March 30, 2011
UW students from different health professions train as patient-care teams
The UW Hogness Auditorium quickly fills to capacity. The new arrivals greet their friends, take their seats, flip open their lap books and program their smart phones to respond to on-the-spot classroom surveys.
In attendance are students and faculty from the schools of medicine, nursing, pharmacy and dentistry. Some instructors are staff from UW Medical Center and Harborview, where nurses, doctors, pharmacists, physician assistants, social workers and others in the helping professions work together every day in caring for patients and their families.
When they enter their careers, the students will be part of similar teams. Traditionally, however, each health profession trains its students in separate classes, using separate simulations, and with little faculty overlap.
All-professions interdisciplinary training at the UW health schools is changing that. Todays event, and several other ongoing programs and voluntary student service organizations, are providing students from different health professions the opportunity and skills to collaborate in patient care.
Dr. Tom Gallagher, an expert on patient safety, opens the session. He is an associate professor of medicine, Division of General Internal Medicine, as well as of bioethics and humanities: “When I was a medical student I received zero training in interprofessional collaboration. The opportunity to learn and practice interactions with my colleagues in other professions would have been helpful to me. Nowhere is this more important than when something goes wrong. We need to focus less on blaming, and more on the impact on the patient.”
This afternoon, students learn how to tell each other that an error with significant consequences for a patient has occurred, and to meet with the family to explain what has happened. This is a conversation students entering the health professions hope will never be necessary.
“We hit the third-rail with that topic,” one of the faculty members, Dr. Peggy Schlesinger, a clinical professor of medicine in the WWAMI Montana program, said later.
To see what it feels like to admit a damaging wrong, students are asked to tell the person to their left that they had spilled a latte into the persons keyboard, and listen and respond to their reactions.
“Our first tendency is to want to keep our heads down and wait for the situation to pass,” Gallagher says. “But institutions and professionals realize it is essential to be open, transparent and honest with patients, and health care organizations and state governments are adopting new standards for disclosure and apology.”
The students witness what the organizers called a fishbowl. UW Medicine Surgeon Dr. Patch Dellinger, UW Medical Center Chief Nursing Officer Dr. Lorie Wild, and Medication Safety Pharmacist Dr. Jacqueline Biery, enact an error disclosure concerning a fictitious patient.
“Holy smokes!” Dellinger just heard that the patient had not been tested regularly while receiving massive doses of an antibiotic, and was in kidney failure. The nurse, the surgeon, and the pharmacist go over the consequences for the patient – dialysis, uncertainty about regaining kidney function, hospitalization, loss of time and income from his work as a self-employed car mechanic, financial and personal hardship, needing someone to look after his home and his pet.
When they meet with the patient (in this case, an actor in the role of patient), the students sense the awkwardness and discomfort, the patients anger, and the time it takes for the realization to sink in. They are also attune to the responsiveness of the health professionals and the patients efforts to come to terms with the situation and accept what needed to be done next.
Midway through, the action stops. Students in the auditorium and the health professionals on stage comment on what has unfolded.
“He was mad,” Dellinger says of the patient. “Id be mad, too, if what happened to him had happened to me.” Several students offer their impressions and advice on improving the situation during the second act.
The students watch the difficulty in reaching a closing, and notice that feelings are raw and sad at the conclusion.
“Its very uncommon for people to hug at the end of these conversations,” says Dr. Sarah Shannon, an associate professor of nursing who introduced and closed the enactment. Completing an error disclosure is not one of those collaborative moments that bring a sense of relief to health-care team, a faculty member later explains to her students, unlike delivering a healthy baby after a complicated labor or saving a patient in the Emergency Department.
The students break into groups of about 8 to 10 and walk to small classrooms around the health sciences building. The teams have a variety of students from medicine, nursing, pharmacy, the MEDEX program, and dentistry. Each group is met by a UW health sciences faculty member and a person in the role of the adult son or daughter of a patient.
In a fictitious scenario, they are told that the elderly father had arrived at a hospital from a nursing home for a routine procedure. In the recor
ds transfer, an alert on his allergies was missed. The patient was given a penicillin-type antibiotic. He had a serious reaction, and was moved to intensive care. He isnt yet alert, but is beginning to recover.
The students discuss the case amongst themselves and decide how and what to tell the family. They ask themselves, What can we do to rectify the situation? They then meet with the elderly mans family. (They dont realize the person in the role of son or daughter is actually a faculty member or a UW Medical Center or Harborview health professional.) In one of the sessions, the facilitator is WWAMI faculty physician Peggy Schlesinger and the actor is School of Nursing professor, Dr. Carol Landis. She expresses her fear at losing her only living relative, her mistrust of his future care, and her upset that her father couldnt remember her. Her voice trembles.
Shes incredulous: “How could something like this happen?”
The students explain the situation truthfully and tell how sorry they were that the error had occurred. They answer the daughters questions with compassion. The pharmacy student mentions steps that would be taken to avoid future drug errors during nursing home and hospital transfers. All the students think of ways they could be of solace to the father and daughter. When the daughter says she wants to be by her fathers side to be sure no more foul ups occur, the nursing students suggest arrangements for her stay at the hospital, with her comfort in mind.
“We hope that despite what has happened you might be willing to collaborate with us,” one of the medical students says. “We would like you to be near your father, both because it will help him, and for your own peace of mind.” A nursing student continues, “He doesnt recognize you now, but he will soon, and it would be good for you to be there because it will help him become oriented.” The daughter is now more accepting and calm.
Schlesinger ends the scenario by introducing Landis, as “a nursing school professor in real life.” The students, a bit taken aback, smile. The intensity is over.
The All Health Professions Training Day was sponsored by grants from the Josiah Macy Jr. Foundation and The Hearts Foundations to Dr. Brenda K. Zierler, associate professor of biobehavioral nursing and health systems, and Dr. Brian K. Ross, professor of anesthesiology, who worked with Dr. Karen McDonough, Dr. Sarah Shannon, and Debra Liner, Macy Project manager, to plan and produce the afternoon of learning. With aviation background, two Boeing executives consulted on team leadership to foster quality and safety. Nearly 500 students and faculty participated in the March 8th event.
The next All Health-Professions session will take place in early June. In a nearly week long training, students from the various health sciences schools will practice teamwork in realistic simulations of acute, rapidly changing patient care situations. The sessions will be held at the three learning laboratories of the Institute for Simulation and Interprofessional Studies (ISIS), located at Harborview Medical Center, Seattle Childrens and UW Medical Center.