Live Blog: Interprofessional Education

The newest installment of the Interprofessional Education series was presented by Maria Dolce and Jessica Hollman of Northeastern University School of Nursing, focusing on communication in the clinic. The TeamSTEPPS system was used as a guide.

Communication:

• A two-way process making sure each person understands what is conveyed.
• Most medical errors come from communication. 

Evidence-Based Tools/Techniques:

• Ensuring communication is complete
• Concise
• Timely

Barriers:

• Language
• Distractions
• Physical proximity
• Personalities
• Workload
• Varying comm styles
• Conflict
• Lack of info verification
• Shift change
• Family has fear of healthcare providers

Consequences:

• Conditions getting worse
• Adequate medication not prescribed

Info Exchange Strategies:

• SBAR:
• situation
• background
• assessment
• recommendation :
• Call-out
• used to communicate critical info to an entire emergency team 
• Checkback:
• closing the loop
• receiver accepts/confirms info
• Handoff: 
• transition of care 
• convey all pertinent info
• allow for period of time where person can ask questions

What is SBAR?

• Framework for team members to effectively communicate info to one another.
• Situation: whats going on with the patient?
• Background: what is the context?
• Assessment: what is the problem?
• Recommendation: what do i need from you?

Think-Pair-Share:

• Think about team.
• What are opportunities to improve communication?
• What strategies would you use to overcome communication breakdowns?

Primary Care Teams Should:

• Make sure patient's voice is being heard.
• Allow time for open/honest communication.
• Make the patient the center of the team.
• Make sure patients share fully in decision-making.
• Speak to patients in a way they can understand and enable them to feel empowered to be control of their care.

Equipping the Patient:

• Encourage patient to ask questions so pts can improve their care by taking an active role in the process.
• Inform them of questions they should ask the doctor.

Image of the Week 1/20/2014

A 51-year-old man with hypertension told his physician that in the past five hours his right arm and leg and the right side of his face felt weak. He had no sensory, cognitive, or language deficits, and an MRI was performed. What does the MRI show?

Live Blog: Hypertensive Patient Case

Today’s talk was given by Dr. Lindsey Hintz, 3rd year primary care resident here at Healthcare Associates. She discussed one of her former patients, a 28 year old African American male who comes in for routine checkups. Dr. Hintz noticed that his blood pressure was 148/95 both times it was checked. He also has sleep apnea, snores, and goes to bed at 6PM.

When to work up for Secondary HTN: 

• Young age (under 30 with risk factors)
• Has no risk factors (including family history)
• African American less likely to look for secondary HTN
• Drug use 
• Illicit 
• OTC stimulants
• NSAIDs
• Oral contraceptive pills
• SSRIs
• EtOH use
• People with resistant HTN (uncontrolled with 3 meds with adequate doses)
• People who have severe HTN
• Stable blood pressures with abrupt change
• Renal artery stenosis
• Pheochromocytoma
  

  • Headache
  • Palpitations
  • Sweats
  • HTN
• Endocrine
• Hypothyroidism
• Cushing’s Disease
• Hyperparathyroidism
• Hypertensive before puberty

• Sleep apnea
• Kidney disease
• Coarctation of aorta with decreased femoral pulses and hypotensive legs
• Primary hypoaldo (low K+ with HTN)

Questions to Ask:

• What’s causing the 2° HTN? 
• How do we change the treatment?

First Line Treatment:

• Chlorthaladone
• Diuretic
• ACE inhibitor
• Ca2+ channel blockers (Lodipine)

Take Home Points: 
Check for secondary HTN when

• Person under 30 has no risk factors
• HTN before puberty
• People with good doses and HTN still not controlled

Image of the Week 1/13/15

A 45-year old woman with diabetes comes in with concerns about lesions on her foot. What is the diagnosis and why has it occurred?