Nursing and Medical Students participate in Room of Errors-2

Evidence-based Learning Strategies for the "Creating a Culture of Safety" Program

Effective learning strategies must be based on a knowledge of program goals and aims, target learners, adult learning theories, as well as desired competencies and learning objectives. Furthermore, learning strategies must align with the institutional and faculty resources available. The ASPIRE Approach to IPE Development is an evidence-based step-wise process that includes the development and implementation of various learning strategies.

For the "Creating a Culture of Safety" Program, five learning strategies were developed:

  • DNP/Resident PSQI Workshops
  • DNP Brown Bag Seminars
  • Interprofessional Simulations
  • DNP Project Development Workshops 
  • Expert Speaker Sessions

Exemplars

Following are detailed exemplars of the 5 Learning Strategies (including time needed, learning objectives, planning notes, session materials, student comments, and lessons learned):

DNP/Resident PSQI Workshops

DNP/Resident PSQI Workshops

Exemplar:  "Patient Safety, Error Disclosure and Peer Support"

Exemplars are provided as a guide and can be adapted based on the experience of the learners and resources of the institution.  PDF version of this Error Disclosure Exemplar.Icon of Error Disclosure Examplar

Total Time:  120 minutes

Instructor:  Margaret Plews-Ogan MD, MS; Brodie Professor of Medicine, UVA School of Medicine; Chief, Division of General Medicine, Geriatrics and Palliative Medicine

Learning Objectives

  • Identify and demonstrate the elements of an ideal medical error disclosure
  • Understand the power of the words “I am sorry” in a disclosure conversation
  • Demonstrate the ask-tell-ask methodology in a disclosure conversation
  • Identify and avoid common pitfalls in error disclosure
  • Understand and experience the ways that emotions affect disclosure conversations and identify ways to mitigate negative effects of these emotions
  • Identify available resources for team member and peer support surrounding a significant adverse event
  • Place the interests of patients at the center of IP health care delivery.
  • Demonstrate high standards of ethical conduct in team-based care.
  • Act with honesty and integrity with patients, families, and other team members.

Planning Notes

  • Divide residents into 4 separate sessions and match with 2 DNP students
  • Prepare a brief (20 minute) PowerPoint presentation describing the basic elements of an ideal medical error disclosure process
  • Set up the room for the learners to work in groups of three, then come back together for discussion
  • Write a case study that includes a difficult interprofessional medical error that must be disclosed to a patient and his/her family
  • Have one resident and one DNP student role play an interprofessional error disclosure based on the case study to the third learner in the group using the ask-tell-ask methodology.
  • Create a debriefing outline for larger group discussion
  • Distribute a resource list for peer support around an adverse event
  • Distribute evaluation forms

Session Materials

  • PowerPoint
  • Case Study
  • Debriefing guide
  • Evaluation form

Student Comments

“This was a very valuable lecture for our training. It was nice to work with nurses and practice an integrated disclosure.”

“It was important to learn the power of ‘I'm sorry’ and a support group for us.”

“It was good to role play scenarios with residents & practice patient interactions concealing errors.”

“The practical exercise reinforced the need to practice disclosures/difficulty in disclosures.”

“This scenario helped demonstrate the importance of developing a team prior to addressing and error & discussing it with a patient & their family.  This provides time for the team to develop a plan & address any team issues prior to meeting patient & family.”

Lessons Learned

  • Incorporate greater nurse examples & involvement; it would benefit everyone if more of the nursing perspective was given.
  • More time to do scenarios - longer or more sessions only to practice each aspect
  • Better describe physician vs nurse role in disclosure process
DNP Brown Bag Seminars

DNP Brown Bag Seminars

Exemplar: Be Safe Training Part 1 & 2

Exemplars are provided as a guide and can be adapted based on the experience of the learners and resources of the institution. PDF version of this Be Safe Exemplar.Icon of Be Safe Exemplar

Total Time:  Part 1- 90 minutes/ Part 2- 90 minutes

Instructors: Stephanie Mallow-Corbett; PharmD., FCCM; Clinical Pharmacy Services; Clinical Assist Prof of Pharmacy; Clinical Inst Poison Center; Center for ASPIRE Steering Committee

Learning Objectives

  • Identify potential safety hazards that can exist in an inpatient setting
  • Work as an interprofessional team to identify safety concerns
  • Learn from one another in this setting by capitalizing on one another’s expertise
  • Develop a greater sense of responsibility for patient safety

Planning Notes

Session 1
  • Arrange for use of the ASPIRE Center conference room and AV support
  • Develop an overview PowerPoint presentation and videos of LEAN methodology as it is used at UVA (Be Safe)
  • Develop a case study based on an actual patient safety issue and how the BeSafe Lean methodology might be used to address it
  • Have students work in pairs to complete an A3 table for the case study and then present their findings to the whole group
  • Develop a debriefing outline for a group discussion
  • Distribute evaluation forms
Session 2
  • Arrange for the students to participate in the UVA Health System ‘Situation Room’ in which a safety event is discussed by a large interprofessional team of clinicians and administrators.
  • Arrange for the students to follow the interventional team to the hospital unit and engage with the unit staff in the BeSafe analysis and response process
  • Create a feedback form for students to reflect on this experience and how it applies to their training and practice
  • Return to the ASPIRE Center conference room for a group debriefing
  • Distribute evaluation forms.

Session Materials

  • Overview PowerPoint and videos
  • Case Study
  • A3 form
  • Feedback form
  • Debriefing guides
  • Evaluation forms

Student Comments

“It was very valuable learning about the Situation Room- every morning discuss mortality, CAUTI, CLABSI, falls, team errors.”

“Bottom up approach is a great systems approach to problem solving.”

 “Helped me in defining what time wastes are.  I thought this was useful because most times we don’t know or understand what time wastes are & how they can affect teams.”

“Learning to place blame on the process & not the individuals involved in the situation.”

“Learning that leadership is essential in changing the culture.”

I liked the emphasis on culture and system change and direct observations.”

“The concept that people are valuable no matter what the situation is.”

“Placing the emphasis on finding a situation as a team & using the experience & help of the leadership to facilitate the process.”

Lessons Learned

  • Provide more examples of “Be Safe” implementation
  • Print off power point so that students can take notes
  • More examples of real time problem solving
Interprofessional Simulations

Interprofessional Simulations

Exemplar: "No Room for Error"

Exemplars are provided as a guide and can be adapted based on the experience of the learners and resources of the institution. PDF version of this No Room for Error ExemplarIcon of No Room for Error Exemplar

Total Time:  Approx. 30 minutes

  • Individual error observation- 7 minutes
  • Development of team error list- 10 minutes
  • Facilitator-led group debrief- 10 minutes

Instructor: Julie Haizlip, MD, MAPP, FAAP- Clinical Professor of Nursing, UVA School of Nursing and Attending Physician in Pediatrics, UVA School of Medicine

Learning Objectives

  • Identify potential safety hazards that can exist in an inpatient setting
  • Work as an interprofessional team to identify safety concerns
  • Learn from one another in this setting by capitalizing on one another’s expertise
  • Develop a greater sense of responsibility for patient safety

Planning Notes

  • Create patient scenario and identify multiple possible safety hazards specific to patient's care
  • Obtain necessary equipment and materials for the staging of the room
  • Create questionnaires and evaluations
  • Pilot the activity, review the process, seek feedback from pilot participants, and revise as necessary
  • Schedule activity to allow maximal participation from different disciplines

Session Materials

  • Simulation space and equipment (e.g., mannequin, hospital bed, bedside table, sharps container, IV pump)
  • Printed Materials (e.g., Facilitator Script, sample list of errors, blank individual and team error lists, Post-Activity survey). For more information on these materials, please send a written request to aspire@virginia.edu 
  • Other Materials (e.g., Facilitator timer, Participant clipboards and pens)

Student Comments

"This definitely opened my eyes to what different members of the care team identify as errors. It makes it evident how important a multidisciplinary approach is to patient safety."

"This activity was awesome! I loved collaborating at the end so all the errors were brought to light...so many I didn't notice."

Lessons Learned

  • Limit size of group so participants have space to move around while observing errors
  • When creating scenario, include errors of omission
  • Consider interprofessional facilitation of group debrief
  • In group debrief, let students drive the conversation
DNP Project Development Workshops

DNP Project Development Workshops

Exemplar: Qualitative Methods in QI

Exemplars are provided as a guide and can be adapted based on the experience of the learners and resources of the institution.  PDF version of this Qualitative Methods ExemplarIcon of Qualitative Methods exemplar

Total Time:  90 minutes

Instructor: Jessica Keim-Malpass, PhD, RN; Associate Professor of Nursing; Translational Health Institute of Virginia (Thriv) Scholar

Learning Objectives

  • Discuss the value of qualitative methods to the DNP project
  • Describe the challenges inherent in qualitative methodology
  • Identify opportunities for QI projects involving qualitative methods

Session Materials

  • Overview PowerPoint
  • Debriefing guides
  • Evaluation forms

Student Comments

"I now understand the difference between true qualitative research as the primary methodology vs integrating some qualitative data into my PSQI project.”

Qualitative data provides the ‘why’ behind the ‘what’ of quantitative data.”

“Collecting good qualitative data is tricky and requires a great deal of preparation.”

Lessons Learned

  • Provide more time to discuss the potential use of qualitative methods for each of the individual projects.
  • Provide more resources to learn about the application of qualitative methods to QI.
Expert Speaker Sessions

Expert Speaker Sessions

Exemplar: IP Care for Veterans with Multiple Chronic Conditions

Exemplars are provided as a guide and can be adapted based on the experience of the learners and resources of the institution.  PDF version of this Visiting Speaker ExemplarIcon of Visiting Speaker exemplar

Total Time:  90 minutes

Instructor: Malcolm Cox MD; Member: Global Forum on Innovation in Health Professions Education of the Institute of Medicine, the National Leadership Board of the Veterans Health Administration, the National Advisory Committee of the Robert Wood Johnson Clinical Scholars Program, the National Board of Medical Examiners, and the Accreditation Council for Graduate Medical Education.  Chair, Institute of Medicine Committee on Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes, and Chair, Macy Foundation Conference “Transforming Patient Care: Aligning Interprofessional Education with Clinical Practice Redesign.

Learning Objectives

  • Identify the special needs of veterans with Multiple Chronic Conditions
  • Describe the VA approach to team training
  • Discuss the April 2015 IOM report on the impact of interprofessional education (NOTE: add link?)

Session Materials

  • Announcements
  • Evaluation forms

Planning Notes

  • Arrange for Dr. Cox to be the speaker for Medical Grand Rounds
  • Develop informational announcement emails for Medical Grand Rounds featuring Dr. Cox
  • Personally invite other interested clinicians, faculty and students from Schools across UVA
  • Set up Q & A and discussion for DNP students with Dr. Cox in ASPIRE Center conference room
  • Distribute evaluations

Student Comments

"Dr. Cox has a wealth of experience and knowledge to share about the complex care of veterans."

"It is great to know that such a distinguished individual is dedicated to team-based practice."

"His work in measuring the impact of IPE on patient outcomes is important in keeping the momentum for team-based care going."

Lessons Learned

  • Have speaker do Medical Center Hour in addition to or instead of Medical Grand Rounds so that surgeons and other wider audience will attend.
  • Provide more time for interacting with IP groups of students and residents.

Practical IP/PSQI Program "Nuts & Bolts"

Hand holding pencil and wrench There are many practical and logistical considerations in implementing an interprofessional PSQI program like "Creating a Culture of Safety."  Following is a list of issues that institutions developing or expanding their own unique IPE programs might consider.

Standing people with bubbles Program Team

  • Administration
    • Principal Investigator (PI): Depending on the structure of your grant/program, the PI may also be the Program Director. S/he may be the primary grant writer, and is ultimately responsible for all program activities and required reporting (e.g., Grantors, IRB).
    • Program Director/Manager: The Program Director/Manager's role may include grant writing, developing program content, identifying guest speakers/content experts, coordinating with program faculty, communicating with program team and students, overseeing expenses and budgets, supervising data analysis and reporting, dissemination of scholarly materials (e.g., journal articles, conference presentations), and assuring required reporting.
    • Program Coordinator: The Coordinator's role may include implementing session plans and logistics, assisting with program marketing, recruiting, and reporting, obtaining program training materials and equipment, communicating with team members and students, overseeing timely data collection/entry/analysis, ensuring institutional confidentiality measures are met, tracking expenses and budgets, and completing timely required reporting.
  • Content Experts
    • Faculty: The "Creating a Culture of Safety" grant was developed by a committed team of UVA faculty members from the Schools of Nursing and Medicine. Information on faculty involved in the grant can be found in the Contact Section.
    • Guest Speakers: Students benefitted from diverse perspectives of local and national content experts; a listing is provided in the Contact Section.

Dollar sign Budget

  • Personnel: This includes study team members and others (such as I.T. services, facilities management, data analysis).
  • Equipment/Supplies- These may include computer hardware/software, simulation supplies, general office supplies, digital camera.
  • Food: Depending on your budget, food can be a major incentive for busy students.
  • Travel: For faculty and/or students to attend/present at professional conferences or off-site events.

Speaker word bubble (grey) Scheduling/Communication

  • IRB-approved "recruiting" materials: The grant team invited DNP and medical residents to participate in this voluntary IRB-approved program. A Notification Letter- Creating a Culture of Safety Program was sent to students. 
  • Planning Checklist: A helpful reminder for the Coordinator/Planner. This ASPIRE Planning Checklist Sample was stored electronically and physically in a shared team space. 
  • Learning Management System
    • Session announcements/assignments: Study team created Cohort Group Lists, and used the UVA LMS (Collab) to communicate with students. The Program Director and Coordinator were also available to students by email, phone, or in person.
    • Reminders: Busy DNP students told the study team they appreciated reminders.

Power cable Equipment/Supplies

  • Computer/large viewing screen: For PowerPoint and other presentations.
  • Video Camera/Tripod (if recording): If the study team wanted to record a session or activity, we reserved a digital camera and tripod from our Health Science Library. Be sure to check institutional guidelines about photo/recording permission requirements. 
  • Special equipment, as needed: (e.g., simulation supplies)

Pencil and clipboard Data Collection

  • Session evaluations: As noted in the Assessment Section, the grant team collected session evaluations. Forms were distributed at each session and students were asked to complete them at session end (we recommend leaving a few minutes at the end of each session to do this; "late" feedback is often less specific and harder to obtain). The session evaluation form included a Likert-type scale, as well as open-ended questions. We have included 2 sample forms:
  • Program assessments: As noted in the Assessment Section, the grant team collected pre- and post-program assesssments. To assure confidentiality, student assessments were de-identified, stored and documented following institutional guidelines.
  • Project Development Analysis: The "Creating a Culture of Safety" program used the Quality Improvement Proposal Assessment Tool (QIPAT). Information on this tool is available through the NCBI website.

Laptop Data Analysis/Reporting

  • Grant reporting requirements: As a federally-funded program, the grant team was required to file electronic reports. System errors can slow down reporting; we highly recommend scheduling ample time to complete filing before due dates.
  • Institutional reporting/updates: Per IRB/institutional guidelines.
  • Scholarly dissemination: We recommend documenting dissemination activities of both program faculty and students.
  • Post-graduation student updates: Updates (including professional advancement and scholarly dissemination) from the students who participated in the program are welcomed.