Instructional Resources:
Culture of Healthcare
General Information
An understanding of the culture of healthcare is essential for effectively navigating a career in this industry.
Patient safety, quality of care, and patient privacy are several key areas of focus in healthcare organizations. The
following activities, assignments and resources will be valuable to both clinical and technical students who will
operate in a healthcare environment.
Course Materials
The instructional materials in this document are listed by appropriate learning objectives under Activities,
Discussions, or Assessments. Additional resource materials are included in the section marked Articles, Videos,
Etc. Many of the course materials were developed for online use but are equally applicable for in-class sessions.
Each resource includes a course reference. The indicated course is one example of where the item was used.
NOTE: An assessment question may apply to more than one learning objective; if so, it is listed under each
learning objective to which it applies.
The course materials were developed and piloted by Health eWorkforce Consortium members: Bellevue College,
Bellingham Technical College, Clark College, Clover Park Technical College, Northern Virginia Community College,
Pierce College, Renton Technical College, Spokane Community College, and Whatcom Community College.
Stanford University OLI Instructional Resources
For additional superb online resources, see the (free) Stanford University Open Learning Initiative Health
Information Technology Foundations course. For content and activities relevant to the culture of healthcare, see
Unit 3, Module 3, Healthcare Delivery Organizations, and Module 5, Roles of Healthcare Professionals. Access at
http://oli.stanford.edu/health-technology.
Activities
Learning Objectives:
1. Describe the current “culture of safety” in healthcare and the factors driving change
2. Give examples of ways the nurse can improve processes and medication safety
Activity: A culture of safety
Complete this article: Duke University Culture of Safety Module
Resources Needed:
Duke University. (2014) Culture of Safety. Retrieved from:
http://patientsafetyed.duhs.duke.edu/module_c/module_overview.html
In a written paper, describe the following six aspects of a culture of safety and give examples of how they can be
applied effectively n a nursing setting:






Assessing the Culture
Teamwork
Patient Involvement
Systems
Openness/Transparency
Accountability
Course: Bellevue College: Associate Degree Nursing Program: Health IT module Content for NURS 101Y
Learning Objective:
Compare and contrast different health IT systems and their role in patient-centered care
Activity: Learn about Patient Centered Care
Instructions: Review the telemedicine devices and applications presented in the article below, and then choose
two devices or applications and compare how each improves or hinders patient-centered care.
McGee, Marianne Kolbasuk. (2012) 11 Telemedicine Tools Transforming Healthcare. InformationWeek (March 21)
Retrieved from http://www.informationweek.com/mobile/11-telemedicine-tools-transforming-healthcare/d/did/1103487
Open-source software is software whose source code is published and made available to the public, enabling
anyone to copy, modify and redistribute the source code without paying royalties or fees. Open source code
evolves through community cooperation and collaboration. These communities are composed of individual
programmers as well as very large companies. Traditional proprietary companies compete with each other and
software solutions must be invented anew for each company which wastes valuable resources. In contrast, open
source communities and companies collaborate their resources to build software much more efficiently. It has
been reported that open-source software has resulted in at least $60 billion dollars in savings to consumers. - See
more at: OpenEMR Retrieved from: http://open-emr.org/#sthash.g2fS4EEO.dpuf
Resources Needed:
Finkelstein J, et als. Enabling Patient-Centered Care Through Health Information Technology. Evidence Report No.
206 (Executive Summary). Retrieved from http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guidesreviews-and-reports/?pageaction=displayproduct&productID=1158&preview=1
Course: Bellevue College: Associate Degree Nursing Program: Health IT module Content for NURS 222Y
Learning Objective:
Define Health Literacy and describe what skills nurses need to be health literate
Activity: Health literacy Definition
a. Come to class with a definition of Health Literacy written on a piece of paper from a credible resource.
b. Divide into groups of 6 and list the skills nurses need to be health literate.
c. Respond to this question: What are the skills patients need to be health literate?
Feedback: Good written and verbal skills, ability to analyze, cost benefit ratio, etc.
Health literacy is the ability to read, understand and use health care information to make good decisions for
follow up and treatments.
Nursing is profession that is highly trusted by the public. Nurses teach and are advocates for their patients.
Nurses can translate medical language into everyday language. We are culturally competent, etc. Health care
providers evaluate information for credibility and quality, interpret test results, calculate dosages, locate reliable,
valid health information and analyze risks and benefits.
According to the AMA:
Poor health literacy is a stronger predictor of a person’s health than age, income, employment status, education
level and race.
Course: Clark College: Health IT Module Content for NURS 110 Foundations of Nursing Concepts
Discussions
Learning Objective:
Compare and contrast different health IT systems and their role in patient-centered care
Discussion questions:


What is patient centered care?
What are some technologies that are transforming health care to a more patient centered model?
Possible Responses: Patient centered care is defined many ways, but the general idea is that the healthcare
system is built around the unique needs of the individual patient. Technologies that contribute to this tend to
allow patients to receive care and interact with the healthcare system on their own “terms” and in a way that
is supportive of their unique situation, the needs of their family in a holistic manner.
Course: Bellevue College Associate Degree Nursing Program: Health IT module Content for NURS 222Y
Assessments
Learning Objective:
Define Health Literacy and describe what skills nurses need to be health literate. Acquisition of
Evidence Based Research through online research to provide ‘best care’ to patients.
a. Observe your student explaining a medical procedure to his/her patient. Is the student able to describe
the pathophysiology and/procedure in lay terms.
b. If new medication is being prescribed, can the student tell the patient about the dosing, desired effects,
side effects and cost?
Course: Bellevue College Associate Degree Nursing Program: Health IT module Content for NURS 101Y
Learning Objectives:

Describe the current “Culture of safety” in healthcare and the factors driving the change.

Discuss the types of medication errors and when they occur.

Give examples of technologies and equipment that promote safety.
Question: What is/are the best method(s) to use to avoid the following situation?
A patient has an Acetaminophen overdose due to multiple doses administered in both Percocet and Tylenol
as ordered.
a.
b.
c.
d.
* The eMar tracks total grams of acetaminophen a day, provides alert when max is reached
*CPOE has alert when multiple acetaminophen meds are ordered
Pyxis® medstation will not dispense meds as ordered
Nurse keeps track of grams acetaminophen administered during shift on notepad in patient’s room
Feedback: Correct: a and or b Rationale: eMars and CPOE both have the ability to track data as it is entered, and
also provide alerts to providers when a potential or near miss may occur.
Incorrect: C= a Pyxis® system will only dispense meds it is programmed to provide and those orders must first be
entered in CPOE; D= this is an ineffective and potentially unsafe way to document and track medication
administration
Course: Clark College: Health IT Module Content for Nursing 136 Medical Surgical Clinical Nursing I
Question: What is/are the best method(s) to use to avoid the following situation?
A doctor orders the XL formulation of a medication three times a day instead of once daily
a. *CPOE only offers once daily dosing in order screen
b. Nurse cuts into 3 parts to give three times daily
c. Bar code scanner identifies wrong pill
d. Nurse calls pharmacy, delays med administration to confirm
Feedback: Correct A= in a CPOE system, the provider is unable to order incorrect dosing of a medication by being
offered limited options, in the case of a sustained release med, it should only be offered once daily.
Incorrect: B= not proper administration of an XL medication; C= bar code scanner will only identify the med that is
ordered and confirm with eMAR, if It is ordered incorrectly, the bar code scanner cannot determine this.; D= this
is the most common practice when CPOE is not in place, however a well designed CPOE system will prevent this
delay in medication administration
Course: Clark College: Health IT Module Content for Nursing 136 Medical Surgical Clinical Nursing I
Question: What is/are the best method(s) to use to avoid the following situation?
There are two patients on a unit with the same name and birthday: Robert K. James and Robert L. James. The
Robert K James receives Robert L James’ medications
a. The nurse places red dot on all pills for Robert k. James
b. *The bar code scanner identifies each patient with a unique identifying code instead of name and date of
birth
c. Patients wear different colored hospital gowns
d. *RFID chip in wrist band detects patient when in proximity of the bedside computer and opens only the
chart for the identified patient
Feedback: Correct: B and/or D = both provide unique identifiers for the patient that do not require name or date
of birth
Incorrect: A= not a common medication administration technique; C= does not resolve similar name/DOB issue
with an additional unique identifier that is immune to human error (colors could be confused)
Course: Clark College: Health IT Module Content for Nursing 136 Medical Surgical Clinical Nursing I
Question: What is/are the best method(s) to use to avoid the following situation?
A nurse makes an error in drug calculation and draws and administers an incorrect heparin bolus dose.
a. *Pharmacy sends up premeasured bolus based on patient’s weight in the EMR and attaches unique
bar code to syringe which must be scanned at bedside
b. *High alert med sign on in eMar/EMR with a second nurse before administration
c. Nurse does math calculations on a piece of paper and shows it to charge nurse
d. Verbal double check with another nurse
Feedback: Correct: A, B =the pharmacy premixed med is confirmed with patient weight and is double checked in
pharmacy. The bar code ensures the proper dose is administered. A high alert med check is most effective when it
is actually done and documented. An EMR system that requires documentation and sign in by a second nurse
ensures compliance.
Incorrect: C= when double checking calculations, each nurse should do the calculations separately; D= verbal
double checks are not always done consistently and are not documented
Course: Clark College: Health IT Module Content for Nursing 136 Medical Surgical Clinical Nursing I
Question: What is/are the best method(s) to use to avoid the following situation?
The MD orders an eptifibatide drip at 2 micrograms/kilogram/hour. The patient weighs 150 kilograms and the
hourly dose is calculated to be 18 mg/hr. The nurse programs the pump to administer this medication and
later it is found the max hourly dose of this drug is 15mg/hr.
a.
b.
c.
d.
*Smart pump guard rail “hard stop” for dosing above 15 mg/hr
Chart in med room calculates hourly dose
Second nurse confirms dose calculation
*Pharmacy labels correct dosing for patient weight and bar codes med so the pump read it and run at
ordered rate.
Feedback: Correct: A, D= smart pumps have preprogrammed dosing ranges to ensure safe IV medication
infusions. A “hard stop” cannot be ignored and the nurse must review the med dosing before starting the pump.
Pharmacy can also do the calculations, provide a bottle with the patient’s correct dosing (based on the upper limit
of the medication) and a bar code for the pump to read and set the rate.
Incorrect: B= charts are not often available; C= if the second nurse does not know about the max hourly dose, the
error will still occur.
Course: Clark College: Health IT Module Content for Nursing 136 Medical Surgical Clinical Nursing I
Question: What is/are the best method(s) to use to avoid the following situation?
A patient begins to complain of headache and dizziness an hour after receiving a new blood pressure
medication. The nurse is going to call the doctor but doesn’t know if this is a new patient symptom, a med
side effect or something else. What technology assists the nurse in making this determination?
a.
b.
c.
d.
*Embedded drug info in the EMR, reviewed at the bedside
The nurse calls pharmacy and is put on hold.
The nurse uses a cell phone to do a Google search
The nurse spends 20 minutes looking around the unit for an outdated drug book
Feedback: Correct: A= This is the best choice, as the information is easily accessible and provided by the
facility to ensure that it is reliable. Using a CDSS tool such as a medication library, the nurse can then review
known side effects of the medication in preparation for the SBAR call to the provider in a timely manner.
Incorrect: B, C, D= all are time consuming and the google search may not be reliable. Also the drug book
may not have the most up to date information about the medication.
Course: Clark College: Health IT Module Content for Nursing 136 Medical Surgical Clinical Nursing I
Articles, Videos, Etc.
Office of the National Coordinator for Health Information Technology (ONC) curriculum materials, archived at the
AMIA Knowledge Center Retrieved from: http://knowledge.amia.org/onc-ntdc. These materials formed the basis
for the Open Learning Initiative (OLI) Health Information Technology Foundations course,
http://oli.stanford.edu/health-technology/.
Finkelstein J, et als. Enabling Patient-Centered Care Through Health Information Technology. Evidence Report No.
206 (Executive Summary). Retrieved May 21, 2013 from:
http://www.effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-andreports/?pageaction=displayproduct&productID=1158&preview=1
Ignatavicius, D. D., & Workman, M. L. (Eds.). (2012a). Medical-surgical nursing: Patient-centered collaborative
care (7th ed., Vol.1). St. Louis, MO: Saunders Elsevier.
Medline Plus (2014). Health Literacy. Retrieved from: http://www.nlm.gov/medlineplus/healthliteracy.html
Howard, B. (2013). Explore hospital features that keep you safe in Hospital Room. AARP Magazine (April/May)
Retrieved from: http://www.aarp.org/health/healthy-living/info-04-2013/hospital-room-safetygraphic.html?cmp=RDRCT-TNTRM_MAR12_013
bbraunus (B. Braun Medical USA) (2010, August 27) Medical Center Reduces IV Medication Errors to Zero.
Retrieved from: https://www.youtube.com/watch?v=T2g_92nX0RQ
Freyer, F. (2013, Nov 3) Flaw found in hospitals’ prescriptions. Providence Journal e Edition. Retrieved from:
http://digital.olivesoftware.com/Olive/ODE/ProJo/LandingPage/LandingPage.aspx?href=VFBKLzIwMTEvMTEvMD
M.&pageno=MQ..&entity=QXIwMDEwNA..&view=ZW50aXR5
Hancock, J. (2013) Health Technology’s ‘Essential Critic’ Warns Of Medical Mistakes. Kaiser Health News.
Retrieved from: http://www.kaiserhealthnews.org/stories/2013/february/18/scot-silverstein-health-informationtechnology.aspx
Led by Bellevue College, the Health eWorkforce Consortium was formed to elevate Health Information Technology
workforce development locally and nationally and provide career paths into this promising field for veterans and
others. The nine-college consortium includes Bellevue College, Bellingham Technical College, Clark College, Clover
Park Technical College, Northern Virginia Community College, Pierce College, Renton Technical College, Spokane
Community College, and Whatcom Community College. The Health Information and Management Systems Society
(HIMSS) is also a primary partner.
This workforce solution was 100% funded by an $11.7m grant awarded by the U.S. Department of Labor's
Employment and Training Administration, Grant #TC-23745-12-60-A-53. The solution was created by the grantee
and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor
makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information,
including any information on linked sites and including, but not limited to, accuracy of the information or its
completeness, timeliness, usefulness, adequacy, continued availability or ownership.
Except where otherwise noted, this work is licensed by Bellevue College
(http://hiteducation.org) under a Creative Commons Attribution 4.0 International License –
http://creativecommons.org/licenses/by/4.0/. Any ONC materials included in this work are licensed under a more
restrictive CC BY-NC-SA license – https://creativecommons.org/licenses/by-nc-sa/3.0/.