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What is Team Stepps?

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an evidence-based framework to optimize team performance across the health care delivery system

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What is the idea about team stepps?

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The idea is that teams will make less mistakes than individuals

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What is team work essential for?

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It is essential for patient care, quality and safety

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A team should...

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Collaborate, Cooperate, and Coordinate

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Is team stepps evidence based?

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Yes

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Key principles of the Team Stepps model

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1. Team Structure 2. Leadership 3. Situation Monitoring 4. Mutual Support 5. Communication

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What is involved in the element of Team Structure?

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It delineates fundamentals - Team size - Membership - Leadership - Composition - Identification and Scope Types of Teams - Core teams - Coordinating teams - contingency teams

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What is involved in the element of Team Leadership?

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- ability to direct and coordinate the activities of team members and manage resources - resolve conflict - develop knowledge, skills, attitude (KSA) - motivate team members, establish positive atmosphere, ensure good communication and methods -plan and organize

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Situation Monitoring

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-the process of continually scanning and assessing a situation to gain and maintain an understanding of what's going on around you situation awareness: the state of "knowing what's going on around you" S: Status of the Patient T: Team members - I'M SAFE checklist E: Environment P: Progress toward the goal

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cross-monitoring

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a harm error reduction strategy that involves: - monitoring actions of other team members - providing a safety net within the team - ensuring that mistakes or oversights are caught quickly and easily - "watching each other's back"

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What is involved in the element of Mutual Support?

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Teams need to demonstrate backup behavior - ability to shift workload among the team - members need to demonstrate adaptability -recognition of under utilized team members

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feedback

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information provided to team members for the purpose of improving team performance - timely - respectful - specific - directed - considerate

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advocacy and assertation

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advocate for patient assert a corrective action in a firm and respectful manner

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two-challenge rule

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empowers all team members to "stop the line" if they sense or discover an essential safety breach.

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CUS

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assertive statement Concerned Uncomfortable Safety issue

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DES script

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a constructive approach for managing and resolving conflict D = describe the specific situation or behavior; provide concrete data E = express how the situation makes you feel/ what your concerns are S = suggest other alternatives and seek agreement C = consequences should be stated in terms of impact on established team goals; strive for consensus

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What is involved in the element of Communication?

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Communication on a team - closed-looped: communication is validates and there is a follow through - acknowledging there are senders and receivers - when you are the receiver make sure that you understand the senders message - clarify with the sender to make sure there is no misinterpretation

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SBAR

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a technique for communicating critical information that requires immediate attention and action concerning a patient's condition. Situation Background Assessement Recommnedations/Request

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call-out

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strategy used to communicate important or critical information -informs all team members simultaneously during emergent situations -help team members anticipate next steps -important to direct responsibility to a specific individual responsible for carrying out the task

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check-back

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using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended. 1. sender initiates the message 2. receiver accepts the message and provides feedback 3. sender double-check to ensure that the message was received

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handoff

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the transfer of information (along with authority and responsibility) during transitions in care across the continuum. it includes an opportunity to ask questions, clarify, and confirm. "I PASS THE BATON" I-introduction P- patient A- assessment S- situation S- safety concerns THE B- background A- actions T- timing O- ownership N- next

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Barriers to Team Effectiveness

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- Inconsistent team membership - lack of clear goals and expectations - inconsistent sharing of info - conflict - hierarchy - differences in communication styles - distractions - fatigue - workload

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Team Tools and Strategies

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- Team briefings and huddles everyday - Team roundings - Debriefings after a neg. outcome - SBAR - Handoff tools - STEP - IM SAFE - assertive statement - two-challenge rule - CUS - DES script

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brief

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short sessions prior to start to share the plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, anticipate outcomes and likely contingencies

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huddle

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ad hoc meeting to re-establish situational awareness, reinforce plans already in place, and assess the need to adjust the plan

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debrief

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informal information exchange session designed to improve team performance and effectiveness through lessons learned and reinforcement of positive behaviors

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Implementation of TeamStepps

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1. Set the stage: Pre training assessment of KSA (knowledge, skills, attitude) 2. Decide what to do: Planning & training 3. Make it happen: implementation and testing 4. Make it stick: sustaining the change, coaching, monitoring the plan, continuous improvement

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Summary of TeamStepps

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Improving the functioning of teams improving quality, safety, and efficiency of team based care Leadership, situation monitoring, communication, mutual support, and

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Breech of duty/failure to rescue

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nurse fails to make every effort to get attention of doctor. This is due to RN staff shortage in facility. If the nurse had made all efforts and was the advocate she would not have been in breech of duty - regardless how physician responded.

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Medical orders

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nurse is responsible in examining orders, not for the order itself. Nurse should identify descrepancies. Nurse has a duty to understand plan, and communicate if orders conflict.

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Telephone orders

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Joint commission encourages written orders or faxed orders when possible. Guidelines are; speak directly to prescriber; write down order; read back order for verification.

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Confidentiality

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Rights in HIPPA should protect pt's privacy. Only information the patient releases should be shared. Third party payers-insurance-will not pay otherwise. Nurse that gives information can be held LIABLE. Only people involved in care need to know. Specific written instructions can be given otherwise.

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fraud

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deliberate deception for personal gain. covering up medication errors. misleading title when one has not received education.

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Assault

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saying or doing someting to make a person afraid. civil suit

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battery

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touching a person without consent. civil suit

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false imprisonment

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making one stay in a place without consent. civil suit

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autonomy

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right to self determination. dignity, self reliance, power. Autonomy is primarily a western value.

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beneficence

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obligation to do good, not harm other people.we should prevent evil or harm.

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nonmaleficience

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the prohibition of intentional harm.

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justice

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fairness. obligation to treat like cases similarly.

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distributive justice

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fair distribution of limited resources relative to demand. all should have equal access.

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fidelity

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obligation to be faithful to agreements, commitments, and responsbilitiy, both implicitly and explicitly.

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"rights" of delegation

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a Right task b. Right circumstance d Right person e. Right communication f. Right evaluation

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Assisting with ambulation

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UAP - would be assigned this task as it is within the ECHO Hospital Scope of Practice for the UAP. Gilda has received clear communication from the nurse on when, how often, and how far Mr. Hart is to ambulate.

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The Registered Nurse (RN)

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•Assessment • Diagnosis (nursing) • Outcomes Identification • Planning • Implementation •Evaluation •Delegation •Education The RN may delegate tasks to appropriate staff but retains accountability for the outcome. The RN is responsible for seeing that delegated tasks are completed and performed adequately and (s)he needs to be available to observe, facilitate, coach, answer questions, and speak with and assess patients, to evaluate the care provided by others.

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The Licensed Practical Nurse* (LPN)

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The LPN functions in a dependent role and may, under the direction of the RN: •Administer Medications; •Provide Nursing Treatments; •Give direct patient care to those whose condition are considered stable; •Gather patient measurements and signs and symptoms. Observe, record, and report patient data to the RN. That data will be used by the RN to support decision making about the nursing care of specific patients. The LPN may not: •Function independent of direction; •Assess or evaluate; •Interpret patient clinical data or act independently on such data; •Administer intravenous (IV) push medications; Initial dose of IV medications or administer blood or blood products; •Triage; •Create, initiate, or alter nursing care goals; •Establish nursing care plans.

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Unlicensed Assistive Personnel** (UAP)

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The UAPs function in an unlicensed and dependent role and may, under the direction of the Registered Nurse (RN) or Licensed Practical Nurse (LPN): •Perform delegated tasks; •Provide comfort measures; •Assist with activities of daily living; •Observe and report changes in a patient's condition; •Gather and report specific patient measurements for which all ECHO Hospital UAPs have been trained to perform and for which their skills have been verified. These measurements are: vital signs (temperature, blood pressure, pulse rate, respiratory rate, and pulse oximetry), weight, intake and output, and blood glucose measurements; •Collect urine and stool specimen. The UAP may not: •Function independent of direction; •Administer medications; •Assess, plan care or determine nursing care goals; •Perform nursing interventions.

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SBAR:

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Situation Background Assessment Recomendation

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Outcomes of an effective team

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a. Mutual trust of the team members b. Improved patient safety c. Common understanding within the team d. Adaptability to patient needs e. Enhanced team performance

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Check back

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validating verbal order in closed loop communication.

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call out

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stating EPI I mg push given - during resucitation

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Reason for SBAR

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organized approach for reporting patient condition.

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Hand off

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exchange of information when transferring patient.

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Leadership

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to guide, motivate, inspire, instill vision and purpose

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authority

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the right to command power and enforce rules or give orders.

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manage

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ability to plan organize direct, achieve.

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accountability

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willingness to accept responsibility.

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