Transcript Week Two: Correcting Medical Errors

Flue
Final Module
Interdisciplinary Teamwork
Healthcare Importance
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Develop understanding as to how each
professional contributes to a patient-centered
approach to health and wellness.
Promote clearer communications among
diverse professionals to improve quality of
healthcare standards.
Understand how each professional can better
assist fellow team members in overall care for
the patient.
Team Building Activity
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This activity requires the leader to purchase enough
Dum-Dum lollipops for each student to have one lollipop
prior to the start of class.
In this activity, the leader needs to pass out a DumDum lollipop to each member of the health care group.
For every letter that appears in the flavor, a group
member has to share something about his or her
profession.
Team Building Activity
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For instance if the member speaking were a
nurse and got the flavor grape her facts may be
as follows:
G: I give patient prescribed medications
R: I raise public awareness on health issues
A: I advocate for my patient's rights
P: I protect my patients from injury
E: I am empathetic toward my patients
Pre / Post Test Questions
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During the first week students will be presented with a pretest that
will test their current level of knowledge on the other professions
Students must complete this test at home and on their own. We
encourage you to be resourceful with online resources as you learn
about one another, but please refrain from asking individuals in your
group or outside for the answers.
After you have completed the test please review your results and
indicate the correct answer on any questions you got wrong, and the
reason your answer was incorrect while the correct answer is the
right choice. Submit these answers on a word document to
blackboard under the correct tab to receive credit for your answers.
Pre / Post Test Questions
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The following week in class, get together with your
group for a few moments to discuss the answers. If
there were any you felt confused about and wanted
clarification on, seek the advice of the member of your
group from that profession.
At the end of this class you will be asked to take this
test once again. It is expected that once you have
discussed answers you struggled on with group
members, and learned more about the other
professions this may be easier for you to complete.
Pre / Post Test Questions
1. All of the following statements are a reason SLPs can provide professional services via telepractice except:
A. Telepractice may be used to overcome barriers of access to services caused by distance, unavailability of
specialists, and impaired mobility.
B. Telepractice removes service delivery responsibilities including adherence to HIPAA, licensure requirements,
and adherence to the Code of Ethics.
C. Telepractice offers the potential to extend clinical services to remote, rural, and underserved populations.
D. The American Speech-Language Hearing Association (ASHA) position is that telepractice is an appropriate
model of service delivery for the professions of audiology and speech-language pathology.
2.
SLPs in Ohio may be required to attain multiple licensures/certifications depending on their professional setting.
Choose the answer that contains only SLP licensure requirements in Ohio.
A. ASHAs Certification of Clinical Competence, Ohio Board of Education licensure, Great Lakes Regional Board of
Speech Language Pathology and Audiology licensure.
B. ASHAs Certification of Clinical Competence, Ohio Certificate of Praxis Completion.
C. Ohio Board of Education licensure, ASHAs Certification of Clinical Competence, Ohio Board of Speech Language
Pathology and Audiology licensure.
D. Certification of acceptance from the American Academy of Pediatrics, Certification of acceptance from the
National Association of Hospitals, Licensure from the American Speech-Language Hearing Association
(ASHA).
Questions continued
3. Chose the answer that is not part of an SLPs scope of practice:
A. Donating two hours of free speech-language therapy services each month at a local school or
hospital.
B. Screening, assessment, diagnosis and treatment of acquired and organic speech and language
delays/disorders in all ages.
C. Treatment of fluency (stuttering), social language, dysphagia (swallowing), and singing voice.
D. Screening for outer and middle ear pathology.
4. SLPs can work in a variety of settings. Choose the setting that is not considered a typical setting
for SLP services.
A. Private practice
B. Individuals' homes and community residences
C. Correctional institutions
D. Industrial settings
E. None of the above
Questions continued
5. What body system do physical therapists specialize in?
A.
Musculoskeletal
B.
Cardiopulmonary
C.
Neurological
D.
Integument
6. How long is the doctorate of physical therapy academic program?
A.
4 years
B.
1 year
C.
D.
3 years
2 years
Questions continued
7. In a hospital setting, what is a major/the most important responsibility of a
physical therapist that they do not have in other settings?
A.
Fitting a prosthesis
B.
Long term rehabilitation
C.
Discharge planning
D.
Walking patients
8. What other profession do physical therapists often work closely with because
they provide similar services?
A.
Occupational therapists
B.
Speech language pathologist
C.
Physician
D.
Social worker
Questions continued
9.) As a nurse, what patient would you see first?
A.
The patient who has a minor ankle injury
B.
The patient who was just in a house fire and has a swelling face and burnt nose
hairs
C.
The patient who scheduled to have their pain medication in ten minutes
D.
The patient who has a an infected paper cut
10.) As a nurse it is our job to provide patient education and support and follow up on what the
physician says. How would a nurse respond to a male client who says, “Only girls can get
Gardasil shots”
A. That is correct, this vaccination is reserved for women in protecting from the HPV virus
and there are no benefits for males
B. Both men and women can get this shot and be protected from newly getting the HPV
virus
C. Both men and women can get this shot but there are no benefits for men, it simply won’t
harm them.
D. This vaccination is not safe for men or women currently.
Questions continued
11.) As a nurse you are following up with a client recently diagnosed with diabetes who is confused
about what insulin to give at what time of the day. He asks you which insulin he should take before
meals, and which insulin is long acting. What is the best response? You are trying to explain which
is short acting, and which is long acting.
A. You should give glargine (Lantus) before meals and detemir (Levemir) as your long acting dose in
the morning or before bed for 24 hour control.
B. You should give lispro (Humalog) before meals and detemir (Levemir) as your long acting dose in
the morning or before bed for 24 hour control.
C. You should give glargine (Lantus) before meals and lispro (Humalog) as your long acting dose in
the morning or before bed for 24-hour control.
D. You should give lispro (Humalog) before meals and aspart (NovoLog) as your long acting dose in
the morning or before bed for 24-hour control.
12.) What settings would you find an RN (with or without any special certification), practicing in?
A.
A mental health unit
B.
A school or university
C.
An oncology outpatient unit
D.
All of the above
Questions Continued
13. Which of the following do NOT have the authority to prescribe drugs?
A. MDs
B. DOs
C. Social Workers
D. Nurse Practitioners
E. Dentists
14. Which of the following is a typical requirement for admission to any U.S.
medical school?
A. Bachelor's degree
B. Master's degree
C. PhD
D. Associate's degree in nutrition
Questions Continued
15. Which of the following is the best description for the difference between
MDs and DOs?
A. MDs are better doctors
B. DOs cannot practice in all 50 states
C. DOs can only prescribe noncontrolled drugs
D. DOs are trained to view the patient as a "total person" with a focus a primary
and preventive care, employing techniques such as OMT for the
maintenance
of health.
16. OUHCOM has an ambitious goal of sending ______% of its students into
primary care fields:
A. 50%
B. 70%
C. 90%
Pre Post Test Answer Key
1. B
D
2. D
D
3. A
C
4. E
A
5. A
D
6. C
11.
12.
13.
14.
15.
16.
Case Study Video
Alone in a crowd (~4 minutes)
Review the clinical scenario on the following slide.
1. Be sure that there is a clear role for your discipline.
1. If you feel there is not a clinical role for your discipline in this case, ADD or
MODIFY the case to provide a reasonable access point. This could be the
result of adding a concomitant disorder that is unrelated or that may
reasonably co-occur.
Case Study Video
Week One: Evidence-Based Medicine
After careful considerations, the medical team has decided
our patient from the video, Ms. Shore, has suffered a
cerebrovascular accident (CVA).
1. Apply EBP principles using a project-based approach
by completing Steps 1-5 on the next slide.
Start a SINGLE Google document for your group and
share it with the each member. Conduct your own
individual EBM search. All group members add search
responses to their group document. Step #5 should be
a summary of your group’s performance on what you
learned about this case and this process. Feedback will
be provided to each of the five EBM steps to answer the
clinical question in this case
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Week One: EBM Contd
1. Formulate an answerable clinical question Develop a good clinical question based on the case.
[Report your clinical question]
2. Finding the evidence* Search relevant search databases to identify clinical trials, systematic
reviews, original research, etc. to help you answer your clinical question. [Provide a list of search
terms you used]
3. Appraise the evidence Focus on the validity and clinical importance of what you found in the
literature related to your clinical question. Were you able to answer your clinical question? [Draft a
brief summary appraisal of your search findings]
4. Apply the evidence How might you apply your findings in steps 1-3 to the care of this patient?
[Report your thoughts and observations]
5. Evaluating performance Evaluating clinical performance and outcomes takes time and clinical
experience to develop. As such, in this step, discuss how what you learned about EBM.
[Summary of your group’s performance on what you learned about the EBM process]
*[Provide reference list (AMA/APA format) of the pertinent articles your group developed]
Week One: EBM Resources
Here are a few links that you may want to peruse:
PubMed Tutorials: http://www.nlm.nih.gov/bsd/disted/pubmed.html
PubMed Clinical Queries:
http://www.youtube.com/results?search_query=pubmed+clinical+queries&o
q=pubmed&gs_l=youtube.1.6.0l10.7982.9331.0.14060.6.5.0.1.1.0.148.459.
3j2.5.0...0.0...1ac.1.11.youtube.PcIeOn-g0n4 These are YouTube videos
that have been produced by various health sciences libraries. I suggest you
find the most current as PubMed tweaks the website periodically. Also keep
in mind, the length of the video is not always the best.
Cochrane: http://www.thecochranelibrary.com/view/0/HowtoUse.html On this
page, there are two online self-paced tutorials. You might find something
on YouTube as well.
Week One, Part Two
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During the acute care of Ms. Shore, the medical team
has administered a series of Coumadin (Warfarin
Sodium) and streptokinase. The intravenous
thrombolytic therapy with recombinant tissue
plasminogen activator (rt-Pa) was given at 0.9 mg/kg to
a max of 90 mg, with a 10% bolus over 1 minute and
the remainder over 1 hour.
After 5 days of treatment, Ms. Shore develops
thrombocytopenia. The medical team also notes the
formation of IgG autoantibodies.
It is also discovered that Ms. Shore was taking
mifepristone and aspirin.
Please use this new information for the next section.
Week Two: Correcting Medical
Errors
Ms. Shore is admitted to the hospital with the diagnosis of
a stroke. Upon her arrival to the unit, a nurse does a head to
toe assessment, reviews and confirms the patient history,
and takes her vitals. In the head to toe assessment, it is
found that Ms. Shore has one sided weakness, very dry skin,
slurred speech, and is aware of only one side of her body. In
reading the patients history, the nurse confirms with the
family that the patient takes fish oil for depression,
mifepristone, and aspirin. Her labs confirm that she has
thrombocytopenia. Her vitals seem to be within normal limits;
however, the orders the physician prescribes cause reasons
for concern. The nurse also advocates for medications to be
added to the regimen for this patient based on arising needs.
Week Two: Correcting Medical
Errors
Believe it or not, there are times even
physicians make medication errors. They
may prescribe the wrong medication to a
patient, prescribe medications at wrong
doses, and even prescribe medications that
can cause a harmful drug to drug interaction.
As a nurse, it is critical to review all your
medications prior to administration to avoid
potentially life threatening situations.
Week Two: Correcting Medical Errors
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Before starting this weeks activity, please use a google doc
to answer the following questions.
Each member of the group must answer these questions
individually, but it is important read what other members
have said. Perhaps there is something you don't agree with
another member added, or something you would like to
expand upon.
Turn in your assignment before the start of class next week
specifying each individual group members input by typing
their name and major prior to their response.
Week Two: Correcting Medical Errors
Questions and Discussion
1. What is a good way to approach a physician about
correcting an order after they have made a medication error
and why?
2. Why is it important to check medications before distributing
them, and what obstacles do nurses face that may make
checking every medication each time unrealistic or difficult?
3. Why is it important to know what medications a patient takes
regularly prior to prescribing new medications, and what
might happen if a nurse chooses not to review the new
medications and drug history?
4. What are some ways a nurse can best manage her time so
she is able to adequately review medications, and what
resources are available to her to review them?
Week Two: Correcting Medical
Errors
Activity:
Teach healthcare professionals how to use
resources to verify physician orders and to
confirm them if they have found an error.
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First: download the latest Micromedex drug
information app to your device.
Then watch the following tutorial.
Week Two: Correcting Medical Errors
Week Two: Correcting Medical Errors
Continued directions:
1. Once you have searched for the medication you
want information on select that medication and there
you will find a number of options such as clinical
teaching, generic names, dosing and indications,
black box warnings, drug interactions etc.
2. Use these tabs as a guide for answering the
following questions about the drugs this stroke
patient was prescribed.
Week Two: Correcting Medical
Errors
Group Activity:
Using the Micromedex Drug Information application and the
knowledge gained from preview the tutorial, please answer
the following questions as a group using a Google Doc.
Turn in your assignment before the start of class next week
specifying each individual group members input by typing
their name and major prior to their response. Also, have
one group member screenshot and incorporate into the
Google doc the place they found the answer. For instance,
if you find the answer under adverse effects, screenshot
the list of adverse effects that includes the answer to the
question in the Google doc.
Week Two: Correcting Medical Errors
1.) As discussed in the previous scenario, Ms. Shore developed thrombocytopenia.
Of the medications prescribed, are there any that should be reconsidered with
this discovery? Each profession please provide various insights on potential
hazards this could bring. Your answers may be similar.
2.) Ms. Shore is taking both Aspirin and Mifepristone, are there any potential
issues that may arise combining these drugs? If so please provide details. As a
group, discuss the details of this question and explore reasons why this could be
hazardous.
3.) Ms. Shore was having difficulty sleeping so the doctor called in an order for
trazodone. Although this is not a sleeping aid, the side effects induce drowsiness
and aid in sleeping. What would you teach Ms. Shore about using this drug?
Each member lists two different teachings that have not yet been listed by
another group member. If your answer is not displayed on the screenshot shown,
please provide another screen shot that includes yours.
Week Two: Correcting Medical
Errors
4.) When taking the patient’s history, the nurse notices that the patient is
also taking fish oil at home. Ms. Shore believes that it is a natural way to
deal with her depressed mood recently. Are there any issues with Ms.
Shore taking this medication? Are there issues with any other
medications that she should be aware of? Each member please answer
the question on fish oil and name three other medications that may be
contraindicated with warfarin.
5.) Ms. Shore shares a few concerns about adding trazodone into her
medication regimen. She is very irregular with her bowels already and
has concerns it will alter her patterns. What can you tell her about this
and other side effects? Each member select a body system and
describe the side effects trazodone has on this system.
Week Two: Correcting Medical
Errors
6.) During the nurses review, she notices that Ms. Shore has
developed extremely dry skin near her elbow that appears to be
irritating her. The nurse advocates for Ms. Shore and contacts the
physician who prescribes Amlactin (Ammonium Lactate). Ms.
Shore asks the nursing aid to open the window and let the sun in
because she is so cold. What should the nurse do in this situation,
and why?
7.) Have each group member construct a question about a
medication of choice. After constructing the question place it in the
Google Doc with your name and initials before it as you have done
with all your answers. Next answer each group members question
and get together as a group to confirm your answers and ask any
questions.
Week 3: Rehab of Motor Deficits
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The woman in the video, Ms. Shore, had
severe weakness in her right arm. This was
seen when she could not raise her right arm
or squeeze the physician's hand. She did not
show the same weakness on her left side.
The hemiparesis commonly seen after
stroke can be reversed (best case scenario)
or managed (usual scenario) through
rehabilitation.
Week 3: Rehab of Motor Deficits
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Assignment: Make a google hangout within
your group to answer the following
questions.
Use this Youtube tutorial to familiarize
yourself with Google Hangout.
http://www.youtube.com/watch?v=4oouI7KSea
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Week 3: Rehab of Motor Deficits
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CVA is a leading cause of disability in the
U.S. Imagine yourself without the use of your
dominant arm.
1. What tasks do you use your right arm only
for? (i.e. picking up a cup)
2. What tasks do you use your right arm to
support/aid your left arm to complete
(bimanual tasks)? (i.e. buttoning a shirt)
3. What tasks imperative to your job/career
require the use of your right arm?
Week 3: Rehab of Motor Deficits
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Regaining motor function after a CVA is a
long process and requires dedication from
the patient/client and support from family,
friends, and the healthcare team.
1. What adjustments/accommodations can you
make for a patient/client with minimal use of
one of their arms?
2. As a healthcare professional, how could you
promote the use of a hemiparetic arm during
your appointments? Focus on ways to
change the environment to make it easier .
Week 3: Rehab of Motor Deficits
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Depending on the location in the brain of the
CVA, motor deficits tend to correlate with the
structures damaged. Using the same
thought process as above, discuss
implications for a patient with hemiparesis of
the left leg.
Week 3: Rehab of Motor Deficits
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Here are a few questions to guide the
discussion:
1. Where in the brain might this CVA occurred
based on the symptoms?
2. Other than using the legs to walk, what tasks
will this patient/client have difficulty
completing?
3. Which requires more effort, to sit in a chair
that is taller or shorter? To stand up from a
chair with armrests or without armrests?
Week 4: Rehab & Communication
Activity: view this video of a patient 9 months post CVA who has Broca's
aphasia. It is probable that the woman in the original video (Alone in a
Crowd) would have also acquired this type of aphasia from her stroke.
http://www.youtube.com/watch?v=1aplTvEQ6ew
If necessary, review the videos or other resources to assure all group members
understand the strengths and limitations of someone with Broca's aphasia.
This understanding is vital to interacting with these patients/clients and to
helping their families. How would this limited communication affect your
professional interaction with a patient/client?
Week 4: Rehab & Communication
Deliverable 1: work with your group to develop a list of 10 short "power
phrases" that will facilitate communication between the patient with Broca's
aphasia, the medical team, and the family. Examples of power phrases are
'stop that now,' and 'I love you.' (If you had to choose 10 phrases to
communicate with for the rest of your life, what would they be?)
*Create a new 'notebook' using the Evernote app to record your group's 10
power phrases. Be sure to share the notebook with everyone in your group
AND with the instructor.
Week 4: Rehab & Communication
Deliverable 2: Using the app "Say hi" from the Gwendolyn Strong Foundation
each team member will create one new communication page. Each team
member will use 1-2 of the group's power phrases on their page. Pages and
phrases must include a photo or icon of some sort and must include an
audio recording of the phrase. Remember that you are creating functional
communication for a patient who is recovering from a stroke.
Take screen shots of each step as you add pages, phrases and pictures (this
can be done when your page(s) is completed). Move these screen shots
from the camera roll on the iPad to the Evernote notebook you created for
this project.
NOTE: this app can be used on an iPad
in conjunction with two additional apple
products as controllers (ex. iPhones).
For this activity simply use the app as-is
on the iPad. No additional devices are
necessary!!
Week 4: Rehab & Communication
Deliverable 3: Each member of the group will choose an alternative
communication app to review and share with other group members. Review
your selected app from a professional perspective 1. Would you recommend this app for medical professionals to keep on
their iPhone or iPad? Why or why not?
2. Would you be comfortable using this app with a patient/client who was
not able to speak? Why or why not?
3. Is there additional information that would need to be added to the app to
make it more appropriate for the medical setting; for example additional
terminology, icons, text, etc.?
Save your review, including the answers to these questions, in the shared
notebook in Evernote.
Free apps to review: Verbally, Picture Board, Vox4All Free, Speech+,
Communicate Mate, Small Talk Aphasia (by Lingraphica).
Questions for test: Social Work
1: What is the formal national professional organization for professional Social Workers in US:
A: National Social Work Association
B: American Social Workers Organization
C: National Association of Social Workers
D: Social Workers of America
2: At Ohio University, Social Work degree programs are accredited by:
A: Council of Social Work Education
B: North Central Council of Social Work
C: Ohio Council of Social Work
D: None of the above
3: In Ohio, This is required to be a Licensed Independent Social Worker:
A: MSW
B: BA in Social Worker
C: 2 years and 3,000 hours of supervision
D: A and C
4: All of the listed are core values of Social Work except:
A: Social Justice
B: Integrity
C: Service
D: Courtesy
Week 5:Discharge PlanningReturning to the care of the family
"Discharge is often a time of anticipation. Yet at
the same time, it can be anxiety for patients
who have undergone transformative trauma
or diseases in their lives. The role of the
Social Worker involves many areas during
the hospitalization, but none as important as
helping family members understand the
needs and anxiety involved in adjusting to
shifts in roles of family members."
Week 5 continued
Questions and discussion:
What are some concerns that the patient will
most likely have involving returning to their
family?
What are some of the concerns of the family
members?
Pick a profession other than your major and tell
how it will help prepare the patient for
discharge. For example: Social Work will
assist family members to understand
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Week 5 continued
Activity:
Teaching families about patient concerns.
First,Download the latest Explain Everything
app from the app store.
Then,go to
https://www.youtube.com/watch?v=bMttsHd0
M8M, the YouTube tutorial for Explain
Everything's latest free version.
Week 5 continued
With the Explain Everything app, create a
presentation that helps others better
understand the feelings and frustrations the
patient is experiencing as a mother who was
vibrant and involved prior to her stroke.
Using the patient's family as the audience who
will view and benefit from your work, make
sure it is understandable for all ages.
Week 5 continued
Concentrate on the communication and
frustrations associated with her limits.
The presentation must be between 5 - 7
minutes long and contain 12 total slides.
Upload the presentation onto BlackBoard when
complete.