Action Plan Step 1: Define the Aim(s) of the TeamSTEPPS Intervention • Change team began discussions in April 2008 • Aim(s) to be determined by August 2008
Step 2: Design a TeamSTEPPS Intervention • Began and completed design discussion September 2008
Step 3: Develop a plan to test effectiveness • During September surveys distributed and observations report reviewed with Coaches and Change Team
Step 4: Development an Implementation Plan • Part A: 4-hour fundamentals course given to all staff • This occurred in October 2008 • Part B: Begin actual TeamSTEPPS Interventions • Began when fundamentals course was done
Step 5: Develop a plan for sustained continuous improvement • Planning began in October and was implemented in January 2009
Three Levels of Training • TeamSTEPPS Master Training for Core Group • ED Staff Coach Training • Fundamental TeamSTEPPS content for the multidisciplinary team All levels of training included didactic, videotape, case studies and application of content.
MasterTraining • Approximately 6 individuals received Master Training conducted by Agency for Healthcare Research and Quality (AHRQ) and Department of Department of Defense (DoD) • The education is 2.5 days in length
ED Coach Preparation-Agenda • One Eight Hour Educational Day • Psychology of Change and Change Management-45” • Essentials of Team Training – Key Principles-120” • Team Structure • Leadership • Situation Monitoring • Mutual Support • Communication • Human Factors-60” • Coaching Workshop-60” • Coach Break out Sessions-90”
Teamwork Coach Tips for Success 1. Do… • Actively monitor and assess team performance • Support established performance goals and expectations • Acknowledge desired teamwork behaviors and skills through tactful and thoughtful feedback • Coach by example; be a good mentor 2. Don’t… • Coach from a distance • Coach only to problem-solve • Lecture instead of Coach 3. When providing feedback… • Be descriptive and non-evaluative • Allow for two-way interaction, which allows team members the opportunity to interact and ask questions This was a ‘tip card’ for the coaches
Coach Breakout Sessions-Coaching Exercise Example • Scenario 1 You are assigned to coach day shift staff in the Emergency Department (ED) on teamwork skills. When you arrive at 0900, the department is very busy and there is no evidence that teams have been formed. You locate the coordinating team nurse in the department for an update, and she tells you, “We’re not doing teamwork today, the ED is just too busy. I have made the assignments, and we are going to manage things ‘the good old fashioned way today’.”
Coach Breakout Sessions-Coaching Exercise Example • Scenario 2 A staff member comes to you complaining of being put on the team in the West corridor with a “slacker”. She says, “Joan makes herself scarce and almost never offers to help her teammates, even when she has down time. I’ve had it!”
Coach Breakout Sessions-Brief • ED Teamwork Scenario: (Brief) • Situation: You are about to start your shift in the West hallway today. • Background: The hallway is fully staffed with 3 RNs, 1 LPN, 1 PCA, 1 Ops CA, 1 ED Consultant, and 2 ED Residents. • Assessment: There are only 3 patients in the hallway this morning who have all been seen and are awaiting test results. • Recommendation: A shift brief should be done. Follow the briefing checklist within your group to practice the shift brief.
Coach Breakout Sessions-Huddle • ED Teamwork Scenario: (Huddle) • Situation: There is a 3 car rollover accident with multiple trauma victims coming to the ED with a 20 min ETA. From the scene it was reported that 3 adults were severe enough to be considered a level 1 trauma. 2 more adults were considered to be less severe and likely to be a level 3 trauma status. • Background: The ED is busy today yellow light status is observed and critical is full with only one bed available. It seems like a three ring circus type of atmosphere in the entire department. • Assessment: On quick assessment it appears that there is only one critical bay available and 3 rooms in the west hall available. One good thing is that the ED is fully staffed today. • Recommendation: What would you recommend? Demonstrate within your group your teamwork action plan for this situation. Be able to share/discuss your teamwork action.
Fundamentals For All Staff Class Objectives • Four hour interactive session • Describe role of teamwork to help reduce risk of error due to human factors • Explain the IIMF Teamwork Project • Recall and discuss opportunities for improving teamwork in the ED • Learn and demonstrate evidence-based teamwork skills and strategies with focus on ED opportunities • Define psychology of change
Exercise from Fundamentals Non-clinical Staff Example: • You work in operations in the control room and you notice that a patient has been mis-identified. The patient is in east hallway and the clinical team is extremely busy today. You have gone to the nurse taking care of the mis-identified patient and he requested that you “hang on a second because he is busy giving a med”. You wait for 5 minutes and then see him going to another room. It seems like he has forgotten you are there. As a group formulate a statement/question using “advocacy/assertion” language to express your need.
Shift Brief Critical Care Brief Trauma Brief Sharing Patient Info
Go Live Priorities • Provide Tools • Brief Checklist • SBAR Triage Form • AIDET Pocketcard • Facilitate Briefs • Coach Presence • Feedback
Brief Checklist • Introductions of core team (names) • Review roles and responsibilities (when new staff/ interns) • Room coverage • Coverage hours / shift changes • Teamwork focus for day • ________________________________________ • Plan of care / Resource issues • Charge RN briefs on staffing issues, inpatient bed situation, resource issues • Individual SBAR reports on patients (consultants report)
Example of Checklist Coordinating Team Area Summary of Brief/Huddle • Staffing Issues (e.g. shortage or surplus) • Time intensive patient care procedures (e.g. Moderate Sedations) • Elopement or Safety Concerns (e.g. need for security ) • Patient Care Triggers (e.g. acuity concerns) • Potential patient delays (e.g. multiple CTs, off-service consultations, inpatient bed delays) • Substantive issues needing follow-up (e.g. Charge Nurse, NM, CNS, NES, Social Services, MD Chair etc…)
Options forPatient Assessment In Order of Preference 1 Nurse & MD/PA enter together Nurse or MD/PA not available initially Nurse or MD/PA starts assessment. Other team member enters room as soon as available & is given quick update on the assessment performed so far. 2 Nurse or MD/PA not available Direct communication to other team member: SBAR format 3 Nurse or MD/PA not available Complete written SBAR form 4 Nurse or MD/PA not available & form not completed 5 Explain to patient & give option to assess patient now or step out to talk to other team member “Hello Mr./Mrs... _____. I am _________ and I will be the nurse/resident/PA taking care of you. I realize you have shared information with my co-worker. I apologize but they are with another patient right now so I have not had a chance to find out what they know from you already. I am free now if you don’t mind repeating yourself, otherwise I can step out and try to find them. What would you prefer?”
Brief Times Posted Broadly Chronological Brief Times • 0800-West/South • 0815-Critical • 0830-Pediatrics • 0915-East • 1545-West/South • 1600-East/EDOU • 1615-Pediatrics • 1630-Critical • 2300-West/South • 2345-Critical • Nights: Huddle PRN when West Consultant goes home
Objectives for Coaches Objectives for Shift • Facilitate scheduled briefs. • Facilitate huddles for: • Traumas • Codes • Assess and facilitate white board (collect data) use: • Names • VS • Orders • Observe overall teamwork and roles performed. Take note and document who is doing well! Send me their names for awards. • Facilitate observations and debriefs for traumas and resuscitations (as coaches comfort level allows) • Provide feedback on whom and why unwilling to participate using the attached log. Please keep this confidential.
Feedback Obtained by Coaches • Issues List • Short term problemsolving • Long term problemsolving
Positive Feedback • Coaches recognized staff that were doing a great job with Briefs, Huddles, Teamwork • Names were submitted and displayed on computer screens • Prizes were awarded to recipients
Summary-Key Factors for Success • Active, dedicated “Change Team” • Coach presence at bedside • Pocketcards, checklists, posters • Positive feedback for all • Ongoing communication regarding status and changes • Knowledge that you must not let up, but be relentless • Constantly be receptive of feedback