught, then we re preparing students for a health care system that no longer exists! What is Interprofessional Education? Interprofessional Education (IPE) When two or more professionals* learn about, from, and with each other to enable effective collaboration and improve health outcomes (WHO, 2010, p.13) * Professional is an all-encompassing term that includes individuals with the knowledge and/or skills to contribute to the physical, mental and social wellbeing of a community. World Health Organization (2010) Framework for Action on Interprofessional Education & Collaborative Practice 2

3 Quality and Safety Education for Nurses (QSEN) Teamwork and Collaboration Function effectively within nursing and interprofessional teams, fostering open communication, mutual respect, and shared decision-making to achieve quality patient care. K: Describe examples of the impact of team functioning on safety and quality of care. S: Function competently within own scope of practice as a member of the healthcare team A: Appreciate the risks associated with handoffs among providers and across transitions in care. Joint Commission 2011 National Patient Safety Goals for Hospitals Improve the effectiveness of communication among caregivers Identify patients correctly Use medications safely Reconcile medications Prevent Infections Identify patient safety risks ( Joint Commission National Patient Safety Goal-2E Are our graduates equipped with a good teamwork & collaboration GPS? Implement a standardized approach to hand-off communications including an opportunity to ask and respond to questions. Patient Safety Interprofessional Collaborative Practice F A C I L I T A T I N G I N T E R A C T I O N A M O N G H E A L T H P R O F E S S I O N S S T U D E N T S I S E S S E N T I A L T O E S T A B L I S H I N G R E S P E C T F O R T H E C O N T R I B U T I O N E A C H P R O V I D E R M A K E S T O Q U A L I T Y H E A L T H C A R E. B Y M O V I N G T O A D O P T M O D E L S T H A T E M B R A C E I N T E R P R O F E S S I O N A L E D U C A T I O N A N D P R A C T I C E, I P E C I S W O R K I N G T O H E I G H T E N C O L L A B O R A T I O N A C R O S S D I S C I P L I N E S T O M A X I M I Z E T H E S T R E N G T H S T H A T I N D I V I D U A L P R O F E S S I O N S B R I N G T O I N T E G R A T E D C A R E D E L I V E R Y. G E R A L D I N E P O L L Y B E D N A S H, P h D, R N, F A A N C H I E F E X E C U T I V E O F F I C E R A N D E X E C U T I V E D I R E C T O R A M E R I C A N A S S O C I A T I O N O F C O L L E G E S O F N U R S I N G 3

4 FIGURE 6: Interprofessional Collaborative Practice Domains found in the Core Competencies for Interprofessional Collaborative Practice UNC-CH Interprofessional Training (IPT) Logistics 3 credit hour elective Evening Class Approval required from Curriculum Committees Student Learners 2 nd year Medicine, 2 nd year Nursing, 3 rd year Pharmacy Faculty and Staff Faculty Course Director from each profession Teaching Assistants Reprinted with permission from The Association of American Medical Colleges (AAMC). Core Competencies for Interprofessional Collaborative Practice. IPT Course- Course Content IPT Course - Simulation Interactive Class Sessions TeamSTEPPS Medical Error & Error Disclosure Patient Handoffs Root Cause Analysis Medical Malpractice Just Culture Basic Life Support (BLS) Tears to Transparency Video- Lewis Blackman Patient Simulation Standardized Patients (SPs) Difficult Communications Error Disclosure Cultural Sensitivity High Fidelity Simulators 3 Acute interventions Role Play Handoffs Medical Malpractice Mock Trial Root Cause Analysis 21 1/16/20131/16/2013 IPT Course - Outcomes Students report statistically significant improvement on interprofessional communication collaboration roles and responsibilities collaboration patient/family centered approach conflict management resolution team function after our interprofessional training preparing graduates to meet the IPE competencies and to be collaborative practice-ready Team Strategies and Tools to Enhance Performance and Patient Safety 4

5 TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety Developed by the Department of Defense s Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality A teamwork system designed for health-care professionals to: Improve patient safety Improve communication and teamwork skills among health care professionals Two-Challenge Rule Invoked when an initial assertion is ignored It is your responsibility to assertively voice your concern at least two times to ensure that it has been heard The member being challenged must acknowledge If the outcome is still not acceptable Take a stronger course of action Use supervisor or chain of command Birthing Simulations with Neonatal Resucitation Please Use CUS Words but only when appropriate! 27 Birthing & Resuscitation Simulation Nursing Students Roles Rationale for IPE Assessment & care of laboring women Assessment of fetal status per FHM Support of woman and family Communication with OB MD and Peds/Neo (TeamSTEPPS ) Assist with vaginal birth Assist with initial newborn care Collaborate with physicians in care of baby & mom Medical Students Roles Respond to call for help Communication with OB nurse (TeamSTEPPS ) Assist with vaginal birth Assist with initial newborn care Direct neonatal resuscitation Interprofessional collaborative practice KEY to safe, high quality, accessible, patient-centered care Continuous development of interprofessional competencies by health professions students needs to be integral component of clinical skills Requires immersing students of different professions in interactive learning with each other Goal is for graduates to enter workforce ready to practice effective teamwork and team-based care Collaborate with nurses in care of baby & mom 2011 American Association of Colleges of Nursing, American Association of Colleges of Osteopathic Medicine, American Association of Colleges of Pharmacy, American Dental Education Association, Association of American Medical Colleges, and Association of Schools of Public Health. 5

6 To Err is Human It is simply not acceptable for patients to be harmed by the same health care system that is supposed to offer healing and comfort Reprinted with permission from D Amour, D. & Oandasan. I. (2005). Interprofessionaltiy as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care, Supplement 1, Who should be a part of IPE? Who Benefits from IPE? P H Y S I C I A N S N U R S E S P H Y S I C A L T H E R A P I S T A N C I L L A R Y S T A F F P A T I E N T F A M I L Y M E M B E R S P H A R M A C Y D E N T I S T S P L U S... A N Y O N E E L S E O N T H E P A T I E N T C A R E T E A M P H Y S I C I A N S N U R S E S P H Y S I C A L T H E R A P I S T A N C I L L A R Y S T A F F PATIENT F A M I L Y M E M B E R S P H A R M A C Y D E N T I S T S P L U S... A N Y O N E E L S E O N T H E P A T I E N T C A R E T E A M Our Challenge All health professionals should be educated to deliver patientcentered careas members of an interdisciplinary team, emphasizingevidence-based practice,quality improvement approaches, and informatics. Committee on Health Professions Education Institute of Medicine (2003) Reprinted with permission from World Health Organization (WHO). (2010). Framework for Action on Interprofessional Education Collaborative Practice. Geneva: World Health Organization. 6

7 The Faces of Medical Error From Tears to Transparency The Story of Lewis Blackman Transparent Health, Reason s Swiss Cheese Model Defenses prevent error Putting faces with Medical Error Considering how interprofessional communication, collaboration and teamwork could avoid tragic errors. Let s consider Lewis story \ Case Study Key events Reason s Swiss Cheese Model Holes line-up and Error Occurs Day 1 Pectus Excavatum 15-year old (co-morbidity asthma) Epidural analgesic Ketorolac (NSAID) for pain management Bed space admitted to pediatric oncology versus Day 2 not eating yet diet increased lots of uncontrolled pain unable to ambulate without help Day 3 112/ bpm sips of water and nausea Pain 2-4 Scale of 5 Day 4 5/5 severe, sudden abdominal pain No water, no solid food, no ambulation 152/ bpm pain due to constipation oxycodone added black circles under eyes, diaphoresis, distended abdomen Day 5 SpO2 85 applied O2, 137/85 HR am Severe abd pain 140/100 HR 140, R 28, pale nausea/weak Few hours later pain suddenly gone away ml s blood in abdomen Duodenum ulceration - perforation posterior wall eroded into gastro duodenum artery 4 year before Ketorolac identified as post-op GI bleed Black box warning Autospy Results ANYWHERE but If Lewis had been ANYWHERE but in a hospital he would be alive today The hospital was the one place We were not able to get him the medical attention he needed H E L E N H A S K I L L, M O T H E R 7

8 Reflective Questions for Educators Further thoughts about IPE What collaborative behaviors do you demonstrate that foster IPE? What will you tell your students about IPE? P A T I E N T S L I K E L E W I S A R E W H Y W E A L L S H O U L D B E I N T E G R A T I N G I N T E R P R O F E S S I O N A L E D U C A T I O N I N T O O U R P R O G R A M S What do you want your program to accomplish relative to IPE? Requirement for Accreditation Question & Answer National League for Nursing Accrediting Commission (NLNAC) Commission on Collegiate Nursing Education (CCNE) Both reviewers seek evidence of interprofessional education at time of accreditation TeamSTEPPS Quality and Safety in Education for Nurses (QSEN) T E A M S T E P P S [ T E A M S T R A T E G I E S A N D T O O L S T O E N H A N C E P E R F O R M A N C E A N D P A T I E N T S A F E T Y ] T E A M W O R K A N D C O M M U N I C A T I O N C U R R I C U L U M D E V E L O P E D B Y T H E D E P A R T M E N T O F D E F E N S E ( D O D ) I N C O L L A B O R A T I O N W I T H T H E A G E N C Y F O R H E A L T H C A R E R E S E A R C H A N D Q U A L I T Y ( A H R Q ) H T T P : / / T E A M S T E P P S. A H R Q. G O V / Q S E N. O R G - F A C U L T Y R E S O U R C E S - L E A R N I N G M O D U L E S M O D U L E T E N I N T E R P R O F E S S I O N A L E D U C A T I O N ( I P E ) : L E A R N I N G F O R P R A C T I C E T H I S M O D U L E H A S B E E N D E S I G N E D T O A S S I S T Y O U I N U N D E R S T A N D I N G T H E B A C K G R O U N D A N D D E V E L O P M E N T O F I N T E R P R O F E S S I O N A L E D U C A T I O N ( I P E ) I N I T I A T I V E S A N D T O S H A R E A P R O P O S E D C O N C E P T U A L F R A M E W O R K O F I P E. Y O U W I L L R E A L I Z E T H E R E Q U I R E D I N F R A S T R U C T U R E A N D O R G A N I Z A T I O N A L S U P P O R T N E E D E D F O R S U C C E S S F U L I P E P R O G R A M S A N D F I N A L L Y H A V E S E V E R A L C O N C R E T E E X A M P L E S O F I P E A C T I V I T I E S T H A T H A V E B E E N S U C C E S S F U L L Y I M P L E M E N T E D I N A V A R I E T Y O F E D U C A T I O N A L S E T T I N G S. 8

9 Quality and Safety Education for Nurses (QSEN) Quality and Safety Education for Nurses (QSEN) Q S E N. O R G - F A C U L T Y R E S O U R C E S - L E A R N I N G M O D U L E S M O D U L E S E V E N T E E N P A T I E N T S A F E T Y : O U R I N T E N T I S T O D O N O H A R M S O W H Y D O E R R O R S H A P P E N? T H E S I G N I F I C A N C E O F E R R O R S I N P A T I E N T C A R E H A S B E E N H I G H L I G H T E D I N T H E L I T E R A T U R E A N D M E D I A S I N C E T H E S E N T I N E L W O R K O F T H E I N S T I T U T E O F M E D I C I N E E N T I T L E D T O E R R I S H U M A N : B U I L D I N G A S A F E R H E A L T H S Y S T E M. U S I N G Q S E N C O M P E T E N C I E S T O P R E P A R E S T U D E N T S T O B E V I G I L A N T A R O U N D P A T I E N T S A F E T Y A N D T O U N D E R S T A N D T H E I M P A C T O F E R R O R S, T H I S M O D U L E W I L L S H A R E E X A M P L E S O F P A T I E N T S A F E T Y, J U S T C U L T U R E, A N D W I L L S H A R E S O M E P E D A G O G I E S U S I N G S I M U L A T I O N T O A L L O W I M M E R S I O N I N T O T E A M W O R K A N D C O L L A B O R A T I O N T O P R O M O T E S A F E P A T I E N T C A R E. Q S E N. O R G - V I D E O S - T H E L E W I S B L A C K M A N S T O R Y H E L E N H A S K E L L I S T H E M O T H E R O F L E W I S B L A C K M A N, A Y E A R - O L D B O Y W H O D I E D I N A H O S P I T A L F O L L O W I N G R O U T I N E S U R G E R Y. T H E V I D E O S W E R E P A R T O F A L E C T U R E A N D I N T E R V I E W S W I T H M S. H A S K E L L R E C O R D E D A T T H E U N C - C H A P E L H I L L S C H O O L O F N U R S I N G I N S U M M E R NLN Simulation Innovation Center (SIRC) Core Competencies for Interprofessional Collaborative Practice Sponsored by the Interprofessional Education Collaborative* *IPEC sponsors: American Association of Colleges of Nursing American Association of Colleges of Osteopathic Medicine American Association of Colleges of Pharmacy American Dental Education Association, Association of American Medical Colleges Association of Schools of Public Health Report of an Expert Panel May 2011 T H E S I M U L A T I O N I N N O V A T I O N R E S O U R C E C E N T E R ( S I R C ) N A T I O N A L L E A G U E F O R N U R S I N G T H E S I R C I S A N O N L I N E E - L E A R N I N G S I T E F O R N U R S I N G F A C U L T Y T O L E A R N A B O U T S I M U L A T I O N A N D W A Y S T O I N T E G R A T E I T I N T O T H E I R C U R R I C U L U M. I T P R O V I D E S V A R I O U S W A Y S F O R F A C U L T Y T O E N G A G E W I T H E X P E R T S A N D P E E R S. H T T P : / / S I R C. N L N. O R G / T H I S M A Y R E P O R T O U T L I N E S T H E C O R E C O M P E T E N C I E S F O R I N T E R P R O F E S S I O N A L C O L L A B O R A T I V E P R A C T I C E A N D H O W T O P R O M O T E M O R E T E A M B A S E D E D U C A T I O N. H T T P : / / W W W. A A C N. N C H E. E D U / E D U C A T I O N - R E S O U R C E S / I P E C R E P O R T. P D F S I M U L A T I O N - B A S E D I N T E R P R O F E S S I O N A L E D U C A T I O N H T T P : / / S I R C. N L N. O R G / M O D / R E S O U R C E / V I E W. P H P? I D = WHO Framework for Action on Interprofessional Education and Collaborative Practice W W W.WHO.I N T /H R H /RESO U R C E S /F R A M E W O R K _ A C T I O N /E N /I N D E X. H T M L - s The Josiah Macy Jr. Foundation Jefferson InterProfessional Education Center (JCIPE) Center for Health Sciences Interprofessional Education 9

10 Best Standards of Practice: Simulation INASCL Board of Directors. (2011). Best Standards of Practice: Simulation. Clinical Simulation in Nursing, S3-S19. S %2811%29X A Nursing Perspective on Simulation& IPE A Nursing Perspective on Simulation and Interprofessional Education (IPE): A report from the National League for Nursing s Think Tank on using simulation as an enabling strategy for IPE es/pdf/nursing_perspective_sim_education.pdf AACN Teamwork and Collaboration Joanne Disch, PhD, RN, FAAN Contact Information AACN Member Collaboration Community State of the Science for Teamwork and Collaboration Learning Module Teamwork and Collaboration Carol F. Durham EdD, RN, ANEF Clinical Professor & Director, Education- Innovation-Simulation Learning Environment University of North Carolina at Chapel Hill School of Nursing INACSL President-Elect cdurham@ .unc.edu Martina S. Harris, EdD, RN UC Foundation Assistant Professor University of Tennessee at Chattanooga School of Nursing INACSL Vice-President of Membership martina-harris@utc.edu