Risky Business,
Delegation and Prioritization
Delegation and Prioritization
To the
Rescue!
Rescue!
Come
Together🙏🏽
Together🙏🏽
Remember
This?
This?
Critical
Thoughts
Thoughts
Year 2 at BIDN
100
Stage 3 and 4 Pressure Injuries, falls with injuries, Catheter Associated Urinary Tract Infections, and Central Line Associated Bloodstream Infections are examples of these.
What are Serious Reportable Events (SREs)?
100
You note that a patient is bCAM positive for the first time since admission. These are 2 of your next considerations.
What are (we are looking for 2):
Contact the provider with to inform them of the positive bCAM and any new findings.
Consider the source (new medications, withdrawal of meds, pain, urinary retention, constipation, hunger, thirst, labs, infection....)
Implement Fall Precautions, etc.
100
These are two benefits of successful teamwork in the hospital.
What are (we are looking for 2):
Reduced clinical errors
Improved outcomes for patients
Increased patient satisfaction
Increased staff satisfaction
100
You are doing an initial assessment on Mr. Jones and you note this new finding. These are your next steps.
What are:
Offload
Inform provider
Wound Consult
STARS
100
Your patient is receiving fluid through their double lumen PICC. You go to draw blood from their available lumen without success. These are your next steps.
What are:
Draw blood from the available lumen.
Reposition, change the needleless connector, and pursue Cathflo (alteplase) if the other interventions are unsuccessful.
100
These are 2 examples of things to do to advance professionally at BIDN in year 2
What are:
Join a hospital committee
Become a preceptor
ACLS Certification
Clinical Advancement
Pursue certification in an area that interests you
200
In the vast majority of malpractice claims, patients or family members cite this one key factor in their decision to sue.
What is poor communication.
200
These are 4 signs of sepsis
What are (we are looking for 4):
Fever
Tachypnea
Tachycardia
Pain
Pale/mottled Skin
Acute Mental Status Changes
200
These are 2 processes we use in the hospital to effectively communicate information
What are (we are looking for two):
Huddles
Check Backs
Handoffs
Time Out
SBAR
200
This is the pressure injury represented by tissue erosion to the urethra that occurs as a result of an indwelling urinary catheter.
What is mucosal pressure injury (medical device related PI).
200
This is the goal systolic BP and MAP for a patient with sepsis
What is:
SBP > 90
MAP > 65
200
Liz is organizing a fabulous bowling event on Tuesday for the med/surg staff and everyone's going. You and your orientee are working on Tuesday and you ask them to come along. Which part of your role as preceptor, if any, does this gesture address?
What is the Socializer!
300
You have just received report on your assigned patients on Derenzo. Which of the following patients should be assessed first?
A.The patient 2 days status post bowel resection complaining of 7/10 pain
B.The patient scheduled for a surgical procedure immediately after report
C.The patient complaining of chest pain
D.The patient on fall precautions setting off the bed alarm
C.Who is the patient complaining of chest pain (be sure the fall alarm is being addressed by a colleague).
300
This is why lactate levels are important in the setting of sepsis.
What is:
An elevated lactate level is indicative of decreased blood flow and oxygen throughout the body
A serum lactate >2 can be a manifestation of hypoperfusion with or without hypotension
300
These are two of the three primary causes of workplace conflict.
What are 2 of the following: differences, interdependence, and scarce resources.
300
Identify this image:
What is Second Degree Mobitz Type 1 Heart Block - Wenckebach.
PR interval gets progressively longer and eventually the atrial impulse fails to conduct
300
This is why it is important to trend troponin levels
Serial measurements are important as they may be able to identify cardiac damage that was not apparent at the time of the cardiac event.
Troponin levels are elevated as early as 3 hours post- MI, but peak between 10-24 hours.
300
You are addressing an issue related to safety with your orientee and they keep interrupting you and changing the subject. After Describing your concerns to your orientee, this is an example of what you might say to address the next step using the DESC Model of Conflict Resolution.
D - Describe the specific situation or behavior
E - Explain how the situation makes you feel
S - Suggest other alternatives
C - Consequences (can be positive and/or negative)
What is: "It makes me feel like you don't value my feedback when you interrupt me while I try to give you feedback about important safety issues."
D - Describe the specific situation or behavior
E - Explain how the situation makes you feel
S - Suggest other alternatives
C - Consequences (can be positive and/or negative)
400
These are at least 3 of the 5 rights of delegation always taken into account by the RN when delegating
What are (any 3 of these):
Risk task
Right circumstance
Right person
Right direction/communication
Right supervision/evaluation
400
You are documenting at the Nurses Station and you notice a red alarm on the telemetry monitor. Your patient has just gone into V-tach. This is the first thing you need to do.
What is check the patient for responsiveness and a pulse.
400
You are charge on a busy Friday evening and the floor is being asked to take several patients from the ED at once. You communicate your safety concerns to the nursing supervisor and you both agree on the solution of having a nurse float to your unit until the admissions are settled. This is an example of which style of conflict resolution?
What is Compromising
400
This should be included in the discharge teaching for an ambulatory patient going home with an indwelling catheter.
What is information on how to care for their catheter and leg bag
400
This is one strategy nurses can use to improve their critical thinking skills (feel free to provide more than one strategy)
What are (we are looking for one):
Use a case-based approach
Practice self-reflection
Develop a questioning mind
Practice self-awareness in the moment
Use a process
400
You and your orientee have created a mutual goal of focusing on prioritization. You've both just finished taking report. Given the goal you've created, this could be your next step.
What is to ask your orientee to look at their assignment and tell you in what order they would want to prioritize seeing their patients.
500
This individual in the Quality Department at BIDN is available to support you and walk you through the next steps, in the event that you are involved in a safety issue.
Who is the Risk Manager (Amy Taylor)?
500
Your patient admitted with pneumonia and respiratory failure is on an OxyMask at 15 Liters and his O2 sat won't go above 80%. You've called a Rapid Response. While you are waiting for the responders, this is what you can do to raise Mr. Jones's O2 sat.
What is apply a non-rebreather mask.
500
This is the only assumption we should make with respect to conflict management
What is: everyone working here seeks to provide the best possible care, wants to do their best, and wants to improve.
500
These are 3 things the nurse should consider before administering IV Lasix to a patient with heart failure
What are:
Rate of administration
Labs e.g. potassium level, renal function (must have results before giving Lasix)
HR/BP (if low, are they symptomatic, is it their baseline)?
Strict I and Os
Consider Fall Risk/Fall Precautions, need bedside commode?
Is the IV lasix working? Do they need a continuous infusion?
After administration: vs 30 mins after, repeat labs in 6 hours,
500
This is an example of what nurses who think critically may ask themselves when they encounter a problem or challenging situation.
What are (we are looking for one):
What do I know about the situation?
How do I know this?
What personal biases do I have that affect this situation?
What options do I have in this situation?
500
It is the beginning of the shift and you and your orientee are caring for a patient who appears pleasantly confused. You ask your orientee if they recall hearing that the patient was confused in report and they respond "No, should we contact the doctor"? In an effort to facilitate your orientee's critical thinking, how might you respond?
What is: ask questions such as "What are some things we should consider before contacting the doctor"? Give them time to answer....
What is the patient's mental status at baseline?
Physical exam - Vital signs? O2 sat? Neuro signs? labs? Is the patient delirious, what is their bCAM?
Infection, new meds....