Decision Making in Clinical Settings

Introductory Information about Interprofessional Engagement in Shared Decision-Making

Definition of interprofessional engagement. Although no universal definition exists, interprofessional engagement can be regarded as the collaboration that occurs between professionals from different disciplines who work together to identify and solve problems as well as formulating treatment strategies. The engagement process is based on a teamwork approach that draws on the knowledge and experience of various fields to develop comprehensive solutions to frequently complex problems (Fang, 2023).

History of interprofessional engagement. It is reasonable to suggest that humankind has relied on interprofessional engagement in some form since time immemorial when different people were recognized as possessing prized skills that were not shared by many others. In a modern context, however, the history of interprofessional engagement can be traced to the late 1960s when teamwork became the cornerstone for effective collaboration as primary care centers (Barr, 2019).

Impact of interprofessional engagement on delivery of healthcare. Interprofessional collaboration in healthcare settings allows professionals from diverse backgrounds to cooperate as a coordinated unit. This team-based approach draws on the unique talents and viewpoints of various disciplines to enhance patient care. Working together fosters mutual understanding and respect between team members. Likewise, it also provides opportunities to learn best practices from one another which facilitates the detection and prevention of medical errors, while speeding intervention when risks emerge (The Importance of Interprofessional Collaboration in Healthcare, 2023).

Identify innovative practice changes. Contributions from administrators, physicians, IT staff, and nurses facilitate the development of documentation tools, communication platforms, and data infrastructure to capture real-time patient insights at the bedside. By working within an interprofessional framework, nurses can help shape future best practices rather than simply adopting new policy guidelines (Clark et al., 2023).

Introduce the six steps for implementing interprofessional SDM within clinical. Implementing interprofessional shared decision making (SDM) within clinical setting is a step-wise process that is intended to maximize the value of the contributions of each team members by drawing on their respective areas of expertise, including doctors of nursing practice (DNPs). In this context, the DNP essentials outline core competencies for nursing's highest practice degree in order to equip nurses to be effective leaders and clinicians. Several of these essential areas specifically relate to DNP competencies for facilitating shared decision-making as discussed further below.

Six Steps for Implementing Interprofessional Shared Decision Making

Step1: Engage clinical team should include:

Identify the team (key players) used in the innovative practice change. Although a core clinical team comprised of healthcare professionals from relevant specialty areas, such as physicians, nurses, social workers, rehabilitation specialists and case managers is routinely used, every decision-making scenario and patient -- is unique. Therefore, this step requires a careful assessment concerning which disciplines should be represented to achieve optimal clinical outcomes.

How will you propose the practice change to the key players? Persuading professionals of any ilk to leave their respective comfort zones by implementing changes to establish policy and practice protocols can be a daunting enterprise. Therefore, prior to any proposal for practice change, policy proposers should ensure that the evidence supports suggested changes through data analysis and literature reviews. In addition, careful assessment concerning the readiness for change among key players and the identification of any knowledge gaps should be performed, followed by targeted messaging concerning the expected benefits of the proposal for patients, providers and the organization to help buy-in among the key players.

Because clinicians are busy professionals, extra efforts should be made to minimize any disruption to current protocols and ongoing feedback from representative interprofessional team members should be solicited. Likewise, recruiting champions from the represented disciplines...

…departments. The DNP leader could also champion investments in training frontline staff concerning contamination risks and evidence-based prevention practices, leveraging their quality improvement expertise to drive broader culture change through new processes, checklists, and electronic documentation integrated hospital-wide.

Provide one example of utilizing a shared decision-making approach to resolve this deficiency. A DNP leader could organize an interprofessional task force with representation from physicians, nurses, quality specialists, hospital administration, environmental services, dietary, patient advocates and IT. Each member would assess current gaps and best practices to propose targeted solutions within their domain from policy changes to cleaning checklists.

Deficiency No. 3: 10.01.08 History and Physical Update Requirement: Medical records must document an updated examination of the patient within 24 hours of admission if an H&P was completed within 30 days of the admission. This update must be in the record prior to any procedure requiring anesthesia services.

What was the deficiency? Deficiencies are medical records without documented updates.

Example of surveyor citation? Based on observation of patient care, no physical exam was

completed as part of the pre-surgical update.

How can a DNP leader make a clinical change to help improve a similar deficiency in a hospital setting? A DNP leader could work with the electronic health record team to build a hard stop forcing providers to complete a pre-op exam update before proceeding with surgical orders.

Provide one example of utilizing a shared decision-making approach to resolve this deficiency. A DNP could form a taskforce comprise of representatives from surgery, anesthesia, nursing, IT and administration to address gaps in consistency. These representatives would assess barriers and vulnerabilities across the surgical continuum. They could develop a pre-procedure checklist for nurses to validate up-to-date consent, medications, exams and clearance and IT could also create EHR alerts to capture missing elements, while administration would fund…