stepping into a safer environment · 2012. 12. 3. · stepping into a safer environment wendy...

STEPPING into a Safer Environment Wendy Bellows, BSN, RNC; Sally Bennett, PhD, MS, RN; Donna Marie Campbell, RN, C; Kimberly Paris, BSN, RN

Robert Packer Hospital, Sayre, PA 18840

Purpose

Concentrating on the core concepts of the model, important changes resulted in positive outcomes related to both patient safety and Registered Nurse (RN) Satisfaction.

• Team Strategies & Tools to Enhance Performance and Patient Safety

• A powerful solution to improving patient safety based on 25 years of research from other high risk industries

• Increases TEAM awareness and clarifies the team roles and responsibilities

• Helps resolve conflict and improve information sharing, while eliminating barriers to quality and safety

• Highly effective medical teams using all available ‒ Information ‒ People ‒ Resources

• The TeamSTEPPS™ framework consists of four teachable, learnable skills ‒ Leadership ‒ Mutual Support ‒ Situation Monitoring ‒ Communication

Significance

What is TeamSTEPPS™?

Implications for Practice To ensure a culture of safety on an obstetrical unit, the TeamSTEPPS™ program, which focuses on promoting teamwork and communication to reduce errors and ensure patient safety, was implemented in June 2010.

Disclosure Poster Reference: TeamSTEPPS™ Instructor Guide

TeamSTEPPS™ Strategies Barriers Tools & Strategies Outcomes

• Team member inconsistency • Lack of Time • Lack of Information Sharing • Hierarchy • Defensiveness • Conventional Thinking • Complacency • Varying Communication Styles • Conflict • Lack of Planning/Follow-Up • Distractions • Fatigue • Workload • Misinterpretation of Cures • Lack of Role Clarity

• Brief • Huddle • Debrief • STEP • Cross Monitoring • Feedback • Advocacy and Assertion • Two-Challenge Rule • CUS • DESC Script • Collaboration • SBAR • Call-Out • Check-Back • Handoff

• Shared Mental Model • Adaptability • Team Orientation • Mutual Trust • Team Performance • Patient Safety!!

Briefs • Short session with all team members to assign roles,

establish expectations and anticipate outcomes • White Board Rounds ‒ Interdisciplinary shift briefs ‒ 8 a.m. and 8 p.m.

Debriefs • Informal, recap of a situation, background and key

events for all team members • Held after an adverse/near miss event or positive

occurrence

Huddles • Quick, as needed, team gatherings to focus on a

problem requiring immediate attention • Re-establishes situation awareness • Reinforces plans • Can be organized by any team member

• Nursing Foundations for Quality of Care ‒ A clear patient care philosophy pervades the unit for all

disciplines ‒ An active quality assurance program

• Collegial Nurse-Physician Relations ‒ Physicians and nurses have good working relationships ‒ Teamwork between nurses and physicians ‒ Collaboration (joint practice) between nurses and

physicians • A Safer Practice Environment • Unit Perceived Quality of Care

‒ Nurses described an improved quality of care within the department • Last Shift • In General

• During their last shift, nurses more often ‒ Felt important things were accomplished ‒ Reported they had a “Good Shift” ‒ Described their patient assignment as “Appropriate”

NDNQI RN Satisfaction Improvements 2010-2011

2.84

2.3 2.59

3.38 3.29 3.43

4.29 4.33

3.05

2.55 2.66

3.55 3.36

4.36 4.91 4.73

00.5

11.5

22.5

33.5

44.5

5

NursingFoundation forQuality of Care

Collegial RN/MDRelationships

Mean PES Score Mean QualityRating Last Shift

Mean QualityRating in General

Important ThingsDidn't Get Done

Overall Had aGood Shift

PatientAssignment was

Appropriate

Scor

es

20102011