Leah - 11 year old girl, 59", 38 kg
- coming out of evening surgery (pectus carinatum)
- placed on epidural fentanyl and bupivacaine (marcaine) to manage pain

middle of night patient complaining of pain (2 am)
- dosage increased from 6ml/hr to 8ml/hr
What are you anticipating you will need to do next
(each team member to answer)
What tasks would you be doing with this patient
(each team member to answer)
Discuss Tasks
... 6 hours later ...

patient still complaining of severe pain
- fentynal dosage increased to 10 ml/hr
What are you anticipating you will need to do next
(each team member to answer)
What tasks would you be doing with this patient
(each team member to answer)
Review Patient Status
... 6 hrs later ...

- patient still complaining of severe pain
- father expresses concern of over medication

Resident orders Ativan,
- Ativan administered 2mg via IV
Question to discuss at end of the story (~5 min)
Clinical Debrief (What)
- What was going on with this patient, what was being treated in this case?
- Was patient centered care being used, and if so, how?
- What did the team do well?
- What could have been done better?
Team (Who/How)
- What were everyone's roles and responsibilities?
- What communication tools did the team use?
- What additional communication tools could have been used?
Facilitated Practice (Practice situation monitoring, advocacy, and assertion) (~8 min)
Have the team create an advocacy statement using TeamSTEPPS:
- Nurse/Intern to Resident
Practice with each other to refine the "advocacy statement":
- challenge the need for Ativan
- challenge the need for monitoring
- advocating for reassessment of mental status
- advocating for reassessment of pain management
How to assert for reassessing treatment plan using TeamSTEPPS
- Reference Pocket Guide
Discuss as a Team any System's Issues (~5 min)
Were there any issues with any given process or procedure?
Did you have the necessary support resources?
- enough personnel with the appropriate skills?
- support services?
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