Transcript TeamSTEPPS - SherrardWeb.com

TeamSTEPPS
A new tool to improve patient care
in Franklin County
Lindsay Sherrard, MD
CFMH Medical Staff Meeting
May 27, 2009
What is TeamSTEPPS?
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teamwork system
evidenced-based
developed by the DoD and AHRQ
Used in numerous hospitals and clinics
across the country
It’s all about improving patient safety
and quality of care
Why improve patient safety?
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annual cost of medical errors
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44-98K lives
$38 billion
Most errors are preventable
Root cause of errors usually communication,
a learnable skill
Why did CFMH choose
TeamSTEPPS?
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Teamwork skills must be practiced
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“Our malpractice suits, high severity case claims,
and the associated reserves required were reduced
by 50% over a 3-year period after training teamwork
in our Labor and Delivery Units.”
-Benjamin P. Sachs, MD, BS
Chief of Ob/Gyn, Beth Israel
Deaconess Medical Center
Case Study
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38y G1 at 41 weeks, BP 144/85, preeclampsia labs
negative and NST/AFI ok
Given misoprostol at 10pm and sent home with BP
124/90
Returned in active labor at 12m, BP 174/104
SROM at 1:30, ctx q1-2 min, epidural at 3:30
FWB nonreassuring at 4:30
Started pushing at 5:20, late decels at 5:30, FHR
continued to slow
Forceps delivery attempted at 6:20
Emergency c-section at 6:45, stillborn (FHR was in
130s prior to c-section)
Uterus had ruptured; placenta was in the abdomen
Case Study
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Postpartum hemorrhage from uterine atony;
got hysterectomy 3 hours after delivery
Severe DIC, ARDS, sepsis, wound infection
3 week hospitalization, still not completely
recovered 3 years later
Case Study: What went wrong?
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4 errors in judgment:
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Should not have been sent home with high BP
Later, with high BP and non-reassuring FHTs a
clear plan was not developed, discussed with
patient, or documented
C-section should have been done at 5:30 at the
lastest for non-reassuring FHTs
Forceps should have been attempted in OR (if at
all)
Case Study: What went wrong?
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6 system failures:
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Poor communication b/t doctors, nurses, patient
Lack of mutual performance cross-monitoring
Inadequate conflict resolution
Poor situational awareness
Physician workload too high
Attending on call for 21 very busy hours
This is the sort of situation
we hope to prevent with
TeamSTEPPS!
What does TeamSTEPPS
teach?
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Four areas in which a team must be
competent
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leadership
situation monitoring
mutual support
communication
Leadership
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each team needs at least one leader
direct others, delegate tasks, manage
resources
provide encouragement and performance
expectations
facilitate problem solving and conflict
resolution
Situation Monitoring
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being aware of the needs of others in one’s
team and other teams
watching each others’ backs
Mutual Support
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helping others do tasks to evenly distribute
work
giving and receiving constructive feedback
Communication
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using structured techniques to communicate
critical information
acknowledgement of understanding the
information
So, what is different
at CFMH?
Leadership at CFMH
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You may notice people leading team events:
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Brief (planning)
Huddle (problem solving)
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8am and 8pm daily with representatives from all
departments
Debrief (process improvement)
Situation Monitoring at CFMH
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We should all be considering “STEP”:
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Status of the patient
Team members’ (fatigue, workload, skill, etc)
Environment (equipment, bed availability)
Progress towards the goal (plan still appropriate?)
Situation Monitoring at CFMH
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I’M SAFE Checklist
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Illness
Medication
Stress
Alcohol/Drugs
Fatigue
Eating/Elimination
We should be looking out for one another!
Mutual Support at CFMH
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Task assistance: it is expected that
assistance will be actively sought and offered
Feedback: provided for the purpose of
improving team performance, this should be
timely, respectful, specific, directed towards
improvement, and considerate
Advocacy for the patient: using the “two
challenge rule” which is everyone’s
responsibility
Mutual Support at CFMH
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DESC Script
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Describe the situation
Express concerns
Suggest alternatives
Consensus should be sought to meet team goals
with commitment to a common mission
Communication at CFMH
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Specific communication strategies have been
taught to staff
These are designed to be clear and concise
Communication at CFMH
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Nurses will call using the SBAR technique:
Situation
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Background
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“She is the 62-year-old female POD#1 from abdominal
surgery with no history of cardiac or lung disease
Assessment
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“I’m calling about Ms. Hodges in room 102 because she is
having shortness of breath”
“Breath sounds are decreased on the right and I’m
concerned about pneumothorax.”
Recommendation
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“I feel strongly the patient needs to be assessed now; are
you available to come in?”
Communication at CFMH
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In critical situations the “Call-Out” strategy
may be used. Example:
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Leader: “Airway status?”
EMT: “Airway clear.”
Leader: “Breath sounds?”
EMT: “Breath sounds decreased on right”
Leader: “Blood pressure?”
Nurse: “BP is 96/62”
Communication at CFMH
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Check-back for closed-loop communication:
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Doctor: “Give 25mg Benadryl IV push”
Nurse: “25mg Benadryl IV push”
Doctor: “That’s correct”
Communication at CFMH
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I PASS the BATON (handoff technique)
Introduction (your role)
Patient (identifiers)
Assessment (diagnoses)
Situation (current status)
Safety concerns (allergies, critical labs)
Background (past history, medications)
Actions (what was done today, needs to be done?)
Timing (prioritize actions)
Ownership (who is responsible for what?)
Next (the plan?)
Barriers to Teamwork
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Team member changes
Lack of time
Poor communication
Hierarchy and lack of role clarity
Defensiveness
Conventional thinking
Complacency
Conflict
Lack of coordination and follow up
Distractions, fatigue, workload
Misinterpretation of cues
Tools and Strategies for
Teamwork
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Brief, huddle and debrief
STEP
Two challenge rule
DESC script
SBAR
Call-out
Check-back
Handoff
Good Teamwork Outcomes
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Shared goals
Adaptability
Mutual trust
Team performance
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Patient safety and outcomes!
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References
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TeamSTEPPS Curriculum. Agency for
Healthcare Research and Quality, 2006.
Kohn LT, et al, ed. To Err is Human: Building
a Safer Health System. Institute of Medicine.
Washington: National Academy Press, 1999.
Sachs BP. A 38-year-old woman with fetal
loss and hysterectomy. JAMA: 2005 Aug
17;294(7):833-40.