welcome! thursday plenary. four common conference questions where’s the beef—or food, or...

WELCOME!

Thursday Plenary

Four Common Conference Questions

• Where’s the beef—or food, or coffee, or wi fi?

• Where’s the DOD?

• Where’s the slides?http://www.teamsteppsportal.org/

• Where’s the conference next year?

http://www.teamsteppsportal.org/

Recognizing Our Debts

My mom and baby niece

Sue Sheridan

TeamSTEPPS in Crisis Situations

Timothy Adam, MBASheila Smyth-Giambanco, RN, MA, ACNS-BCMark Mayes RN, MHA, CEN

Captain Tim AdamMaster Trainer - TeamSTEPPS

TeamSTEPPS in a Crisis

TEAMSTEPPS 05.2Mod 1 05.2 Mod 1 05.2 Page 6

TeamSTEPPS

Where were you on September 11, 2001?


TeamSTEPPS

Captain Jason Dahl


TeamSTEPPS

United Airlines in a Crisis All airline flight

operations ceased for 3 days

26% of United revenues gone

Financial, Public and Personal Crisis


TeamSTEPPS

Leadership required the application of every principle and discipline of

Crew Resource Management


TeamSTEPPS

TeamSTEPPS Fundamentals Used

Leadership

Communication

Team Structure

Situation Monitoring

Mutual Support

SBAR

CUS Words


TeamSTEPPS

1972 - Miami, Florida

1978 - Portland, Oregon

Review by NASA directed by

Congress

Flight Training in Crisis


TeamSTEPPS

NASA Findings

1. Faulty Judgment

2. Poor Decision Making

3. Inadequate Communications

4. Poor Management

5. Poor Leadership

http://images.google.com/imgres?imgurl=http://pnt.gov/membership/nasa-large.png&imgrefurl=http://pnt.gov/membership/nasa.shtml&h=527&w=638&sz=105&hl=en&start=2&tbnid=LcH170TxVPnJJM:&tbnh=113&tbnw=137&prev=/images?q=nasa&gbv=2&hl=en


TeamSTEPPS

CRM in Airline Training United Airlines first to start

CRM training in 1981

By 1990 CRM implemented

by all major air carriers

FAA: required CRM Training

& Evaluation in 1990

6 generations of CRM


TeamSTEPPS

Crew Resource Management has been

proven to effectively change cultures

of safety in the organizations that

choose to adopt it


TeamSTEPPS

Crew Resource Management Is Not

A quick fix to improve patient safety

A stand-alone system

A passive series of classroom lectures

A psychological or personality assessment tool

A way to control behavior by management


TeamSTEPPS

Crew Resource Management Is Not


TeamSTEPPS

What Crew Resource Management Is

A system that uses of ALL available resources

A system that promotes a non-punitive culture

A system that centers on clear, comprehensive

Standard Operating Procedures (SOPs)


TeamSTEPPS

Identifying potential Threats

Identifying potential Errors

Implementing steps to solve threats BEFORE they happen

Developing a TEM Safety Model

Threat and Error Management (TEM) added in 1996


TeamSTEPPS

What Would You Do?


TeamSTEPPS

Threat and Error Countermeasures

1. Standard Operating Procedures

2. Checklist discipline3. Team situational

awareness4. Quality briefings (Pre & Post)


TeamSTEPPS

What is a Threat?

Events or conditions which occur beyond the influence of the team; increase a situation’s complexity; and must be managed to maintain the margins of safety

www.caas.gov


TeamSTEPPS

Threat Error

Threat


TeamSTEPPS

Six Categories of Threats1. Environmental threats -

Weather, Construction2. Organizational threats –

Corporate, Regulatory3. Expected threats –

Complex/risky procedure4. Unexpected threats - Power

outage, Equipment malfunctions

5. Latent (hidden) threats – Training, Hardware design

6. Other threats - Stress, Fatigue, Distractions


TeamSTEPPS

Unrecognized or mismanaged THREATS

generate ERRORS


TeamSTEPPS

What is an Error?An error is an action or inaction that leads to a different outcome than the

crew expects. In other words…

It is a MISTAKE


TeamSTEPPS

Types of Errors

1. Procedural errors Not following SOPs

2. Handling errors Improper system input

3. Communication errors


TeamSTEPPS

Communication Errors

Miscommunication

Misinterpretation

Incomplete Briefings

Non-Standard Phraseology

Incorrect information passed


TeamSTEPPS

Words Or Phases That Can Mean Trouble No problem, we can do that. What's he/she doing now? Is this safe? Are you falling behind? Are you rushed? I’m concerned…this doesn’t look right to

me. Looking good! I'm uncomfortable! Hey…Watch this!


TeamSTEPPS

What is Error Management?The process of detecting and responding to

errors with countermeasures that mitigate

the probability and/or severity of further

errors or undesired states

It is a PLAN


TeamSTEPPS

We cannot PREVENT all errors

Nor can we AVOID all errors

- BUT -

We can MANAGE errors


TeamSTEPPS

5 Keys to Managing Errors1. Follow established procedures2. Use proper and consistent

phraseology3. Continuously monitor activity4. Clarify / challenge inconsistencies5. Make errors ‘visible’ (don’t hide

them)


TeamSTEPPS

Does all this really work?

US Airways Flight 1549 – Hudson River


TeamSTEPPS

Does all this really work? YES!

It works in a crisis, and more importantly…It can PREVENT a crisis!


TeamSTEPPS

Tim [email protected]: http://www.linkedin.com/in/tadam/Master Trainer - TeamSTEPPS

THANK YOU!

mailto:[email protected]

http://www.linkedin.com/in/tadam/

Contingency Leadership during Crisis:Managing a Virtual and Satellite Clinic Post-Storm Sandy in NYC


TeamSTEPPS

World Trade Center Environmental Health Center: Survivor Program


TeamSTEPPS

Who are we? WTC Environmental Health Program is a program

to evaluate and treat medical and mental health problems associated with the destruction of the WTC and the resulting spread of dust and fumes.

The Survivor program services the residents, students and local workers who lived or were in the area where the disaster occurred


TeamSTEPPS

Training Background Human Resources and WTC EHC Bellevue staff

participated in ½ day TeamSTEPPS Essentials for the clinic’s inter-professional team in July 2012

Focus was on strengthening communication and team building while providing care to vulnerable population

Discussions focused on individual skill of situation monitoring and group skills of cross-monitoring with a “shared mental model” in place

Tools practiced- brief, debrief, SBAR, huddle Conflict resolution – two challenge rule, Desc

Script, CUS


TeamSTEPPS

Summer 2012 “Growing Pains” White Board for clinical staff to give “mental

picture” of new patients and monitoring patients schedules so all knew where patients were and assured that all tasks were performed (lab, PFT, EKG, Xray, SW, MD, etc)

A.M. “Huddles” to review team roles, patient volume, challenges, events, expectations

Informal Briefs called when some event of an urgent nature arose

Debriefs employed at end of week to review how the week went, then briefed a plan for following week. SBAR encouraged but not formalized


TeamSTEPPS

9/11/12 Zadroga Bill Expansion brings new clinic challenges

Coverage extended to include over 50 cancers related to exposure of survivors/responders

National program for Survivors went “live”

NIOSH/Govt. programs face sequestering of funds due to budget crises and purse strings are tightened to be “LEAN” yet efficient


TeamSTEPPS

“Superstorm Sandy” The Anticipation Plan… “Deja Vue” Lessons from Hurricane Irene 2011 The Reality of Autumn, 2012


TeamSTEPPS

Aftermath of Sandy’s wrath…


TeamSTEPPS

Evacuation post-storm


TeamSTEPPS


TeamSTEPPS

WTC EHC “Our Huddle” Bellevue closed, staff re-deployment plan in

progress Temporary office space loaned to Clinical and

Administrative team in WTC corporate offices at 125 Worth Street

Roundtable reflections of storm, storytelling and self-care started our team discussions

Brainstorming on “telephone triage” hotline set-up , using SBAR to prioritize and “bucket” calls

Borrowing “ creative space and resources” for clients needing urgent visits at our sister sites as interim plan during closure


TeamSTEPPS

Contingency Leaders emerge… Social workers fielded calls related to stress

response, referred escalated or vulnerable clients to a mental health provider for follow-up at satellite

WTC Clinic clerical staff became the “dispatch operators” taking the calls that came in at the Central Office toll-free hotline which was created in 4 languages by the team(Chinese, Russian, Spanish, English)

All calls logged onto Excel spread sheets with columns for documentation of responses, interventions and need for “closing the loop” debriefs at end of each day


TeamSTEPPS

Our Virtual and Present Reality Clinical Nurse Manager reviewed calls logged and

priority coded into follow-ups: call-backs, prescription refills, urgent care appointments, emergency follow-ups, calls to new and former patients with concerns

Pulmonary MDs worked out a coverage schedule using the limited space offered at Gouveneur Hospital, PFT techs worked with their techs to meet needs of clients, Psychiatrist/Psychologist saw patients at high risk by appointments


TeamSTEPPS

Other Team Roles Patient Navigator- role became one of more

“physical” navigation so WTC Bellevue patients would be able to find where they needed to go to be seen and receive care

WTC Clinic Administrator- became the “go to” for all the Gouv space and scheduling as well as resource allocation

Patient Care Associate(PCA) and pulmonary RN had multiple functions added onto roles in new space and had to immerse into existing team


TeamSTEPPS

TeamSTEPPS tools that helped Brief Debrief SBAR and handoffs Cross-monitoring * STEP (status of patient) * I’M SAFE (status of team member)


TeamSTEPPS

Challenges Time and space and resources Volume of calls and limited resources Maintaining Patient Safety by check-back of two

identifiers Maintaining HIPAA and documentation in the

interim situation Taking care of ourselves and each other as the

results of the storm impacted staff and clients alike


TeamSTEPPS

Our post-storm virtual and satellite clinic was a success…

Patients received their medications uninterrupted using pharmacy callbacks, access to EMR was not interrupted as both hospitals were on same network.

Temporary Access given to MD and Clinical RN Manager for Elmhurst network EMR as new patient referrals were made to this site and cancer coverage enrollment certifications weren’t delayed

Acute resp pts were seen, triaged and treated for their conditions which were exacerbated due to storm experiences


TeamSTEPPS

Successes… Mental Health services and crisis referral

provided to our most vulnerable clients at satellite in Gouvenuer Hospital and Elmhurst site was prepared if any clients needed to transfer to their site

Team-building between our clinics staff who now were temporarily working together – standardization of PFT functions and competencies is one example of a positive outcome


TeamSTEPPS

Lessons learned… Planning is critical Adaptability is essential Every team member COUNTS Every role is IMPORTANT Give KUDOS to a job well done! Chronicle the “Silver lining”stories


TeamSTEPPS“The first choice we make each and every day is “Will we act

upon life, or will we be merely acted upon?” Steven Covey

Rapid response to tragedy in Aurora, Colorado

Mark Mayes RN, MHA, CEN


TeamSTEPPS

Background Aurora, Colorado The Medical Center of Aurora


TeamSTEPPS

ED – Trauma Center


TeamSTEPPS

Aurora Theater ShootingJuly 20, 2012


TeamSTEPPS

Our Journey Emergency Nurses Association Beginning April 2011

Site assessment & culture survey Action planning

Just-in-time training Real-time coaching and feedback Check-in calls Wrap up/Observation April 2012


TeamSTEPPS

Process Improvement Leadership Development – ED Charge Nurses

Team Leader Role – Communication

Instant Communication

ED Surge / Diversion


TeamSTEPPS

Clear Role Definition

Charge Nurse & Charge MD

RRT Assignment


TeamSTEPPS Call a Huddle!ED Trigger List

• All ED beds are full• ED SAFE change in status• Pre Code/Trauma patient arrival• > 5 M1 holds in ED• > 1 hour wait in the lobby• > 2 ESI level 2’s in the lobby• Arrival of new physicians• Divert within our zone• Whenever you think we need one!

Huddles


TeamSTEPPS

Night of the ShootingUnder construction

12:38 shooting begins

Call at 12:55

12 GSW by 01:16 (Mode of arrival)


TeamSTEPPS

Emergency Department Huddles

Several Decon team

SBAR Situation Monitoring

Team leaders Brief and Debriefs


TeamSTEPPS

Emergency Department Signs of success…

Patient stories Bio Phone calls

1st call How many can you take?


TeamSTEPPS

Summary Framework Structure Communication Leadership

Let me get my charge nurse

welcome! thursday plenary. four common conference questions where’s the beef—or food, or...

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