TeamSTEPPS and Patient Safety in Healthcare, Exams of Nursing

Download TeamSTEPPS and Patient Safety in Healthcare and more Exams Nursing in PDF only on Docsity! NU470 Week 7 PrepU Collaboration Teamwork & Collaboration 2023 to 2024 exam Key Recommendation from IOM for health care organizations - establish interdisciplinary team training programs for providers that incorporate proven methods of team training Leading cause of preventable patient deaths - Communication failures TeamSTEPPS - -Team Strategies and Tools to Enhance Performance and Patient Safety -Evidence-based teamwork system aimed at optimizing patient outcomes by improving communication and other teamwork skills among healthcare professionals. Who was TeamSTEPPS developed by? - Department of Defense Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality (AHRQ) 3rd leading cause of death - -Iatrogenic -Medical Errors Iatrogenic - when a patient dies as a direct result of treatments by a physician, whether it is from misdiagnosis of the ailment or from adverse drug reactions used to treat the illness How many deaths are from medication errors? - 7,000 How many deaths are from unnecessary surgery? - 2,000 How many deaths are from other errors in hospitals? - 20,000 How many deaths are from infections? - 80,000 How many deaths are from non-error adverse effects of medications? - 106,000 Students and working professionals should develop and maintain proficiency in five core areas - - Delivering patient-centered care, -Working as part of interdisciplinary teams, -Practicing evidence-based nursing, -Focusing on quality improvement and -Using information technology. TeamSTEPPS focuses on - -pecific skills supporting team performance principles, including training requirements, behavioral methods, human factors, and cultural change designed to improve quality and patient safety Teamwork concepts are introduced that provide specific tools for - improving communication and teamwork, reducing chance of error, and providing safer patient care 4 teachable/ Learnable skills of TeamSTEPPS - leadership, mutual support, situation monitoring, and communication 5 Key Principles of TeamSTEPPS - -Team Structure -Leadership -Situation monitoring -Mutual support -Communication Attitudes - -Mutual trust -Team orientation Performance - -Adaptability -Accuracy -Productivity -Efficiency -Safety Multi-Team System - -Key component: patient -Core team -Coordinating Team -Contingency Teams Core Team - Core teams consist of team leaders and team members who are involved in the direct care of the patient. Core team members include direct care providers (from the home base of operation for each unit), and continuity providers (those who manage the patient from assessment to disposition, for example, case managers). The Core team is based where the patient receives care. Coordinating Team - The coordinating team is the group responsible for: - Day-to-day operational management - Coordination functions - Resource management for Core Teams Contingency Teams - - Formed for emergent or specific events - Time-limited (e.g., Code Team, Disaster Response Team, Rapid Response Team) - Composed of team members drawn from a variety of core teams Benefits of Teamwork - - Reduce clinical errors -Improve patient outcomes -Improve process outcomes -Increase patient satisfaction -Increase staff satisfaction -Reduce malpractice claims Team Leaders should be able to - • Organize the team • Articulate clear goals • Make decisions based on input of team members • Empower team members to speak up and openly challenge, when appropriate • Promote and facilitate good teamwork • Resolve conflict Effective Team Leaders - • Are responsible for ensuring that team members are sharing information, monitoring situational cues, resolving conflicts, and helping each other when needed • Manage resources to ensure team performance • Facilitate team actions by communicating through informal exchange sessions • Develop norms for information sharing • Ensure that team members are aware of situational changes to plans Team Events Include - -Planning -Problem Solving -Process Improvement Team Events are accomplished through - -Briefs -Huddles -Debriefs Brief - -Planning -Short session prior to start to discuss team formation, assign essential roles, est. expectations and climate, anticipate outcomes and likely contingencies Brief Checklist - -Who is on our team? -All members understand and agree upon goals? -Roles and responsibilities are understood? -What is our plan of care? -Staff and providers availability throughout the shift? -Workload among team members? -Availability of resources? Purpose of Briefs - • They clarify who will be leading the team so that others know to whom to look for guidance • They open lines of communication among team members, ensuring that everyone can contribute their unique knowledge base to the task, and thereby set the tone for the upcoming procedure. Protocols, responsibilities, and expected behaviors are discussed and reinforced so that possible misunderstandings are avoided • They prepare the team for the flow of the procedure, contingency plans, and the means for resolving any unusual Circumstances • By delineating expectations, they reduce disruptive or unexpected behaviors STEP - -A tool for monitoring situations in the delivery of health care -Components of situation monitoring -Status of the patient -Team members -Environment -Progress toward goal Assess Status of Patient - -Patient Hx -Vitals -Meds -Physical Exam -Plan of care -Psychosocial Assess level of team memebers - -Fatigue -Workload -Task performance -Skill -Stress Assess Environment - -Facility Information -Administrative information -Human resources -Triage acuity -Equipment Assess progress towards goal - -Status of teams patients? -Established goals of team? -Task/actions of team? -Plan still appropriate? I'M SAFE - -Assess your own conidtion for work -Illness -Medication -Stress -Alcohol and rugs -Fatigue -Eating and elimination Task Assistance - -Form of mutual support -Team members protect each other from work overload situations -Effective teams place all offers and requests for assistance in the context of patient safety -Team members foster a climate where it is expected that assistance will be actively sought and offered Feedback - -Information provided for the purpose of improoving team performance Feedback should be - -Timely (given soon after the target behavior has occurred) -Respectful (focus on behaviors not person attributes) -Specific ( be specific about what behaviors need correcting) -Directed towards improvement (provide direction for future improvement) -Considerate ( consider a team members feelings and deliver negative information with fairness and respect) How feedback benefits the team - • Fosters improvement in work performance • Meets the team's and individual's need for growth • Promotes better working relationships • Helps the team set goals for ongoing improvement Avocate for - -The Patient -Invoked when team members viewpoints don't coincide with that of the decision maker Assert a corrective action in a - -Firm and respectful manner -Make an opening -State the concern -Offer a solution -Obtain an agreement Two Challenge Rule - When an initial assertion is ignored: -It is your responsibility to assertively voice concern at least 2 times to ensure it has been heart -The team member being challenged must acknowledge "Patient is a 62 year old female post OP day 1 from abdominal surgery. No prior Hx of cardiac or lung disease" Assessment - -What do I think the problem is? "Breath sounds are decreased on the R side with acknowledgement of pain. Would like to rule out pneumothorax" Reccomendation - -What would I do to correct it? "I feel strongly the patient should be assessed now. Are you available to come in?" Call out - -Strategy used to communicate important information -Informs all team members simultaneously during emergent situations -Helps team members anticipate next steps -Importation to direct responsibility to a specific individual responsible for carrying out the task Example of Call out - -Leader: "airway status?" -Resident: "airway clear" -Leader: "Breath sounds?" -Resident" "Breath sounds decreased on the right" Check Back - Process of employing closed- loop communication to ensure that information conveyed by the sender is understood by the receiver as intended Check Back Steps - 1. Sender initiates message 2. Receiver accepts the message and provides feedback 3. Sender double checks to ensure that the message was received Example of check back - -Doctor: "Give 25 mg Benadryl IV push" -Nurse: "25 mg Benadryl IV push" -Doctor: "Correct" Hand off - -The transfer of information (along with authority and responsibility) during transition in care across the continuum, to include an opportunity to ask questions, clarify, and confirm -Strategy designed to enhance information exchange during transitions in care Hand off includes - -Transfer of knowledge and info about the degree of uncertainty -Response to treatment -Recent changes in condition and circumstances -The plan of care I PASS the BATON (hand off) - -I Introduction—Introduce yourself and your role/job (include patient) -P Patient—Name, identifiers, age, sex, location -A Assessment—Presenting chief complaint, vital signs, symptoms, and diagnosis -S Situation—Current status/circumstances, including code status, level of uncertainty, recent changes, response to treatment -S Safety Concerns—Critical lab values/reports, socioeconomic factors, allergies, alerts (falls, isolation, etc.) THE -B Background—Co-morbidities, previous episodes, current medications, family history -A Actions—What actions were taken or are required? Provide brief rationale -T Timing—Level of urgency and explicit timing and prioritization of actions -O Ownership—Who is responsible (nurse/doctor/team)? Include patient/family responsibilities -N Next—What will happen next? Anticipated changes? What is the plan? Are there contingency plans? Barriers to TeamSTEPP - -Inconsistency in team membership -Lack of time -Lack of info sharing -Hierarchy -Defensiveness -Conventional thinking -Complacency -Conflict -Varying communication styles -Lack of coordination and follow up with co workers -Distractions -Fatigue -Workload -Misinterpretation of cues -Lack of role clarity Tools and Strategies of TeamSTEPP - -Brief -Huddle -Debrief -STEP -Cross monitoring -Feedback -Advocacy and assertion -CUS