HQ003 Interdisciplinary Collaboration in Nursing

HQ003 Interdisciplinary Collaboration in Nursing

Written Response Submission Form

Your Name: First and last

Your E-Mail Address: Your email here

Instructions

In each of the four Written Response items, you will encounter a situation involving interdisciplinary collaboration. Write your responses where it reads “Enter your response here.” Write as much as needed to satisfy the requirements indicated. Each item contains the rubric that will be used to evaluate your responses.

Item 1

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For this Written Response item, consider the following scenario:

At Meridien Medical Center, hospital policy is to document the “reason” for not administering a medication that is ordered but not administered. The documented reason of “patient refusal” for venous thromboembolism (VTE) prophylaxis has been high across hospital units.

In order to improve patient outcomes, the Quality and Patient Safety Committee decided to explore why so many patients refuse VTE prophylaxis. Their inquiry revealed that less experienced nurses were not very comfortable teaching patients about the risks of VTE and pulmonary embolism if they declined the shot.

Respond to the following prompt:

  • Using an interdisciplinary approach, how would you plan to address the less-experienced nurses’ lack of comfort in teaching patients?

Your Response

Enter your response here.

  0

Not Present

 1

Needs Improvement

 2

Meets Expectations
Module 1: Interdisciplinary Collaboration in Nursing
Using an interdisciplinary approach, how would you plan to address the less-experienced nurses’ lack of comfort in teaching patients?

LO1.1: Apply an interdisciplinary approach to address quality and safety problems in healthcare

 An interdisciplinary approach for addressing the less-experienced nurses’ lack of comfort in teaching patients is missing. The response applies an inappropriate or vague interdisciplinary approach to addressing the less-experienced nurses’ lack of comfort in teaching patients. The response recommends an appropriate and clear interdisciplinary approach for addressing the less-experienced nurses’ lack of comfort in teaching patients.

Item 2

For this Written Response item, consider the following scenario:

Current practice for interdisciplinary rounds on the post-surgery cardiac unit of Meridien Medical Center is to include the surgeon, attending physician, medical student, and nurse. These team members work well together to assess cases and coordinate care. But you know that the unit has had some adverse drug events lately, particularly in the older patient population.

Respond to the following prompts:

  • What additional roles/team members would you advocate adding, and how would you get buy-in from existing team members?

Your Response

Enter your response here.

Rubric

  0

Not Present

 1

Needs Improvement

 2

Meets Expectations
Module 1: Interdisciplinary Collaboration in Nursing
What additional roles/team members would you advocate adding, and how would you get buy-in from existing team members?

LO1.2: Recommend effective interdisciplinary team compositions for quality and safety

 A recommendation for additional roles/team members and for achieving buy-in is missing. The response provides an inappropriate or vague recommendation for adding roles/team members and for achieving buy-in. The response provides an appropriate and clear recommendation for adding roles/team members and for achieving buy-in.

Item 3

For this Written Response item, consider the following scenario:

A new social work graduate, Monica, just started on your unit at Meridien Medical Center, 14 South. She is young and energetic, and everyone seems to like her. The other day during interdisciplinary rounds she was on her phone repeatedly. At first you gave her the benefit of the doubt . . . maybe she was responding to patient messages.

But when the attending physician asked Monica a direct question about a patient, she looked up from her phone, mumbled an excuse, and asked the doctor to repeat his question. The physician has voiced his frustrations, citing unprofessionalism and inattentiveness as concerns. Fran, also a member of the team, is an older nurse who has had a productive career at the hospital.

When talking about Monica, Fran has lately been seen rolling her eyes and making sarcastic comments about “Gen Z.” You want to help both Monica and Fran be effective team members. What do you do before the problem involving Monica, Fran, and the physician gets out of hand?

Respond to the following prompts:

  • Recommend and justify a strategy for addressing the central conflict or issue in the scenario through interdisciplinary collaboration best practices.
  • Explain what diversity (e.g., different generation cohorts, levels of experience, specialties, backgrounds, races, and/or genders) brings to the team and how you would leverage that in the scenario.

Interdisciplinary Collaboration

INTRODUCTION

Healthcare organizations accredited by the Joint Commission are required to conduct a root cause analysis (RCA) in response to any sentinel event, such as the one described in the scenario attached below. Once the cause is identified and a plan of action established, it is useful to conduct a failure mode and effects analysis (FMEA) to reduce the likelihood that a process would fail. As a member of the healthcare team in the hospital described in this scenario, you have been selected as a member of the team investigating the incident.

SCENARIO

It is 3:30 p.m. on a Thursday and Mr. B, a 67-year-old patient, arrives at the six-room emergency department (ED) of a sixty-bed rural hospital. He has been brought to the hospital by his son and neighbor. At this time, Mr. B is moaning and complaining of severe pain to his (L) leg and hip area. He states he lost his balance and fell after tripping over his dog.

Mr. B was admitted to the triage room where his vital signs were B/P 120/80, HR-88 (regular), T-98.6, and R-32, and his weight was recorded at 175 pounds. Mr. B. states that he has no known allergies and no previous falls. He states, “My hip area and leg hurt really bad. I have never had anything like this before.” Patient rates pain at 10 out of 10 on the numerical verbal pain scale. He appears to be in moderate distress. His (L) leg appears shortened with swelling (edema in the calf), ecchymosis, and limited range of motion (ROM).

Mr. B’s leg is stabilized and then is further evaluated and discharged from triage to the emergency department (ED) patient room. He is admitted by Nurse J. Nurse J finds that Mr. B has a history of impaired glucose tolerance and prostate cancer. At Mr. B’s last visit with his primary care physician, laboratory data revealed elevated cholesterol and lipids. Mr. B’s current medications are atorvastatin and oxycodone for chronic back pain. After Mr. B’s assessment is completed, Nurse J informs Dr. T, the ED physician, of admission findings, and Dr. T proceeds to examine Mr. B.

Staffing on this day consists of two nurses (one RN and one LPN), one secretary, and one emergency department physician. Respiratory therapy is in-house and available as needed. At the time of Mr. B’s arrival, the ED staff is caring for two other patients. One patient is a 43-year-old female complaining of a throbbing headache. The patient rates current pain at 4 out of 10 on numerical verbal pain scale. The patient states that she has a history of migraines. She received treatment, remains stable, and discharge is pending. The second patient is an eight-year-old boy being evaluated for possible appendicitis. Laboratory results are pending for this patient. Both of these patients were examined, evaluated, and cared for by Dr. T and are awaiting further treatment or orders.

After evaluation of Mr. B, Dr. T writes the order for Nurse J to administer diazepam 5 mg IVP to Mr. B. The medication diazepam is administered IVP at 4:05 p.m. After five minutes, the diazepam appears to have had no effect on Mr. B, and Dr. T instructs Nurse J to administer hydromorphone 2 mg IVP. The medication hydromorphone is administered IVP at 4:15 p.m. 

After five minutes, Dr. T is still not satisfied with the level of sedation Mr. B has achieved and instructs Nurse J to administer another 2 mg of hydromorphone IVP and an additional 5 mg of diazepam IVP. The physician’s goal is for the patient to achieve skeletal muscle relaxation from the diazepam, which will aid in the manual manipulation, relocation, and alignment of Mr. B’s hip. The hydromorphone IVP was administered to achieve pain control and sedation. After reviewing the patient’s medical history, Dr. T notes that the patient’s weight and current regular use of oxycodone appear to be making it more difficult to sedate Mr. B.

Finally, at 4:25 p.m., the patient appears to be sedated, and the successful reduction of his (L) hip takes place. The patient appears to have tolerated the procedure and remains sedated. He is not currently on any supplemental oxygen. The procedure concludes at 4:30 p.m.,and Mr. B is resting without indications of discomfort and distress. At this time, the ED receives an emergency dispatch call alerting the emergency department that the emergency rescue unit paramedics are enroute with a 75-year-old patient in acute respiratory distress. 

Nurse J places Mr. B on an automatic blood pressure machine programmed to monitor his B/P every five minutes and a pulse oximeter. At this time, Nurse J leaves Mr. B’s room. The nurse allows Mr. B’s son to sit with him as he is being monitored via the blood pressure monitor. At 4:35 p.m., Mr. B’s B/P is 110/62 and his O2 saturation is 92%. He remains without supplemental oxygen and his ECG and respirations are not monitored.

Nurse J and the LPN on duty have received the emergency transport patient. They are also in the process of discharging the other two patients. Meanwhile, the ED lobby has become congested with new incoming patients. At this time, Mr. B’s O2 saturation alarm is heard and shows low O2 saturation (currently showing a saturation of 85%). The LPN enters Mr. B’s room briefly, resets the alarm, and repeats the B/P reading.

Nurse J is now fully engaged with the emergency care of the respiratory distress patient, which includes assessments, evaluation, and the ordering of respiratory treatments, CXR, labs, etc.

At 4:43 p.m., Mr. B’s son comes out of the room and informs the nurse that the monitor is alarming. When Nurse J enters the room, the blood pressure machine shows Mr. B’s B/P reading is 58/30 and the O2 saturation is 79%. The patient is not breathing and no palpable pulse can be detected.

A STAT CODE is called and the son is escorted to the waiting room. The code team arrives and begins resuscitative efforts. When connected to the cardiac monitor, Mr. B is found to be in ventricular fibrillation. CPR begins immediately by the RN, and Mr. B is intubated. He is defibrillated and reversal agents, IV fluids, and vasopressors are administered. After 30 minutes of interventions, the ECG returns to a normal sinus rhythm with a pulse and a B/P of 110/70. The patient is not breathing on his own and is fully dependent on the ventilator. The patient’s pupils are fixed and dilated. He has no spontaneous movements and does not respond to noxious stimuli. Air transport is called, and upon the family’s wishes, the patient is transferred to a tertiary facility for advanced care.

Seven days later, the receiving hospital informed the rural hospital that EEG’s had determined brain death in Mr. B. The family had requested life-support be removed, and Mr. B subsequently died.

Additional information: The hospital where Mr. B. was originally seen and treated had a moderate sedation/analgesia (conscious sedation) policy that requires that the patient remains on continuous B/P, ECG, and pulse oximeter throughout the procedure and until the patient meets specific discharge criteria (i.e., fully awake, VSS, no N/V, and able to void). All practitioners who perform moderate sedation must first successfully complete the hospital’s moderate sedation training module. 

The training module includes drug selection as well as acceptable dose ranges. Additional (backup) staff was available on the day of the incident. Nurse J had completed the moderate sedation module. Nurse J had current ACLS certification and was an experienced critical care nurse. Nurse J’s prior annual clinical evaluations by the manager demonstrated that the nurse was meeting requirements. Nurse J did not have a history of negligent patient care. Sufficient equipment was available and in working order in the ED on this day.