lepslstafftrain.htm

Research

TeamSTEPPS® Enhancing Safety for Patients With Limited English Proficiency Module

Staff Training Classroom Slides

Slides:

Slide 1: Enhancing Safety for Patients With Limited English Proficiency
Slide 2: Overview/Objectives
Slide 3: The Story of Willie Ramirez
Slide 4: High-Risk Settings and Situations
Slide 5: Added Risk for LEP Patients
Slide 6: LEP Patients in Your Clinical Area
Slide 7: Close Call: An Interpreter's Story
Slide 8: "Opportunity" Scenario
Slide 9: Benefits of Including Interpreter on the Care Team
Slide 10: Implementation
Slide 11: Assertion, Advocacy, and Conflict Resolution
Slide 12: Advocacy and Assertion
Slide 13: Stop the Line: CUS
Slide 14: When Initial Assertion Is Ignored...
Slide 15: Briefs
Slide 16: Psychological Safety
Slide 17: Practice
Slide 18: Check-Back Is...
Slide 19: Teach-Back Is...
Slide 20: Putting It All Together
Slide 21: Summary


Slide 1: Enhancing Safety for Patients With Limited English Proficiency

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Enhancing Safety for Patients With Limited English Proficiency

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Slide 2: Overview/Objectives

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  • Understand the safety risk to patients with limited English proficiency.
  • Know the process to assemble the most appropriate and effective care team.
  • Identify and raise patient communication issues.

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Slide 3: The Story of Willie Ramirez

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Results of not having an appropriate interpreter:

  • Misunderstanding of "intoxicado."
  • Inaccurate medical history.
  • Cultural deference to authority.
  • Quadriplegic teen.
  • $71 million lawsuit.

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Slide 4: High-Risk Settings and Situations

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  • ED.
  • OB/GYN.
  • Surgery.
  • Transitions in care, including intake and discharge.
  • Medication reconciliation.

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Slide 5: Added Risk for LEP Patients

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  • Not using a professional interpreter:
    • Using family members or housekeeping staff as interpreters.
    • "Getting by" with provider's or patient's poor language skills.
  • Interpreter only present for part of the encounter.

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Slide 6: LEP Patients in Your Clinical Area

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  • Percentage of patients LEP.
  • Common languages spoken.
  • Less common languages.
  • Specific issues or problems.

Images: A penguin in a white, medical coat speaks to two other penguins in pink shirts.

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Slide 7: Close Call: An Interpreter's Story

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Patient spoke some English...

  • Interpreter not called.
  • Inaccurate medical history.
  • Latex allergy almost missed before surgery.

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Slide 8: "Opportunity" Scenario

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  • What are the risks in this scenario?
  • What was done badly?
  • What key information was missed?
  • What could be done differently?

'Roll 'Em!' Play Video (icon: penguin film director)
Opportunity (Flash® video, 4 min., 35 sec.; 38.5 MB; Plugin Software Help)

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Slide 9: Benefits of Including Interpreter on the Care Team

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  • Receive more complete and accurate information.
  • Facilitate better clinical decisions.
  • Receive support from a cultural broker who is also an advocate for the patient.

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Slide 10: Implementation

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Identify language/cultural needs
Who?How?
Contact interpreter
Who?How? List various methods. Note contingency plans.
Ensure that interpreter is present for entire encounter
Who?How?
Ensure that interpreter is fully informed and integrated into team
Who?How?

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Slide 11: Assertion, Advocacy, and Conflict Resolution

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  • Scenario:
    Mrs. Gilbert, a Haitian immigrant, is in the ED in triage. The front desk staff called the Creole interpreter, Ms. Pierre-Louis. Dr. Malbec is interviewing Mrs. Gilbert in French, but she does not understand his French. Ms. Pierre-Louis knows that Mrs. Gilbert does not understand, but when she attempts to interpret, Dr. Malbec says, "You are not needed. I've got it."

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Slide 12: Advocacy and Assertion

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  • Advocate for the patient
    • Stop all activity if needed.
    • Speak up on behalf of the patient.
  • Assert a corrective action in a firm and respectful manner
    • Assertion is not aggression.

Image: A penguin with a white coat and stethoscope listens to an enthusiastic small penguin who is jumping up and down.

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Slide 13: Stop the Line: CUS

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C—I am Concerned!

Image: A penguin in a green shirt looks concerned.

U—I am Uncomfortable!

Image: A penguin in a white shirt looks embarrassed.

S—This is a Safety Issue!

Image: A penguin in a blue shirt says "Stop!" and emphatically holds up crossed wings.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
CUS (Flash® video, 47 sec.; 6.3 MB; Plugin Software Help)

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Slide 14: When Initial Assertion Is Ignored...

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  • Voice your concern at least two times...it's your responsibility.
  • If you are being challenged, acknowledge the concern.
    • Correct the problem.
    • Teach.
  • If the outcome is still not acceptable.
    • Take a stronger course of action.
    • Use supervisor or chain of command.

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Slide 15: Briefs

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Planning

  • Form the team.
  • Designate team roles and responsibilities.
  • Establish climate (psychological safety) and goals.
  • Engage team in short-and long-term planning.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Briefs (Flash® video, 36 sec.; 4.9 MB; Plugin Software Help)

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Slide 16: Psychological Safety

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  • Proactively invite input.
  • Be accessible.
  • Ask for mutual support.
  • Remember: Team leader sets tone for the team, while interpreter creates safety for the patient.
    • Leader: "Feel free to stop us at any time if anything is not clear, or if there is anything I should know about the patient's culture, beliefs, or concerns".
    • Interpreter: "If anything we say is not clear, please let me know".

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Psychological Safety (Flash® video, 40 sec.; 5.4 MB; Plugin Software Help)

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Slide 17: Practice

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(Optional Exercise)

  • Scenario: Discharge from the hospital following myocardial infarction.
  • 3 characters: a nurse, an interpreter, and a patient.

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Slide 18: Check-Back Is...

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Image: A circle depicts the following process: Sender initiates message—Clockwise arrow with word "Closed"—Receiver accepts message, provides feedback information—Clockwise arrow with word "Loop"—Sender verifies message was received—Clockwise arrow with word "Communication."

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Checkback (Flash® video, 57 sec.; 7.5 MB; Plugin Software Help)

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Slide 19: Teach-Back Is...

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  • Confirmation of understanding.
  • Opportunity to correct miscommunication.
  • Comprehensive:
    • "Tell me in your own words how you will take this medicine when you get home..."

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Slide 20: Putting It All Together

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  • "Success" video.

Select the penguin director icon below to access the video.

'Roll 'Em!' Play Video (icon: penguin film director)
Success (Flash® video, 6 min., 8 sec.; 50 MB; Plugin Software Help)

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Slide 21: Summary

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Tools and Strategies to Enhance the Safety of Patients With Limited English Proficiency:

  • Process for including in-person and phone interpreters.
  • Brief/ psychological safety.
  • Advocacy and assertion.
  • CUS.
  • Check-back.
  • Teach-back.

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Internet Citation:

TeamSTEPPS Enhancing Safety for Patients With Limited English Proficiency Module: Staff Training Classroom Slides. Slide Presentation (Text Version). Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/teamsteppstools/tslepfiles/traintrainers/lepslstafftrain.htm


Page last reviewed December 2012
Internet Citation: lepslstafftrain.htm. December 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/lep/traintrainers/lepslstafftrain.html