Transcript Slide 1

FRIDAY PLENARY SESSION
DAY 2 of TeamSTEPPS
National Conference 2012
TeamSTEPPS
How This Conference Fits
 What is needed for successful TeamSTEPPS
implementations?
 Passion for safety and quality care
 Understanding of teamwork tools & how to equip
people to use them
 Support to overcome challenges and make rapid
progress
 Resources to support implementation efforts and
knowledge about how to use them most efficiently
 How AHRQ is addressing each of these needs
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TEAMSTEPPS 05.2
TeamSTEPPS
Passion
 National Meeting:
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Next year: same general time, probable location:
San Antonio
Meeting sponsors
Larger venue
Call for papers/panels to share your
TeamSTEPPS successes
Adjustments made based on feedback from this
year
TEAMSTEPPS 05.2
TeamSTEPPS
Understanding
 TeamSTEPPS trainings
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Expanded number of seats in trainings and locations
they’re offered
Planning some advance topic trainings
Large backlog of interested participants
Addressing by:
 Reallocating resources to offer more trainings
 Opening up new set of trainings to enroll in by late
summer
 Increased efforts to ensure participants can succeed
 Coordinate with hospitals, systems, HENS, etc. to pair
groups wanting trainings with strong training teams
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TEAMSTEPPS 05.2
TeamSTEPPS
Support
 User Support Network
Webinars
 ListServ/Discussion forum
 Library of resources
 http://teamsteppsportal.com/
 Resources:
 TeamSTEPPS materials:
http://www.ahrq.gov/teamsteppstools/
 TeamSTEPPS mailbox:
[email protected]
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TEAMSTEPPS 05.2
TeamSTEPPS
Resources
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TEAMSTEPPS 05.2
TeamSTEPPS
Acknowledgments
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TEAMSTEPPS 05.2
TeamSTEPPS
Our Organizations
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TEAMSTEPPS 05.2
TeamSTEPPS
TeamSTEPPS National Training
Centers
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TEAMSTEPPS 05.2
TeamSTEPPS
Key People
 HRET:
Chris Hund
 Ashka Dave
 Jessica Blake
 IMPAQ:
 Andrea Amodeo
 Booz Allen Hamilton:
 Melanie Sellers
 ZeAmma Brathwaite
 TN Hospital Association
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TEAMSTEPPS 05.2
The State of
TeamSTEPPS:
New Modules and Other
Available TeamSTEPPS
Resources
TeamSTEPPS
Today’s Presenters
 James Battles, PhD (Social Science Analyst for
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Patient Safety, AHRQ)
Heidi King, Heidi King, MS, FACHE (Deputy Director
of the Department of Defense Patient Safety Program
Barb Edson, RN, MBA, MHA (Vice President,
HRET)
Deborah Milne, RN, MPA (Senior Research Scientist
American Institutes for Research)
Michelle Pandolfi, MSW, LNHA (Director of
Counsulting Services, Qualidigm)
Melanie Wasserman, PhD (Senior Associate/
Scientist Abt Associates)
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TEAMSTEPPS 05.2
TeamSTEPPS
Top 10 for Creating a TeamSTEPPS® Module
It takes a team!
2. Literature review and course design plan
3. Story boards; draft curriculum
4. Identify gaps in content
5. Develop supplemental exercises/activities
6. Field test draft curriculum
7. Develop video vignettes
8. AHRQ review
9. Pilot test with end users
10. Finalize all components
1.
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TEAMSTEPPS 05.2
TeamSTEPPS
For Release in Fall 2012
New TeamSTEPPS®
Modules
New Toolkit, with
TeamSTEPPS integrated
 Long Term Care Module
 Comprehensive Unit-Based
 Primary Care Medical Office
Module
 Limited English Proficiency
Module
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TEAMSTEPPS 05.2
Program (CUSP) Toolkit
TeamSTEPPS
TeamSTEPPS® Sweet 16
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TEAMSTEPPS 05.2
TeamSTEPPS
Contact Information
Heidi King
[email protected]
Jim Battles
[email protected]
http://teamstepps.ahrq.gov/
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http://health.mil/dodpatientsafety/
TEAMSTEPPS 05.2
LEP
module
TeamSTEPPS
Module on patients with limited
English proficiency – why?
 Large and growing population – 8.6% of U.S.
 Greater length of stay  greater risks
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line infections, falls, surgical infection, and more
 More readmissions
 So many horror stories
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Mod 1 05.2 Page 19
One misunderstood word, “intoxicado” ->
quadriplegic teen, $71 million settlement
TEAMSTEPPS 05.2
TeamSTEPPS
The evidence
 Patient safety events more severe and more often
due to communication errors for LEP patients (Divi et al.
2006, Flores 2005)
 Ad hoc interpreters (family members, house staff)
make serious medical interpretation errors (Flores et al.
2003)
 LEP patient safety events cost hospitals millions
Wise 2008; Quan 2010; Carbone et al. 2003)
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TEAMSTEPPS 05.2
(Price-
TeamSTEPPS
More evidence
 Professional interpreters reduce length of stay and
readmissions for LEP (Linholm et al. 2012)
 Despite evidence that LEP patients are safer with
professional interpreters, health care providers often
try to “get by” without (Diamond et al. 2009; Ring et al. 2010)
 Even when interpreters are present, they often can’t
speak up when they see a patient safety risk (Betancourt
et al. 2012)
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TEAMSTEPPS 05.2
TeamSTEPPS
Other reasons for LEP focus
 Joint Commission patient-centered communication
standards come into effect July 1, 2012
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Identify the patient’s oral and written communication needs; and
Meet those needs
 Including the need for qualified interpreters
TEAMSTEPPS 05.2
TeamSTEPPS
How the LEP module can help
 1-hour staff training module and 4-hour train-the-
trainer program so unit staff and interpreters can:
 Understand the risks to LEP patients
 Assemble the right team (call an interpreter!)
 Identify and raise patient communication issues
 Also includes a guide for hospital leaders
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To identify/ implement needed system changes
ahead of training
TEAMSTEPPS 05.2
TeamSTEPPS
Module Development Process
Adverse Events
Database
Environmental
Scan
Interpreter Pilot
Results
TeamSTEPPS
Module
Qualitative Interviews
with Frontline Staff &
Leaders
Hospital
Guide
Field
test,
Validate
Revisions
508 compliance
production
dissemination
Town Meeting
Original Research
Mod 1 05.2 Page 24
Tool Development
TEAMSTEPPS 05.2
We are here!
TeamSTEPPS
Module preview: process map
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TEAMSTEPPS 05.2
TeamSTEPPS
Field-test results
 Module can be implemented various ways in
various settings
 TeamSTEPPS/non-TeamSTEPPS hospital (MO,
DE, NC)
 Stand-alone or part of overall TeamSTEPPS
 Hospital units (ED, L&D, OB), or primary care
 Catalyst for institutional changes
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TEAMSTEPPS 05.2
TeamSTEPPS
Evaluation
 Module includes an evaluation guide
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Satisfaction scores high
Knowledge scores significantly increased
Qualitative results:
 Clinicians more aware of need for interpreter
 Interpreters more empowered to raise/address
communication issues
Problems with language data  challenges
evaluating provider behavior and patient outcomes
TEAMSTEPPS 05.2
TeamSTEPPS
Next steps
 Module available late summer/early fall
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Want a copy? Sign up with me today!
TEAMSTEPPS 05.2
TeamSTEPPS
Outline
 Why LTC version
 What changes were made and why
 Video creation
 TEP recommendations
 Field testing
 Findings – potential future work
 Availability
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TEAMSTEPPS 05.2
TeamSTEPPS
Why Long-Term Care?
 Long-term care environment is unique
 Long-term/chronic and short term/sub-acute
 Patients are called “residents”
 Multi-disciplinary teams, including non-clinical
staff
 Long-term care: custodial care through IV therapy
 Approximately 16,000 nursing homes and 1.6M
nursing home residents across the country
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TEAMSTEPPS 05.2
TeamSTEPPS
Changes Targeted
 The work of this project was to modify the text
and associated training materials to be relevant
to the long-term care environment
 Changed language throughout to be meaningful
to long-term care
 Exercises, scenarios, tests and videos were
changed and centered around chronic medical or
rehabilitation circumstances
 Graphics and pictures were changed to reflect
nursing home staff, care and environment
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TEAMSTEPPS 05.2
TeamSTEPPS
Long-Term Care Team
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TEAMSTEPPS 05.2
Therapeutic
Recreation/Activity
Staff
TeamSTEPPS
Chef
Long
Term Care Team
Social
Worker
Nurse
Assistant
Nurse
Rosie the
Housekeeper
Administrator
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TEAMSTEPPS 05.2
TeamSTEPPS
Videos
 Two videos created
Long-term care – subtle decline in a resident over
a 24 hour period
 Sub-acute care –possible MI/PE in a resident
receiving physical therapy
 14 of 15 TeamSTEPPS skills were highlighted
 Time-Out is not a skill deemed necessary for most
nursing homes
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TEAMSTEPPS 05.2
TeamSTEPPS
Long Term Care Video
 Filmed in a Connecticut nursing home
 2 days of filming
 Over 40 hours of footage
 3 nursing home
staff served as
“extras”
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TEAMSTEPPS 05.2
TeamSTEPPS
Sub-Acute Video
 Filmed in a Massachusetts nursing home’s
rehabilitation gym
 1 day of filming
 15 hours of footage
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TEAMSTEPPS 05.2
TeamSTEPPS
Technical Expert Panel
 National Experts in:
Long-term care
 TeamSTEPPS (Master Trainers)
 Nursing Workforce Development
 Culture Change
 Quality of Care/Life Outcomes
 Individual calls with each TEP Member were
conducted
 Materials were sent prior to each call: description,
agenda, questions
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TEAMSTEPPS 05.2
TeamSTEPPS
TEP Recommendations
 Joint Commission
Accreditation of nursing homes is very low nationally
 Language/terms not commonly used in nursing
homes
 Culture Change and Patient Safety
 Clear language on the two “concepts”
 Sample Exercise
 Illustrate benefit of including all members of the
healthcare team in care planning
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TEAMSTEPPS 05.2
TeamSTEPPS
TEP Recommendations2
 Other
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Mod 1 05.2 Page 40
Content should be delivered at literacy levels
appropriate for the audience
Deliver training in interactive sessions: role play
and “teach back”
Advanced skills introduced after basic concepts
mastered
TEAMSTEPPS 05.2
TeamSTEPPS
Field Testing
 120-bed nursing home, part of a continuing care
retirement community (CCRC)
 1 day (8 hour) training
 Held on the campus of the nursing home
 Various departments and staffing levels attended
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Nursing
Staff
Development/Education
Therapeutic Recreation
Social Work
Dietary/Food Service
TEAMSTEPPS 05.2
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Housekeeping
Maintenance/Physi
cal Plant
Administrator/COO
TeamSTEPPS
Field Test Findings
 Participants pleased with training
86-98% gave the training session a positive grade
Communication module had widest appeal
Appreciated the interactive exercises; wanted more
Videos complemented material, though “too
clinical”
Add more examples and exercises that included
non-clinical staff/departments
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TEAMSTEPPS 05.2
TeamSTEPPS
Field Test Findings2
Recommended including:
 resident abuse prevention exercises and
examples
 interactions and role plays of communicating
with families (staff to family)
 intergenerational communication among staff
 removing the multi-team system exercise
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TEAMSTEPPS 05.2
TeamSTEPPS
TeamSTEPPS for Long Term Care
 Available: ???
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TEAMSTEPPS 05.2
TeamSTEPPS
Contact Information
 Abt Associates:
Donna Hurd [email protected]
 Qualidigm:
 Michelle Pandolfi [email protected]
 Ann Spenard [email protected]
 TeamSTEPPS® Primary Care Medical Office
Module
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Deborah A. Milne, RN MPA
American Institutes for Research
June 22, 2012
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TEAMSTEPPS 05.2
TeamSTEPPS® Primary
Care Medical Office Module
Deborah A. Milne, RN MPA
American Institutes for Research
June 22, 2012
TeamSTEPPS
First Step
 Convened Technical Expert Panel (TEP)
December 2010
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Representatives from AHRQ and DoD
Experts in primary care and quality improvement
Interprofessional primary health care providers
TEAMSTEPPS 05.2
TeamSTEPPS
Laying the Groundwork
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Defined the “team”
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Identified the “system”
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Evaluated the challenges
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Decided areas of focus
TEAMSTEPPS 05.2
TeamSTEPPS
Primary Care Office (PCO) Team
 TEP defined the scope of “team” for purpose of this
project
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Focus of the project was intended to be on optimizing
teamwork within the medical office
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Caveat - it was noted that external care coordination
is of extreme importance for future work
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TEAMSTEPPS 05.2
TeamSTEPPS
Primary Care
Team Structure
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TEAMSTEPPS 05.2
TeamSTEPPS
How is the PCO Different?
 Complex Adaptive System
 Non – linear, non – episodic
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The agents in the system are all the components of that
system
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Agents interact and connect with each other in unpredictable
and unplanned ways
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Interactions cause regularities to emerge
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Start to form a pattern which feeds back on the system and
informs the interactions of the agents
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TEAMSTEPPS 05.2
TeamSTEPPS
Model of a Complex Adaptive System
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TEAMSTEPPS 05.2
TeamSTEPPS
Primary Care Office Environment
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TEAMSTEPPS 05.2
TeamSTEPPS
Some of the “Agents”
 Missed appointments
 Patient phone
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calls/emails
Scheduling
Medication refills
Interruption of patient
flow
Walk-ins, lab results
Formulary questions
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 Population data
management
 Information from
insurers
 Urgent appointments
 Calls from
consultants/external
providers
TEAMSTEPPS 05.2
TeamSTEPPS
Challenges to Teamwork in Primary
Care Offices
 Delayed Manifestation of Mistakes
 Role Ambiguity
 Non – linear work flow
Mod 1 05.2 Page 55
TEAMSTEPPS 05.2
TeamSTEPPS
Curriculum Training Structure
 When training teams to implement TeamSTEPPS:
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developed to be taught in conjunction with
TeamSTEPPS Essentials
OR
 When training Master Trainers:
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To be taught as an addition to TeamSTEPPS
Fundamentals
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TEAMSTEPPS 05.2
TeamSTEPPS
Next Steps
 Literature review
 Curriculum design guide development
 Developed draft curriculum slides and instructor
guide
 Begin preliminary scripts for video vignettes
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Mod 1 05.2 Page 57
We asked all TEP members to send us brief “stories”
that represented actual scenarios they had
experienced
TEAMSTEPPS 05.2
TeamSTEPPS
Field Testing
 Two sites
 TeamSTEPPS essentials followed by
Primary Care Office Module
 Data collection
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TEAMSTEPPS 05.2
TeamSTEPPS
Highlights of Field Testing Focus Groups
 “What parts of the module are most relevant to
primary care?”
 Patient advocacy and communication
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Conflict resolution
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Situation monitoring
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Debriefing
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TEAMSTEPPS 05.2
TeamSTEPPS
Highlights of Field Testing Focus Groups
 “What improvements could be made to the module?”
 More emphasis on roles of non-clinical staff in the care team
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More case-based scenarios, especially across team roles
Non clinical staff felt that they often had important
information to communicate but no process to do so
Quote: “Little bits that you don’t automatically put into the
records as a formal thing are so important.”
 Resulting module change:
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Included 4 scenarios in module that emphasize non-clinical
staff
Mod 1 05.2 Page 60
TEAMSTEPPS 05.2
TeamSTEPPS
Highlights, cont…
 “What parts of the module do not make sense?”
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Definitions of “Huddles” and “Briefs” conflicts with NCQA
Primary Care Medical Home (PCMH) language
Quote: “PCMH designates the TeamSTEPPS Brief as a Huddle. We
all need to know what we mean in terms of what we’re doing.”
 Resulting module change:
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More emphasis on flexibility/customizability throughout the
curriculum, as long as each team member has the same
mental model.
Mod 1 05.2 Page 61
TEAMSTEPPS 05.2
TeamSTEPPS
Video Production
 Scenario video production – 4 paired scenarios
(right way and wrong way)
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Script changes influenced by field testing results
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Each based on an actual event
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Leadership, Communication, Mutual Support,
Situation Monitoring
Mod 1 05.2 Page 62
TEAMSTEPPS 05.2
Comprehensive Unit-based
Safety Program
Barbara Edson, RN, MBA, MHA
VP, Clinical Quality
Health Research and Educational
Trust
American Hospital Association
TeamSTEPPS
What is CUSP?
 The Comprehensive Unit-Based Safety Program
 A safety culture program that is designed to;
Educate & improve awareness about patient safety and
quality of care
 Empower staff to take charge and improve safety in
their workplace
 Create partnerships between units & hospital
executives
 Provide resources and tools for unit improvement
 Provide tools to investigate and learn from defects
 Used in combination with technical intervention
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TEAMSTEPPS 05.2
TeamSTEPPS
Adaptive + Technical
CUSP
CAUTI
1. Science of safety
1. Appropriate reason for insertion
(HICPAC Guidelines)
2. Identify defects
2. Prompt removal catheters when no
longer indicated (HICPAC
Guidelines)
3. Sr. exec. partnership
3. Proper care for appropriate
catheters
4. Learning from defects
4. Insertion intervention –sterile
placement
5. Teamwork and communication
Mod 1 05.2 Page 65
TEAMSTEPPS 05.2
TeamSTEPPS
CUSP Toolkit
 Content –CUSP and
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Funded by AHRQ
Mod 1 05.2 Page 66
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TEAMSTEPPS 05.2
other safety content
Modular
PowerPoint presentations
with facilitator notes
Exercises
Short video vignettes
illustrating key messages
Vignettes demonstrate
CUSP used with various
healthcare acquired
conditions
TeamSTEPPS
CUSP Modules
Module steps
Module Description
Learn about CUSP
Describes the CUSP Toolkit and its modules
Assemble the Team
Develop team, characteristics of high performing
teams, define roles and responsibilities
Engage the Senior
Executive
Role, assist with alignment within organization
resources, remove depart barriers, accountability
Understand the Science of
Safety
Context of safety in healthcare, system design,
common system breakdowns
Identifying Defects
Through Sensemaking
Identify potential harms, contributing factors and
potential solutions, organizational learning
Implement Teamwork &
Communication
Importance of communication and safety,
TeamSTEPPS tools
Apply CUSP
Implementation steps, accountability
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TEAMSTEPPS 05.2
TeamSTEPPS
How do you use CUSP?
 Educate teams on CUSP components using
PowerPoints with facilitator notes
 Share videos, lead discussions with staff
 Train on use of teamwork and communication tools
 Provide templates and discussion guides to project
leaders
Mod 1 05.2 Page 68
TEAMSTEPPS 05.2
TeamSTEPPS
Briefing
A briefing is a discussion between two or more people, often a team,
using succinct information pertinent to an event.
A briefing immediately:
Maps out the care plan
Identifies each team member’s roles and
responsibilities
Heightens awareness of the situation
Allows the team to plan for the unexpected
Allows team members’ needs and
expectations to be met
Sets the tone for the day
Encourages team members’ participation
As seen in TeamSTEPPS®
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TEAMSTEPPS 05.2
69
TeamSTEPPS
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TEAMSTEPPS 05.2
TeamSTEPPS
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TEAMSTEPPS 05.2
TeamSTEPPS
DISCUSSION AND Q&A
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TEAMSTEPPS 05.2