Students' Reflection on Current Practiceto Avoid Tubing Misconnection: A Simple Solution,

A Difficult Compliance, A Training OpportunityAlRasheedi S [1], Borahmah A [1], Al-Braheem A [1], Elamir H [3], Jacob S [1], Bouhaimed M [1,2]

[1] Department of Community Medicine and Behavioural Sciences, Kuwait University Faculty of Medicine.[2] Department of Surgery, Kuwait University Faculty of Medicine.

[3] Department of Quality and Accreditation, Mubarak Al-Kabeer Hospital, MOH

Case Summary: Background:

Learning consists of cognitive, emotional and social dimensions. In medical education, the cognitive dimension is usually measured through

assessments of performance (Fig 1), while the social and emotional dimensions are more challenging to capture. One of the objectives of the

course on “Patient Safety: Better Knowledge for Safer Care” is to support emotional reflection in the learning process to enable a critical

assessment of both self as a professional –in our case a future doctor- and as an agent of change. The Kolb’s cycle (Fig 2) begins with

a concrete experience or task, reflecting on the experience and then applying the learning to new situations. In this case report, we present

the task of carrying out a patient safety hospital round as an object of reflection to explore adherence to the “Avoiding Catheter and Tubing

Misconnections” protocol which is one of the World Health Organization (WHO) “Nine Patient Safety Solutions” adopted by the Ministry of

Health in Kuwait.

Harming patients can take place at different levels within health care like lack of funding, system level (structure or process), or at the point

of interaction between patients and practitioners. When asked to reflect about their experience, it was evident that the students in this

elective course successfully developed a new realisation of the role of human factors in errors and the concept of system failure suggesting

that training for patient safety should start early during medical education.

Conclusion:

We would like to acknowledge the assistance provided by Quality Nurses of Mubarak Al-Kabeer Hospital:

Abeer G. Dossokey, Amal T. Mohamed, Asila A. Alrasheedi, Lea Martinez & Rinto Francis.

Acknowledgement:

Contacts:

The students completed a hospital round of 19 wards and inspected 175 opportunities in tubing of 152 patients who had different

catheters and tubes for the following criteria:

Nursing Notes

Labelling of Proximaland Distal endsFull 53.1%Partial 8.6%Not 38.3%

Full 55.4%Partial 1.7%Not 42.9%

Rooting Tubes andCatheters in correctdirections

Yes 99.4%No 0.6%

Name or Number andDate of insertion

Yes 85.1%No 14.9%

Documentation ofTubes and Catheterin nursing notes atthe start of the shift

ConcreteExperience(Feeling)

Fig 2: Kolb’s Learning Cycle

AbstractConceptualisation

(Thinking)

Adapted by Ivan Mactaggart from Mcleod,2010

“Learning is the process whereby knowledge is createdthrough the transformation of experience”

(David A Kolb, 1984)

http://www.simplypsychology.org/learning-kolb.html#sthash.DOwEfaZC.q20UZ5MW.dpbs

ReflectiveObservation(Watching)

ActiveExperimentation

(Doing)

Remembering

Understanding

Applying

Analyzing

Evaluating

Creating

1. Bloom, Benjamin (ed.). Taxonomy of Education al Objectives. Handbook I: Cognitive Domain. David McKay Company, Inc. New York: 1956.http://pcs2ndgrade.pbworks.com/w/page/46897760/Revised%20Bloom's%20Taxonomy

Fig 1: Bloom’s Taxonomy (Revised)

Can the student distinguishbetween di�erent parts?

Appraise, compare, contrast, criticize,di�erentiate, discriminate, distinguish,

examine, experiment, question, test

De�ne, duplicate, list, memorize,recall, repeat, state

Can the student recall orremember the information?

Can the student explain ideas orconcepts?

Can the student use informationin a new way?

Classify, describe, discuss, explain,identify, locate, recognize, report,

select, translate, paraphrase

Choose, demonstrate, dramatize,employ, illustrate, interpret, operate,

schedule, sketch, solve, use, write

Can the student justify a standor decision?

Appraise, argue, defend, select,support, value, evaluate

Can the student create a newproduct or point of view?

Assemble, construct, create, design,develop, formulate, write

For further information, please contact Dr. Manal Bouhaimed Email: manal_q8 @hsc.edu.kw - Tel (office): 24636532