Accreditation Standards

1.      What did I expect to learn about this topic before beginning the unit?

Accreditation is an important aspect of healthcare. I was excited to learn more about what standards are out there for facilities and what guidelines they go by.

2.      What I actually learned:

      It was really beneficial to read more and learn about the HCAHPS scores. I was actually really surprised about the large influence nurses have on many of the questions. I would say we have influence over most of the questions which makes sense. Nurses spend the most time with the patient and I think the patient’s overall experience is really dependent upon the patient’s nurses because that is who and what they will really remember.

      The case study helped me learn what a sentinel event really is. I realized that sentinel events can’t always be prevented but there are guidelines and precautions/rules to follow to help prevent them from happening. I think it’s always important to know facility policies/expectations as well as to know my resources so I can use them in emergent situations. I also realized how important it is to report sentinel events because data and research is how the medical field has been able to create rules and make changes based on what is happening in daily practice.

      The discussion helped me realize how important those patient safety goals are. It was difficult for our group to come to a consensus because each of the national patient safety goals are important. However, implementing the basics such as correctly identifying the patient and hand hygiene can also help prevent others from occurring. I feel that all the patient safety goals are intertwined and influence the others.

3.      My feelings/experiences from the individual and team activities:

      I enjoyed this final week and felt that the discussion was a good one, especially because it was difficult to come to a consensus. It allowed for us to really think and explore reasons behind that.

4.      How I will utilize the information learned in my nursing practice:

      I want to always remember HCAPS surveys and realize that every interaction I have with a patient can either improve the score or lower it. I will do my best to always prevent sentinel events and take action if one does occur. I will follow the patient safety goals and work on hand hygiene, identifying patients, preventing medication errors as well as infection.

5. My personal feelings about the material covered:

Thought this was important to learn about as we end the semester and continue with our jobs. These are concepts that are very relevant and applicable to the real world. We should always be focusing on accreditation and work to improve patient outcome and experience. 

Patient Safety Application

1.      What did I expect to learn about this topic before beginning the unit?

I was expecting to learn how I can apply patient safety concepts to my daily practice. I was interesting in learning how everything was going to come together.

2.      What I actually learned:

The case study this week allowed me to learn about the error disclosure process. I guess I didn’t realize what sort of an issue this is for patients, families, and clinicians. I didn’t really think about the fear physicians may have about embarrassment and malpractice lawsuits for errors made. It makes sense that this would be a worry just like I have some of those same worries as a nurse. But I learned that it is better to be open and honest with patients. Some may choose to go the lawsuit direction but if that is the case then at least you have been completely open and honest and that does look positive in your case. I am happy that things are changing and there are organizations out there to help clinicians and be there for support when adverse events or traumatic events happen. This is a field of work that is unique and we deal with life and death situations every single day. That is not normal. We need to have support.

The discussion reminded me of importance of following policies and procedures and helped me decide what to do when I see other coworkers not abiding by these policies. It is important to always treat and approach others with respect but being willing to take the steps necessary to help them correct their habits and use superiors if necessary.

The article I found for the literature search was unique but I was able to see how patient safety became the driving force for a change in procedure and standardization of care.

3.      My feelings/experiences from the individual and team activities:

I enjoyed the assignments this week. I think reading about a case study like we had this week was important for us as nurses to realize what happens when errors occur and how it should be disclosed to patients as well as barriers to that disclosure. I think the discussion was successful and my group was able to come to a consensus about how to handle the situation.

4.      How I will utilize the information learned in my nursing practice:

I can remember these things and always have patients at the center of care. By doing this, full disclosure and open communication with them should be natural. It is also important to seek out what resources I have as a nurse and IMC if I need debriefing or just someone to talk to about traumatic events.

5. My personal feelings about the material covered:

Great material for the end of the semester! 

Creating a Culture of Safety

1.  What did I expect to learn about this topic before beginning the unit?
I expected to learn about how we as nurses can continue to maintain that culture of safety. What things I can do each day to keep myself safe, my coworkers safe, and my patients safe. This past week has been interesting at work regarding safety. A code green was called because of a patient who suffered from a TBI. It was a scary situation for many of us.

2.   What I actually learned:

       The discussion brought about some bad feelings in me. I was angry with the fact that the physician would not listen to the RN. I hope this never happens to me but I’m sure it will. In that moment, I have to take action in order to keep that patient safe. I’m glad I was able to discuss with my classmates what options we have. A culture of safety is created by utilizing the chain of command and other team members for support whether that is having the charge RN give pain meds to a patient you are unable to get to or for an insulin double check. It all helps with safety.

       The case study was another one that was so interesting and heartbreaking to learn about. Again, safety was an issue with this young boy who passes away. Members of the team were not communicating with the family, no clarification was ever done, and the possible complications and sometimes common complications of that procedure were never even considered. Education was not done or given to the family and the doctors and nurses really needed to brush up on this. Safety was compromised because members of the care team made a lot of simple mistakes.

       The critical thinking exercise helped me to understand that just because something has been done for a “long time” doesn’t mean it is the best. This semester the focus has been on EBP in some of my other classes. I think this is such an important thing to learn about and realize that I can make a difference, I can implement change, and I can use EBP in my practice as a nurse. EBP does affect safety. Most of the times, EBP is the safest practice.

3.  My feelings/experiences from the individual and team activities:

      I learned a lot about safety and creating a culture of safety this week. It was very impactful for me. Our discussion went well this week and we were all able to decide on what should be done in that situation. It is good to be able to use teamwork even though we are taking classes online.

4. How I will utilize the information learned in my nursing practice:

      Like I have previously stated, I have realized how I am able to create that culture of safety as a nurse. I can use EBP every day , be a patient advocate, use my resources, use the chain of command when/if necessary, and always trust myself and my instincts. This is a good reminder for me.

5. My personal feelings about the material covered:

Safety is always a great thing to be reminded of and learn about. I like the idea of creating a culture of safety. I think that is a very powerful phrase and something that can be implemented no matter where someone works. 

Errors and Near Misses

1.  What did I expect to learn about this topic before beginning the unit?
When I read the topic was “Errors and Near Misses” I was worried. Making a mistake always scares me especially as a new nurse. I was hoping to learn more about ways to prevent these errors and near misses.

2.   What I actually learned:

The case study this week put a pit in my stomach as I was reading it. I definitely felt like that was the main focus this week and for good reason. I think it is so beneficial to read about situations like this in order to learn from it. I’m glad there are others who have gone before me and have made those mistakes to hopefully I will never do the same thing. I also realized that it is beneficial for the health industry when things like this happen and changes are made to improve patient safety.

Human error is something that will never go away. It will never and can’t ever be 100% eliminated no matter what. It is my job as a nurse and person to think about what I am doing, question myself, question others, ask questions, make changes if necessary, and follow protocol. If something doesn’t feel right, I need to stop and think about it for a second. I also realize the value of the electronic health record and the fact that patient safety is perhaps the main focus of the entire system. It is convenient for us to be able to look at patient information at the click of a button but to be able to see that information to help in a critical situation or to plan care, that is so beneficial not only for healthcare professionals but for the patient and their overall safety, health, and progression.

3.  My feelings/experiences from the individual and team activities:

I enjoyed this week even though reading that case study was SO depressing. I’m glad I was able to discuss it with my class members and come a consensus as to why and how mandatory changes affect outcomes. It was good to realize that everyone felt that same way I did and we all have those similar fears as being new nurses. Nobody wants to make mistakes.
4. How I will utilize the information learned in my nursing practice:

      I can’t be afraid of mistakes. But I can minimize how many I make and what I do about it when a mistake is made. I will continue to always ask questions and utilize the resources I have. I also want to always listen to the patient and their family members. I have dealt with some helicopter children when it comes to care for their mother or father. Some nurses have been really irritated by that but I honestly am happy to answer questions over and over for them. I’m happy to listen to their concerns and talk to the doctor again about the same medication. I want to do anything and everything I can to prevent mistakes and errors by involving those people that know the patient the best.
5. My personal feelings about the material covered:

I though this week was full of beneficial information. Case studies always make an impact and I learn a lot from reading about these experiences of other people. I think it was important for me to realize that human error is a part of this practice but patient safety always needs to be the goal and I need to do everything I can to help honor and protect that. 

Building a Culture of Safety

1.  What did I expect to learn about this topic before beginning the unit?
Safety is such an important aspect of healthcare. I was hoping to learn about how to build that culture of safety and what I can do as an RN to promote safety in all aspects of care not only for my patients but for myself as well.

2.   What I actually learned:

       The discussion this week was great! I hope I am never in that situation that RN was in with a nurse to patient ratio of 32:1. I realize that this does happen and it needs to stop. This is not creating a safe environment for staff or for the patients. Intermountain is focusing a lot on zero harm. A situation like this is not in line with the zero harm initiative in any way. I feel the need to stand up for myself and the patients and talk with a manager and/or supervisor about any situation that is compromising safety. Safety should be the number one priority.

       With the critical thinking exercise I was able to reflect on the values of Intermountain healthcare and examine the facility and its employees and how compliant the employees are to the values. I agree and love the values intermountain strives to uphold.  I do see employees with these values and find it to be a wonderful place to work. I will continue to strive to have these values as well because I know that because of their mission, vision, and values, Intermountain has become a highly reliable facility. A highly reliable facility also becomes a safe facility. That is and should be a main focus for all facilities to have.

       The case study this week was complex and had many different aspects to think about but it was very interesting to analyze the situation. It is so unfortunate that a young boy had to lose his life for people to realize a break in the system. But I am so glad to have people that are willing to let us learn from mistakes and help better the system rather than just seeking revenge. Reflecting on this scenario really made me realize how important it is for me to really know my stuff and to now be afraid to speak up, no matter what!  I hope I am never involved in a lawsuit or anything like this but reality is I might be. I hope I can always remember this and always document fully, communicate with my team and especially the doctors, and not always rely on the “system” to be my second check. It is not bad to question things sometimes and seek clarification.

3.  My feelings/experiences from the individual and team activities:

      Like I said, I really liked the case study and the fact that I was able to read and learn about a real event and reflect on it. The discussion was a good topic as well because I know this happens and we may be faced with unethical situations like the one in the scenario and it is good for us to talk with each other and decide what we should do about it and who we should talk to fix it.

4. How I will utilize the information learned in my nursing practice:

      Like I have mentioned before, I want to make sure I am communicating with doctors and other nurses regarding my patients and their care so we are all on the same page with what is going on. I want to help create that safe and reliable environment for not only the patients but for myself and my fellow coworkers.

5. My personal feelings about the material covered:

I think safety is a great topic to discuss and I liked the direction we went with it this week with the case study and looking at working conditions for staff and how that affects the patients. I also thought it was important to look up the values of institutions and see how those values really affect the reliability of an institution in analyzing if the employees actually uphold those values. 

Informatics

1.      What did I expect to learn about this topic before beginning the unit?

I knew we would be talking about technology and its use in healthcare. I was expecting to learn about how technology has evolved or affected healthcare in both good and bad ways.

2.      What I actually learned:

CRITICAL THINKING

1.       The use of EMR does not guarantee error-free patient care. While using the EMR often helps catch mistakes or limit the amount of them, there is still room for mistakes and errors. Nurses and others using the EMR can override the bar code scan. It is also possible that the order was written down incorrectly and put in the MAR incorrectly. That is why it is important for nurses to verify the EMR with the written order from the doctor before verifying it in the EMR.

2.       Nurses who do not pay attention to the alerts and choose to bypass those just because they are in a hurry jeopardizes patient safety. Also, nurses may choose not to scan the medication or double check and just administer it because the patient is in a hurry or the nurse is in a hurry. That is never an ok thing to do and often results in mistakes. A friend told me a story about something that happened on her floor. The charge nurse administered heparin IV to the wrong patient. My first question was how was she able to scan that in?...she didn’t scan it. She did not verify and take the extra 15 seconds to do so and that resulted in a huge mistake. I sure hope the patient is ok. That behavior is never ok.

3.       Excessive system alerts may just get annoying but honestly I don’t feel that there is a danger to having them. I guess the danger would be that nurses stop paying attention to or stop reading them. They may also just get so annoyed and bypass them because of that. I don’t feel that there are excessive alerts right now in the system I am currently using.  I have actually caught myself giving the entire tablet instead of just giving half like I am supposed to because of the system alerts.

4.       Nurses cannot become lazy. Nurses need to see the value and understand the importance of those alerts. Nurses should not have the annoyed attitude either.  If a bypass is necessary for some reason the nurse should be calling the pharmacist directly and have them in the room witnessing it. I would hope nurses see the value in the alerts of the EMR and take the time to check the orders and the MAR before just assuming a new medication is correct for that patient.

Technology is an amazing thing and we have made so many advancements with technology in healthcare. The EMR is incredible and being able to do all computerized charting is crazy! It is so helpful in so many ways. The critical thinking exercise this week made me realize though how important it is to always be checking the MAR and orders especially with medication administration. There have been many times I am in a patient room or gathering medications and I see a new order in the computer. Many nurses will just give it. I try very hard to always check the chart for the order and verify that it has been correctly entered into the system and it is for the correct patient before I give it. I also was reminded of the importance of barcode scanning. This has helped so much with minimizing medication errors. I don’t want to always just rely on the scanner and I know I need to be checking and doing the 5 patient rights. I also have promised myself that I will never bypass an alert. If there is an alert, more times than not, it means I have made an error of some kind whether I scanned the wrong barcode, the wrong medication, or it is the wrong dose. I will always immediately call the pharmacist and verify if I am unsure.

CASE STUDY

1.       Diabetic Patient: The nurse should look at the patient’s history and see what his blood sugars have been and see if there is a pattern or trend. A blood sugar of 54 is pretty low and does cause some concern for most patients. I would advise the nurse to contact the patient directly or contact nursing personnel in his area to visit him and get a set of vital signs. I think it would be good for the nurse to call him or have someone call him and can ask him about how he is currently feeling (checking for signs of hypoglycemia) and tell him to drink some apple juice or have graham crackers and milk. I would then ask for a repeat glucose after 1 hour.

2.       The first thing is to try and call the patient and/or family and contact nursing staff in their area. If the nurse didn’t get an answer I would ask nursing to visit the patient.  Best case scenario the patient just forgot to report or was delayed. Worst case, the patient was taken to the hospital or the patient is not doing well at home. Calling first can prevent any unnecessary action but following up will determine the status of the patient.

Because of technology we are able to do nursing and communicate with patients and nurses across the country. I liked the case study this week and realized how difficult it may be to make medical decisions without even seeing the patient. I know that I will get calls from friends and family desperate for help or for an answer and I want to be confident and educated enough to be able to make a decision and help others in those situations. I know I won’t always know what exactly is going on but I can know enough to decide whether they should go to the hospital or if it is something I can assist with. Technology also allows for pictures to be sent and other helpful resources for everyone to use.

The discussion this week was interesting. It is perfect for what is happening with IHC with switching to ICENTRA and more recently the new CareFusion pumps. I know there were staff members that did not want to use the new pumps and would hide /stash the old pumps to pull out and use when they worked. I think this is terrible. But it is hard to make a change after years and years of using a system. Computer charting is very difficult-I am still learning so much and can’t imagine how difficult it is going to be for those that have used Tandem for 30 years to switch to a new system. But we are in a profession of change and adaptation. Change is necessary and it is a good thing. I want to be helpful to all my coworkers and help be the motivation to comply with new policies and changes. Doctors are very intimidating to me and with this discussion I realized how hard it would be to approach them. I realized all the resourced I had and who I can go to for help. But, if patient safety is a concern, I will go directly to the doctor.

3.      My feelings/experiences from the individual and team activities:

I enjoyed the discussion this week with my team and thought we worked well together coming to a consensus. We all provided information to each other that was helpful and I definitely learned some new things from my teammates. Focusing on informatics and doing the critical thinking and case study exercises was helpful and reading the article from AHRQ reminded me about patient safety and they tied together well.

4. How I will utilize the information learned in my nursing practice:

Technology is amazing and can be so helpful to me. However, I need to not allow myself to become completely reliant on the EMR or the scanning or computer system to ensure patient safety. I always need to be checking all patient rights with medication administration and always checking the orders from the physician. I also feel empowered as a new nurse and realize I can be an influence and speak up. I can approach doctors if necessary and let them know that what they are doing is possibly jeopardizing patient safety if that is the case. I am a smart person and I am a smart nurse. There are so many resources out there for me to use and I need to always embrace the change.

5. My personal feelings about the material covered:

Informatics in many ways is complicated and hard to understand but the material this week was presented in a great way and the discussions were helpful. I liked the case study and critical thinking exercises this week and felt they were very applicable to my current situations in my nursing practice. 

Quality Improvement Strategies IV

11.   What did I expect to learn about this topic before beginning the unit?

I expected to learn about how we can involve our patients specifically with continuous quality improvement. I also hoped to have a better understanding of indicators and benchmarks and how those are identified/created. 

2.   What I actually learned:

The discussion this week was difficult for me to understand. I guess I learned/understood more of what indicators are and how to create an effective benchmark. I realized how many elements need to be considered when creating process of care or outcome indicators and how impactful and important these are/can be. Benchmarks are also important and need to be created properly and at an attainable range, otherwise, hospitals may never meet the specified benchmark if it was created with improper data and that can reflect false information.

As we continue to develop our CQI in healthcare, it is important to remember the involvement of the patient. It is crucial for patients to be involved in their treatment. I understand that error rates haven’t necessarily dropped significantly with this new initiative but I believe in the long run, these rates will go down as people are more and more educated about healthcare with the advancing technology. I would hope that I can empower my patients to speak up and help them gain that desire to be involved in the quality improvement and their healthcare specifically.

The critical thinking exercise this week was interesting. I was able to think of a problem and I asked myself “why” five times. I do feel that with each time I asked myself the question I was able to have more clarity and understanding of the root of my problem. I think this is beneficial and can be applied to all problems in life. I need to stop and think about it for a few minutes and ask myself the why question multiple times. By doing this I allow myself to brainstorm possible causes and can come to a conclusion and begin to fix it if possible. If I don’t allow myself that time to think about the root cause, I may continuous have the problem and not realize how to fix it.

The case study this week got me thinking about what authority I have as a new nurse and how I can stand up for my patients as well as myself, even if it means calling a doctor out on something. I realize that I have the responsibility to speak up for my patients in all aspects but especially when something could possibly compromise their safety and well-being. IHC is focusing on Zero Harm. I believe this specific situation that was discussed is part of zero harm and I need to take action no matter what. If the doctor needs to speak to me afterward that is fine. I want to always be respectful of all members of the interdisciplinary team and I believe I can be respectful but still remind them of proper care/technique if necessary.
3.  My feelings/experiences from the individual and team activities:

I thought the case study and critical thinking exercises were beneficial this week. I did learn more about myself and how I might handle certain situations. It was good to think about how I might approach an MD who isn’t following proper protocol. I know this is something that will happen in my career. The discussion was complex and abstract for me. I don’t know that I fully understood what was being asked.
4. How I will utilize the information learned in my nursing practice:

Like I have previously mentioned, I appreciate the fact that I was able to think about how I might solve some problems in life and how I can communicate with physicians and feel that I do have proper authority. I will also involve patients in their care and encourage them to be a part of the continuous quality improvement.
5. My personal feelings about the material covered:

This week was full of a lot of good things. I really had a difficult time with the discussion and hope to receive more clarity and understanding as we continue with more units.