This document provides information on effective handoffs between medical professionals. It discusses how poor communication during handoffs can lead to medical errors and adverse patient outcomes. The document outlines components of ideal handoffs, including using a structured format to systematically communicate important patient information, contingency planning, and having the receiver repeat back key details to confirm understanding. Examples of effective handoff practices from high-risk industries are also presented. The document concludes by emphasizing the importance of good communication to ensure quality and safety of patient care.
This document provides guidance on effective patient handoffs between medical providers. It discusses the importance of communication in healthcare and reducing errors. Two case studies demonstrate ineffective and effective handoff examples. Key components of an ideal handoff are outlined, including providing structured yet concise patient summaries, discussing contingency plans, and having the receiver repeat back critical information. The document emphasizes face-to-face interactions and standardized formats to improve information transfer between doctors.
Most hospital staff and patients try to avoid rude physicians…
Lawyers look for them.
Jurors may not understand the medicine in a malpractice case, but all have been the target of rude or rushed care. This rude behavior multiplier leads to “Jackpot Justice”.
Lawyers just love a good “service lapse”- angry words, a “TUDE”, even a late return phone call, or a cranky staff person. They revel when doctors and nurses are at odds.
In fact, patients often sue not because of genuine rude behavior, but their perception of short, curt treatment, or a feeling of incomplete disclosure. How can caregivers improve their patients’ perceptions, their expectations of care, to immunize themselves against suits?
Truvada and raltegravir are the preferred regimen for occupational post-exposure prophylaxis (PEP) for HIV exposure. PEP should be started immediately after exposure and continued for 28 days to reduce the risk of HIV infection. Important follow up includes monitoring for side effects, adherence support, and HIV testing at baseline and over several months to evaluate infection status. Pharmacists play a key role in ensuring appropriate PEP regimens can be obtained and supporting patient adherence for full treatment duration.
Eastzone Medico Legal provides medical legal services anywhere and anytime. It offers friendly and affordable services including timely advice, awareness tips, and doorstep assistance. The company aims to provide freedom from digital connectivity and peace of mind to customers. It emphasizes that if the right monitoring is not available, medical legal risks may arise.
For more course tutorials visit
www.newtonhelp.com
Max Points: 20.0
The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
This case study describes the end-of-life care of Lorna, a 77-year old woman with metastatic renal cell carcinoma. Lorna originally presented with flank and abdominal pain and was diagnosed with advanced renal cell carcinoma in 2011. In 2014, the cancer recurred and metastasized to her spine, causing cauda equina syndrome with lower limb weakness and urinary/fecal incontinence. She was admitted to palliative care for pain and symptom management, where she received psychological support, medication via syringe pump, and focus on comfort. The document discusses renal cell carcinoma, cauda equina syndrome, medications, nursing interventions and compassionate end-of-life care.
Five priorities for care of the dying personMarie Curie
Dr Bill Noble, Medical Director of Marie Curie Cancer Care, speaks at the end of life sesion with Dr Adam Firth (RCGP Clinical Support Fellow for End of Life Care).
This session was chaired by Dr Peter Nightingale, Marie Curie and RCGP End of life lead at the RCGP Annual Conference, ACC Liverpool, 2-4 October, 2014.
For more information visit: mariecurie.org.uk/rcgp
This document provides a summary of a presentation given by Catherine Henry on negligence and patient safety in health law. Some key points:
- Catherine Henry Lawyers specializes in health and medical law cases, with a focus on medical negligence.
- Medical negligence cases are challenging due to complex medical issues but can improve patient safety by holding healthcare providers accountable and deterring breaches of standards of care.
- Examples of successful medical negligence claims handled by the firm include birth injuries, surgical errors, failures to diagnose in emergency departments, and an avoidable patient death in a mental health unit.
- While litigation may not be "about the money," injuries and losses from medical negligence can be extremely significant and life-
This document provides guidance on effective patient handoffs between medical providers. It discusses the importance of communication in healthcare and reducing errors. Two case studies demonstrate ineffective and effective handoff examples. Key components of an ideal handoff are outlined, including providing structured yet concise patient summaries, discussing contingency plans, and having the receiver repeat back critical information. The document emphasizes face-to-face interactions and standardized formats to improve information transfer between doctors.
Most hospital staff and patients try to avoid rude physicians…
Lawyers look for them.
Jurors may not understand the medicine in a malpractice case, but all have been the target of rude or rushed care. This rude behavior multiplier leads to “Jackpot Justice”.
Lawyers just love a good “service lapse”- angry words, a “TUDE”, even a late return phone call, or a cranky staff person. They revel when doctors and nurses are at odds.
In fact, patients often sue not because of genuine rude behavior, but their perception of short, curt treatment, or a feeling of incomplete disclosure. How can caregivers improve their patients’ perceptions, their expectations of care, to immunize themselves against suits?
Truvada and raltegravir are the preferred regimen for occupational post-exposure prophylaxis (PEP) for HIV exposure. PEP should be started immediately after exposure and continued for 28 days to reduce the risk of HIV infection. Important follow up includes monitoring for side effects, adherence support, and HIV testing at baseline and over several months to evaluate infection status. Pharmacists play a key role in ensuring appropriate PEP regimens can be obtained and supporting patient adherence for full treatment duration.
Eastzone Medico Legal provides medical legal services anywhere and anytime. It offers friendly and affordable services including timely advice, awareness tips, and doorstep assistance. The company aims to provide freedom from digital connectivity and peace of mind to customers. It emphasizes that if the right monitoring is not available, medical legal risks may arise.
For more course tutorials visit
www.newtonhelp.com
Max Points: 20.0
The case scenario provided will be used to answer the discussion questions that follow.
Case Scenario
This case study describes the end-of-life care of Lorna, a 77-year old woman with metastatic renal cell carcinoma. Lorna originally presented with flank and abdominal pain and was diagnosed with advanced renal cell carcinoma in 2011. In 2014, the cancer recurred and metastasized to her spine, causing cauda equina syndrome with lower limb weakness and urinary/fecal incontinence. She was admitted to palliative care for pain and symptom management, where she received psychological support, medication via syringe pump, and focus on comfort. The document discusses renal cell carcinoma, cauda equina syndrome, medications, nursing interventions and compassionate end-of-life care.
Five priorities for care of the dying personMarie Curie
Dr Bill Noble, Medical Director of Marie Curie Cancer Care, speaks at the end of life sesion with Dr Adam Firth (RCGP Clinical Support Fellow for End of Life Care).
This session was chaired by Dr Peter Nightingale, Marie Curie and RCGP End of life lead at the RCGP Annual Conference, ACC Liverpool, 2-4 October, 2014.
For more information visit: mariecurie.org.uk/rcgp
This document provides a summary of a presentation given by Catherine Henry on negligence and patient safety in health law. Some key points:
- Catherine Henry Lawyers specializes in health and medical law cases, with a focus on medical negligence.
- Medical negligence cases are challenging due to complex medical issues but can improve patient safety by holding healthcare providers accountable and deterring breaches of standards of care.
- Examples of successful medical negligence claims handled by the firm include birth injuries, surgical errors, failures to diagnose in emergency departments, and an avoidable patient death in a mental health unit.
- While litigation may not be "about the money," injuries and losses from medical negligence can be extremely significant and life-
This document discusses the importance of nursing documentation and how a nurse's license may depend on thorough and accurate documentation. It notes that poor documentation can lead to malpractice lawsuits and loss of a nursing license. The document provides examples of legal cases where nurses faced consequences due to deficiencies in their documentation. It emphasizes that if an action is not documented, it is considered as if it was not performed.
Ms. G, a 23-year-old diabetic woman, was admitted to the hospital with cellulitis of her left lower leg. She had been applying heating pads for 48 hours as the leg became more painful and she developed chills. Examination found a wound above her medial malleolus with drainage and her left leg was red from the knee to ankle. Laboratory results showed an elevated white blood cell count with many neutrophils and bands. Wound culture grew Staphylococcus aureus.
This document discusses various aspects of informed consent in anesthesia practice and medical malpractice litigation. It notes that informed consent is required to respect patient autonomy and involves explaining the risks, benefits and alternatives of a procedure to allow for substantially autonomous decision making. The key elements of competence that a patient must demonstrate to provide valid consent are described. Maintaining thorough anesthesia records and communicating well with patients can help minimize the risk of malpractice lawsuits.
Treating Migraine Ardhavbhedaka with Ayurveda A Single Case Studyijtsrd
This case study examines the treatment of a 27-year-old male patient suffering from migraines for 6 years using Ayurvedic methods. The patient underwent a week-long treatment involving purification therapies like induced vomiting as well as applications and medications to balance the doshas. This included nasal drops, forehead pastes, oil massages, and internal herbs. Over the course of two months of follow-ups, the patient remained migraine-free. The case study concludes Ayurveda's holistic approach targeting the root causes was able to achieve complete relief where other methods had only provided temporary symptom relief.
This document outlines various alternatives to evidence-based medicine that some physicians may use in practice when evidence is lacking, including experience-based, appearance-based, communication-based, and belief-based approaches. It provides examples of how factors like a doctor's age, hair, race, beauty, gender, smile, dress, use of ties, white coat, pens, stethoscope, glasses, voice, listening skills, confidence, and more may influence patient care when true evidence and scientific research are absent. The document also discusses religion-based, celebrity-based, and pharmaceutical marketing-influenced alternatives to evidence.
Strategies & Techniques In Taking The ExamALLEICARG DC
The document provides strategies and techniques for taking nursing exams, including focusing on what comes first, most important, or initially in test questions. It also discusses using mnemonics, rules of thumb, prioritization principles like ABCs, and critical thinking approaches like analyzing prefixes/suffixes, eliminating incorrect answers, and using common sense. Key advice includes identifying priority nursing needs based on concepts like Maslow's hierarchy and the nursing process.
Caring Conversations: Talking about goals of care with patients and familiesAndi Chatburn, DO, MA
The document discusses goals of care and advance directives, providing evidence-based guidance on discussing end-of-life wishes and preferences with patients. It outlines tools and resources for starting conversations about advance care planning, including living wills, durable powers of attorney, and forms tailored for pediatric patients. The presentation also addresses barriers to discussing code status and provides suggestions for conducting effective family meetings on goals of care.
This document provides a case study on a 5-year old male patient diagnosed with pneumonia. It includes an introduction to pneumonia, the patient's data, health history, physical assessment findings, definitions of key terms, developmental tasks, anatomy and physiology of the respiratory system, and pathophysiology of pneumonia. The objectives are to understand the patient's condition, underlying causes, appropriate medical and nursing interventions, and formulate a nursing care plan.
This case study summarizes the medical details of 75-year-old male patient Sergio Abbago who was admitted to the hospital due to difficulty breathing and leg swelling. He was diagnosed with atrial septal defect, hospital-acquired pneumonia, and acute urinary retention. The case study provides background on the patient's medical history, presents results from diagnostic testing, discusses the conditions diagnosed and their pathophysiology, outlines the medical and nursing management of the patient, and establishes goals for his care and discharge plan. The objectives are to comprehensively present the case and develop knowledge and skills for delivering quality healthcare to patients.
1. The document provides background information on pneumonia including its causes, risk factors, signs and symptoms, and treatment. It discusses pneumonia as a leading cause of death from infectious disease.
2. It then outlines the general and specific objectives of studying the case of a 47-year-old female patient admitted for difficulty breathing later diagnosed with pneumonia.
3. The theoretical framework draws upon Florence Nightingale's environmental theory, noting how the patient's living conditions relating to air, water, sanitation and space likely contributed to her illness.
This is an open book” test with regard to CPT and ICD-10 coding booblossomblackbourne
This is an “open book” test with regard to CPT and ICD-10 coding books.
Question number 1-
Please identify the words in the following statement that match at least 4 of the HPI (history of present illness)
elements identified below:
Patient was admitted yesterday with severe asthma exacerbation. She had been trying to
maintain with her inhaler but continued to worsen over the last 24 hours before admit. She
has had 5 breathing treatments and been on 4Lpm O2 for the last 12 hours and now has a
stable 90% sats. ORA she decreases to 78-70%. She has been around her boyfriend’s cat a
lot lately and feels this may have triggered this attack.
Quality ____________________ Modifying Factors ___________________
Context ___________________ Timing ___________________
Duration __________________ Severity __________________________
Question number 2-
Please identify the Level of Medical Decision Making (MDM) in the following statement:
1. Chest pain- new since last visit
2. DOE (dyspnea on exertion) - worsening
I have discussed this with him, and we will screen for ischemia with stress myocardial
perfusion imaging. If Abnl test, then this may represent a high probability for CAD and angio
should be considered. If test is low risk, then may follow syndrome clinically, and seek other
causes of chest pain. The patient was instructed to avoid strenuous physical activity until
complete stress test results are known.
F/U OV the week after these studies to consolidate eval and recommend further investigations
as indicated.
Low __________ Moderate _________ High___________
2 | Page
Question number 3-
Please select the level of History (HX) documented in the following statement:
Patient comes in today complaining of 4 days history of cough and congestion. No Fever,
Chest pain or dyspnea. Cough is mildly productive. He has been using Sudafed and Nyquil
with some relief.
Past Medical History-Seasonal allergies
Past Surgical History-tonsillectomy
Past Family History- Asthma---Father and Brother
Smoking status: Smokeless tobacco: Alcohol Use:2 drink(s) per week
Allergies-Cephalexin/Penicillin’s- Rash
Review of systems: Positive for malaise/fatigue. Positive for cough and sputum production
(scant, clear). Negative for shortness of breath and wheezing. All remaining 10 point ROS and
are negative.
HPI- # of Elements__________ PFSH- # reviewed_______ ROS- # of systems ________
History Level __________________
Question number 4-
Please select the level of Exam Both 95 and 97 guidelines documented in the following statement:
Constitutional: He is oriented to person, place, and time. He appears well-developed and
well- nourished.
Head: Normocephalic and atraumatic. Right Ear: Tympanic membrane normal. Left Ear:
Tympanic membrane normal. Nose: No mucosal edema or rhinorrhea.
Mouth/Throat: Oropharynx is clear and moist and mucous membranes are normal. Eyes:
EOM are normal. Pupils are equal, round, and reactive to light.
Neck: ...
The CNS will provide education and support to the nursing staff regarding palliative care for dyspnea at end of life. This includes assessing the staff's comfort level and understanding of palliation, as well as determining if family input influenced the decision to transfer Mrs. J to the emergency department against her wishes. The goal is to develop strategies to improve end of life care and decision making in the nursing home setting.
The document discusses a case study involving a patient named Mrs. Smith who suffered a stroke and is experiencing dysphagia and malnutrition. It outlines the nurse's initial and ongoing assessments of Mrs. Smith's condition, which include monitoring her vital signs, tube feeding site, nutritional status, and ensuring her readiness for discharge. The priority nursing diagnosis identified for Mrs. Smith is imbalance in nutrition less than body requirements.
The document discusses the 2012 Joint Commission National Patient Safety Goals. It provides 3 goals: 1) improve patient identification, 2) improve communication among caregivers, and 3) improve safety of medication use. It also presents several case studies on medication errors and discusses root causes, prevention strategies, and recommendations to reduce errors.
Module 02 ContentAPA formatTop of FormPurposeTo use critic.docxkendalfarrier
This document provides content for an educational module, including instructions for learners. It discusses traumatic injuries to the urinary tract, interventions for related disorders, and a case study scenario. The scenario describes an unstable male stab victim who develops a bleeding kidney. Learners are asked to identify clues that signaled problems, explain discolored urine, suggest interventions, determine if the actions were within the LPN's scope of practice, and how the emergency department environment impacted the outcome.
GR AFHS COPD.7.8.2020 -FINAL wo CE for ho.pptxAFHSResources
The learning outcome for this activity: Participants will have increased knowledge and ability to apply the Age-Friendly 4Ms Framework to older adult patients presenting with COPD in a convenient care setting.
3 rules for online assessments - How to MCQsgedoyle
The document provides guidelines for writing multiple choice questions (MCQs) for online assessments. It discusses choosing between one-best answer and extended matching item formats. Key points include focusing questions on patient vignettes or practice scenarios, avoiding technical flaws like repeating words in stems and options, and using concise language. The document also outlines procedures for pre-testing questions by experts, analyzing results, and reworking or removing poor questions to improve future assessments.
Evaluation of patient and clinician experience in the Lothian Telehealth trial. Alex Tarling
Evaluation of patient and clinician experience in the Lothian Telehealth trial. Presentation delivered at the World Congress for IT conference, Amsterdam, June 2010.
This document discusses the importance of nursing documentation and how a nurse's license may depend on thorough and accurate documentation. It notes that poor documentation can lead to malpractice lawsuits and loss of a nursing license. The document provides examples of legal cases where nurses faced consequences due to deficiencies in their documentation. It emphasizes that if an action is not documented, it is considered as if it was not performed.
Ms. G, a 23-year-old diabetic woman, was admitted to the hospital with cellulitis of her left lower leg. She had been applying heating pads for 48 hours as the leg became more painful and she developed chills. Examination found a wound above her medial malleolus with drainage and her left leg was red from the knee to ankle. Laboratory results showed an elevated white blood cell count with many neutrophils and bands. Wound culture grew Staphylococcus aureus.
This document discusses various aspects of informed consent in anesthesia practice and medical malpractice litigation. It notes that informed consent is required to respect patient autonomy and involves explaining the risks, benefits and alternatives of a procedure to allow for substantially autonomous decision making. The key elements of competence that a patient must demonstrate to provide valid consent are described. Maintaining thorough anesthesia records and communicating well with patients can help minimize the risk of malpractice lawsuits.
Treating Migraine Ardhavbhedaka with Ayurveda A Single Case Studyijtsrd
This case study examines the treatment of a 27-year-old male patient suffering from migraines for 6 years using Ayurvedic methods. The patient underwent a week-long treatment involving purification therapies like induced vomiting as well as applications and medications to balance the doshas. This included nasal drops, forehead pastes, oil massages, and internal herbs. Over the course of two months of follow-ups, the patient remained migraine-free. The case study concludes Ayurveda's holistic approach targeting the root causes was able to achieve complete relief where other methods had only provided temporary symptom relief.
This document outlines various alternatives to evidence-based medicine that some physicians may use in practice when evidence is lacking, including experience-based, appearance-based, communication-based, and belief-based approaches. It provides examples of how factors like a doctor's age, hair, race, beauty, gender, smile, dress, use of ties, white coat, pens, stethoscope, glasses, voice, listening skills, confidence, and more may influence patient care when true evidence and scientific research are absent. The document also discusses religion-based, celebrity-based, and pharmaceutical marketing-influenced alternatives to evidence.
Strategies & Techniques In Taking The ExamALLEICARG DC
The document provides strategies and techniques for taking nursing exams, including focusing on what comes first, most important, or initially in test questions. It also discusses using mnemonics, rules of thumb, prioritization principles like ABCs, and critical thinking approaches like analyzing prefixes/suffixes, eliminating incorrect answers, and using common sense. Key advice includes identifying priority nursing needs based on concepts like Maslow's hierarchy and the nursing process.
Caring Conversations: Talking about goals of care with patients and familiesAndi Chatburn, DO, MA
The document discusses goals of care and advance directives, providing evidence-based guidance on discussing end-of-life wishes and preferences with patients. It outlines tools and resources for starting conversations about advance care planning, including living wills, durable powers of attorney, and forms tailored for pediatric patients. The presentation also addresses barriers to discussing code status and provides suggestions for conducting effective family meetings on goals of care.
This document provides a case study on a 5-year old male patient diagnosed with pneumonia. It includes an introduction to pneumonia, the patient's data, health history, physical assessment findings, definitions of key terms, developmental tasks, anatomy and physiology of the respiratory system, and pathophysiology of pneumonia. The objectives are to understand the patient's condition, underlying causes, appropriate medical and nursing interventions, and formulate a nursing care plan.
This case study summarizes the medical details of 75-year-old male patient Sergio Abbago who was admitted to the hospital due to difficulty breathing and leg swelling. He was diagnosed with atrial septal defect, hospital-acquired pneumonia, and acute urinary retention. The case study provides background on the patient's medical history, presents results from diagnostic testing, discusses the conditions diagnosed and their pathophysiology, outlines the medical and nursing management of the patient, and establishes goals for his care and discharge plan. The objectives are to comprehensively present the case and develop knowledge and skills for delivering quality healthcare to patients.
1. The document provides background information on pneumonia including its causes, risk factors, signs and symptoms, and treatment. It discusses pneumonia as a leading cause of death from infectious disease.
2. It then outlines the general and specific objectives of studying the case of a 47-year-old female patient admitted for difficulty breathing later diagnosed with pneumonia.
3. The theoretical framework draws upon Florence Nightingale's environmental theory, noting how the patient's living conditions relating to air, water, sanitation and space likely contributed to her illness.
This is an open book” test with regard to CPT and ICD-10 coding booblossomblackbourne
This is an “open book” test with regard to CPT and ICD-10 coding books.
Question number 1-
Please identify the words in the following statement that match at least 4 of the HPI (history of present illness)
elements identified below:
Patient was admitted yesterday with severe asthma exacerbation. She had been trying to
maintain with her inhaler but continued to worsen over the last 24 hours before admit. She
has had 5 breathing treatments and been on 4Lpm O2 for the last 12 hours and now has a
stable 90% sats. ORA she decreases to 78-70%. She has been around her boyfriend’s cat a
lot lately and feels this may have triggered this attack.
Quality ____________________ Modifying Factors ___________________
Context ___________________ Timing ___________________
Duration __________________ Severity __________________________
Question number 2-
Please identify the Level of Medical Decision Making (MDM) in the following statement:
1. Chest pain- new since last visit
2. DOE (dyspnea on exertion) - worsening
I have discussed this with him, and we will screen for ischemia with stress myocardial
perfusion imaging. If Abnl test, then this may represent a high probability for CAD and angio
should be considered. If test is low risk, then may follow syndrome clinically, and seek other
causes of chest pain. The patient was instructed to avoid strenuous physical activity until
complete stress test results are known.
F/U OV the week after these studies to consolidate eval and recommend further investigations
as indicated.
Low __________ Moderate _________ High___________
2 | Page
Question number 3-
Please select the level of History (HX) documented in the following statement:
Patient comes in today complaining of 4 days history of cough and congestion. No Fever,
Chest pain or dyspnea. Cough is mildly productive. He has been using Sudafed and Nyquil
with some relief.
Past Medical History-Seasonal allergies
Past Surgical History-tonsillectomy
Past Family History- Asthma---Father and Brother
Smoking status: Smokeless tobacco: Alcohol Use:2 drink(s) per week
Allergies-Cephalexin/Penicillin’s- Rash
Review of systems: Positive for malaise/fatigue. Positive for cough and sputum production
(scant, clear). Negative for shortness of breath and wheezing. All remaining 10 point ROS and
are negative.
HPI- # of Elements__________ PFSH- # reviewed_______ ROS- # of systems ________
History Level __________________
Question number 4-
Please select the level of Exam Both 95 and 97 guidelines documented in the following statement:
Constitutional: He is oriented to person, place, and time. He appears well-developed and
well- nourished.
Head: Normocephalic and atraumatic. Right Ear: Tympanic membrane normal. Left Ear:
Tympanic membrane normal. Nose: No mucosal edema or rhinorrhea.
Mouth/Throat: Oropharynx is clear and moist and mucous membranes are normal. Eyes:
EOM are normal. Pupils are equal, round, and reactive to light.
Neck: ...
The CNS will provide education and support to the nursing staff regarding palliative care for dyspnea at end of life. This includes assessing the staff's comfort level and understanding of palliation, as well as determining if family input influenced the decision to transfer Mrs. J to the emergency department against her wishes. The goal is to develop strategies to improve end of life care and decision making in the nursing home setting.
The document discusses a case study involving a patient named Mrs. Smith who suffered a stroke and is experiencing dysphagia and malnutrition. It outlines the nurse's initial and ongoing assessments of Mrs. Smith's condition, which include monitoring her vital signs, tube feeding site, nutritional status, and ensuring her readiness for discharge. The priority nursing diagnosis identified for Mrs. Smith is imbalance in nutrition less than body requirements.
The document discusses the 2012 Joint Commission National Patient Safety Goals. It provides 3 goals: 1) improve patient identification, 2) improve communication among caregivers, and 3) improve safety of medication use. It also presents several case studies on medication errors and discusses root causes, prevention strategies, and recommendations to reduce errors.
Module 02 ContentAPA formatTop of FormPurposeTo use critic.docxkendalfarrier
This document provides content for an educational module, including instructions for learners. It discusses traumatic injuries to the urinary tract, interventions for related disorders, and a case study scenario. The scenario describes an unstable male stab victim who develops a bleeding kidney. Learners are asked to identify clues that signaled problems, explain discolored urine, suggest interventions, determine if the actions were within the LPN's scope of practice, and how the emergency department environment impacted the outcome.
GR AFHS COPD.7.8.2020 -FINAL wo CE for ho.pptxAFHSResources
The learning outcome for this activity: Participants will have increased knowledge and ability to apply the Age-Friendly 4Ms Framework to older adult patients presenting with COPD in a convenient care setting.
3 rules for online assessments - How to MCQsgedoyle
The document provides guidelines for writing multiple choice questions (MCQs) for online assessments. It discusses choosing between one-best answer and extended matching item formats. Key points include focusing questions on patient vignettes or practice scenarios, avoiding technical flaws like repeating words in stems and options, and using concise language. The document also outlines procedures for pre-testing questions by experts, analyzing results, and reworking or removing poor questions to improve future assessments.
Evaluation of patient and clinician experience in the Lothian Telehealth trial. Alex Tarling
Evaluation of patient and clinician experience in the Lothian Telehealth trial. Presentation delivered at the World Congress for IT conference, Amsterdam, June 2010.
The document discusses the 2012 Joint Commission National Patient Safety Goals. It aims to improve patient identification, communication among caregivers, and medication safety. Case studies are presented that illustrate medication errors related to issues like look-alike drugs, lack of labeling, and failure to clarify orders. The document emphasizes clear communication, questioning inconsistencies, and following safety protocols to prevent errors.
Test bank advanced health assessment and differential diagnosis essentials fo...robinsonayot
Test bank advanced health assessment and differential diagnosis essentials for clinical practice 1st edition myrick.pdf
Test bank advanced health assessment and differential diagnosis essentials for clinical practice 1st edition myrick.pdf
The document discusses the use of evidence-based medicine to evaluate complementary and alternative medicine. It begins with background on the importance of staying current with medical literature and using well-formulated clinical questions. It then discusses how to develop background and foreground clinical questions using the PICO framework to identify patients, interventions, comparisons, and outcomes. Several examples of applying PICO to clinical scenarios are provided. The document also reviews types of medical literature and types of clinical studies used in evidence-based evaluations.
This document summarizes a presentation on active learning and increasing faculty-student interaction. It discusses how active learning is supported by brain research and provides practical examples of active learning strategies. These strategies include case studies, clinical scenarios, and reflective activities. The presenters also discuss outcomes from a study showing that increasing faculty interaction through activities like active learning and reduced threats led to improved student outcomes like higher grades and fewer failures.
Running Head Comparison and contrast2Comparison and contras.docxhealdkathaleen
Running Head: Comparison and contrast 2
Comparison and contrast 2
Post Concussive Syndrome and Traumatic Brain Injury
Student’s Name
Instructor Affiliation
Date
Requirements:
Week 2: Case Discussion: Pulmonary Part One
Setting: A free medical clinic that provides health care for the under-insured.
Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.
You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. "I think I may have a cold. I've been having a hard time breathing on and off lately."
HPI: "I notice I'm short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.
Surgeries: Cholecystectomy
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20's. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker's assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.
Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.
PE: Height 5'10", Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does ...
Approach to history taking in internal medicine postingAR Muhamad Na'im
This document provides guidance on conducting an effective history taking for internal medicine postings. It outlines the key sections to cover, including identification data, chief complaints, history of present illness, past medical history, social history, and others. For each section, it describes the essential information to obtain, such as relevant symptoms and their progression, past and current medical issues, medication usage, lifestyle and family factors. The document emphasizes a structured yet flexible approach, using open-ended questioning followed by focused questions, to fully understand the patient's condition and identify potential diagnoses.
CA in Patna is a team of professional Chartered Accountant which are providing best services like Company Registration, Income Tax Return, Sales Tax Consultants, Bank Audit and other services specially in Patna.
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CA in Dwarka is a team of professional Chartered Accountant which are providing best services like Company Registration, Income Tax Return, Sales Tax Consultants, Bank Audit and other services specially in Dwarka and Delhi NCR.
CA in Dwarka is a team of professional Chartered Accountant which are providing best services like Company Registration, Income Tax Return, Sales Tax Consultants, Bank Audit and other services specially in Dwarka and Delhi NCR.
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Beyond Degrees - Empowering the Workforce in the Context of Skills-First.pptxEduSkills OECD
Iván Bornacelly, Policy Analyst at the OECD Centre for Skills, OECD, presents at the webinar 'Tackling job market gaps with a skills-first approach' on 12 June 2024
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Chapter wise All Notes of First year Basic Civil Engineering.pptxDenish Jangid
Chapter wise All Notes of First year Basic Civil Engineering
Syllabus
Chapter-1
Introduction to objective, scope and outcome the subject
Chapter 2
Introduction: Scope and Specialization of Civil Engineering, Role of civil Engineer in Society, Impact of infrastructural development on economy of country.
Chapter 3
Surveying: Object Principles & Types of Surveying; Site Plans, Plans & Maps; Scales & Unit of different Measurements.
Linear Measurements: Instruments used. Linear Measurement by Tape, Ranging out Survey Lines and overcoming Obstructions; Measurements on sloping ground; Tape corrections, conventional symbols. Angular Measurements: Instruments used; Introduction to Compass Surveying, Bearings and Longitude & Latitude of a Line, Introduction to total station.
Levelling: Instrument used Object of levelling, Methods of levelling in brief, and Contour maps.
Chapter 4
Buildings: Selection of site for Buildings, Layout of Building Plan, Types of buildings, Plinth area, carpet area, floor space index, Introduction to building byelaws, concept of sun light & ventilation. Components of Buildings & their functions, Basic concept of R.C.C., Introduction to types of foundation
Chapter 5
Transportation: Introduction to Transportation Engineering; Traffic and Road Safety: Types and Characteristics of Various Modes of Transportation; Various Road Traffic Signs, Causes of Accidents and Road Safety Measures.
Chapter 6
Environmental Engineering: Environmental Pollution, Environmental Acts and Regulations, Functional Concepts of Ecology, Basics of Species, Biodiversity, Ecosystem, Hydrological Cycle; Chemical Cycles: Carbon, Nitrogen & Phosphorus; Energy Flow in Ecosystems.
Water Pollution: Water Quality standards, Introduction to Treatment & Disposal of Waste Water. Reuse and Saving of Water, Rain Water Harvesting. Solid Waste Management: Classification of Solid Waste, Collection, Transportation and Disposal of Solid. Recycling of Solid Waste: Energy Recovery, Sanitary Landfill, On-Site Sanitation. Air & Noise Pollution: Primary and Secondary air pollutants, Harmful effects of Air Pollution, Control of Air Pollution. . Noise Pollution Harmful Effects of noise pollution, control of noise pollution, Global warming & Climate Change, Ozone depletion, Greenhouse effect
Text Books:
1. Palancharmy, Basic Civil Engineering, McGraw Hill publishers.
2. Satheesh Gopi, Basic Civil Engineering, Pearson Publishers.
3. Ketki Rangwala Dalal, Essentials of Civil Engineering, Charotar Publishing House.
4. BCP, Surveying volume 1
How to Setup Warehouse & Location in Odoo 17 InventoryCeline George
In this slide, we'll explore how to set up warehouses and locations in Odoo 17 Inventory. This will help us manage our stock effectively, track inventory levels, and streamline warehouse operations.
Temple of Asclepius in Thrace. Excavation resultsKrassimira Luka
The temple and the sanctuary around were dedicated to Asklepios Zmidrenus. This name has been known since 1875 when an inscription dedicated to him was discovered in Rome. The inscription is dated in 227 AD and was left by soldiers originating from the city of Philippopolis (modern Plovdiv).
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A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
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Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
2. Handoffs
National Pediatric Nighttime Curriculum
Written by Shilpa Patel and Lauren Destino
Stanford University
admission.edhole.com
3. Case 1
The handoff from your fellow intern:
“Your first patient is Will, a 4 yo with asthma,
probably going home tomorrow, so nothing to
do. Is still on a little oxygen, but try to wean it
overnight so he can actually go home, ok?”
admission.edhole.com
4. Case 1
Are you ok with this information?
Do you think you have all you need to take
care of this patient overnight?
What can you do to improve this
communication?
What if the nurse calls you and states Will
is needaidnmgi smsioonr.eed hooxley.gcoemn?
5. Case 2
The handoff from your fellow senior:
“The sickest patient is Mackenzie. She is a 3 yo
ex-preemie with CP, developmental delay,
chronic lung disease who is here with
pneumonia. She just came up from the ED
and her main issue is respiratory distress.
She is on continuous albuterol at 15mg/hr, IV
clinda and ceftriaxone and IVF. I would look at
her right after sign out since if she gets a lot
worse, the PICU may need to be consulted.”
admission.edhole.com
6. Case 2
Are you ok with this information?
Do you think you have all you need to take care
of this patient overnight?
What can you do to improve this
communication?
What will you discuss with the intern?
What would you do if you get a page about this
patient in the middle of the hand off? admission.edhole.com
7. Objectives
To recognize effective vs. ineffective
handoffs
To identify the components of an effective
handoff
To understand the importance of
communication to patient care
admission.edhole.com
8. Why Should We Care?
Institute of Medicine estimates up to 100,000 patients die
in U.S. hospitals annually due to errors in their care.
Failures in communication a leading cause of adverse
events in healthcare.
Issues around communication, continuity of care, or care
planning cited as root cause in >80% of reported sentinel
events.
Australian review of 28 hospitals found communication
errors associated with twice as many deaths as clinical
inadequacy.
admission.edhole.com
Coverage by a second team of residents one of strongest
predictors of adverse outcome
9. Sentinel Events
Unanticipated event that results in death or serious physical or
psychological injury to a patient and is not related to the
natural course of the patient’s illness
admission.edhole.com
10. Why Now?
More turnover of patients and personnel:
Increase in rate of transfers and discharges12 by 40% since
duty hour changes made
New duty hours: average of 15 handovers during a 5-day
hospitalization
Each intern involved in >300 handovers in average month-long
rotation13
Healthcare more specialized:12
Greater number of clinicians providing narrow focus of care
Specialized units designed for specific diseases, procedures,
phases of illness may mean loss of big clinical picture
Increase in rate of discontinuity13
Changes in the resident schedule structure to reduce fatigue
Cultural change in healthcare delivery that utilizes schedules
with shifts
Many points of transitions, transfers of responsibility (MD to
MD, RN to RN)
admission.edhole.com
11. What do we know about
communication?
A recent handoff study supports literature on the
psychology of miscommunication:
Speakers systematically overestimate how
well their message is understood by listeners
Speakers also assume that the listener has all
the same knowledge that they do (gets worse
the better you know someone)
admission.edhole.com
13. What Works: a look at other high risk
industries 3,4
Face to face: verbal, interactive questioning in safe
environment
Limit interruptions: so can go through handover
systematically
Sender provides updated printed summary
Opportunities for both receiver and sender to
introduce topics
Information relayed in structured format: decreases
omissions
admission.edhole.com
14. What Works: a look at other high risk
industries 3,4
Specific contingency plans
Read back: insures info received correctly
Checklist: avoids content omissions
Delay transfer of responsibility when concerned
about patient status
Unambiguous transfer of responsibility: wards know
who to call
Receiver scans historical data either right before or
right after the handoff
admission.edhole.com
15. Components of Ideal Handoff
Brief one liner about the patient including:
How sick is the patient?
Significant past medical history
Reason for admission
CURRENT condition, recent interventions,
active problems
admission.edhole.com
16. Components of Ideal Handoff
Systematic approach to communicating needed
information. Use one consistently so receiver
knows what to expect.
--Systems --IPASS the BATON
--SIGNOUT --SBAR
--SAFE-IR --Problems
Contingency planning – i.e. anticipated problems,
results, procedures and what to do about them: BE
SPECIFIC
“Read back” to verify a shared mental model admission.edhole.com
17. Two Way Street to a Shared Mental Picture
Sender
Paints picture
Relevant items
Specific directions with
rationale
Check receiver
understanding
Receiver
Listens
Ask questions
Use system to
remember important
items
Read back
admission.edhole.com
18. Back to Case 1
Identification:
Will is a 4 yo with mild persistent asthma on
hospital day #2 for an asthma exacerbation,
triggered by URI. He is improving and no
longer very sick and should go home
tomorrow if he can be weaned off oxygen
overnight.
admission.edhole.com
19. Back to Case 1
Problems
Asthma: He was on continuous albuterol at 10mg/kg on
admit but now weaned to 4 puffs MDI every 4 hours. He
has wheezing before treatments but no retractions,
flaring or work of breathing. He is on day 2 of oral
steroids and on Flovent twice a day.
Nutrition: He has an IV and required a bolus on admit.
He is now eating and drinking well.
Hypoxia: Will has needed 0.5-2L by nasal cannula and
is currently down to 0.25 L with sats >95%.
Infectious Disease: Will has been afebrile and his
current exacerbation is thought to be due to a viral
process. He is in isolation given his runny nose and
cough.admission.edhole.com
20. Back to Case 1
Contingency Planning:
If Will has an increasing oxygen requirement try
increasing albuterol frequency to every 3 hours
If he is febrile, recheck his lung exam to assure no
focal signs concerning for a developing pneumonia
Wean the oxygen as the goal is discharge tomorrow
If his IV falls out there is no need to replace it
Readback:
Receiver admi srseipone.aetdsh oimlep.coormtant information
21. Practice a handoff
Please practice signing out the patient on the
following slide using the ideal sign-out
components in a pre-determined standard order
The details are intentionally disorganized
One person should observe the sign-out and
give feedback
One person should give the sign-out
One person should receive the sign-out (ask
questions and read back).
admission.edhole.com
22. Practice handing off this patient
• JS is a 7 yo girl with known asthma who was admitted to the PICU 2 days ago.
• In the PICU she was on heliox, continuous albuterol and a terbutaline drip for one day. The
terbutaline has been off for 15 hours, the heliox off for 24 hours.
• She is currently on 6 puffs every 2 hours, a 2 Liter O2 requirement, IV methylprednisolone at 4
mg/kg/day.
• She is also on maintenance IVF for continued poor po intake.
• She came to the floor this morning and was doing well until around 3 pm when the intern was
called to evaluate for increasing O2 requirement. On assessment, she seemed to be aerating
less on the right when compared to the left; a CXR was done but is not yet up. She was
restarted on continuous albuterol at 5 mg/kg/hr. The plan is to get a gas if things continue to
worsen.
• Also a pulmonary consult was obtained for multiple recent admissions, and for poor
compliance. If they have recommendations, it is okay to follow through with them unless they
seem excessive, in which case, they should be discussed with the attending. If CXR shows
consolidation, antibiotics should be started. If there is concern for a pneumothorax on the CXR,
talk to the senior resident and consider PICU consult for thoracentesis.
• She should be kept NPO due to her worsening clinical status. But if the CXR is normal and she
is improving from a respiratory point of view, consider restarting diet.
• Currently on exam, her RR=35, she is on 10L face mask, and she is retracting and wheezing
everywhere except on the right side, where there are diminished breath sounds. She can speak
in 3 word sentences, which is a decline from this morning. However, she is still alert and
responsive. This afternoon at 1300, she had a fever to 38.4 C; she had been afebrile at home. admission.edhole.com
23. Take Home Points
Giving sign out: Be specific, concise and deliver
the information in a standardized format.
Receiving sign-out: Summarize what you were
told and ask questions as needed; listen actively
by anticipating potential issues. “Read back” the
most salient points of the sign-out.
Communication
Poor communication can lead to errors, near
misses and adverse events
Good communication can improve quality and
safety of patient care
It is baedsmt inssoito nto.e adhsosluem.coem knowledge
24. Selected References
Chang VY, Arora VM, Lev-Air S, D’Arcy M, Keysar B.
Interns overestimate the effectiveness of their hand-off
communication. Pediatrics 2010;125(3):491-496.
Arora VM, Johnson JK, Meltzer DO and Humphrey HJ.
A theoretical framework and competency-based
approach to improving handoffs. Qual Saf Health
Care 2008; 17:11-14.
Patterson ES, Roth EM, Woods DD, Chow R and
Gomes JO. Handoff strategies in settings with high
consequences for failure: lessons for health care
operations. Intl J Qual Health Care 2004;16(2):125-
132
admission.edhole.com
25. Bibliography
1. Arora V, Johnson J: A model for building a standardized hand-off protocol. J Qual Patient Safety 32(11), 646-655,
Nov 2006.
2. Sidlow R, Katz-Sidlow RJ: Using a computerized sign-out system to improve physician-nurse communication. J Qual
Patient Safety 32: 32-36, Jan 2006.
3. Patterson ES, et al: Handoff strategies in settings with high consequences for failure: lessons for health care
operations. Intl J Qual Health Care 16(2): 125-132, 2004.
4. Arora V, Johnson J et al: Communication failures in patient sign-out and suggestions for improvement: a critical
incident analysis. Qual Saf Health Care 14:401-407, Dec 2005.
5. Streitenberger K, Breen-Reid K, Harris C: Handoffs in care - can we make them safer? Pediatr Clin N Am 53:1185-
1195, 2006.
6. Solet DJ, Norvell JM, et al: Lost in translation: challenges and opportunities in physician-to-physician communication
during patient handoffs. Acad Med 80:1094-1099, 2005.
7. Williams RG, et al: Surgeon information transfer and communication. Ann Surg 245(2): 159-169, 2007.
8. Frank G, Lawless ST, Steinberg TH: Improving physician communication through an automated, integrated sign-out
system. J Healthcare Info Mgmt 19(4):68-74, 2005.
9. VanEaton EG, et al: A randomized, controlled trial evaluating the impact of a computerized rounding and sign-out
system on continuity of care and resident work hours. Surgery 136(1):5-13, 2004.
10. Haig, KM, et al: SBAR: a shared mental model for improving communication between clinicians. J Qual Patient
Safety 32(3): 167-175, March 2006.
11. Bernstein JA, Imler DL, Longhurst CA: Physicians report improved workflow after integration of sign-out notes into
the electronic medical record. Submitted for publication, transcript provided by Dr. Longhurst.
12. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. (AHRQ Publication No. 08-0043)
http://www.ahrq.gov/qual/nurseshdbk/
admission.edhole.com
26. Bibliography continued
13. Vidyarthi, AF, Arora, V, Schnipper JL Managing discontinuity in academic
medical centers: strategies for a safe and effective resident sign-out. Journal of
Hospital Medicine 2006; 1:257-266.
14. Peterson LA, Brennan TA, O’Neill AC Does housestaff discontinuity of care
increase the risk for preventable adverse events. Ann Intern Med. 1994; 121:866-
872.
15. Mukherjee S A precarious exchange. NEJM 2004; 351:1822-1824.
16. Chang VY, Arora VM, Lev-Air S, D’Arcy M, Keysar B. Interns overestimate the
effectiveness of their hand-off communication. 2010;125(3):491-496.
admission.edhole.com
Editor's Notes
Take some time to read this handoff, given to you by a fellow intern, who is leaving for the evening.
How would you rate this handoff?
This handoff is actually inadequate. A danger in hand off communication is that the receiver doesn’t think critically about the information being given, assuming that the sender will give all the pertinent information. Studies show that the more familiar the sender and receiver are with each other, the more potential for missed information.
2. Think about whether you have all the information you need: there are many things that could happen with this patient that you may not be able to predict at the time of the hand off. However, with each illness there should be some important pieces of information that are communicated. For instance, for a patient with asthma it is good to know:
The current respiratory status with recent exam and exact amount of oxygen the patient is on
The current medications and their frequency or method of delivery – for instance, is the patient on albuterol nebs or MDIs? Are the steroids oral or IV? Is the patient on inhaled corticosteroids?
If the patient did not follow a typical hospital course, what has gone wrong in the past and what helped.
It is also important to note any historical data that further describe baseline status (e.g. is the patient an ex-preemie or have they had previous PICU stays for asthma exacerbations?)
e. It is also always good to know if the patient has IV access and what the plan should be if that IV falls out or if there are any psychosocial issues and who to call if there are questions or concerns.
What can be done to improve the communication?
The sender can provide the additional information just mentioned above. The receiver should also ask questions and summarize the salient information he or she heard. If there is time before the hand off occurs, it is also very useful to review any documentation that may be readily available. These concepts are discussed ahead in the didactic.
4. The final question brings out the critical piece of contingency planning – what to do if something does not go as planned. Maybe the patient needed more oxygen in the past at various times and improved with decreased time between respiratory treatments – this is the type of thing that should be communicated in the hand off. There are many other reasons why the patient could need more oxygen and one should think about these reasons in addition to the ones potentially communicated in the handoff. Contingency planning saves time and allows the covering physician to provide better patient-specific care without having to “figure it out” from scratch.
Take some time to read this second case about a patient whom a fellow senior is signing out to you before she leaves for clinic.
How would you rate this handoff?
One positive is that it starts out with a helpful piece of information – “this is your sickest patient” and thus sets the stage for the communication. However, as with the first example there is lack of information: current respiratory status (Retracting? Tachypneic? Alert?); what was done in the ED?; potential contingency plans (Repeat CXR if worsens? Go up on albuterol? Add O2 to reduce work of breathing? Though the potential need for the PICU is mentioned, there are several things that could be tried prior to calling the PICU).
Do you think you have all the information you need to take good care of this patient overnight?
Again, the receiver should get a little more information. Has Mackenzie ever been sick like this before and what worked or didn’t work? Who should be called if she worsens – you could imagine that a patient that is complex may have subspecialty services involved in his or her care. You were told she was on IVF but why (was she made NPO because of her respiratory distress is severe or is she on IVF because she is dehydrated? It is unclear from the information given to you). Problems often arise when one assumes something that may or may not be true.
What can be done to improve the communication?
The same concepts discussed in Case 1 apply here as well. In addition, with this patient – “the sickest” – it is often helpful for the receiver and sender of the hand off to visualize the patient together. Some terms used to describe patients can be vague and/or residents with different levels of training may interpret and communicate physical findings differently. Visualizing the patient together assures that everyone is on the same page and the receiver can clarify what they heard during the hand off.
As a supervising resident you would want to be sure to communicate your concerns to your intern: let the intern know when you want to be notified about the patient and set up a specific plan for re-evaluating the patient throughout the evening. Your level of supervision may change depending on the intern’s level of training and knowledge but with any ill patient it is better to be more involved. And it is always better to be specific about expectations for re-evaluation, rather than assume the intern has the same level of concern that you do.
And lastly, how would you handle an interruption during the hand off? Though interruptions can be bothersome and may derail a handoff that is going well, some interruptions may actually contribute important facts or updates to the handoff itself. If the page has more information (such as a text page), it can be helpful to triage it appropriately (for example, “mom has arrived and wants an update” versus “Mackenzie now working harder to breath”). Without that information, it is best to interrupt the hand off or delegate tasks to other available care providers if possible.
This first bullet is data from the article, To Err is Human, and thus is already a decade old. Despite an increased focus on quality improvement after this information came out, there is no real evidence to say that this number has decreased.
The other bullets are taken from various articles in the literature and are cited at the end of this presentation.
A sentinel event is an ….
As described in this table, communication is clearly the main contributor to sentinel events. As hand offs are all about communication, they are a very vulnerable piece of the medical care we provide.
Thus it is important to:
Be aware of the problems with hand offs
Be aware of what elements help hand offs go more smoothly
Continue to work on this piece of communication just as one may work on his or her presentations at rounds
Provide ongoing feedback to each other regarding the quality of the hand off and any near misses, errors or adverse events where the hand off may have been a contributing factor.
The first piece of information is from the original duty hour change (80 hour work week, 30 hour max shifts). It does not take into account the more recent changes which will potentially lead to even more hand offs.
One must also consider the handoffs that occur at all other times and with other care providers. Any time a patient goes somewhere for a procedure, transfers units, nursing changes, attending on service changes there is a hand off.
This slide refers to the study performed by Chang et al in Pediatrics 2010. Though it focused on interns, the psychology of miscommunication likely holds true for all care providers.
In any hand off there is a sender: the person giving the information; and a receiver: the person receiving the information. The sender is typically post call or the day time resident who is leaving for the evening and the receiver is typically on call or the night time resident.
This is a well-known Gary Larson cartoon that depicts the psychology of miscommunication - speakers/senders overestimate how well their message is understood and also overestimate the amount of knowledge the receiver has.
Examination of other high-risk industries that are successful at handovers, such as the aerospace, railway and nuclear industries, tell us that the following things contribute to effective hand offs…
Continuation of the listed started on previous slide
So, how might you hand off patients better? The next 2 slides review the components of an ideal handoff:
A brief one liner about the patient sets the stage as well as communicates whether the patient is sick or not sick and why they are still hospitalized.
There are various systematic approaches to providing this type of information. Handoff mnemonics allow the receiver to know what to expect and may prevent omissions if the sender gives the information in the same way every time.
Some examples of mnemonics are:
IPASS the BATON – Introduce yourself, Patient introduction, Assessment, Situation, Safety concerns, Background, Actions, Timing, Ownership, Next
SIGNOUT – Sick or DNR, Identify Data, General Hosp Course, New events, Overall health status, Upcoming possibilities with plan and rationale, Tasks to complete with plan and rationale
SBAR – Situation, Background, Assessment, Recommendation
It is very important to talk about anticipated problems – what might go wrong and what to do about it as well as what has gone wrong in the past and what has worked. For example, stating, “if the patient is fluid overloaded, give lasix” is not nearly as helpful as stating “if patient is >500 cc positive at midnight, give 0.5mg/kg of IV lasix and check the fluid status every 6 hours”.
Read back of the salient points confirms that the receiver and the sender are on the same page: they have a shared mental model of the patient.
This slide depicts the goal of the handoff: that both the sender and the receiver of the handoff have a shared mental picture of the how best to care for the patient.
For the sender:
You want to be sure you are specific and that you are creating the picture of the patient that you want the receiver to see. Make sure that the receiver understood your communication correctly by listening carefully during the read back.
For receiver:
You should listen actively and concentrate on the information you are receiving. Asking questions ensures you understand directions and learn. Read back the salient points confirming that everyone is on the same page.
It is all too often true that the sender thinks they communicated something clearly and what the receiver heard was actually something different -- this is why READ BACK is one of the most important steps to an effective hand over.
Here is another pass at the handoff about our first patient – this handoff continues on subsequent slides.
Case 1 handoff revisted continued…
Case 1 handoff revisted continued…
The presenter may want to print the slide with the patient information on it to hand out to the residents for this part of the module.
It is recommended that the presenter familiarize themselves with the information on this slide prior to giving the module and organize it themselves into a good hand off format.