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CHSU COMPETENCY ASSIGNMENT
Patient Advocacy (Advocate)
_______________________________________________________________________________
COMPETENCY ASSIGNMENT (CA)
Competency assignments demonstrate competency in areas of performance aligned to PLOs. CAs are backwards designed to create evidence of competency for the targeted learning outcomes. CAs must be OBJECTIVE measures of INDIVIDUAL performance (typically by rubric or checklist) with reasonable inter-rater reliability. CAs should align to PLO rubrics and indicators (the rows within the PLO rubric) but may add additional context and focus relevant to the course. Each course typically has one to two competency assignments.
Description Table:
CA
CA Description
Design for PLO
Evaluation Instrument
Post-Mortem Case
Essay on Post-Mortem Case
PLO Patient Advocacy (Advocate)
Modified AACU Inquiry and Analysis Rubric
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PLO KSM Table
PLO Patient Advocacy (Advocate)
Courses
List the courses here
Patient Self-Care (S1)
Patient Care I (S3)
Patient Care II (S4)
Patient Care III (S5)
List the courses here
Advanced Patient Assessment (S3)
List the courses here
Advanced Patient Assessment (S3)
P3 OSCEs (S6)
Pharmacy Law (S6)
KSM
Introduce/Experience
Practice/Movement
Competency
Knowledge
PC I – III:
RATs/Block Exams
ADVANCED PATIENT ASSESSMENT:
APPs on Recognition of Advocacy Challenge
ADVANCED PATIENT ASSESSMENT:
Final Simulation/SOAP Note/Rubric
P3 OSCEs:
St 5: Vulnerable Patient Populations (ADVOCATE)
PHARMACY LAW:
Essay – Post-Mortem Case
Skills
PATIENT SELF-CARE:
Counseling Simulation
Motivational Interviewing Skill Set
PC I: Counseling
PC II: APPs
PC III: P&T Presentation on Formulary
ADVANCED PATIENT ASSESSMENT:
Preliminary Simulation/SOAP Note
Mindset
FULL DESCRIPTION OF THE ASSIGNMENT AND EXPECTATIONS
You specialize in forensic analysis and see yourself as the patient’s advocate even in death. A law firm contacted you concerning the sudden death of a hospital patient. The firm is developing a case against Healing Arts Medical Center on behalf of the patient’s family. You are serving as part of the claimant’s side and you are tasked with providing a report of your professional assessment of the patient’s care and recommendations for changes.
FULL CA INSTRUCTIONS FOR STUDENTS:
You will evaluate the medical information obtained from the case narrative. Your report will describe the sequence of events during the hospital stay. Use the PICO Model to ensure you include all relevant information. The report will conclude with your professional recommendations to prevent this scenario from repeating, and strategies on disclosing errors to patients and death to their family members.
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The PICO Model of Review
The PICO Model will help you include all relevant information as you describe the sequence of events during the hospital stay.
P = Patient or Population
• Describe the patient.
• Why was the patient admitted?
• What was the treatment pathway for this case?
I = Intervention
• What was the team treating with each medication featured in the case?
• What types of medication and non-medication treatment options were given?
• What type of prognosis do patients have when admitted with similar conditions?
C = Comparison
• How does the intervention and treatment plan described here compare to the guidelines and evidence on treating this condition?
• What, if anything, could have been done differently?
O = Outcome
• What did the intervention hope to accomplish, measure, improve, or affect (i.e., the therapeutic goal)?
• How did the therapeutic goals change?
Recommendations
The report will conclude with your professional recommendations to prevent this scenario from repeating and strategies on disclosing errors and deaths to patients and their family members.
• What information, not included in the case narrative, do you want and explain how you use this information?
• What could be improved, measured, or changed at Healing Arts Medical Center to help prevent this scenario from repeating in the future?
• What type of work environment and culture is essential for this incident to become a learning experience at Healing Arts Medical Center?
• What are the current “best practices” for healthcare organizations disclosing medical errors to patients and death to their family members?
EVALUATION TOOL (RUBRIC(s) and INSTRUCTIONS:
• Each student must achieve 80% on this assignment to demonstrate competency.
• The paper needs to be greater than two pages and no more than four pages.
• You can use 1-inch margins on all four sides, standard portrait paper, double spaced, 12 pt. font, and use a sans-serif font (e.g., arial, caliibri, tahoma, but not comic sans).
• An assignment upload will be made available on BrightSpace a few weeks before the due date.
• Late papers will receive a reduced grade.
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Modified AACU Inquiry and Analysis Rubric
Capstone
4
Milestones
3 2
Benchmark
1
Score
Explanation of central thesis, problem or issue
The central thesis, issue, or problem is stated clearly and described comprehensively, delivering all relevant information necessary for full understanding.
The central thesis, issue, or problem is stated, described, and clarified, so omissions do not seriously impede that understanding.
Issue/problem/thesis is stated, but description leaves some terms undefined, ambiguities unexplored, boundaries undetermined, and backgrounds unknown.
Issue/ problem / thesis is stated without clarification or description.
Maximum score = 20
Existing Knowledge, Research, Views, and uses the PICO model.
Synthesizes in-depth information from relevant sources representing various points of view/approaches.
Presents in-depth information from relevant sources representing various points of view/approaches.
Presents information from relevant sources representing limited points of view/approaches.
Presents information from irrelevant sources representing limited points of view/approaches.
Maximum score = 20
Analysis
Organizes and synthesizes evidence to reveal insightful patterns, differences, or similarities related to focus.
Organizes evidence to reveal important patterns, differences, or similarities related to focus.
Organizes evidence, but the organization is not effective in revealing important patterns, differences, or similarities.
It lists evidence, but it is not organized or is unrelated to focus.
Maximum score = 20
Conclusions and Recommendations
States a conclusion and recommendations that are a logical extrapolation from the inquiry findings.
States a conclusion and recommendations focused solely on the inquiry findings. The conclusion arises specifically from and responds specifically to the inquiry findings.
States a general conclusion and recommendations that, because it is so general, also applies beyond the scope of the inquiry findings.
States an ambiguous, illogical, or unsupportable conclusion and recommendations from inquiry findings.
Maximum score = 20
Control of syntax and mechanics
Uses elegant language that skillfully communicates meaning to readers with clarity and fluency and is virtually error-free. Proper use of citations.
Uses straightforward language that generally conveys meaning to readers. The language has few errors — proper use of citations.
Uses language that generally conveys meaning to readers with clarity, although writing includes some errors — lacking proper use of citations.
Uses language and structure that impedes meaning because of errors in usage — lacking proper use of citations.
Maximum score = 20
Maximum score = 100
Expert Witness/Testimonial Dossier
Background: You have been contacted by a legal firm to review the material related to sudden death in the hospital from 2018. The family of the individual has been working with their attorney to conduct a thorough review of all information related to the death of their family patriarch and leader. The family has obtained legal support and has developed a case against Healing Arts Medical Center. You are serving as part of the claimant’s side and are tasked with reviewing all the medical information and providing your professional assessment and evaluation of the next steps in the case.
Case Summary Dossier:
Healing Arts Medical Center is a community healthcare facility. The hospital can hold up to 200 inpatients and has multiple outpatient clinics. Medical services include; an emergency department, ICU, CICU, general surgery, labor and delivery, pediatrics, NICU, and a cancer center. The medical center has modern diagnostic equipment, and advanced technology supporting modern treatments. Also, the center has a state-of-the-art electronic health records (EHR) system that contains patient medical history, diagnoses, computerized provider order entry (CPOE), immunization dates, allergies, radiology images, and laboratory and test results. The CPOE system can warn clinicians ordering medications about potential allergic or adverse reactions, duplicate therapy, interactions with other medications, and a transaction log.
JF is a 62-year-old Caucasian male who was brought to the emergency department on October 8, 2019, for shortness of breath. He was also suffering from severe leg pain causing a ground-level fall and various complications related to his physical wellness. The course of treatment in the emergency department included ordering a battery of investigational labs (CMP, CBC, CK, ABG, UA, UDS, D-dimer and US) and start oxygen treatment (nasal cannula), IV fluids, diuretics, and additional renal and cardiac monitoring. The course of the emergency department was uneventful and JF was admitted for more critical care in the CICU (Cardiac Intensive Care Unit) within hours of admission. The initial impression and diagnosis were consistent with pulmonary congestion and an overlapping deep vein thrombus. The individual will be treated for congestive heart failure exacerbation and venous thromboembolism in the intensive care unit. The plan will be to stabilize his condition and then transition his care back home to his family.
In the CICU, JF spent 15 days in critical and acute care as his heart failure was being treated and as his circulation was being stabilized. He was placed on a ventilator and has periodic assessments for arterial blood gases and regular labs for body chemistry. He was also on cardiac monitoring using an EKG, and his urine output was collected and analyzed while in care. He was placed on furosemide therapy for his cardiac and pulmonary congestion and he was given both volume expansion with various crystalloid fluids and vasopressors (dobutamine and epinephrine) for cardiac stability, contractility, and chronotropy. During this time, he was placed on heparin to help him with the stability of the clot. To evaluate the safety of the medication regimen, renal function was assessed periodically, and the anticoagulation was monitored using aPTT, PT, and periodic INR checks.
During the care in the ICU, JF soon stopped producing urine 3 days into treatment, and his furosemide therapy was stopped. With a serum creatinine at 5.8 (up from 1.5 at admission), he was also carefully
titrated on his IV fluids and pressor therapy. During this time, on day 5, he also developed an upper
respiratory tract infection that had to be treated and started on a combination of antimicrobial agents
(ceftriaxone, levofloxacin, and vancomycin). Cultures and sensitivities on sputum were sought out and
he was evaluated holistically for other signs and symptoms of infections. On day 7, his fever subsided
and was starting to get weaned off the ventilator and the drip rates of the IV fluids were modified
accordingly. JF was transferred to the general acute care ward early on day 8 and some of his home
medications were continued. He was still on heparin therapy and was restarted on his home agents,
including enoxaparin. The medication was thought to have a significant DDI with heparin, so it was
stopped by pharmacy during rounds. On day 9, the home medications surfaced once more and were repopulated
on the Medication Administration Record. Enoxaparin was on the list once again and no one
halted the agent. Heparin was still being used during this time and was given concurrently with heparin
for a total of 3 days. On day 12, the nurse called the pharmacist and physician rounding in the unit that
the patient had blood in the urine and had been having an altered mental state. The patient was given
vitamin K and protamine to help reverse the condition to no avail. Packed red blood cells were
administrated, as was FFP with no improvement. The patient died.
The last physical exam and laboratory results reported in the medical chart.
Physical examination:
1. Confused state up until death – confusion increased, and dementia-like symptoms and
irritability followed by extremely still behavior.
2. Petechiae of the eyes and oral mucosa
3. Bruising on the arms and legs in places of friction with the bed
Laboratory Results:
1. Bleeding time (BT) elevated
2. Platelet count reduced (< 75)
3. Activated partial thromboplastin time (aPTT) elevated
4. Prothrombin time (PT) elevated,
5. Thrombin time (TT)
6. LFT elevated > 150 for AST and ALT
7. INR: 2.4
