actions from last meeting - iowa healthcare collaborative · pdf filesbar provides ! a...

Actions from Last Meeting n  Look for ways the Lean tools (standard work, 5S, mapping, error

proofing, visuals) can be used for improvement at your facility. n  Review information handoffs (EMS to ED) for improvement

opportunities. n  Invite Dean to visit your facility/service (hospital or EMS) and help

with any issues that the Lean tools can address. n  Deliver the message to your staff - Stroke is time critical. n  Review Iowa stroke system is including EMS and categories of

hospital capability and share this information at hospital/EMS level n  Understand relationships between providers in your area n  Standardize stroke assessment and data collection as this can be

used to influence care acutely and for quality improvement

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Strategies and Tools to Enhance Performance

and Patient Safety

TEAMSTEPPS 05.2 Mod 6 06.1

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Introduction Evolution of TeamSTEPPS

Curriculum Contributors •  Department of Defense

•  Agency for Healthcare Research and Quality

•  Research Organizations

•  Universities

•  Medical and Business Schools

•  Hospitals—Military and Civilian, Teaching and Community-Based

•  Healthcare Foundations

•  Private Companies

•  Subject Matter Experts in Teamwork, Human Factors, and Crew Resource Management (CRM)


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“Initiative based on evidence derived from team performance…leveraging

more than 25 years of research in military, aviation, nuclear power, business and

industry…to acquire team competencies”

Team Strategies & Tools to Enhance Performance & Patient Safety


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2006

Patient Safety and Quality

Improvement Act of 2005

Patient Safety Movement

Executive Memo from President

DoD MedTeams®

ED Study

Institute for Healthcare

Improvement 100K lives Campaign

“To Err is Human” IOM Report TeamSTEPPS

1995 1999 2001 2003 2004 2005

JCAHO National Patient

Safety Goals

Medical Team Training


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The Components of a Patient Safety Program


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Course Agenda

n  Module 1—Introduction n  Module 2—Team Structure n  Module 3—Leadership n  Module 4—Situation Monitoring n  Module 5—Mutual Support n  Module 6—Communication n  Module 7—Summary—Pulling It All Together


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If I had a “Magic Wand” and could make changes within my unit or facility in the areas of patient quality and safety…

Introductions and Exercise: Magic Wand


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Why Do Errors Occur—Some Obstacles

n  Workload fluctuations

n  Interruptions n  Fatigue

n  Multi-tasking n  Failure to follow up

n  Poor handoffs

n  Ineffective communication

n  Not following protocol

n  Excessive professional courtesy

n  Halo effect

n  Passenger syndrome n  Hidden agenda

n  Complacency n  High-risk phase

n  Strength of an idea n  Task (target) fixation

Communication

Assumptions Fatigue Distractions HIPAA

®


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n  The process by which information is exchanged between individuals, departments, or organizations

n  The lifeline of the Core Team

n  Effective when it permeates every aspect of an organization

Communication is…

Assumptions Fatigue Distractions HIPAA


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Standards of Effective Communication

n  Complete n  Communicate all relevant information

n  Clear n  Convey information that is plainly understood

n  Brief n  Communicate the information in a concise manner

n  Timely n  Offer and request information in an appropriate timeframe n  Verify authenticity n  Validate or acknowledge information


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Brief Clear

Timely


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Information Exchange Strategies

n  Situation–Background– Assessment– Recommendation (SBAR)

n  Call-Out n  Check-Back n  Handoff


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SBAR provides… n  A framework for team members to effectively

communicate information to one another n  Communicate the following information:

n  Situation―What is going on with the patient? n  Background―What is the clinical background or

context? n  Assessment―What do I think the problem is? n  Recommendation―What would I recommend?

Remember to introduce yourself…


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SBAR Example


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SBAR Exercise

Create an SBAR example based on your role.


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Call-Out is… A strategy used to communicate important or critical information n  It informs all team members

simultaneously during emergency situations

n  It helps team members anticipate next steps

…On your unit, what information would you want called out?


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Check-Back is…


Communication ®

Handoff The transfer of information (along with authority and responsibility) during transitions in care across the continuum; to include an opportunity to ask questions, clarify, and confirm


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Handoff n  Optimized Information n  Responsibility– Accountability n  Uncertainty n  Verbal Structure n  Checklists n  IT Support n  Acknowledgement

Great opportunity for quality and safety


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“I PASS THE BATON” Introduction: Introduce yourself and your role/job (include patient)

Patient: Identifiers, age, sex, location

Assessment: Present chief complaint, vital signs, symptoms, and diagnosis

Situation: Current status/circumstances, including code status, level of uncertainty, recent changes, and response to treatment

Safety: Critical lab values/reports, socio-economic factors, allergies, and alerts (falls, isolation, etc.)

THE Background: Co-morbidities, previous episodes, current medications, and family history

Actions: What actions were taken or are required? Provide brief rationale

Timing: Level of urgency and explicit timing and prioritization of actions

Ownership: Who is responsible (nurse/doctor/team)? Include patient/family responsibilities

Next: What will happen next? Anticipated changes? What is the plan? Are there contingency plans?


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Communication Challenges n  Language barrier n  Distractions n  Physical proximity n  Personalities n  Workload n  Varying communication styles n  Conflict n  Lack of information verification n  Shift change

Great Opportunity for

Quality and Safety


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Questions?

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Teamwork

®


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Team Events

n  Briefs – planning n  Huddles – problem solving n  Debriefs – process improvement

Leaders are responsible to assemble the team and facilitate team events

But remember…

Anyone can request a brief, huddle, or debrief


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Briefs

Planning n  Form the team n  Designate team roles and

responsibilities n  Establish climate and

goals n  Engage team in short and

long-term planning


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Planning Essentials for Teams

n  Leader usually initiates the planning process

n  Team members are included in the planning process

n  Team members have a common understanding of the problem and their roles


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TOPIC

Who is on core team?

All members understand and agree upon goals?

Roles and responsibilities understood?

Plan of care?

Staff availability?

Workload?

Available resources?

Briefing Checklist


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Huddle Problem solving n  Hold ad hoc, “touch-base”

meetings to regain situation awareness

n  Discuss critical issues and emerging events

n  Anticipate outcomes and likely contingencies

n  Assign resources n  Express concerns


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Debrief Process Improvement n  Brief, informal information exchange and

feedback sessions n  Occur after an event or shift n  Designed to improve teamwork skills n  Designed to improve outcomes

n  An accurate reconstruction of key events n  Analysis of why the event occurred n  What should be done differently next time


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TOPIC

Communication clear?

Roles and responsibilities understood? Situation awareness maintained?

Workload distribution?

Did we ask for or offer assistance? Were errors made or avoided? What went well, what should change, what can improve?

Debrief Checklist


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Debrief

Situation Monitoring

“Attention to detail is one of the most important details ...” –Author Unknown

®


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Objectives n  Define situation monitoring n  Define cross monitoring n  Discuss the components of the STEP process n  Define situation awareness (SA), and identify

conditions that undermine SA n  Discuss the importance of a shared mental model n  Discuss when to share information n  Recognize the barriers, tools, strategies, and

outcomes of situation monitoring


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Scenario A patient in the ICU has coded, and CPR is in progress. The Resuscitation Team is busy ensuring that intravenous access is available, and the ET tube is inserted correctly. Dr. Matthews, the Team Leader, is calling out orders for drugs, X-rays, and labs. Judy, a nurse at the bedside, is inserting an IV. Nancy, another nurse, is drawing up meds. Judy can tell by Nancy’s expression that she didn’t get the last order called out by Dr. Matthews. Judy calls out while continuing to place the IV, “Nancy, he wants the high-dose epinephrine from the vial in the top drawer.”


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A Continuous Process

Situation Monitoring

(Individual Skill) Situation

Awareness (Individual Outcome)

Shared Mental Model

(Team Outcome)


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Process of actively scanning behaviors and actions to assess elements of the situation or environment

n  Fosters mutual respect and team accountability n  Provides safety net for team and patient n  Includes cross monitoring

Situation Monitoring (Individual Skill)

… Remember, engage the patient whenever possible.


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Process of monitoring the actions of other team members for the purpose of sharing the workload and reducing or avoiding errors n  Mechanism to help maintain accurate situation

awareness n  Way of “watching each other’s back” n  Ability of team members to monitor each other’s task

execution and give feedback during task execution

Cross Monitoring is…

Mutual performance monitoring has been shown to be an important team competency.

(McIntyre and Salas 1995)


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Cross Monitoring


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Components of Situation Monitoring:


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§  Patient History §  Vital Signs §  Medications §  Physical Exam §  Plan of Care §  Psychosocial Condition

Status of the Patient


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§  Fatigue §  Workload §  Task Performance §  Skill Level §  Stress Level

Team Members


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I = Illness M = Medication S = Stress A = Alcohol and Drugs F = Fatigue E = Eating and Elimination

An individual team member’s responsibility …

I’M SAFE Checklist


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§  Facility Information §  Administrative Information §  Human Resources §  Triage Acuity §  Equipment

Environment


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§  Status of team’s patient(s)?

§  Goal of team? §  Tasks/actions that are

completed or that need to be done?

§  Plan still appropriate?

Progress Toward Goal


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Situation Monitoring n  Recollect examples of situation monitoring,

in which you needed to— n  Be aware of what was going on n  Prioritize and focus on different elements

of the situation n  Share this information with others

n  Select one or two that best represent the concept of situation monitoring

n  Share


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n  Knowing the status of a particular event

n  Knowing the status of the team’s patients

n  Understanding the operational issues affecting the team

n  Maintaining mindfulness

The state of knowing the current conditions affecting the team’s work

Situation Awareness is…


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Conditions that Undermine Situation Awareness (SA)

Failure to— n  Share information with the team n  Request information from others n  Direct information to specific team members n  Include patient or family in communication n  Utilize resources fully (e.g., status board,

automation) n  Document


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Questions?

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